Informal care at old age at home and in nursing homes: determinants and economic value

This paper provides a comprehensive analysis of informal care receipt by the French individuals aged 60 or older. The literature has focused on the community, leaving informal care in residential care settings in the shadow. We leverage data from a representative survey (CARE) conducted in 2015-2016 on both community-dwelling individuals and nursing home residents. Focusing on the 60+ with activity restrictions, we show that 76% of nursing home residents receive help with the activities of daily living from relatives, against 55% in the community. The number of hours conditional on receipt is yet 3.5 times higher in the community. Informal care represents 186 million hours per month and a value equivalent to 1.1% of GDP at least, care in the community representing 95% of the total. We investigate the determinants of informal care receipt. Using an Oaxaca-type approach, we disentangle between two mechanisms explaining that nursing home residents are more likely to receive informal care, namely the differences in population composition (endowments) and the differences in the association of individual characteristics with informal care (coefficients). Both are found to have a similar contribution. Our results imply that private costs make up for the majority (76%) of the costs associated with long-term care provision once informal care is taken into account. They also highlight that informal care is extremely common for nursing home residents. Existing evidence on the determinants of informal care receipt in the community has, however, limited relevance to understand informal care behaviors in nursing homes.

Automated summary

This study provides a comprehensive analysis of informal care receipt for French individuals aged 60 or older. The research finds that informal care in residential care settings is often overlooked in literature that focuses on the community. By leveraging data from a representative survey conducted in 2015-2016, the study reveals that nursing home residents are more likely to receive help from relatives for daily activities, but the amount of help is significantly lower compared to community-dwelling individuals. Informal care represents a significant amount of hours and value in terms of GDP, with the majority coming from community care. The study also investigates the factors influencing informal care receipt and highlights the importance of both population composition and individual characteristics in nursing homes. However, the determinants of informal care receipt in the community may not be relevant in understanding informal care behaviors in nursing homes.