State provision down, offspring's up: the reverse substitution of old-age care in Sweden

Abstract

Substitution among the providers of old-age care has usually meant a process whereby the state ‘takes over’ what families used to do, but during the 1980s and 1990s, both home help and institutional care were cut back substantially in Sweden as elsewhere. Comparable, nationally representative surveys in Sweden of the provision of care for older people living in the community enable analysis of the effects of these cutbacks on the sources and patterns of care. It emerges that increased inputs from families match the decline of public services, that is, a ‘reverse’ substitution has recently been taking place. Local studies, of older people who have been followed over time as the provision of home help has changed, support these conclusions. Of the increased informal care, most has been provided by daughters, but sons have also contributed. A problematic aspect of these shifting patterns of care is that an increasing number of family carers with increasingly heavy care commitments are now without formal or informal support, whereas in the recent past many could expect their responsibilities to be shared with the state. The evidence from this study also calls into question common metaphors and assumptions about the assumed interdependence between informal care and public services for older people, and challenges the so-called substitution thesis.

Nordic eldercare – Weak universalism becoming weaker?

“…Re-familialisation has been evident in Sweden since the 1980s (Johansson et al, 2003;Szebehely and Trydegård, 2012;Ulmanen and Szebehely, 2015), where the share of population 75 and over in need of practical help care who received care from non-cohabiting relatives rose from 40% in 1988-89 to 65% in 2010 (Ulmanen 2015: 22). Data is patchier on the other countries, but available evidence points to similar trends in Finland, (Anttonen and Häikiö, 2011;Henriksson and Wrede, 2008;Kröger and Leinonen, 2011) and in Norway (Svalund 2005).…”

Care utilisation in the last years of life in Sweden: the effects of gender and marital status differ by type of care

“…Parents are less likely than childless people to receive support at home from formal helpers in Sweden (Johansson et al 2003), Germany (Linden et al 1999) and the United States (Barrett & Lynch 1999). On the other hand, numerous studies reveal that having relatives, particularly children, who may act as advocates enhances the use of formal services in Scandinavia (Lingsom 1997), the United States (Langa et al 2001) and the Netherlands (Pot et al 2009).…”

Changing policies, changing patterns of care: Danish and Swedish home care at the crossroads

“…Even in the Nordic countries where the family does not have a legal responsibility to provide care, family care continues to be an important source of care of older people, and, at least in the case of Sweden, of increasing importance in recent years (Sundström et al 2002;Johansson et al 2003;Szebehely 2005). For instance, Sundström et al (2002) have estimated that, in Sweden in the year 2000, families provided 70% of all community care for elders 75?…”