benchmarking long term care in europe...

BENCHMARKINGLONGTERMCAREINEUROPE:EXPLORINGTHESHAREDATA

Dr.PlatonTinios–UniversityofPiraeusThomasGeorgiadis–UniversityofPiraeus

SocialProtectionInvestmentinLong-TermCareHORIZON2020-GrantAgreementNo649565

D.2.1ConceptualReportonLongTermCare/PartBExploringtheSHAREdata

TableofContents

EXECUTIVESUMMARY......................................................................................................9

Keyfindings......................................................................................................................9

1.Introduction..................................................................................................................1

2.SHAREasasourceofinformation................................................................................2

3.Thebottomline:TheCareGapandtheCareMix........................................................83.1TheCareGap..........................................................................................................83.2TheCareGapbyageandgender..........................................................................113.3TheCareMix.........................................................................................................153.4TheCareMixandtheneedforcare.....................................................................22

4.Analysisbylargeagegroupandgender.....................................................................254.1Theover65group................................................................................................264.2Caregapbylargeagegroup.................................................................................284.3TheCaremixbyagegroup...................................................................................30

5.Analysisbytypeofhousehold....................................................................................345.1Afirstlookatcohabitation...................................................................................345.2Caregapbyhouseholdtype.................................................................................375.3Caremixbyhouseholdtype.................................................................................41

6.Attitudesaboutcare:theroleofthestateandgenderroles.....................................50

7.Furtherwork...............................................................................................................57

8.Definingtheneedforcare–exploringSHARE...........................................................59

9.TheSupplyside:DefiningFormalcare.......................................................................70

10.Defininginformalcare..............................................................................................78

11.Investigatingthecaresurfeit....................................................................................90

A. APPENDIXACrosstabulationsbycountry.............................................................97

B. APPENDIXB:Samplesizesfortheanalysis...........................................................1051.1 B1:Byageandgender.....................................................................................1051.2 SamplesizebyHouseholdType.......................................................................108



ListofFiguresFigurei.1:Caregapbyinneed-of-carestatus,personsaged50+,SHAREwave5.........10

Figurei.2:Caremix,allpersonsneedingcareaged50+,SHAREwave5.......................10

Figure2.1:CountriesparticipatingintheSHAREdatacollection.....................................4

Figure3.1:Caregapbyinneed-of-carestatus,personsaged50+,SHAREwave5...........9

Figure3.2:Thecaregap,peopleover65.......................................................................12

Figure3.3:Caregapbyinneed-of-carestatus,bygender,SHAREwave5....................13

Figure3.4:Caremix,allpersonsaged50+,SHAREwave5............................................16

Figure3.5:Compositionofcaremixbyageandgender,allpersons.............................17

Figure3.6:Caremixbyageandgender,allpersons......................................................18

Figure 3.7: Summary picture of care mix by in need-of-care status and groups ofcountries,persons50+vis-à-vispersonsaged65+,SHAREwave5.......................19

Figure 3.8: Summary picture of care mix by in need-of-care status and groups ofcountries,persons50+bygender,SHAREwave5.................................................20

Figure3.9:Caremixbyinneed-of-carestatus,personsaged50+,SHAREwave5........22

Figure 3.10: Composition of care mix by in need-of-care status and groups ofcountries,persons50+bygender,SHAREwave5.................................................24

Figure4.1:Caregapbyinneed-of-carestatus,bygender,SHAREwave5....................25

Figure 4.2: Care Gap by gender and age, persons with at least one ADL or IADL(definition3),SHAREwave5..................................................................................27

Figure4.3:SummaryfigureofCareGapbyage,genderandin-need-of-carestatus....28

Figure4.4:Caremix,allpersonsaged50+,SHAREwave5............................................29

Figure4.5:Caremixbygenderandinneed-of-carestatus,persons65+......................30

Figure 4.6: Composition of care received by gender and in need-of-care status,persons65+............................................................................................................31

Figure4.7:Caremixbygenderandage,personswithatleastoneADLorIADL(def.3)SHAREwave5.....................................................................................................32

Figure5.1: Living arrangementsof persons aged50+ andpersons aged65+ acrossSHAREwave5countries.........................................................................................34

Figure5.2:LivingarrangementsbyagegroupacrossSHAREwave5countries............36

Figure5.3:Caregapbyinneed-of-carestatusandhouseholdtype,personsaged65+,SHAREwave5.........................................................................................................37



Figure5.4:Caregapbyhouseholdtypeofpersonsaged50+andpersonsaged65+with1+adloriadlor2+chronicdiseases,SHAREwave5......................................38

Figure5.5:Caregapbyhouseholdtype,groupofcountryandagegroupofpersonswith1+ADLorIADL(def.3),SHAREwave5...........................................................39

Figure5.6:Caremixbyhouseholdtypeandgroupofcountrypersons65+,SHAREw540

Figure 5.7: Composition of care received by household type and group of countrypersons65+,SHAREw5..........................................................................................41

Figure5.8:Caremixbyhousehold typeandgroupof countrypersons65+with1+ADLorIADL(def.3)SHAREw5...............................................................................42

Figure 5.9: Composition of care received by household type and group of countrypersons65+with1+ADLorIADL(def.3)SHAREw5..............................................43

Figure5.10:Caremixbyhouseholdtype,groupofcountryandagegroupSHAREw5.44

Figure5.11:Caremixbyhouseholdtype,groupofcountryandagegroupSHAREw5.45

Figure5.12:Caremixbyhousehold type, groupof country andage group, personswith1+ADLorIADL(def.3)SHAREw5..................................................................47

Figure5.13:Caremixbyhousehold type, groupof country andage group, personswith1+ADLorIADL(def.3)SHAREw5..................................................................48

Figure 6.1: Perceptions on family’s responsibility in providing helpwith householdchoresandpersonalcare,personsaged50+,wave1and2..................................52

Figure6.2:Genderrolesincaringforelderly,personsaged50+,wave1.....................55

Figure 8.1: (%) of persons aged 50+ with limitations with activities of daily living(ADL),allcountries,SHAREwave5.........................................................................59

Figure 8.2:(%) of persons aged 50+with limitationswith instrumental activities ofdailyliving(IADL),allcountries,SHAREwave5......................................................59

Figure8.3:Overlapbetweendefinition1anddefinition2intheidentificationoftheneedofcare,SHAREwave5...................................................................................62

Figure8.4:Overlapofdefinition3withdefinitions1and2indefining“need-of-care”,SHAREwave5.........................................................................................................63

Figure8.5:Overlapofdefinition4withdefinitions1,2&3indefining“need-of-care”63

Figure 8.6: (%) of persons aged 50+ identified as in “need-of-care” when movingfromnarrowlydefinedtobroadlydefined“need-of-care”definitions..................64

Figure 8.7: (%) of persons identified as in “need-of-care” when moving fromnarrowlydefinedtobroadlydefineddefinitions,byage&genderSHAREwave565

Figure9.1:Formalcare/help receivedby typeofserviceand inneed-of-carestatus,personsaged50+,allcountries,SHAREwave5.....................................................69



Figure 9.2:Any type of formal care/help received by need-of-care status, personsaged50+,allcountries,SHAREwave5...................................................................69

Figure9.3:Formalcarereceivedbyinneed-of-carestatus,personsaged50+..............70

Figure 9.4: Formal care/help vis-à-vis informal care received by in need-of-carestatus,personsaged50+........................................................................................71

Figure 9.5: Formal care/help vis-à-vis informal care received by in need-of-carestatus,personsaged50+........................................................................................72

Figure9.6:Shareofhousehold’spaidout-of-pocketforhomecareexpensestototalhousehold’sincome,byinneed-of-carestatus,persons50+................................74

Figure 10.1: Receive any type of informal care/help(personal care or practicalhouseholdhelp,helpwithpaperwork) frompersonsoutsidethehousehold,atanyfrequency,byinneed-of-carestatus,personsaged50+,SHAREwave5........77

Figure 10.2: Receive any type of informal care/help(personal care or practicalhouseholdhelp,helpwithpaperwork) frompersonsoutside thehouseholdbyfrequencyandinneed-of-carestatus,personsaged50+,SHAREwave5..............78

Figure 10.3: Receive any type of informal care/help(personal care or practicalhouseholdhelp,helpwithpaperwork)frompersonsoutsidethehouseholdonadailyorweeklybasis,byneed-of-carestatus;personsaged50+,SHAREwave5..79

Figure 10.4:Channels of any type of informal care/help receivedat anyfrequency(personalcareorpracticalhouseholdhelp,helpwithpaperwork)frompersons outside the household by need-of-care status, persons aged 50+,SHAREwave5.........................................................................................................80

Figure10.5:Channelsofanytypeofinformalcare/helpreceivedonadailyorweeklybasis(personal care or practical household help, help with paperwork) frompersons outside the household by need-of-care status, persons aged 50+,SHAREwave5.........................................................................................................81

Figure 10.6:Share care/help received from children (%) to the total care/helpreceived(personalcareorpracticalhouseholdhelp,helpwithpaperwork)frompersonsoutside thehouseholdbyneed-of-care status,personsaged50+whoreceivedinformalcare/helpreceivedatanyfrequency,SHAREwave5................82

Figure 10.7:Share care/help received from children (%) to the total care/helpreceived(personalcareorpracticalhouseholdhelp,helpwithpaperwork)frompersonsoutside thehouseholdbyneed-of-care status,personsaged50+whoreceivedinformalcare/helpreceivedonadaily/weeklybasis,SHAREwave5.....82

Figure 10.8:Personal care received regularly from someone in the household,personswithat leastonemobility limitation,whoarenot livingalone, SHAREwave5....................................................................................................................83



Figure 10.9:Informal care received including either care/help received from anypersonoutsidethehouseholdonadaily/weeklybasis,orpersonalcarereceivedregularlyfromsomeoneinthehousehold,persons50+byinneed-of-carestatus84

Figure10.10:Compositionofanyinformalcarereceived(eitherfromoutsideorfromwithin thehousehold), all persons aged50+by inneed-of-care status, SHAREw5...........................................................................................................................84

Figure10.11:Compositionofanyinformalcarereceived(eitherfromoutsideorfromwithinthehousehold),personsaged50+,whoarenotlivingalone,byinneed-of-carestatus,SHAREw5.......................................................................................85

Figure11.1:Caremixbyageandgenderofpersonswhoarenotinneed-of-care.......87

ListofTablesTable2.1:SHAREwave5(2013)samplesizesbycountry,genderandage......................6

Table2.2:LongitudinalsamplesizesinSHARE,w2andw5,bygenderandw2age..........7

Table3.1:Caregapbyinneed-of-carestatus,personsaged50+,SHAREwave5.........10

Table3.2:Summarypictureofcaregapbyinneed-of-carestatus,personsaged50+.10

Table3.3:Summarypictureofcaregapbyinneed-of-carestatus,personsaged65+.12

Table3.4:Caregapbyinneed-of-carestatus,personsaged65+,SHAREwave5.........13

Table3.5:Summarypictureofcaregapbyinneed-of-carestatus...............................14

Table3.6:Caregapbygender,personsaged50+,atcountrylevelSHAREwave5.......15

Table3.7:CareMixandIn-need-of-careStatus,crosstabulation,Allcountries............21

Table3.8:Caremix,personsaged50+with2ormoreADL,SHAREwave5..................23

Table4.1:Summarypictureofcaregapbyinneed-of-carestatus,personsaged65+..26

Table5.1:Typeofhouseholds-prevalenceofchildrenunder19bynumberofadults.33

Table6.1:Helpwithhouseholdchoresforolderpersons:Perceptionsofresponsibility,persons50+,wave1.......................................................................50

Table6.2:Personalcareforolderpersonsinneed:Perceptionsonwhoseresponsibility,persons50+,wave1.......................................................................50

Table6.3:Helpwithhouseholdchoresforolderpersonsinneed:Perceptionsonwhoseresponsibility,persons50+,wave2............................................................51

Table6.4:Personalcareforolderpersonsinneed:Perceptionsonwhoseresponsibility,persons50+,wave2.......................................................................51



Table6.5:Whointhecoupletakesthemainresponsibilityforcaringforelderly?(personsaged50+wave1).....................................................................................53

Table6.6:Whointhecoupletakesthemainresponsibilityforcaringforelderly?(personsaged50+wave2).....................................................................................54

Table8.1:HealthOutcomesofthe50+population,SHAREwave5...............................58

Table8.2:(%)ofpersonsaged50+withchronicdiseases,allcountries,SHAREw5.....60

Table8.3:Definitionsofneed-of-carepopulation,basedonalternativehealthindicators,(%)ofpersonsaged50+,SHAREwave5..............................................61

Table8.4:Definitionsofneed-of-carepopulation,basedonalternativehealthindicators,samplesize(#),personsaged50+,SHAREwave5...............................62

Table8.5:(%)ofadditionalpersonsaged50+identifiedasin“need-of-care”whenmovingfromnarrowlydefinedtobroadlydefined“need-of-care”definitions.....64

Table8.6:Self-perceivedhealthstatus,byin-need-ofcaredefinition..........................65

Table8.7:Mobilitylimitations,byin-need-ofcaredefinition........................................66

Table8.8:Correlationofalternative“need-of-care”definitionswithmobilitylimitationsindicator,personsaged50+,SHAREwave5........................................66

Table8.9:Overlapof“need-of-care”definition”withmobilitylimitationsindicator,whenmovingfromnarrowlydefinedtobroadlydefined“need-of-care”definitions...............................................................................................................67

Table8.10:Correlationofalternative“need-of-care”definitionswithself-perceivedhealthstatus,personsaged50+,SHAREwave5....................................................67

Table8.11:Overlapof“need-of-care”definition”withself-perceivedhealthstatus,whenmovingfromnarrowlydefinedtobroadlydefined“need-of-care”definitions...............................................................................................................67

Table9.1:Paidout-of-pocketforhomecare,byinneed-of-carestatus,persons50+..73

Table9.2:Shareofhousehold’sout-of-pocketforhomecareexpensestototalhousehold’sincome,byinneed-of-carestatus,persons50+................................73

Table10.1:Receiveanytypeofinformalcare/help(personalcareorpracticalhouseholdhelp,helpwithpaperwork)frompersonsoutsidethehousehold,atanyfrequency,byinneed-of-carestatus,personsaged50+,SHAREwave5........77

Table11.1:CareMixandIn-need-of-careStatus,crosstabulation,Allcountries.........86

Table11.2:CareMixandIn-need-of-careStatus,Allcountries,personsaged50-64....88

Table11.3:CareMixandIn-need-of-careStatus,Allcountries,personsaged65-80....89

Table11.4:CareMixandIn-need-of-careStatus,Allcountries,personsaged80+........89



Table11.5:Compositionofformalcarereceived,byin-need-of-carestatus,allcountries.................................................................................................................90

Table11.6:Differencesinhealthoutcomesandlivingarrangementbetweenpersonswhoarenotinneedofcareandreceiveformalcareandthosewhoarenotinneedofcareanddonotreceiveformalcare/help,allcountries...........................91

TableA.1:CareMixandIn-need-of-careStatus,crosstabulation,Sweden...................93

TableA.2:CareMixandIn-need-of-careStatus,crosstabulation,Denmark................93

TableA.3:CareMixandIn-need-of-careStatus,crosstabulation,theNetherlands.....94

TableA.4:CareMixandIn-need-of-careStatus,crosstabulation,Germany................94

TableA.5:CareMixandIn-need-of-careStatus,crosstabulation,Belgium..................95

TableA.6:CareMixandIn-need-of-careStatus,crosstabulation,Luxembourg...........95

TableA.7:CareMixandIn-need-of-careStatus,crosstabulation,France....................96

TableA.8:CareMixandIn-need-of-careStatus,crosstabulation,Switzerland............96

TableA.9:CareMixandIn-need-of-careStatus,crosstabulation,Austria....................97

TableA.10:CareMixandIn-need-of-careStatus,crosstabulation,Italy......................97

TableA.11:CareMixandIn-need-of-careStatus,crosstabulation,Spain....................98

TableA.12:CareMixandIn-need-of-careStatus,crosstabulation,CzechRepublic.....98

TableA.13:CareMixandIn-need-of-careStatus,crosstabulation,Slovenia................99

TableA.14:CareMixandIn-need-of-careStatus,crosstabulation,Estonia.................99

TableA.15:CareMixandIn-need-of-careStatus,crosstabulation,Israel..................100

TableB.1:Samplesizebyageandgenderatcountrylevel,allpersons......................101

TableB.2:Samplesizebyageandgenderatcountrylevel,personswith2+ADL(definition1).........................................................................................................101

TableB.3:Samplesizebyageandgenderatcountrylevel,personswith1+ADL(definition2).........................................................................................................102

TableB.4:Samplesizebyageandgenderatcountrylevel,personswith1+ADLorIADL(definition3).................................................................................................102

TableB.5:Samplesizebyageandgenderatcountrylevel,personswith1+ADLorIADLor2+chronicdiseases(definition4)............................................................103

TableB.6:Samplesizebyage,genderandin-need-of-carestatusatgroupofcountrylevel,SHAREwave5.............................................................................................103

TableB.7:Samplesize,bytypeofhouseholdandage,atcountrylevel,allpersons..104

TableB.8:Samplesize,bytypeofhouseholdandage,atcountrylevel,personswith2+ADL...................................................................................................................104



TableB.9:Samplesize,bytypeofhouseholdandage,atcountrylevel,personswith1+ADL...................................................................................................................105

TableB.10:Samplesize,bytypeofhouseholdandage,atcountrylevel,personswith1+ADLorIADL......................................................................................................105

TableB.11:Samplesize,bytypeofhouseholdandage,atcountrylevel,personswith1+ADLorIADLor2+chronic................................................................................106

TableB.12:Samplesize,bytypeofhousehold,ageandin-need-of-carestatus,atgroupofcountrieslevel................................................................................................107



EXECUTIVESUMMARY

This reportuses theSurveyofHealthAgeingandRetirement inEurope (SHARE)ofpeople aged 50+ for 2013 as a means to benchmark Long Term Care (LTC) inEuropean countries. This data allows interdisciplinary investigation of both spatialandtemporalaspectsofLTCinEurope.BywayofillustrationestimatesoftheCareGap, that is, the extent to which the need for care is not met by any kind ofprovision, neither formal nor informal. CareGaps are calculated asbothwide andvariable.ItalsoapproachestheCareMix,thatis,howtheoverallprovisionismetbyformalcare(professionalbothpublicandprivate)andbyinformal(unpaidbyfamily,friendsorneighbours).That is foundtovaryaccording to the reachof formalcarebut also by the extent to which that is complemented by informal care. Cross-tabulations are provided about how the two key indicators differ by gender, agegroup, and household type. The exact meaning and robustness of concepts anddefinitionsareprobedindetail.Note that his document contains many diagrams and should either be read onscreenorprintedusingacolourprinter.

Keyfindings

ConceptualisingLongTermCareasSocialInvestmentacrosscountrieswithdisparateinstitutional,socialandeconomicbackgroundsneedstobuildonasolidcomparativeempiricalfoundation.SuchisprovidedbytheuseofdatafromtheSurveyofHealthAgeing and Retirement in Europe (SHARE) of people aged 50+. The data arerepresentative of the populations covered, is internationally comparable andinterdisciplinaryandallowsapproachingbothspatialandtemporaldevelopmentsinlongtermcare.

ThisreportexplorestheuseofSHAREdataasakeyresourcefortheSHAREproject.Assuchitdelvesindetailinthedefinitionofconceptsofthedemand(need)forlongterm care and the supply, that is themodes of provision of care both formal andinformal,acrossEuropeandbeyond. Itusesthe latestSHAREwave5(conducted in2013)andsketcheshowthat canbeenrichedacross space (addingcountries frompreviouswaves)andtime(thelongitudinaldimension).

Theinvestigationfocusesontwokeyconcepts:theCareGapandtheCareMix.

TheCareGapshowsthepercentofthesamplewho,despiteappearingtoneedcareunder the four progressively looser definitions, are not actually receiving any –whether formalor informal. The fourdefinitionofneedstart fromthe inability tofulfillmorethantwoActivitiesofDailyLiving,usedintheUSasaneligibilitycriterionforLongTermbenefit(definition1)andgobybeinglessstringentintermsofADLS



(definition2),adding the inability to fulfill instrumentalactivities (definition3)andconcludebyaddingtheexistenceofmorethantwochronicdiseases(definition4).

TheCareGapbycountryappearsinFigurei.1forindividualsaged65+.Thissub-setofthetotalSHAREpopulation,excludesthe50-64agegroup,andcanbethoughtasthecentralgroupofinterest.

Figure0.1:Caregapbyinneed-of-carestatus,personsaged65+,SHAREwave5

2310 4

15 16 12 1724

929

17 1626 20

919 19

20

2117

13 10 1020

16

11

810 14

1613

7

13 13

5141

36 38 32 3542 46

3243 41 36

57

42

27

40 40

7769

62 67

5363 62

6857 61 62 62

77

6024

64 64

0

20

40

60

80

100

SE DK NL DE BE LU FR CH AT IT ES CZ SI EE IL* SEUR Total

SHAREwave5CareGapofPersons65+byinneed-of-carestatus

Def.1:2ormoreADLDef.2:1+ADLDef.3:1+ADLorIADLDef.4:1+ADLorIADLor2+chronicdiseases

Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:Seetext.

ThemeasuredCareGap is generallywide;Almost one in four (23%)of Europeansappears to lack care. In the intermediatedefinition this rises toone in two (47%).The very large population under the loosest definition can be interpreted as theexistenceof aneven larger latentor potential demand. There is also considerablecountry variation- the range from the lowest (AT 10%) to the highest (SI 34%) islarge.Variabilityfallsastheneeddefinitionwidens.

The Care Mix counts all types of care received, starting from formal care(encompassing paid and unpaid care, public or private) and informal unpaid care(both fromwithin and fromoutside thehousehold). TheCaremix for theover 65populationappearsinFigurei.2.

Figure0.2:Caremix,allpersonsneedingcareaged65+,SHAREwave5



47 4358

3047

37 46 45 2819 22 12 11 15

2231 31

22 29

22

39

2933

3022

36

1621

2417

3641 28 28

31 2719

31 23 31 24 33 36

65 57 64 72

4936 41 41

0%

20%

40%

60%

80%

100%


CompositionofCareMix AllPersonsaged65+

OnlyProfessional ProfessionalandInformal OnlyInformal

Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:Seetext

Figure i.2 shows the mix between professional and informal care, including anintermediatecategorywherean individual receivesbothat thesame time.Formalcarecovershalfthesample,with30%receivingonlyformalcareandafurther23%complementing with informal care. In contrast, total informal care caters for 70percent, with 43% having no access at all to formal care. There is considerablecountry variability, chiefly in the reach of formal care and in the extent to whichformalcare‘standsalone’.InNorthandCentralEuropeformalcareisaround70%andtwoofeverythreerecipientsdonotsupplement itwith informal. IntheSouththeoverallreachofformalcareislessthanhalf(35-40%)andinformalcarereachesmore than 80%. In the east the reach of formal care is even lower (under 25%).Howeverthereremainsconsiderablevariability,(e.g.EEandAT).

Thereportdelvesdeeperintwotypesofcross-tabulation:

By large age group and gender. Care gaps are wider for men; the difference isespecially large in the North and Centre, while it may even lie in the oppositedirection in theSouthandEast.As the focus shifts towardsoldergroupsgaps fall,thelowestcaregapsappearingfortheover80s.Mentendtorelymoreoninformalcarethanwomen,anobservationwhichholds inallagegroupsandcountries.ThepreponderanceofformalcareintheNorthrisesinstricterdefinitionsofneed.

Bytypeofhousehold,theanalysisisconductedintermsofsingleadult,coupleadultandallotherhouseholds,andincludeschildrenunder19asdependents.ThemorecomplexhouseholdsaremorecommonintheSouthandEast,whilethereisstrongevidencethatgenerationalcohabitationisusedthereasacaresubstitute.Caregapsare widest for couple households, as single adults apparently can tap better intoformalcareprovision.ThedifferencebytypeofhouseholdsiswidestintheNorth.

Theobserveddifferencesmaynotonlybeduetodemandorsupplyfactors,butmayreflectunderlyingattitudes.Thereportexaminesevidenceonattitudes fromolderwaves of SHARE. There is a major divide in Europe on who should be primarilyresponsible for care – the family or the State,with the South and East being less



inclinedtoassignresponsibilitytotheState.Ongenderroles,thereisanoteworthydifference in attitudes betweenmen andwomen, even in those countries that ingeneralhaveamorebalancedview.However,thereissomeevidencethatattitudesaresofteningovertime.

Further work could proceed both at the extensive margin (adding data) and theintensivemargin(investigatingcausalrelationships).SHAREcouldalsobedevelopedinto a SPRINT common resource allowing wider use of the data by SPRINTresearchers.

Thereportdelves intothedefinitionsusedbothofdemandandofsupplyforcare.Regardingdemand,thereisconsiderableoverlapbetweenthefirstthreedefinitions,which appear largely nested. The population in need widens considerably indefinitions relying on numbers of chronic diseases. The new people brought inappear to be in better help than those who need care under more stringentdefinitions,butare considerably lesswell than their coevalswhodonotneedanycare.Thisconfirmstheirinterpretationasanintermediateorlatentgroup.Asforthesupply of care, matters are relatively straightforward for formal care. However,considerableoutofpocketpaymentsresultforrecipients,andinsomecountriesandfor some groups these can can reach 20% of incomes. In informal care, it wasdecidedtolimitthedefinitiontoregular(weeklyormorefrequent),theinclusionofintra-household care is investigated and characteristics such as who providesinformalcareareinvestigated.Finally,theinvestigationlooksat‘caresurfeit’–thatisthesituationwherecare(formaland/orinformal)isprovidedbutwheretheneedforcareisnotapparent,theoppositeofthecaregap.Thisiscommonplace,eveninformalcare,andismorewidespreadamongolderrespondents.Thismaybeseenaspartofaninnateproblemwithself-assessment,thoughitcouldalsosignalpossiblecasesofover-supply.


D.2.1ConceptualReportonLongTermCare/BenchmarkingLongTermExploringtheSHAREdatacareinEurope

1

1.Introduction

SPRINTisacollaborativeprojectspanningtheEuropeanUnion,aimingtoexaminethewaysaspecificexamplethancanbethoughtofassocialinvestment,thatisLongTermCare(LTC),isseenormaystillbeseenasaninstanceofsocialinvestment.Giventhatsocialinvestmentanditsperceptiondonotoccurinavacuum,theyarelikelytobepredicatedonboththeneedforinterventionandthepre-existingsituationregardingthewaythatlongtermcareisdelivered.Giventhatboththesearelikelytovaryacrosscountries,itisofimportancetopindowntheinternationalvariationandtoanchorsocialinvestmentdifferencesonthenationalsituationsinboththedemandandthesupplyoflongtermcare.

Seenmoresimply,SPRINTisaninternationalandcollaborativeprojectattemptstohowthesameneedisreflectedindifferentconceptsanddifferentpracticesindifferentenvironments.Thishasbothatemporaldimension–howthingsevolvedandwillevolveovertime–aswellasspatialonecapturingnationalandgeographicaldifferences.

Inotherwords,animportantstartingpointistobenchmark.Whatisthemeaningofhigh/low?Whatismeantbytermsindifferentcontexts–e.g.inthedifferingimportanceormeaningassignedtosimilarthingsindifferentcountries.Secondarily,SPRINTwillneedtoinvestigate,i.e.relatewhatisobserved,tocorrelatesandcofactorsinordertotrytoexplainwhythingsarewhattheyare,andhencehowtheymightbeexpectedtochange,whetheraspartofsocialinvestmentdecisionsorasareactiontoothersources,suchastheimpactofthefinancialcrisisortoageing.Giventhatlongtermcareliesatthecuspofeconomic,financial,psychological,socialandmedicalfactors,toexplainitrequiresinformationthatdoesnotabinitioexcludeclassesofinformationandthatisabletoreachacrossdisciplines.

Thepurposeofthisexploratorynoteisthreefold:Itsfirstconcern,itwillexaminetheuseofdatafromSHARE(TheSurveyofHealthAgeingandRetirementinEurope)asthemaininstrumenttobenchmarkdifferencesacrosscountries(Section2).Sections3and4approachestwoempiricalquestionsusingSHARE:(a)thecaregap,thatistheextentofunmetneedforcare,i.e.theextenttowhichdemandforcareexceedssupplyunderdifferentdefinitionsofdemandand(b)thecaremix–i.e.howthecareofferedisdistributedbetweenformalandinformal,paidorunpaid.Thetwoconceptsareusedtoexaminedifferencesbylargeagegroupandgender,byhouseholdtype.InformationfromolderwavesofSHAREisbroughttobearonattitudestocare,toseewhetherthesecanaccountforobserveddifference.Section6presentsevidenceontheattitudesaboutcarefocusingontheroleoftheStateandthefamily,whilenextsection(section7)sketchesoutfurtherworkthatcanbeundertakenusingthedata–bothattheintensivemargin,doingmorewithexistingdata,andattheextensivedata–



2

extendingtheobservationsgeographicallyorovertime.Asbefitsapaperthatexplorestheuseofthedata,thispaperdoublesbackandtakesathoroughlookatthedefinitionsusedanddistinctionsthatcanbeappliedtothedata(sections8,9,10and11).Thisallowsabetterunderstandingofwhatthebenchmarkeddifferencesareandhowrelyingondifferentdefinitionsaffectsconclusionsdrawn.

2.SHAREasasourceofinformation

TheSurveyofHealthAgeingandRetirementinEuropeisasourceofmicro-data(www.share-project.org),apopulation-basedpanelsurveyofpeopleagedover50.Since2011isaEuropeanResearchInfrastructure,governedbyaResearchInfrastructureConsortiumandproducesdataeverytwoyearswhichareavailablefreeofchargeanddownloadablebyanyresearcher.SHAREwasfirstlaunchedasanFP6projectin2004andiscloselymodelledandhencecomparabletoUSHRS(HealthRetirementSurvey-http://hrsonline.isr.umich.edu/),whichhasbeenrunningsince1993,aswellastotheEnglishLongitudinalStudyonageing(ELSA-http://www.elsa-project.ac.uk/),whichhasrunsince2000.Withboththesesourcesitis,inprinciple,linkable1.

SHAREisapanelsurvey–thatisonewheretherespondentsarefollowedregularlyafterfirstbeingcontacteduntiltheendoftheirlife.Thisdimensionisdesignedtodealwiththekeycausalproblem:Howcanweaddcausalitytostatisticalassociations?Inpanelsurveys,itisoftenpossibletoseparateintimecausesfromeffects(e.g.,anillnessthatlosesearningcapacityisdistinguishedfromdeteriorationinhealthasaresult,say,ofredundancy).Re-interviewingthesameindividualashe/sheagesthuscandistinguishapureageeffectfromdifferencesinbehaviourduetobelongingtoadifferentcohort(orgeneration).

Thefirstwavetookplacein2004,W2in2007.The2009wave3wasaretrospectivequestionnaireprobingtheearlylifeofwave1andwave2respondents(SHARELIFE).Thefourthwavein2011wasthefirsttotakeplacewithnationalfundingasaEuropeanResearchInfrastructure.Wave5,themostrecentwaveavailable,reliedonthequestionsbeingconductedin2013,whilethedatawasreleasedin2015.Wave6wasconductedin2015andwillbeavailabletowardstheendof2016;w7willfollowin2017andwillbesimilartoSHARELIFE(retrospectivequestions).Eachwavehasasetofcorequestionsrepeatedfrompreviouswaves,butmayfocusonaspecificissueingreaterdepth.Thepanelnatureofthesurveymeansthattheyoungestpersoninterviewedin2004,enteredthesurveyaged50andisnow62.

AnumberofdistinctionsmaybethoughttodistinguishSHAREfromotherpossiblesourcesofinformation:SHAREassurveydataisdistinctfrom 1Other countries have introduced SHARE-like surveys– Korea, Japan, India, and others.



3

Administrativedata,typicallyderivedasaby-productofthesupplyofcare.Administrativedataprovidenationalinfodependingonlocaldefinitionsandinterpretation;theytypicallycannotbecomparedacrosscountries.However,itisworthnotingthatdifferentpopulationarecaptured(e.g.peopleinresidentialhomes,hospitalsorprisonsareoftenexcludedfromsurveydata).SHAREisalsoapopulation-basedsurvey,thatis,ithasaknownrelationtotheunderlyingtruepopulationandcanhencebeblownuptorepresentthetotalpopulation.Incontrast,specialtysurveys(e.g.surveysofLTC)maylookatsub-populationwithoutaclearideaofthewholeofwhichtheyarepart.SHAREisalsoageneral-purposeageingsurvey,ratherthanonededicatedtoLongTermCare.GiventhatLTChastocompetewithotherareasofinterest,thedepthtowhichSHAREcangotoislimitedbytheneedtokeeptheinterviewlengthwithinlimits.Italsofrequentlyhastorelyonself-assessedquestions,asthetimeneededtoprobeisnotavailable.Finally,SHAREisaninterdisciplinarysurvey,meaningthatthefocusofdiversedisciplinesinvolvedinageinghastobeaccommodated.Ascomparedtosingle-disciplinesurveysthismaymeanalossofaccuracyduetoaninabilitytoprobedeeperinamorefocusedway.Againisthat,thoughsingledisciplinefocusmaydelvemoreinonedirection,itmaymissoutinter-disciplinaryphenomena;theseinamultidimensionalissuesuchasageingarelikelytobeimportant.

ThusSHAREasthreekeycharacteristicswhichmakeitespeciallysuitableforSPRINT:

A. The data are interdisciplinary. Populationageingdemands simultaneousinput from a number of disciplines: Medicine (physical situation),Psychiatry andPsychology (wayof life, cognition, attitudes),HealthCare(organization of treatment and prevention), Sociology (family, networks,informalsupport),Economics(income,employment,retirement,housing),Finance (Asset andwealthholdings, attitudes to risk). Thequestionnairewas designed by economists, medics, sociologists, psychologists,statisticians.Experimentalmodulesareoccasionallyinserted–e.g.in2007vignettes2,in2013Poverty,in2015Driedbloodspots,etc.

B. Thedataareinternationallycomparable.ComparabilityallowsEuropetobe treated as a kind of ‘research laboratory’, replicating naturalexperiments.Thiscanbeseenasawayofbreakingmulticollinearity:e.g.ifabasicsystemhasremainedunchangedfor50years(asisfrequentlythecasewithina single country),whatare theunderlying structural (causal)relations? Similarly, comparability an allow Europe to be treated as adepository of good practice: How much can be transferred? To whatextent is itduetoco-factors?Hence,majoreffort isexpendedinaspectssuch as: translations; answers are checked over time; randomized

2A set of hypothetical questions attempting to pin down variation in answering modes in many self-assessed questions on health, well-being, psychology and various attitudes.



4

experimentsconducted(eg.ComparisonofUSandEuropeanSelfassessedHealth).

C. Thedatahaveapanelstructure.Individualsfollowedovertimeandhencewecandistinguishtheimpactofagegroupandcohort.Certainkeyeventsareobservedandreactiontothemcanbemonitored:Retirement;majorillnessleadingtodisability;familybreakup.

Meetingtheserequirementscanleadtoverylonginterviews(insomecasesover5hours)andhenceinproblemsinconsenttoparticipate.Similarly,thedatasetcanbecomplex3;familiaritywithworkingwiththedatarequiresaconsiderableinvestmentoftime,whichactsasanaccessbarriertotheuseofthedata.Asimpler,moreeasilyaccessibleformofthedatahasbeendevelopedforteachingpurposes(EASYSHARE).

SHAREisbesetwithfundingproblemsItiscurrentlyreliantonnationalfundingfordatacollection(thoughnotforcleaninganddissemination);nationalfundingauthoritiessometimesforgetthenecessityofconsistentfundingforarunofyearstosafeguardthepanelnatureofthesurvey.So,somecountrieshavingsecuredfundingforonewavefindtheycannotkeepup(e.g.Hungary,Portugal).Administrativeproblemsinherentinaloosegovernancestructure,whichattemptstoplacescientificconsiderationsparamount,canalsoexactatollinparticipation.

Fundingandadministrativeproblemsmeanthatcountriescomeandgo.Figure2.1showsintheformofatimecharttheparticipationofcountriesintheSHAREdatacollection.AllmembersoftheEUwilltakepart,startingfromwave7,tobeundertakenin2017.

Figure2.1:CountriesparticipatingintheSHAREdatacollection

3Centralised handling, corrections, imputations etc allow the possibility to go back to the original data. This increases complexity and introduces delay, but can on occasion be indispensable. There exists documentation (QxQ, questionnaires in all languages).



5

SHAREwave54,whichwillprovidethestartingpointoftheanalysis,comprises15countries,13intheEUplusSwitzerlandandIsrael.TothesecouldbeaddedothercountriesthathavetakenpartinSHAREinpreviouswaves:three(PL,PT,HU)withw4(2011data),GreeceandIrelandwithwave2(2007).Whenwave6comesonstreaminlate2016Greecewillreturnandnewcountries(e.g.Lithuania)willenterforthefirsttime.TheentireEUcomprising27memberstates(plusEnglandwhichalreadyhasELSA)willberepresentedinwave7tobesampledin2017;itwillbeavailableinlate2018.

ComparingSHAREdatawithSPRINTmemberstheoverlapisnotcomplete:FI,LT,PT,ELandHUarenotrepresentedinwave5,whiletheUKwillbepartlyrepresentedbytheEnglishsurveyELSA.EL,PTandHUcanberepresentedusinginformationfrompreviouswaves.Onthepositiveside,allmajorgroupsofEuropeanwelfarestatesarerepresentedwhichwillallowfairlydetailedeconometricwork.

4 This paper uses data from SHARE Wave 5 (DOIs: 10.6103/SHARE.w5.100), see Börsch-Supan et al. (2013) for methodological details. The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7 (SHARE-PREP: N°211909, SHARE-LEAP: N°227822, SHARE M4: N°261982). Additional funding from the German Ministry of Education and Research, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064) and from various national funding sources is gratefully acknowledged (see www.share-project.org).



6

Table2.1:SHAREwave5(2013)samplesizesbycountry,genderandage

SHAREWAVE5(2013)

50+ Men Women 50-64 65-74 75+AT 4,252 1,807 2,445 1,824 1,487 941DE 5,690 2,662 3,028 3,052 1,553 1,085SE 4,531 2,106 2,425 1,618 1,765 1,148NL 4,129 1,844 2,285 1,916 1,354 859ES 6,450 2,950 3,500 2,720 1,735 1,995IT 4,703 2,111 2,592 2,001 1,569 1,133FR 4,445 1,895 2,550 2,000 1,250 1,195DK 4,136 1,899 2,237 2,145 1,191 800CH 3,008 1,352 1,656 1,358 954 696BE 5,614 2,503 3,111 2,828 1,463 1,323IL 2,332 1,013 1,319 1,037 639CZ 5,698 2,338 3,360 2,463 2,049 1,186LU 1,610 755 855 913 419 278SI 2,948 1,266 1,682 1,394 822 732EE 5,735 2,268 3,467 2,271 1,801 1,663

Total 65,281 28,769 36,512 29,540 20,068 15,673

Table2.1showswave5samplesizes.Theoverallpopulationis65,000;whereasthetypicalsamplesizeisinexcessof4,000,withtheexceptionofLU,CHandIL.Giventhatthesurveyconsistsofpeopleover50whoaretheoverwhelmingusersofLTC,thissamplesizecorrespondstoanallagessampleofthreeorfourtimesthatsize.Samplesizesaresufficientfordetailedanalysisbyage,asevenintheover75agegroupsamplesizesarewellover800.InMay2016,whenthisanalysiswashalfwaythrough,SHARErelease5.0cameonstream,containingnewdataimputationsanddatacleaningofallwavesfrom2004.Itwasdecided,nevertheless,toproceedwiththepreviousversionandtoupdatethedataatalaterstage.

SHAREhasbeeninoperationsince2004.Thismeansthatthereisamaximumtimedistanceofeightyearsfromwave1andsixyearsfromwave2foruseinlongitudinalwork.Table2.2focuseson15thousandindividualswhoappearbothinwave2andwave55.Tothosewemustaddthosewhodiedbetweenthedatesandforwhomthereexist‘exitinterviews’.Thesearetypicallycompletedbynextofkinandprovideinformationondeceasedrespondents’finaldays.Similarly,thereareanumberofrecoveredobservationswhohadparticipatedinwave1butnotwave2andhavebeenpersuadedtoanswerinwave5.Thevastmajorityof

5Focusing on wave 1 would exclude the eastern European countries who entered in wave 2.



7

longitudinalrespondentswouldalsohaveparticipatedinwave3,theretrospectivequestionnaireknownasSHARELIFE.

Table2.2:LongitudinalsamplesizesinSHARE,w2andw5,bygenderandw2age

Longitudinal 50+ Men Women 50-64 65-74 75+AT 622 246 376 141 270 211DE 980 460 520 343 368 269SE 1,528 685 843 357 667 504NL 1,481 636 845 515 581 385ES 1,354 591 763 381 429 544IT 1,855 822 1,033 511 743 601FR 1,522 639 883 531 500 491DK 1,680 760 920 635 598 447CH 859 357 502 298 304 257BE 1,925 842 1,083 638 638 649CZ 1,127 438 689 352 482 293Total 14,933 6,476 8,457 4,702 5,580 4,651

Incontrasttoothergeneralpurposesurveys,whichaddresstheentirepopulation,SHAREisasurveyaddressedspecificallytotheissueofageing,andhencecontainsmanyfeaturesthatmakeitmoresuitabletostudyLongTermCareinthecontextofSPRINT:

• In sampling, all households where one member is aged 50+ areinterviewed. To extract household information all members (includingthoseunder50)are interviewed.Under50-yearoldsare includedwithazeroweight.

• Emphasis is placed in retaining older and infirm respondents – whichtranslates into a large number of the ‘oldest old’.Whereas the originalsamplewasbasedonindividualslivinginhouseholds,originalrespondentswerefollowedinoldagehomesorhospicesinsubsequentpanels.

• Proxyinterviewsareundertakenforallthoseunabletoanswerforhealthor cognition problems. Similarly exit interviews attempt to cover thecriticallastfewmonthsoflife.

Afinalquestiontobeapproachediswhethertheexclusivefocuson50+populationisaproblemforSPRINT.Itiscertainthatthebulkofdemand(need)forcareiscoveredbythatpopulation.Asregardsthesupplyofpeopleprovidingformalandinformalcare,the50+agegroupwouldcertainlycoverinformalcareadequately,thoughprofessionalpaidcarepossiblytoalesserextent.Thus,



8

thoughsomethingwouldbeundoubtedlylostbytheexclusionofunder50s,thegaininextradetailprobablycompensates.

3.Thebottomline:TheCareGapandtheCareMix

Theexplorationstartsbypresenting–insummaryformtheoverallpictureinSHAREwave5forthetwoindicatorsofinterest–caregapandcaremix.Inthiswaytheexploratoryinvestigationpostponestheexpositionoftheunderlyingworkprobingthealternativedefinitionsandtheextenttowhichtechnicalissuesaffectthefinalresultsfortheconcludingsections.

Giventhatthepurposeofthisinvestigationisprimarilytoexplorethedataandtotesttherobustnessofdefinitions,theanalysisfocusesontheentirepopulationofSHARE–thatiseveryoneagedover50.Thisincludespeopleaged50-64,whoareoftennotconsideredinLTCanalyses.Thoughforthepurposesofbenchmarking,itisadvisabletokeeptocommonlyuseddefinitions,forthepurposesofexploringthemeaningofdefinitions,itisimportanttomaximiseboththesamplesizeandthevariabilityofbehaviour.Inthisrespect,thefactthattheyoungeragegroupisfrequentlyatypical,isanaspecttobewelcomed,asthatwouldshowuppossibleinfelicitiesorinconsistenciesinindicatorsoransweringmodes.Thus,whileresultsarereportedforthe65+populationaswell,thestatisticalworkwasconductedfortheentiresample.Evenif,subsequentworkdecidestozeroinontheover65s,itisimportantforreferencepurposestoknowwhatholdsfortheentiresample.

3.1TheCareGapThekeyindicatorofinterestistheextentofpeoplewhoarenotcoveredbyanyformofcare,butwho,nevertheless,arejudgedtoneedcare.Thiswillresultastheoveralldifferencebetweenthesupplyofcareandsomeestimateoftheneed,thatisthedemandforcare.

TheCareGappresentstheproportionofpersonswhoaredeemedtoneedcare(with4definitionsofcare)butdidnotreceive:(i)‘Anytypeofformalcare/help’suchas1.Helpwithpersonalcare;2.Helpwithdomestictasks;3.Meals-on-wheels;4.Helpwithotheractivities)duetoaphysical,mental,emotionalormemoryproblemor/and(ii)‘Anytypeofinformalcare/help’(personalcare,practicalhelp,helpwithpaperwork)receivedeitherfrompersonoutsidethehouseholdonadaily/weeklybasisand/orpersonalcarereceivedregularlyfromapersonwithinthehousehold.



9

Figure3.1showsthecaregapthatresultsfromtheapplicationoffourdifferentdefinitionsofneed(seesection8fordefinition).Definition1(2+ADLs)isthemostdemandingandleadstothesmallestgap.IncontrastDefinition4(1+ADLsorIADLor2+chronicdiseases)leadstothelargestgap.

Figure3.1:Caregapbyinneed-of-carestatus,personsaged50+,SHAREwave5

28 19 14 22 22 22 2126

1032

20 1734

2411

23 23

1921

2118 12 8

23 20

18

13

13 16

18

14

8

17 17

5550

45 4840 42

49 5141

48 4741

62

4739

47 47

80 7669

7462

71 72 73 66 68 70 67

83

66 6471 71

0

20

40

60

80

100




Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:Notes:‘CareGappresentstheproportionofpersonswhodidnotreceive:(i)‘Anytypeofformalcare/help’suchas1.Helpwithpersonalcare;2.Helpwithdomestictasks;3.Meals-on-wheels;4.Helpwithotheractivities)duetoaphysical,mental,emotionalormemoryproblemor/and(ii)‘Anytypeofinformalcare/help’(personalcare,practicalhelp,helpwithpaperwork)receivedeitherfrompersonoutsidethehouseholdonadaily/weeklybasisand/orpersonalcarereceivedregularlyfromapersonwithinthehousehold.*‘SEUR’includesallcountriesinSHAREwave5,exceptforIsrael.Figure3.1reportstheindividualcountryresults,theSHAREtotalandtheSHARE-Europeaverage.ThelastexcludesIsrael,butincludesSwitzerland–itisthusEuropeanSHARE(SEUR).Countriesareclusteredaccordingtopresumedwelfarestatemodel:‘Nordics’,‘Continental’,‘Southern’and‘EasternEurope’.Evenaccordingtothestrictestdefinition,almostoneinfourofEuropeansover50whoareinneedofcarereceivenocareatall.Thisshowsconsiderablevariation,withAustriawiththesmallestgap,andSloveniaandItalythelargest,withSweden(28%)howevernotlyingfarbehind.Underthemorestringentdefinitionaquarterofallthosewhoneeddonotreceivecare,andafifthunderthewiderdefinition(def.3).Asthedefinitionwidens,theacross-countriesdispersionfalls.Table3.1showstheindividualcountrydataandTable3.2summaryindicators.



10

Table3.1:Caregapbyinneed-of-carestatus,personsaged50+,SHAREwave5

SHAREw5,AllPersons50+

Def.1:2+ADL

Def.2:1+ADL

Def.3:1+ADLorIADL

Def.4:1+ADLorIADLor2+chronicdiseases

SE 27.9 47.3 55.1 79.5DK 19.3 39.8 50.1 76.1NL 13.7 35.1 45.0 68.6DE 22.4 40.2 48.2 73.9BE 22.4 34.9 40.2 62.5LU 22.1 30.4 41.9 71.1FR 20.9 43.9 48.6 72.0CH 25.6 45.9 50.9 72.6AT 10.2 27.8 41.1 65.9IT 32.0 44.6 47.7 68.3ES 19.5 32.1 46.8 70.4CZ 16.6 32.3 40.8 67.1SI 33.9 51.8 62.3 83.4EE 23.5 37.7 46.8 65.9IL* 10.7 19.2 38.8 64.0SEUR* 23.4 40.1 47.4 71.2Total 23.1 39.8 47.2 71.1Source:SHARE,wave5,(release1.0.0:March31st,2015).*‘SEUR’includesallcountriesinSHAREwave5,exceptforIsrael.

Table3.2:Summarypictureofcaregapbyinneed-of-carestatus,personsaged50+

SHAREwave5,Allpersons50+

Def.1:2+ADL

Def.2:1+ADL

Def.3:1+ADLorIADL


Nordics 18.8 39.4 48.6 73.5Continental 21.5 40.8 47.5 72.2Southern 26.8 39.8 47.3 69.2Transition 19.4 35.1 44.1 69.2SEUR* 23.4 40.1 47.4 71.2Total 23.1 39.8 47.2 71.1CV-weighted 22.0 13.6 7.4 5.7Minvalue AT(10.2) IL(19.2) IL(38.8) BE(62.5)Maxvalue SI(33.9) SI(51.8) SI(62.3) SI(83.4)Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:Nordics:SE;DK;NL.Continental:DE;BE;LU;FR;CH;AT.Southern:IT;ES.Transition:CZ;SI;E



11

3.2TheCareGapbyageandgenderThesamebasicindicatorsareproducedinwhatfollowsbyage,thatisforpeopleaged65andoverseparately,usingthesamedefinitions(Figure3.2andTable3.3and3.4).

Gapsareinallcasesandforallcountriessmaller.Thispresumablyreflectsthatthecareneedsofthoseover65arebothmoreentrenched(andhencehavehadgreatertimetoadapt)butalsopossiblythatcaresystemsaredifferentiallyprimedtorespondtoneedsofthoseover65,ratherthanthoseyounger.Interestingly,thedecreasewithageissmallerintheSouthofEurope(chieflyinItaly)andlargestinScandinavia,whichwouldtendtosupportaninstitutionalexplanation.ThelowestgapisshownbyNLandthelargestbyIT.



12

Figure3.2:Thecaregap,peopleover65

2310 4

15 16 12 1724

929

17 1626 20

919 19

20

2117

13 10 1020

16

11

810 14

1613

7

13 13

5141

36 38 32 3542 46

3243 41 36

57

42

27

40 40

7769

62 67

5363 62

6857 61 62 62

77

6024

64 64

0

20

40

60

80

100




Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:asinFigure3.1.


SHAREwave5,Persons65+

Def.1:2+ADL

Def.2:1+ADL

Def.3:1+ADLorIADL


Nordics 10.6 29.8 41.1 68.3Continental 15.4 31.2 39.0 64.3Southern 24.2 33.4 41.9 61.6Transition 17.8 31.5 39.1 63.8SEUR* 19.0 32.0 40.3 63.7Total 18.8 31.8 40.0 63.5CV-weighted 30.8 16.9 8.8 7.0Minvalue NL(4.5) IL(16.1) IL(29.9) IL(52.0)Maxvalue IT(29.4) SE(42.8) SI(57.3) SI(77.4)Source:SHARE,wave5,(release1.0.0:March31st,2015).



13

Table3.4:Caregapbyinneed-of-carestatus,personsaged65+,SHAREwave5

SHAREw5,Persons65+

Def.1:2+ADL

Def.2:1+ADL

Def.3:1+ADLorIADL


SE 22.7 42.8 50.9 76.6DK 9.9 30.5 41.1 69.5NL 4.5 21.1 35.7 62.0DE 15.0 28.4 38.3 67.2BE 15.5 25.2 31.7 53.1LU 11.8 21.8 34.8 63.5FR 16.7 36.8 41.6 62.5CH 23.6 39.6 46.4 67.7AT 8.8 19.3 31.8 57.4IT 29.4 37.8 42.7 61.3ES 16.9 26.6 40.8 62.1CZ 16.2 30.1 35.7 61.8SI 26.0 42.0 57.3 77.4EE 19.9 32.8 41.6 60.5IL* 8.6 16.1 26.9 52.0SEUR* 19.0 32.0 40.3 63.7Total 18.8 31.8 40.0 63.5Source:SHARE,wave5,(release1.0.0:March31st,2015).Asimilarexerciseisconductedinwhatfollowsbygender.Theresultsarefirstshowndiagrammatically(Figure3.3),followedintabularformbytheindicatorsinsummaryformandthenfortheindividualcountries(Table3.5).Differencesindefinition1betweenmenandwomenarewideintheNorth(SE).

Figure3.3:Caregapbyinneed-of-carestatus,bygender,SHAREwave5

26 19 12 19 16 22 12 9 1033

17 1731 24

1121 21

1914

1413 11

10 23 3115

9

11 13

2012

8

14 14

5246

38 43 3443 43

4840

47 4638

65

46 40 44 44

76 7261

69

5668 67 68 62 65

68 63

83

65 6167 67

0

20

40

60

80

100


SHAREwave5CareGapofWomen50+byinneed-of-carestatus




14

3020 19 27

3523

3550

1129 25 16

3923

1028 28

2028 33 23

14

5

225

21

2115

21

14

17

10

21 21

60 56 60 57 5139

59 5643

51 49 4556

4936

54 54

84 81 79 8072 75

79 7971 73 74 72

84

68 6877 77

0

20

40

60

80

100


SHAREwave5CareGapofMen50+

byinneed-of-carestatus


Source:SHARE,wave5,(release1.0.0:March31st,2015).

Table3.5:Summarypictureofcaregapbyinneed-of-carestatus

SHAREwave5,AllPersons50+

Def.1:2+ADL

Def.2:1+ADL

Def.3:1+ADLorIADL


Women50+ Nordics 16.8 32.4 43.0 67.7Continental 16.4 33.2 42.3 67.3Southern 26.6 36.7 46.2 66.7Transition 19.9 33.0 42.7 66.1SEUR* 20.9 34.5 43.8 67.1Total 20.8 34.3 43.7 67.0CV-weighted 27.5 13.9 7.7 6.4Minvalue CH(9.3) IL(18.9) BE(34.3) BE(55.7)Maxvalue IT(33.0) SI(51.4) SI(65.4) SI(82.9)

Men50+ Nordics 23.2 50.1 58.9 80.9Continental 29.6 51.8 56.4 78.5Southern 27.4 46.4 49.9 73.1Transition 18.7 38.5 46.9 73.5SEUR* 28.1 49.5 54.1 76.9Total 27.6 49.0 53.8 76.8CV-weighted 22.2 15.6 9.9 5.0Minvalue IL(10.0) IL(19.6) IL(36.1) EE(67.7)Genderdifference(M-W)inppNordics 6.4 17.7 15.9 13.2Continental 13.2 18.6 14.0 11.2Southern 0.8 9.6 3.7 6.4Transition -1.2 5.5 4.3 7.3SEUR* 7.1 15.0 10.3 9.8



15

Total 6.8 14.7 10.1 9.7Source:SHARE,wave5,(release1.0.0:March31st,2015).Caregapsarelargestformen.ThisdifferenceariseschieflythroughdifferencesinNorthernEurope(NordicsandContinental–e.g.,DEandFR),ratherthanintheSouthandEastwherethedifferenceislessmarkedandmightevenbeintheoppositedirection(IT).Table3.5showsthesituationbylargegroupofcountries,aswellascomputingthedifferencebetweencaregapsforwomenandformen.ThisdifferenceisespeciallynotableinCentralEurope,coveringalldefinitionsofneed.Widerdefinitionsofneedleadtogreatergenderdifferencesandtomenfaringlesswell(Table3.6bycountry).

Table3.6:Caregapbygender,personsaged50+,bycountry,SHAREwave5

Def.1:2+ADL Def.3:1+ADLorIADL

Personsaged50+ Men Women

GenderDiff.(M-W) Men Women

GenderDiff.(M-W)

SE 29.8 26.5 3.4 59.8 52.3 7.5DK 19.9 18.9 1.0 55.6 46.3 9.3NL 18.7 12.2 6.6 59.7 37.9 21.8DE 27.1 19.4 7.8 56.7 42.9 13.8BE 35.1 16.4 18.7 50.8 34.3 16.5LU 22.8 21.6 1.2 39.1 43.3 -4.2FR 34.9 12.4 22.5 58.7 43.1 15.7CH 49.6 9.2 40.3 55.9 47.9 8.0AT 10.5 9.9 0.6 43.1 40.0 3.2IT 29.3 33.0 -3.7 50.6 46.5 4.0ES 25.0 17.1 8.0 49.0 45.7 3.3CZ 15.5 17.3 -1.8 45.2 38.5 6.7SI 38.6 31.3 7.3 56.4 65.4 -8.9EE 22.9 23.9 -1.0 48.7 45.9 2.7IL* 10.0 11.3 -1.3 36.1 40.3 -4.2SEUR 28.1 20.9 7.1 54.1 43.8 10.3Total 27.6 20.8 6.8 53.8 43.7 10.1Source:SHARE,wave5,(release1.0.0:March31st,2015).

3.3TheCareMixSHAREcarerecipientsmayreceiveseveraldifferentkindsofcare.Thesecanbeprofessionalcare,ofwhichsomepaidatthepointofserviceandsomenot,andinformalcare.Section7examinesthesecategoriesindetailforallthosewhoreceivecare(includingsomewhoreceivebutarenotjudgedtoneedcare).Some



16

peoplemayreceivebothprofessionalandinformalcare.Figure3.4looksatthecaremixforthesecategories,forallcountriesinSHAREwave5,firstasapercentofthesampleandsecondlyasshares.

TYPESOFCAREINTHECAREMIX(1)‘Professional’care/helpincludesreceivinginownhomeanyofthefollowingprofessionalorpaidservices(1.Helpwithpersonalcare;2.Helpwithdomestictasks;3.Meals-on-wheels;4.Helpwithotheractivities)duetoaphysical,mental,emotionalormemoryproblem.(2)‘Informal’care/helpincludesInformalcare/help(personalcare,practicalhelp,helpwithpaperwork)receivedeitherfrompersonoutsidethehouseholdonadaily/weeklybasisand/orpersonalcarereceivedregularlyfromapersonwithinthehousehold.

Figure3.4:Caremix,allpersonsaged50+,SHAREwave5

5 59

511 9 8 6 5 4 4 2 1 3

50

5 52 4

46

76

53 6

2 3 51

77 4 4

56

68

88

56

912 12

18

8

12 99 912

1519 18

2623

1814

20 18 20

25

11

22 2118 18

0

5

10

15

20

25

30

35


CareMix AllPersonsaged50+


43 3650

2644 41 44 41

24 20 229 10 15

24 30 29

1924

20

32

26 26 27 19

29

14 18

18 14

3133 23 24

37 4130

4230 34 28 39 47

67 60 72 7654

43 47 47

0%

20%

40%

60%

80%

100%


CompositionofCareMix AllPersonsaged50+





17

Notes:(1)‘Professional’care/helpincludesreceivinginownhomeanyofthefollowingprofessionalorpaidservices(1.Helpwithpersonalcare;2.Helpwithdomestictasks;3.Meals-on-wheels;4.Helpwithotheractivities)duetoaphysical,mental,emotionalormemoryproblem.(2)‘Informal’care/helpincludesInformalcare/help(personalcare,practicalhelp,helpwithpaperwork)receivedeitherfrompersonoutsidethehouseholdonadaily/weeklybasisand/orpersonalcarereceivedregularlyfromapersonwithinthehousehold.

Countriesfallindistinctgroupsintermsoftheimportanceofformalcare,ifthatisweaddthepercentagesofthosewhoreceiveonlyformalandacombinationofformalandinformal.Nordiccountriesarewellinexcessof60%;Continentalcountriesaresimilar,thoughinsome(DEandAT)thepercentagereceivingbothislarger.Therearesignificantdifferencesinintensity.CountriesoftheSouthandEasthavetorelyoninformalcaretoafargreaterextent.Thecaremixshowsconsiderablevariabilitybyageandgender,aswell.Figure3.5reportssharesandFigure3.6percentagesofthesample.Thepercentageofformalcareriseswithage,whilemenaremorelikelytoreceiveinformalcare,andwomentoreceiveinformalcare.

Figure3.5:Compositionofcaremixbyageandgender,allpersons

4634

21 1030 29 31 26 21

724 24

4835

2110

30 30

5840

20 1533 33

2029

1519

23 24 14 166

10

13 13

1828

1319

21 22

3040

24 34

34 34

33 3764 71

47 47 55 5873 83

64 64

34 36

66 7049 49

12 20

57 5133 33

0

20

40

60

80

100

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Aged50+ Aged50-64 Aged65-80 Aged80+

CompositionofCareMix,AllpersonsOnlyProfessional ProfessionalandInformal OnlyInformal



18

4938

21 1132 32 32 28 23

926 26

51 4022

833 33

5942

20 1535 35

2131

1923

26 2613 17

711

14 14

1928

1624

23 23

3043

26 35

36 36

30 31

60 6642 42

54 5470 80

60 60

31 32

62 6844 44

11 16

54 5029 29

0

20

40

60

80

100

Nordics

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CompositionofCareMix,WomenOnlyProfessional ProfessionalandInformal OnlyInformal

4128 20 9

25 25 29 22 185

20 2143

27 21 1325 25

5535

18 1530 30

1925

1013

19 19 15 144

8

11 11

1629

712

19 19

29

34

19 3128 28

41 4770 78

56 56 56 6478 87

69 69

41 4571 75

56 56

1631

63 5442 42

0

20

40

60

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100

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CompositionofCareMix,MenOnlyProfessional ProfessionalandInformal OnlyInformal


Figure3.6:Caremixbyageandgender,allpersons

8 6 4 2 5 5 3 3 2 1 2 2 7 6 4 2 6 6

3022

10 918 183 5 3 4 4 4 1 2 0 2 1 1

3 5 3 4 4 4

1522

13 1918 18

5 7 12 16 9 96 6 6

14 6 65 6 13 16 9 9

6 11

3029 18 18

16 18 1923

18 1810 10 8

1710 10

15 1820 22 18 19

5156 53

57 54 55

0

10

20

30

40

50

60

70

Nordics

Cont/ntal

Southe

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sition

SEUR

*To

tal

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tal

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tal

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Southe

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SEUR

*To

tal


CareMix,AllpersonsOnlyProfessional ProfessionalandInformal OnlyInformal



19

10 8 5 3 7 7 4 3 2 1 3 310 8 5 2 7 7

3525

11 920 204 7 4 6

6 62 2 1 2 2 2

4 64 6

5 5

1826

15 22

21 21

6 7 13 17 9 96 6 6

13 7 76 6 14 17 9 9

6 9

3030

17 17

20 22 2225 22 22

11 11 916

11 1119 21 22

25 21 21

59 60 5661 59 59

0

10

20

30

40

50

60

70

Nordics

Cont/ntal

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sition

SEUR

*To

tal

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sition

SEUR

*To

tal

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SEUR

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tal

Nordics

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Southe

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SEUR

*To

tal


CareMix,WomenOnlyProfessional ProfessionalandInformal OnlyInformal

5 4 3 2 4 4 3 2 1 1 2 2 5 4 4 3 4 420 17

9 7 14 142 4 2 3 3 3 1 1 0 1 1 12 4 1 2 3 3

11 16

9 1513 13

5 7 11 15 8 8 5 5 515

6 6 47 13 14 9 9

615

30 2620 20

12 14 1520

14 159 8 7

178 8 11

15 1819

15 15

37

48 47 47 47 47

0

10

20

30

40

50

60

70

Nordics

Cont/ntal

Southe

rnTran

sition

SEUR

*To

tal

Nordics

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sition

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tal

Nordics

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tal

Nordics

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SEUR

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tal


CareMix,MenOnlyProfessional ProfessionalandInformal OnlyInformal

Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:*‘SEUR’includesallcountriesinSHAREwave5,exceptforIsrael.‘Total’includesall15countriesparticipatinginSHAREwave5.

Figure3.7examinessummarymeasuresseparatelyforthewholesampleandpeopleover65andprogressivelyrelaxesthedefinitionofneed.Whereastheonlyprofessionalsharegrowssomewhatbyage,thebiggerdifferencecomesinthemixedmode,whichislargerforolderpeople.Lookingattheover65s,thereislittledifferencebyage,otherthanaslightriseininformalcare.

Figure3.7:Summarypictureofcaremixbyinneed-of-carestatusandgroupsofcountries,persons50+vis-à-vispersonsaged65+,SHAREwave5



20

3221 10 8 16 16

24 16 9 7 13 1324 17 9 7 14 14 13 9 6 3 8 8

3845

2037

34 35 26 30

15 2424 24

17 23

11 1918 19

7 10 5 7 8 8

11 13

4336 26 26

10 1437

33 23 23 10 1333 31

20 20

7 9 19 20 13 13

81 79 7381 77 77

61 59 6065 60 60

51 53 53 56 53 53

27 28 31 31 29 29

0

20

40

60

80

100

Nordics

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Southe

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sition

SEUR

*To

tal

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tal

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Definition1 Definition2 Definition3 Definition4

CareMix,Persons50+OnlyProfessional ProfessionalandInformal OnlyInformal

3724

11 10 18 1829 19 9 8 16 16

30 20 10 8 16 16 16 13 7 4 11 11

4450

2139

37 3732

37

17 2628 28

20 29

13 2222 22

9 147 10

11 11

811

4433 26 26 9 13

40 3424 24 9 12

36 3122 22

6 9 24 22 15 15

89 8576

82 81 8170 69 67 68 68 68

59 61 58 61 60 60

32 3638 36 36 36

0

20

40

60

80

100

Nordics

Cont/ntal

Southe

rnTran

sition

SEUR

*To

tal

Nordics

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sition

SEUR

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tal

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tal

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tal


CareMix,Persons65+OnlyProfessional ProfessionalandInformal OnlyInformal

Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:Definition1:Personswith2+ADLlimitations.Definition2:Personswith1+ADLlimitations.Definition3:Personswith1+ADLorIADLlimitations.Definition4:PersonswithatleastoneADLorADLortwoormorechronicdiseases.*‘SEUR’includesallcountriesinSHAREwave5,exceptforIsrael.‘Total’includesall15countriesparticipatinginSHAREwave5(includingIsrael).Nordics:SE;DK;NL.Continental:DE;BE;LU;FR;CH;AT.Southern:IT;ES.Transition:CZ;SI;EE.

Womentendtoreceiveprofessionalhelpmorethanmen,aphenomenonmoremarkedintheNorthandtheContinent(Figure3.8).Theseresultsfrombothfrommorereceiving‘onlyprofessional’careandamorereceivingamixofprofessionalandinformalcare.



21

Figure3.8:Summarypictureofcaremixbyinneed-of-carestatusandgroupsofcountries,persons50+bygender,SHAREwave5

35 259 7 18 18

30 19 9 7 16 1629 20 9 6 16 16 16 12 7 4 10 10

39 49

2241

36 3728

35

17 2827 28

18 26

13 2120 20

8 127 9

10 10

10 10

4232 25 25 10 13

3732 23 23 10 12

32 3020 20

8 9 20 21 13 13

83 8473

80 79 7968 67 63 67 66 66

57 58 54 57 56 56

32 33 33 34 33 33

0

20

40

60

80

100

Nordics

Cont/ntal

Southe

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sition

SEUR

*To

tal

Nordics

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SEUR

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tal

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sition

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tal

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Southe

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SEUR

*To

tal


CareMix,Women50+OnlyProfessional ProfessionalandInformal OnlyInformal

2514 11 10 14 13 16 10 7 8 10 10 17 11 8 7 11 11 8 6 5 3 6 6

3839

1630 31 31 23 23

9 1819 19 14 19

8 1515 15

5 7 3 5 5 5

1318

4541 28 28

11 1537

35 22 22 10 13 34 31 20 21

6 9 19 19 12 12

7770 73

8172 72

50 48 5461

51 5141 44

50 53 46 46

19 2127 27 23 23

0

20

40

60

80

100

Nordics

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Southe

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sition

SEUR

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tal

Nordics

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CareMix,Men50+OnlyProfessional ProfessionalandInformal OnlyInformal

Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:Definition1:Personswith2+ADLlimitations.Definition2:Personswith1+ADLlimitations.Definition3:Personswith1+ADLorIADLlimitations.Definition4:PersonswithatleastoneADLorADLortwoormorechronicdiseases.*‘SEUR’includesallcountriesinSHAREwave5,exceptforIsrael.‘Total’includesall15countriesparticipatinginSHAREwave5(includingIsrael).Nordics:SE;DK;NL.Continental:DE;BE;LU;FR;CH;AT.Southern:IT;ES.Transition:CZ;SI;EE.



22

3.4TheCareMixandtheneedforcareHowdoesthesupplyofcarerelatetothedemand?Table3.7providescross-tabulationsoftheneedforcare(thedemandside)andtheprovisionofcare(thesupplyside).Inthetablewenotethecaregap(thosediagnosedinneedbutwhoarenotreceivingcare),butalsoitsobverse-thosereceivingcarebutwhodonothaveapparentneedforit.Tocoinaneologismthelattergroupmaybecalledthe‘careexcess’or‘caresurfeit’.Thecross-tabulationsshowpercentagesofpopulation,numberofobservations;thesecondhalfshowshowcategoriesofprovisionaredividedamongcategoriesofneed(columnpercent)andhowcategoriesofneedareservedbydifferentkindsofsupply.Inthisway,wecanseeboththecaregaps(supply=’none’)andthecaresurfeit(need=’none’).Thecaseofthecaresurfeitisinvestigatedingreaterdetailinsection11.

Table3.7:CareMixandIn-need-of-careStatus,crosstabulation,allcountries

ALL

(%) Numberofobservations

Formal BothIn-

formal None TotalFormal Both

In-formal None Total

Def.1 1.0 2.1 1.6 1.4 6.0 585 1,454 1,005 778 3,822Def.2 0.6 0.8 1.1 3.3 5.8 432 539 740 1,916 3,627Def.3 1.2 0.8 1.3 4.6 7.9 804 593 953 3,308 5,658Def.4 1.5 0.5 2.6 27.7 32.2 1,056 365 1,745 17,814 20,980None 1.1 0.2 2.1 44.6 48.0 745 151 1,506 28,138 30,540Total 5.4 4.4 8.7 81.6 100.0 3,622 3,102 5,949 51,954 64,627

ALL

Rowpercent(%) Columnpercent(%)

Formal BothIn-

formal None TotalFormal Both

In-formal None Total

Def.1 16.4 34.8 25.8 23.0 100 18.1 48.0 17.9 1.7 6.0Def.2 10.2 13.5 19.2 57.1 100 11.0 18.2 13.0 4.1 5.8Def.3 15.1 9.9 16.7 58.2 100 22.1 18.1 15.3 5.6 7.9Def.4 4.7 1.5 8.0 85.8 100 27.7 11.2 29.9 33.9 32.2None 2.4 0.4 4.3 92.9 100 21.1 4.6 23.9 54.7 48.0Total 5.4 4.4 8.7 81.6 100 100.0 100.0 100.0 100.0 100.0Source:SHARE,wave5,(release1.0.0:March31st,2015).Regardingthe‘caresurfeit’,thetopleftpanelshowsthat48%ofallrespondentsareclassifiedto“noneedofcarestatus”.Ofthose,44.6%doesnotreceiveanykindofhelp,whereasoftherest,3.4%receivesformal(1.1%),both(0.2%)andinformal(2.1%).Thebottomleftpanelshowsthat93outofthe100peoplewhoarenotinneed-of-care,didnotreceiveanykindofcare/help–i.e.7%appeartobeinsurfeit.Finally,thebottomrightpanelshowsthepercentagedistributionof



23

the5.4%oftherespondentswhoreceivedonlyformalcare:21%(oneoutoffive)ofthoseappearnottobeinneedofcare,yetreceiveformalcare.AppendixAreproducescross-tabulationsforeachcountry.

Thesectiongoesontoexaminehowthecaremixvariesbyneedofcarestatus(Figure3.9andTable3.8).,forthetightestdefinition1andtheintermediateonedefinition3.

Figure3.9:Caremixbyinneed-of-carestatus,personsaged50+,SHAREwave5

24 3436

18 23 21 25 16 19 8 12 8 7 11 14 016 16

3237 42

48 40 46 41

31

54

1626 39

19

3949 34 35

1610

812 14 11 14

27

17

44

4336

40

27

2626 26

7281

8678 78 78 79 74

90

68

80 83

6677

89

77 77

0102030405060708090100


CareMixPersons50+,inneed-of-care:Definition1


18 2129

14 22 17 20 18 15 9 8 7 4 9 11 014 14

14 1818

2623 23 20 17 27

10 13 208

22 26 18 19

1312

812

15 17 12 1517

33 3233

26

2224

20 2045

5055 52

60 5851 49

5952 53

59

38

5361

53 53

0102030405060708090100


CareMixPersons50+,inneed-of-care:Definition3


Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:Definition1:Personswith2ormoreADLlimitations.Definition3:PersonswithatleastoneADLorIADL.*‘SEUR’includesallcountriesinSHAREwave5,exceptforIsrael.‘Total’includesall15countriesparticipatinginSHAREwave5.



24

Table3.8:Caremix,personsaged50+with2ormoreADL,SHAREwave5

Personsinneed-of-careDef.1:2+ADL

CareMix;Personsaged50+Only

ProfessionalProfessionalandInformal

OnlyInformal None Total

SE 24.1 32.2 15.7 27.9 100DK 33.6 37.0 10.2 19.3 100NL 35.7 42.5 8.2 13.7 100DE 18.2 47.8 11.6 22.4 100BE 23.2 39.9 14.5 22.4 100LU 21.2 46.2 10.5 22.1 100FR 24.8 40.6 13.7 20.9 100CH 16.4 31.4 26.6 25.6 100AT 18.9 53.7 17.2 10.2 100IT 8.3 16.0 43.7 32.0 100ES 11.8 26.0 42.8 19.5 100CZ 8.2 38.8 36.4 16.6 100SI 7.2 18.8 40.0 33.9 100EE 10.5 38.5 27.5 23.5 100IL* 14.0 48.9 26.5 10.7 100SEUR 16.4 34.5 25.8 23.4 100Total 16.4 34.8 25.8 23.1 100Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:‘Professional’care/helpincludes1.Helpwithpersonalcare;2.Helpwithdomestictasks;3.Meals-on-wheels;4.Helpwithotheractivities)duetoaphysical,mental,emotionalormemoryproblem.‘Informal’care/helpincludes(personalcare,practicalhelp,helpwithpaperwork)receivedfrompersonoutsidethehouseholdonadaily/weeklybasisand/orpersonalcarereceivedregularlyfromapersonwithinthehousehold.‘SEUR’includesallcountriesinSHAREwave5,exceptforIsrael.Anumberofobservationsareinorder:Inthemajorityofcountrieseveninthosewithapparentlywell-developedsystemofprofessionalcare,mixedmodesareveryimportantandlargerthanthe“onlyprofessionalcategory”.Second,therearecountries,especiallyintheEastandSouthwhereinformalcareclearlypredominates.Third,innarrowerdefinitionsofneedtheweightofprofessionalcareiscomparativelylarger.

Finally,Figure3.10looksatthecompositionofthecaremixbyneedofcareandgenderasashareofthetotal.



25

Figure3.10:Compositionofcaremixbyinneed-of-carestatusandgroupsofcountries,persons50+bygender,SHAREwave5

4230

12 923 23

4429

14 1024 24

5034

17 1128 28

5036

21 1131 30

4659

3052

46 46

4152

28 4242 42

3144

24 36

36 36

2636

2027

30 30

12 12

5840 31 31

14 19

58 4835 34

18 21

59 5336 36 24 28

59 6240 40

0

20

40

60

80

100

Nordics

Cont/ntal

Southe

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sition

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CompositionofCareMix,Women50+OnlyProfessional ProfessionalandInformal OnlyInformal

3320 16 13 19 19

32 21 14 13 19 1941

26 16 13 23 2342

28 18 1025 25

5055

22 3743 43

4548

17 3037 37

3444

16 2833 33

2531

12 18

23 23

17 25

6351

39 3923 31

69 5844 44

25 30

69 5944 44

33 41

71 7152 52

0

20

40

60

80

100

Nordics

Cont/ntal

Southe

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sition

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tal

Nordics

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tal

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tal


CompositionofCareMix,Men50+OnlyProfessional ProfessionalandInformal OnlyInformal

Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:*‘SEUR’includesallcountriesinSHAREwave5,exceptforIsrael.‘Total’includesall15countriesparticipatinginSHAREwave5(includingIsrael).Nordics:SE;DK;NL.Continental:DE;BE;LU;FR;CH;AT.Southern:IT;ES.Transition:CZ;SI;EE.

4.Analysisbylargeagegroupandgender

Havingshownanoverviewofthe‘headlineindicators’–thecaregapandthecaremix,theanalysisgoestofocusontwosetsofcross-tabulationsofinterest:bylargeagegroupandbygender.



26

4.1Theover65groupMuchanalysisofLTCfocusesonthegroupagedover65.SimilarlyformalsystemsofLTCprovisionlimitthemselvestotheover65group.Theanalysis,(Figure4.1andTable4.1),thusrepeatsthefindingsformenandwomenofFigure3.3andTable3.5fortheover65group.

Figure4.1:Caregapbyinneed-of-carestatus,bygender,SHAREwave5

198 4

14 13 15 9 12 930

17 1727 21

10 18 18

21

177

11 7 10 2022

9

6

8 9

1410

810 10

4836

2836

2736 37

4431

43 4031

60

4027

38 38

7365

5162

4759 58

6454 58

60 57

77

5948

59 59

0

20

40

60

80

100


SHAREwave5CareGapofWomen65+byinneed-of-carestatus


2812 4

16 23 729

41

826 17 15 23 18 7

21 21

1826 41 17

14

10

207

14

1514 23

2119

6

18 18

5648

56

43 4233

51 50

3343 42 46

50 45

27

45 45

8176 78 74

63 6969 74

63 67 6670

77

6458

70 70

0

20

40

60

80

100


SHAREwave5CareGapofMen65+

byinneed-of-carestatus


Source:SHARE,wave5,(release1.0.0:March31st,2015).Notes:*‘SEUR’includesallcountriesinSHAREwave5,exceptforIsrael.Gapsfortheoldergrouptendtobelowerforthe65+populationthanforthetotalSHAREpopulation50+.Nevertheless,theyremainwideanddiverse.Gapsonaverage,evenwiththestrictdefinitionofneedcompriseoneinfivepeopleinEurope.Withthelooserdefinition3,thisincreasedtoalmostoneintwo.GapstendtobelargerintheSouthandEast,thoughthereisconsiderabledispersion.



27

Asthedefinitionwidens,differencesbecomesmaller,asevidencedinadropinthecoefficientofvariation(Table4.1).

Therearestrikingdifferencesbygender–withmentypicallyshowinglargergapsthanwomen.InSE,BE,FRandCH,thedifferencebygenderexceedstenpercentagepoints.ThesegenderdifferencesarefarsmallerintheSouthandEastandareconcentratedinNorthernandContinentalcountries.Therangeofmagnitudesisthuscorrespondinglylarge.


SHAREwave5,Persons65+

Def.1:2+ADL

Def.2:1+ADL

Def.3:1+ADLorIADL


Women65+ Nordics 8.3 2

benchmarking long term care in europe...

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