COVID-19 and domiciliary care utilisation: Evidence from the English Longitudinal Study of Ageing.

The COVID-19 pandemic significantly affected global health and social care, leading to unmet needs, especially among vulnerable groups. Using data from the English Longitudinal Study of Ageing (ELSA), we investigate disruptions in home care for individuals over 50. We evaluate how the pandemic changed home care use at the extensive and intensive margins; the relative risk of reporting unmet need; and access to acute and primary care for different socio-demographic groups. We find decreases in home care use (extensive margin), mostly driven by informal care, which were partially offset by an increase in the amount of care received among those who were using home care during the pandemic (intensive margin). However, the relative risk of reporting unmet need rose, particularly among ethnic minorities, individuals with musculoskeletal and mental health conditions, and those not in work or retirement (due to long-term sickness or disability, home or family responsibilities, or unemployment). Individuals living alone and those aged 50-59 faced higher unmet needs for home care, but maintained primary care access as opposed to their counterparts. Our findings suggest that while aiming to protect the most vulnerable groups, pandemic containment policies negatively affected access to vital health and social care services, thereby increasing unmet care needs and exacerbating existing inequalities.