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Balancing family and state care: neither, either or both? The case of Sweden
- Authors:
- SUNDSTRÖM Gerdt, MALMBERG Bo, JOHANSSON Lennarth
- Journal article citation:
- Ageing and Society, 26(5), September 2006, pp.767-782.
- Publisher:
- Cambridge University Press
Old-age care has frequently been conceptualised as being either family-based or publicly-provided. This article analyses the overlap in provision from the two sources and their relationship in the Swedish welfare state. Many older people and their carers rely on both sources of help rather than on just one, and prefer to do so. The empirical evidence on patterns of care in Sweden supports a joint family-state conceptualisation of care. Its realisation may depend on general coverage rates of public services and the efficient targeting of frail elderly people who live alone. Most older people in need of care rely on help only from their family, but many are helped by both the family and the state, particularly those with the greatest needs. Dynamic concepts like ‘substitution’ and ‘complementarity’ are hard to apply in cross-sectional studies: there may be complementarity in individual cases but long-term substitution or its reversal in successive cohorts. Yet again, both sources of care may increase simultaneously in individual cases. The need for care varies considerably among Swedish municipalities, with implications for the levels of both public services and family support. High coverage rates of the public services may facilitate and support family care.
The shifting balance of long-term care in Sweden
- Authors:
- SUNDSTRÖM Gerdt, JOHANSSON Lennarth, HASSING Linda B.
- Journal article citation:
- Gerontologist, 42(3), June 2002, pp.350-355.
- Publisher:
- Oxford University Press
This study describes the Swedish debate on the role of family and state in care of elderly persons. It provides empirical evidence on the shifting balance of family, state, and market in the total panorama of elderly care. Total spending on aged adults has stagnated, and institutional care is shrinking in absolute and relative terms, but public home help for elders in the community is decreasing even more. Family members increasingly shoulder the bulk of care, but privately purchased care also seems to expand. This study calculates how public and informal care changed between 1994 and 2000: Informal care is estimated to have provided 60% of all care to elders in the community in 1994 and 70% in 2000. Implications: The results parallel a crisis of legitimacy of public elderly care in Sweden. They also call into question various metaphors used to describe patterns of care.
State provision down, offspring's up: the reverse substitution of old-age care in Sweden
- Authors:
- JOHANSSON Lennarth, SUNDSTRÖM Gerdt, HASSING Linda B.
- Journal article citation:
- Ageing and Society, 23(3), May 2003, pp.269-280.
- Publisher:
- Cambridge University Press
Substitution among the providers of old-age care has usually meant a process whereby the state 'takes over' what families used to do, but during the 1980s and 1990s, both home help and institutional care were cut back substantially in Sweden as elsewhere. Comparable, nationally representative surveys in Sweden of the provision of care for older people living in the community enable analysis of the effects of these cutbacks on the sources and patterns of care. It emerges that increased inputs from families match the decline of public services, that is, a 'reverse' substitution has recently been taking place. Local studies, of older people who have been followed over time as the provision of home help has changed, support these conclusions. Of the increased informal care, most has been provided by daughters, but sons have also contributed. A problematic aspect of these shifting patterns of care is that an increasing number of family carers with increasingly heavy care commitments are now without formal or informal support, whereas in the recent past many could expect their responsibilities to be shared with the state. The evidence from this study also calls into question common metaphors and assumptions about the assumed interdependence between informal care and public services for older people, and challenges the so-called substitution thesis.