Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-04T21:21:17.721Z Has data issue: false hasContentIssue false

How equitable is Sweden's changing care-mix? Linking individual and regional characteristics over time

Published online by Cambridge University Press:  18 June 2007

ADAM DAVEY*
Affiliation:
College of Health Professions, Temple University, Philadelphia, USA.
JYOTI SAVLA
Affiliation:
Human Development and Family Studies, Pennsylvania State University, USA.
GERDT SUNDSTRÖM
Affiliation:
Institute of Gerontology, Jönköping University, Sweden.
STEVEN H. ZARIT
Affiliation:
Human Development and Family Studies, Pennsylvania State University, USA.
BO MALMBERG
Affiliation:
Institute of Gerontology, Jönköping University, Sweden.
*
Address for correspondence: Adam Davey, College of Health Professions, 1700 N. Broad Street, Suite 313, Temple University, Philadelphia, PA 19122, USA. E-mail: [email protected]

Abstract

Given its relative ethnic and socio-economic homogeneity, Sweden is an ideal nation for the study of variations in formal and informal care as a function of gender, disability and advanced age. This paper reports an analysis of the relationships between gender, disability and age and the formal care delivered to more than 1,200 people aged 75 or more years in Sweden in 1994 and 2000. In municipalities that provided above-average home-help hours per recipient, and that had high institutional placement rates, women were relatively less likely to have been receiving informal assistance alone, those with greater disability were more likely to have been receiving all forms of assistance, the oldest-old were less likely to have been receiving either informal or formal help alone, and rates of formal assistance and of no informal care were relatively low. In municipalities with high rates of institutional placement, the oldest-old were relatively more likely to have been receiving both formal and informal assistance. Sweden's system of old-age care appears broadly equitable although the quality of care could not be fully assessed. Although home and community-based service provision (HCBS) has recently decreased, variations in the volume and mix of delivered formal services reflect differences in need.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Berg, S., Branch, L. G., Doyle, A. and Sundström, G. 1993. Local variations in old-age care in the welfare-state: the case of Sweden. Health Policy, 24, 2, 175–86.CrossRefGoogle ScholarPubMed
Berg, S. and Sundström, G. 1988. Kommunal och regional variation inom aldreomsorgen [Municipal and Regional Variations in Old Age Care]. Report 70, Institutet för Gerontologi, Jönköping, Sweden.Google Scholar
Bergmark, Å., Parker, M. G. and Thorslund, M. 2000. Priorities in care and services for elderly people: a path without guidelines? Journal of Medical Ethics, 26, 5, 312–8.CrossRefGoogle ScholarPubMed
Chappell, N. L. and Blandford, A. 1991. Informal and formal care: exploring the complementarity. Ageing & Society, 11, 3, 299315.CrossRefGoogle Scholar
Chappell, N. L. 1992. Informal Support and Aging. Butterworths, Toronto.Google Scholar
Daatland, S. O. 1997. Welfare policies for older people in transition? Emerging trends and comparative perspectives. Scandinavian Journal of Social Welfare, 6, 2, 153–61.CrossRefGoogle Scholar
Davey, A., Femia, E. E., Zarit, S. H., Shea, D. G., Sundström, G., Berg, S., Smyer, M. A. and Savla, J. 2005. Life on the edge: patterns of formal and informal help to older adults in the United States and Sweden. Journal of Gerontology: Social Sciences, 60B, 5, 5281–8.Google Scholar
Davey, A., Johansson, L., Malmberg, B. and Sundström, G. 2006. Unequal but equitable: an analysis of variations in old-age care in Sweden. European Journal of Ageing, 3, 1, 3440.CrossRefGoogle ScholarPubMed
Denton, M. 1997. The linkages between informal and formal care of the elderly. Canadian Journal on Aging, 16, 1, 3050.CrossRefGoogle Scholar
Edelman, P. 1986. The impact of community care to the homebound elderly on provision of informal care. The Gerontologist, 26, Suppl. 1, 263–74.Google Scholar
Edelman, P. and Hughes, S. 1990. The impact of community care on provision of informal care to homebound elderly persons. Journal of Gerontology: Social Sciences, 45, 1, S7484.CrossRefGoogle ScholarPubMed
Esping-Andersen, G. 1990. The Three Worlds of Welfare Capitalism. Princeton University, Princeton, New Jersey.Google Scholar
Esping-Andersen, G. 1999. Social Foundations of Post-industrial Economies. Oxford University Press, Oxford.CrossRefGoogle Scholar
George, L. K. 1987. Easing caregiver burden: the role of informal and formal supports. In Ward, R. A. and Tobin, S. S. (eds) Health in Aging: Sociological Issues and Policy Directions. Springer Publishing Company, New York, 133–58.Google Scholar
Greene, V. L. 1983. Substitution between formally and informally provided care for the impaired elderly in the community. Medical Care, 21, 6, 609–19.CrossRefGoogle ScholarPubMed
Hanley, R., Wiener, J. M. and Harris, K. M. 1991. Will paid home care erode informal support? Journal of Health Politics, Policy, and Law, 16, 3, 507–21.CrossRefGoogle ScholarPubMed
Jeths, A.v.d.B. and Thorslund, M. 1994. Will resources for elder care be scarce? Hastings Center Report, 24, 1, 610.CrossRefGoogle Scholar
Johansson, L., Sundström, G. and Hassing, L. B. 2003. State provision down, offspring's up: the reverse substitution of old-age care in Sweden. Ageing & Society, 23, 3, 269–80.CrossRefGoogle Scholar
Johansson, L. and Thorslund, M. 1992. Care needs and sources of support in a nationwide sample of elderly in Sweden. Zeitschrift für Gerontologie, 25, 1, 5762.Google Scholar
Larsson, K. 2006. Care needs and home-help services for older people in Sweden: does improved functioning account for the reduction in public care? Ageing & Society, 26, 3, 413–29.CrossRefGoogle Scholar
Larsson, K. and Thorslund, M. 2002. Does gender matter? Differences in patterns of informal support and formal services in a Swedish urban elderly population. Research on Aging, 24, 3, 308–36.CrossRefGoogle Scholar
Lawton, M. P. and Brody, E. M. 1969. Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 3, 179–86.CrossRefGoogle ScholarPubMed
Litwak, E. 1985. Helping the Elderly: The Complementary Roles of Informal Networks and Formal Systems. Guilford, New York.Google Scholar
Litwak, E. and Szelenyi, I. 1969. Primary group structures and their functions. American Sociological Review, 34, 2, 465–81.CrossRefGoogle Scholar
Messeri, P., Silverman, M. and Litwak, E. 1993. Choosing optimal support groups: a review and formulation. Journal of Health and Social Behaviour, 34, 2, 122–37.CrossRefGoogle Scholar
Moscovice, I., Davidson, G. and McCaffrey, D. 1988. Substitution of formal and informal care for the community-based elderly. Medical Care, 26, 10, 971–81.CrossRefGoogle ScholarPubMed
Muramatsu, N. and Campbell, R. T. 2002. State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis. Journal of Health and Social Behavior, 43, 1, 107–24.CrossRefGoogle ScholarPubMed
Noelker, L. S. and Bass, D. M. 1989. Home care for elderly persons: linkages between formal and informal caregivers. Journal of Gerontology: Social Sciences, 44, 1, S6370.CrossRefGoogle ScholarPubMed
O'Connor, J. S. 1993. Gender, class and citizenship in the comparative analysis of welfare state regimes: theoretical and methodological issues. British Journal of Sociology, 44, 3, 501–18.CrossRefGoogle Scholar
Orloff, A. S. 1993. Gender and the social rights of citizenship: the comparative analysis of gender relations and welfare states. American Sociological Review, 58, 3, 303–28.CrossRefGoogle Scholar
Patsios, D. and Davey, A. 2005. Formal and informal community care for older adults. In Johnson, M., Bengtson, V. L., Coleman, P. and Kirkwood, T. (eds) The Cambridge Handbook of Age and Ageing. Cambridge University Press, Cambridge, 597604.CrossRefGoogle Scholar
Raudenbush, S. W. and Bryk, A. S. 2002. Hierarchical Linear Models: Applications and Data Analysis Methods. Second edition, Sage, Thousand Oaks, California.Google Scholar
Shea, D. G., Davey, A., Femia, E. E., Zarit, S. H., Sundstrom, G., Berg, S. and Smyer, M. A. 2003. Exploring Assistance in Sweden and the United States. The Gerontologist, 43, 5, 712721.CrossRefGoogle ScholarPubMed
Socialstyrelsen 1994. Hemma På Äldre Da'r [Ageing at Home: Technical Report]. Socialstyrelsen, Stockholm, Sweden.Google Scholar
Socialstyrelsen 2000. Hemma På Äldre Da'r 2000 [Ageing at Home 2000: Technical Report]. Socialstyrelsen, Stockholm, Sweden.Google Scholar
Soldo, B. J., Agree, E. and Wolf, D. 1989. Balance between formal and informal care. In Ory, M. and Bond, K. (eds) Aging and Health Care. Routledge, New York, 193216.Google Scholar
Statistiska Centralbyrån (2003). Undersökning om levnadsförhållanden [Level of Living]. Data file, Statistics Sweden, Stockholm.Google Scholar
Stoller, E. P. and Pugliesi, K. L. 1988. Informal networks of community based elderly: changes in composition over time. Research on Aging, 10, 4, 499516.CrossRefGoogle ScholarPubMed
Stuart, M. and Weinrich, M. 2001. Home- and community-based long-term care: lessons from Denmark. The Gerontologist, 41, 4, 474–80.CrossRefGoogle Scholar
Sundström, G. and Berg, S. 1990. Ensamboende Bland de Äldre: En Analys av Kommunala Variationer och Deras Effekter på Äldreomsorgen. PM Utarbetat för Socialdepartementet [Solitary Living Among Elderly People: An Analysis of Municipal Variations and Their Effects on Public Old Age Care: Memorandum for the Ministry of Social Affairs]. Mimeo, Institutet för gerontologi, Jönköping, Sweden.Google Scholar
Sundström, G., Johansson, L. and Hassing, L. B. 2002. The shifting balance of long-term care in Sweden. The Gerontologist, 42, 3, 350–5.CrossRefGoogle ScholarPubMed
Sundström, G. and Malmberg, B. 1996. The long arm of the welfare state shortened. Scandinavian Journal of Social Welfare, 5, 1, 6975.CrossRefGoogle Scholar
Sundström, G., Malmberg, B. and Johannson, L. 2006. Balancing family and state care: neither, either or both? The case of Sweden. Ageing & Society, 26, 5, 767–82.CrossRefGoogle Scholar
Tennstedt, S. L., Crawford, S. L. and McKinlay, J. B. 1993. Is family care on the decline? A longitudinal investigation of the substitution of formal long-term care services for informal care. Milbank Quarterly, 71, 4, 601–24.CrossRefGoogle ScholarPubMed
Tennstedt, S., Harrow, B. and Crawford, S. 1996. Informal care vs. formal services: changes in patterns of care over time. Journal of Aging and Social Policy, 7, 1, 7191.CrossRefGoogle ScholarPubMed
Tennstedt, S., Sullivan, L., McKinlay, J. and D'Agostino, R. 1990. How important is functional status as a predictor of service use by older people. Journal of Aging and Health, 2, 4, 439–61.CrossRefGoogle ScholarPubMed
Thorslund, M., Bergmark, Å. and Parker, M. G. 1997. Difficult decisions on care and services for elderly people: the dilemma of setting priorities in the welfare state. Scandinavian Journal of Social Welfare, 6, 3, 197206.CrossRefGoogle Scholar
Trydegård, G.-B. and Thorslund, M. 2001. Inequality in the welfare state? Local variation in the care of the elderly: the case of Sweden. International Journal of Social Welfare, 10, 3, 174–84.CrossRefGoogle Scholar
Zarit, S. H., Johansson, B. and Malmberg, B. 1995. Changes in functional competency in the oldest old: a longitudinal study. Journal of Aging and Health, 7, 1, 323.CrossRefGoogle ScholarPubMed
Zarit, S. H., Johansson, B. and Berg, S. 1993. Functional impairment and co-disability in the oldest old: a multidimensional approach. Journal of Aging and Health, 5, 3, 291305.CrossRefGoogle Scholar