ORA (Round 5): How are varying care systems associated with inequalities in care and wellbeing in later life?

Ageing societies and recent reforms to long-term care (LTC) in many European countries are likely to make informal care by kin and nonkin increasingly critical for fulfilling the care needs of older people. To date, it is unknown whether informal care falls disproportionately on disadvantaged populations, and the consequences for the wellbeing of care recipients and their carers are poorly understood. The proposed research examines if and how LTC reforms exacerbate existing social disparities in care and in caregiver and care recipient wellbeing. To this end, this project compares the socioeconomic status (SES) gradient in formal and informal care and its impact on wellbeing across Europe and Japan. This objective is studied a) in context (across nations and regions with different care systems and within countries over time) using an updated set of indicators of LTC policies; b) from the perspectives of both the care recipient and the informal caregiver; c) through a focus on quality of care; and d) by carrying out policy evaluation natural experiments. A better understanding of the consequences of different care policies for inequalities in care, and caregiver and care recipient wellbeing, will inform debate on the potential impact of future policy decisions. The project team combines expertise on LTC arrangements, informal care, and cross-national analyses from demographic, sociological, gerontological, epidemiological and health economic perspectives.

Our key aim is to benefit older people's wellbeing by increasing our understanding of how specific LTC policies influence socioeconomic inequalities in care among older adults, the consequences of these inequalities for the wellbeing of older care recipients and their caregivers, and by identifying policy levers for change. Findings from our research project will be of national and international importance and will benefit a wide variety of stakeholders as outlined below.

First, our research will be of interest to many in the gerontology, demography, social epidemiology, sociology, health economics and social policy academic communities as it will lead to significant theoretical and policy contributions by providing new understandings of inequalities in the critical areas of informal and formal care and their consequences for older people's well being. In addition to the academic community, our project findings on inequalities in (in)formal care will provide a rigorous scientific evidence base for NGOs and other organisations lobbying government on behalf of older people and carers. For instance, groups such as Age UK, the Centre for Ageing Better, Carers UK and the OECD, will benefit from this evidence to lobby national and EU policymakers to inform policies to address and reduce later life inequalities. A significant asset of our project is that we will systematically develop and test hypotheses about which type of LTC policy is either negatively or positively associated with inequalities in the use and provision of care. For example, some measures, like public care services, may crowd in family care in all SES groups, whereas other measures, like cash-for-care schemes, may crowd out family care only among those in the higher SES-groups.

Our findings will also be of interest to politicians working on older people's issues in relevant All-Party Parliamentary Groups (e.g. Ageing and Older People), Go-Science (the organisation which advises the UK Government on policy), government (e.g. the Department of Health, DH; the Department for Work and Pensions, DWP), local authorities, and independent policy bodies (e.g. the King's Fund) . For example, Go-Science convened a recent experts workshp to gather evidence on informal care for their rapid evidence review.

Our findings on the health and wellbeing consequences of (in)formal care for both the care recipient and caregiver will also inform practitioners working with older people, including those working in local government and in healthcare services (e.g. King's Health Partners) to improve health and care interventions among older people and to reduce inequalities. Most importantly, this research will inform older people and their carers about which specific care patterns (e.g. a mix of informal and formal care) may act to enhance the quality of care in comparison to others (e.g. formal care only), resulting in higher levels of wellbeing, and probably even more so among those in lower SES groups.

The Institute of Gerontology has a longstanding relationship with AgeUK who have agreed to be involved in knowledge transfer and dissemination of the project results to key NGOs, politicians, civil servants, policymakers, practitioners and to older people themselves. In addition to assisting with the project's impact and dissemination strategy, Age UK have also agreed to be attend the stakeholder events in the UK, and to act as a member of the Scientific Advisory Board helping to guide the conceptual development and the policy implications arising from our work. Dissemination will take place formally and informally through these wide networks of policy actors. Formal dissemination activities will consist of a project website which will be hosted by TU Dortmund.