Diversification of old-age care services for older people: trade-off between coverage, diversification and targeting in european Countries

Information on public services for older people is often limited to institutional care and Home Help/Home Care, be it for individuals in surveys, statistics for a specific country or for international comparisons. Yet, these two major services in many countries are supplemented - or substituted - by other, minor services. The latter include services such as transportation services, meals-on-wheels, alarm systems, and day care. In this study the authors use various data sources to provide information on all or most of these types of support for Denmark, Norway, Sweden, Germany, England, Spain, and Israel, concluding with a closer scrutiny of Swedish service profiles. When all types of support are considered, service coverage in these countries is approximately 50?100% higher than for the two major types alone. Data suggest some degree of targeting, at least in countries with higher coverage rates for services. Coverage is estimated as a percentage of a specific age group which uses a service. In countries with lower coverage rates, users may demand or get what is available, with little differentiation between client needs. When user rates are high, there is also a greater overlap between family care and public services. In countries with lower coverage rates, family care and public services are more often substituted for each other. It is suggested that a range of services, major and minor, may suit the varying needs of older people more effectively than the choice between nothing, Home Help or institutional care, but minor services also may be used as an inexpensive substitute for full support.