Université Paris Cité & LIEPP Sciences Po Paris France.
Harvard Medical School, Blavatnik Institute Health Care Policy, USA.
Soc Sci Med. 2023 Oct;334:116199. doi: 10.1016/j.socscimed.2023.116199. Epub 2023 Aug 30.
Understanding the influence of grandchildren on long-term care use is a growing issue. Indeed, many countries, middle-aged adults provide unpaid care for aging family members, often their parents, at home. Although the influence of adult children's availability on their aging parents' caregiving decisions has been widely studied, the influence of grandchildren remains largely unstudied. Parental time allocated to childcare may compete with elder care, necessitating paid home care or transfer to a nursing home. Alternatively, grandparents may provide childcare, increasing incentives to keep grandparents at home. Using data from the Survey of Health, Ageing and Retirement in Europe (75,296 observations from 11 countries covering years 2004-2018), we exploit an instrumental variable strategy to study the effect of grandchildren on grandparents' long-term care decisions, specifically, use of paid home care or transfer to a nursing home. We use the generosity of maternity leave policies in time and across countries as an instrumental variable to identify the effect of the number of grandchildren. We find that the presence of grandchildren significantly increases the likelihood of having grandparents live at home: the probability of paid home care significantly increases while the probability of nursing home admission falls significantly. In conclusion, policies influencing the number of grandchildren in families have an indirect impact on long-term care use trajectories, confirming that family policies and long-term care policies are strongly imbricated and should not be considered separately.
了解孙辈对长期护理使用的影响是一个日益重要的问题。事实上，许多国家的中年成年人在家中为年迈的家庭成员（通常是他们的父母）提供无偿护理。尽管成年子女的可用性对其年迈父母的护理决策的影响已被广泛研究，但孙辈的影响在很大程度上仍未得到研究。父母分配给育儿的时间可能会与老年护理竞争，需要聘请家庭护理人员或转移到养老院。或者，祖父母可能会提供育儿服务，从而增加让祖父母留在家里的动机。利用来自欧洲健康、老龄化和退休调查（涵盖 2004 年至 2018 年的 11 个国家的 75296 个观察值）的数据，我们利用工具变量策略研究了孙辈对祖父母长期护理决策的影响，特别是使用家庭付费护理或转移到养老院。我们利用产假政策在时间和国家之间的慷慨程度作为工具变量来确定孙辈数量的影响。我们发现，孙辈的存在显著增加了让祖父母住在家里的可能性：接受家庭付费护理的可能性显著增加，而入住养老院的可能性显著下降。总之，影响家庭中孙辈数量的政策对长期护理使用轨迹有间接影响，这证实了家庭政策和长期护理政策紧密交织，不应分开考虑。
