Use of long-term care services in a universal welfare state - On the importance of age at migration.

There is broad agreement in the international literature that there are significant barriers to the use of long-term care services (LTCS) by older migrants in various contexts. However, there is a lack of comprehensive study in this area, and particularly concerning the diversity of migrants from different sending countries and the heterogeneity of their migration trajectories concerning the age at migration. Barriers to the use of care might be intensified for persons migrating at an older age, resulting in lower use of care. However, it is still unknown whether late-in-life migrants are underrepresented as users of LTCS in comparison to Swedish born and migrants arriving at younger ages. We study the likelihood of using any (1) LTCS, (2) residential care, and (3) personal and domestic care among older foreign-born, compared to Swedish-born older persons. Secondly, we study the likelihood of care across different birth countries compared to older persons born in Sweden. Thirdly, we investigate the likelihood of LTCS among migrants arriving at different ages. The total population of all persons 65 years and over in Sweden, is studied using register data with almost two million observations. The central findings of this study show that there is substantial heterogeneity across and within different birth countries regarding utilization of LTCS, residential care and personal and domestic care. The results from this study also suggest that late in life migration does not have to imply lower utilization of LTCS, residential care and personal, and domestic care. However, results show a slight over-representation of personal and domestic care among those who have migrated later in life. Further, there is an under-representation of residential care among late-in-life migrants. Our findings thus suggest that caution is needed when generalizing about levels of formal care use in migrant populations.