Department of Global Health & Social Medicine, King's College London.
J Gerontol B Psychol Sci Soc Sci. 2021 Jan 1;76(1):121-132. doi: 10.1093/geronb/gbaa139.
We examine whether socioeconomic inequalities in home-care use among disabled older adults are related to the contextual characteristics of long-term care (LTC) systems. Specifically, we investigate how wealth and income gradients in the use of informal, formal, and mixed home-care vary according to the degree to which LTC systems offer alternatives to families as the main providers of care ("de-familization").
We use survey data from SHARE on disabled older adults from 136 administrative regions in 12 European countries and link them to a regional indicator of de-familization in LTC, measured by the number of available LTC beds in care homes. We use multinomial multilevel models, with and without country fixed-effects, to study home-care use as a function of individual-level and regional-level LTC characteristics. We interact financial wealth and income with the number of LTC beds to assess whether socioeconomic gradients in home-care use differ across regions according to the degree of de-familization in LTC.
We find robust evidence that socioeconomic status inequalities in the use of mixed-care are lower in more de-familized LTC systems. Poorer people are more likely than the wealthier to combine informal and formal home-care use in regions with more LTC beds. SES inequalities in the exclusive use of informal or formal care do not differ by the level of de-familization.
The results suggest that de-familization in LTC favors the combination of formal and informal home-care among the more socioeconomically disadvantaged, potentially mitigating health inequalities in later life.
我们考察了残疾老年人家庭护理使用方面的社会经济不平等是否与长期护理（LTC）系统的背景特征有关。具体而言，我们调查了非正式、正式和混合家庭护理使用中的财富和收入梯度如何根据 LTC 系统提供替代家庭作为主要护理提供者的程度（“去家庭化”）而变化。
我们使用 SHARE 调查数据，对来自 12 个欧洲国家的 136 个行政区域的残疾老年人进行了研究，并将其与 LTC 去家庭化的区域指标相联系，该指标通过养老院的可用长期护理床位数量来衡量。我们使用包含和不包含国家固定效应的多项多层模型，来研究家庭护理使用情况，作为个体和区域 LTC 特征的函数。我们将金融财富和收入与 LTC 床位数量进行交互，以评估家庭护理使用的社会经济梯度是否因 LTC 的去家庭化程度而异。
我们发现了强有力的证据，表明在去家庭化程度较高的 LTC 系统中，混合护理使用的社会经济地位不平等程度较低。在 LTC 床位较多的地区，较贫困的人比富裕的人更有可能将非正式和正式家庭护理结合使用。在去家庭化程度不同的情况下，仅使用非正式或正式护理的 SES 不平等没有差异。
结果表明，LTC 的去家庭化有利于在社会经济地位较低的人群中结合使用正式和非正式家庭护理，从而潜在地减轻晚年的健康不平等。
