S4.2 Universalism at stake – Social inequalities in long-term care in the Nordic countries
Chair: Tine Rostgaard
Introduction: Ageing populations put pressure on the sustainability of the long-term care (LTC) systems in the Nordic welfare states. Social reforms have shifted responsibilities in the welfare mix between the state, the family, the market and the voluntary sector, and that, in turn, may have profound impact on social inequalities in access to and in the quality thereof. It is these reforms and trends, and their repercussion on inequality that are in focus within this symposium. The presentations will all address the above-mentioned issues, either with national data or as comparative analyses. Presenters are all part of the Nordic project Social Inequalities in Ageing (SIA).
S4.2.1 Are there occupational class differences in institutional long-term care use or in
care provider among very old people in Finland?
Linda Enroth, Mari Aaltonen, Jani Raitanen, Lily Nosraty, Marja Jylhä
University of Tampere, Finland
Background: Need for long-term care (LTC) increases with ageing. The well-known predictors for entering LTC, disability and social resources, vary between socioeconomic groups. We examined LTC use among the oldest old in the context of ongoing structural changes in LTC organization. LTC use according to occupational class was assessed in total and separately for publicly and privately provided LTC facilities. Methods: Data from the Vitality 90+ Study surveys conducted in 2001, 2003, 2007, and 2010 in Tampere, in Finland ( N=2,862) combined with national register data. Logistic regression and competing-risks regression methods of analyses with adjustments for health, family relations and help at home were used. Results: In total or public LTC use, differences between occupational classes were minor at baseline. However, private LTC use was more frequent among upper non-manual class than among lower non-manual class, skilled manual class and housewives. Entering LTC during the follow-up did not differ significantly between occupational classes after adjustments for all independent variables. During the study, the share of privately provided care out of all LTC increased and the upper non-manual class no more used private care more than other groups. Conclusions: The influence of structural changes in LTC provision on the pattern of LTC use may be different for socioeconomic groups. Thus, there is a need to follow the changes in LTC provision to guarantee that LTC is equally available for all people regardless of a socioeconomic status.
S4.2.2 Are formal care workers a forgotten group in a Nordic ‘passion for equality’?
Marta Szebehely1, Teppo Kröger2, Tine Rostgaard3, Anneli Stranz1, Mia Vabø
1 Stockholm University, Sweden, 2 University of Jyväskylä, Finland, 3 The Danish Centre of
Applied Social Science, Denmark, 4 NOVA, OsloMet – Oslo Metropolitan University, Norway
Background: It has been argued that the Nordic countries have a passion for equality. A crucial aspect of this equality ambition in LTC is that generously funded, high quality, services should be offered to all social groups. Despite this universalistic ideal, to various extent, the Nordic countries have experienced declining service coverage and organisational reforms with increasingly detailed regulation of care. The aim of this paper is to analyse how these changes have affected the formal care workers. Methods: The analysis is based on the 2005 and 2015 Nordcare-surveys of care workers in Denmark, Finland, Norway and Sweden (total n=7,009). Results: In this period, the employment conditions remain problematic in all four countries. Further, several aspects of working conditions have deteriorated, resulting in increased workloads and reduced decision latitude in daily work. Conclusions: Our findings indicate that changes in service coverage and organisational reforms have had repercussions on care workers’ working conditions. These changes have been introduced without considering the consequences for the workers, and we argue that the care workers have never been included in a Nordic passion for equality.
S4.2.3 Association between education and status of receiving care among community
dwelling older adults in Iceland
Milan Chang Guðjónsson1,2, Ólöf Guðný Geirsdóttir1,2, Alfons Ramel1,2, Ingemar Kåreholt3, Sigurveig H. Sigurdarsdóttir1
1 University of Iceland, 2 The Icelandic Gerontological Research Institute, University of Iceland,
3 Aging Research Centre, Karolinska Institutet, Stockholm, Sweden
Background: Older adults in Iceland have a good access to LTC that support elderly to maintain independent living. Receiving informal care is also common among older adults. The aim of this study is to analyze whether education is associated with the use of formal and informal care among older adults in Iceland. Methods: A survey of Icelandic older people living at home was conducted in 2008. (n= 721 persons 65+). Questions focused on socioeconomic status, social network, health status, activities of daily living, and the status of received help either from the community elderly care system and/or from close family members and friends. Results: Among the total sample, 52% reported to receive either type of care. Among those who received care, 53% reported receiving informal care only. Older people with higher education had a significantly lower risk to receive informal care compared with people with lower education, however formal care was not significantly associated with education level. Conclusions: Informal care which is provided from the social network and family members are an important source for the elderly care system in Iceland. The contribution of informal care/help should be recognized when preparing the care of older people.
S4.2.4 Informal caregiver consequences in the light of changing Nordic long-term care
Agnete Aslaug Kjær1, Tine Rostgaard1, Marta Szebehely2
1 The Danish Centre of Applied Social Science, Denmark, 2 Stockholm University, Sweden
Background: In the care literature, Nordic countries are often lumped together, characterized by their commitment to universalism. However, when it comes to long-term care, recent research has shown varying (and changing) degrees of universalism across the countries. Especially in some of the Nordic countries, a recent re-familisation of formal long-term care policies places more responsibility on (female) informal caregivers. This study examines the impact of caregiver-arrangements on consequences for informal care-givers, across a number of life domains in Denmark and Sweden. Methods: A comparative survey study was conducted among mid-life caregivers in Sweden (n = 3,660) and in Denmark (n = 1,105). Self-perceived consequences of caregiving were measured across physical strain, mental strain, social relations, leisure time, and work-life. Impacts of structural characteristics such as gender and SES, as well as the type and intensity of the care-arrangement, were assessed in a comparative regression framework. Results: Variations in care-giver arrangements across the two policy settings, accompanied by varying degrees of caregiver consequences in Sweden and Denmark. In both countries, gender as well as the care-arrangement (i.e. type and intensity), are important factors in understanding care-giver consequences. Conclusion: The increasing re-familisation of care in Sweden, which is likely to follow in Denmark, needs to be evaluated in the light of the often gendered care-giver consequences that play out across multiple life domains.
S4.2.5 The meaning of gender and country of birth for the extent and consequences of
informal caregiving in Sweden
Stockholm University, Sweden
Background: In Sweden since the 1980s, LTC services have declined, followed by an increase in informal care. Studies on the intensity and consequences of this kind of caregiving are sparse in Sweden. The paper analyzes the meaning of gender and country of birth for the extent and consequences of informal caregiving in Sweden. Methods: Analysis is based on a postal survey (n=3630, aged 45-66 years) from 2013. Results: Of the respondents, 28% are caregivers, defined as providing help at least once a week to a family member, relative or friend with a disability or longstanding illness. Immigrant women provide the most intensive care (14.1 hrs/week), compared to immigrant men (6.9 hrs/week) and both women and men. Conclusion: Informal care in Sweden has a gendered as well as an ethnic component.