Impact of welfare state on care mix and providers

Austria and Slovenia have taken thus far different approaches in terms of supporting long-term care needs of frail older people. While the family is supposed to be the main provider of care in both countries, in Austria this role is supported by generous cash benefits; while in Slovenia families are the carers by default given the limited availability of publicly funded benefits (cash or services) to frail older people and their families. The main research question that DET_CAREMIX aims to answer is how frail older people residing in the community and their families make choices regarding the care mix (informal vs formal care or a combination of both) and care tasks in view of the different policy contexts present in Slovenia and Austria. More specifically, we are interested to study differences in the choices made by people according to differences in gender, socio-economic background (e.g. education, income) and access to social networks in the two countries and see whether public policies play a role in these differences. To address the main research question of DET_CAREMIX we will use a mix of complementary methods. Firstly, we will use quantitative research methods, namely statistical analysis of data from a comparative survey of older people in Slovenia and Austria (SHARE survey) and data from the first representative survey of providers and users of social home-care services in Slovenia. Subsequently, we will conduct and analyse 55 semi-structured in-depth interviews with older users of care or their families in each country. DET_CAREMIX will make an original contribution to the understanding of how people from different gender, socio-economic condition and social network characteristics make their choices under different types of public policies for long-term care. This will be relevant also to understand the causes of possible inequalities in the use of different types of care services for older people. By contribution to a better understanding of the choices of frail older people and their families, the findings will have direct relevance for policy-makers, allowing them to better allocate public money and target policies and to address unwanted inequalities in access or non-take up of different types of care. Given the impact of informal care provision on the carers health and employment, the findings of the DET_CAREMIX will also prove relevant to informal carers and users of care.

The main aim of the DET_CAREMIX project was to increase our understanding of decisions regarding how older people use care and how families provide care to their older relatives. Why do some people prefer care to be provided by their relatives, while others choose professional carers instead? Do motivations to provide care change depending on whether you are a woman or a man, richer or poorer? We focused on two countries where families play an important role in the provision of care: Austria and Slovenia. From interviewing older people and their carers, we found that the role of the family in providing care is very much linked to how people idealize or understand 'good care'. For some, providing care is seen as a way to reciprocate previous support one received while young. The family also often steps in to fill gaps left by professional services: family carers are more flexible, professional carers change frequently or arrive at inconvenient hours. Professional care was welcomed, but there is a feeling there is not enough of it. These views were shared regardless of people's economic background. This care provision by families came with a cost though. Many of the carers we had a chance to interview spoke of the personal sacrifices they had to do: leaving their jobs or reducing contacts with friends. Some found themselves providing care because they had moved in with their parents, following a divorce, or because they were without a job, or because of family conflicts between parents and other siblings. Caregiving was not always voluntary. While families in Austria receive support in the form of a cash benefit, in Slovenia, the expectation to care for one's older relative is not accompanied by generous state support. Still, the cash benefit did not entail less care for women in Austria. In Slovenia, carers often live in the same house as their relatives, which is less the case in Austria. We also used statistical methods to analyse who was providing care. For both countries, 'family care' meant care 'female care'. But among women, those with lower education or income provided very intensive and frequent care. Those with higher education or income were actually more likely to provide care, but they did so alongside professional carers, put in fewer hours and could conciliate this with employment. For Austria, we found that this division increased with time after the pension reforms of the early 2000s. In both countries, our findings lead us to believe that we will not be able to rely on the family the same way in the future. Most carers we talked to also did not want their children to care for them in the same way.