Whose responsibility? Elder support norms regarding the provision and financing of assistance with daily activities across economically developed countries

Changes of filial responsibility norms under public long-term care insurance in China

AIM

The public long-term care insurance (LTCI) scheme offers a potential solution to growing long-term care needs. This study investigated its effects on perceived filial responsibility norms and evaluated the heterogeneity of these effects.

METHODS

Using data from the 2014, 2016, 2018, and 2020 waves of the China Longitudinal Aging Social Survey, we focused on 10 042 older adults aged 60 and above living in communities. The quasi-experimental design of staggered difference-in-differences analyses with propensity score matching was employed to assess the policy effects.

RESULTS

The LTCI scheme significantly influenced perceived filial responsibility norms, reducing the likelihood of older adults believing that children should bear primary responsibility for their care by 6%. This effect was more pronounced among older adults who were more educated, lived with their children, or were in better health.

CONCLUSION

The implementation of the public LTCI scheme has had a negative impact on traditional filial piety in China. These findings highlight the importance for countries adopting LTCI or similar policies to develop strategies that prevent the excessive erosion of this cultural value. Geriatr Gerontol Int 2025; 25: 606-619.

The Care Gap in Later Life Across European Countries

OBJECTIVES

Do adults without kin experience a care gap where they need help with activities of daily living but get no help from any source? We examine the prevalence of the care gap across Europe, and test whether those without partners or children substitute for their lack of close kin with help from broader networks, or whether they disproportionately experience care gaps.

METHODS

Using data from the Survey on Health, Ageing and Retirement in Europe, we estimate the care gap in 28 European countries and Israel, how it varies, and who provides help for respondents with different family structures.

RESULTS

The care gap is substantial, with 6.1% of all respondents ages 50 and above reporting a gap. It is highest in Western and Eastern Europe and lowest in Southern Europe and Israel. Respondents without partners or children are significantly more likely to have care gaps than those with close kin. However, respondents without close kin draw more often on more diverse networks of friends and relatives and use nursing home care.

DISCUSSION

Our study introduces the concept of the care gap and shows that although it is most common among unpartnered adults without children it is also quite common for those with immediate family. A broader network partially but not completely substitutes for care gaps among those without immediate family. Our results offer new insights into the demand for public care services in countries with diverse welfare states.

Will Downward Intergenerational Housing Support Increase Parents' Expectations for Old-Age Care from Adult Children? Evidence from China

Toward a background of young people's decreasing housing affordability and parents' increasing involvement in intergenerational housing support, this study investigates how such support influences parents' expectation of future care from adult children. Using data from the China Health and Retirement Longitudinal Study, we found that, in general, middle-aged/older adults who provided adult children financial housing support were more likely to expect old-age care from them. The help-receiving child was more likely to be an expected caregiver than the other children in multi-children families. Moreover, the reciprocal relationship was most prominent among the 1950s cohort, compared with the pre-1950s and the post-1950s cohorts. Our study broadly contributes to understanding how modernization reshapes intergenerational relationships and family members' expectations of commitments toward each other. It also informs the design of a comprehensive multi-level care system for older adults in China.

Public preferences for paying for social care in later life in England: A latent class analysis

There is ongoing debate about how the funding system for social care of older people in England should best be reformed. We investigated how public attitudes to individual and state responsibility for paying for social care in later life vary with demographic and socio-economic characteristics. Four vignettes of individuals in need of home care or residential care with varying levels of savings, income and housing wealth were presented to a sample of people aged 18-75 years (n = 3000) in December 2018. Respondents were asked if care costs should be paid by the user, the state or shared. They were also asked about the best way to pay for social care in old age. Latent class analysis was used to identify sub-groups with similar preferences for paying for care, and to explore their socio-demographic characteristics. We identified five classes. The majority (Class 1, 58%) preferred that the state and the user should share social care costs. Class 2 (18%) thought that the state should pay all costs regardless of users' savings, income or housing wealth. Class 3 (15%) preferred users to pay all costs at all levels of savings, income and housing wealth, with the exception of those unable to afford the costs. Classes 4 and 5 (5% each) were characterised by different patterns of 'don't know' answers. Socio-economic status was higher among those proposing higher user contributions (Class 3) and lower among those with several 'don't' know' responses (Classes 4 and 5). Concerns about care costs in old age were high among those proposing that the state pays all costs (Class 2) and those preferring that users pay all costs (Class 3). This study shows that public views on social care funding vary with respondents' characteristics and that proposals to reform the system need to be carefully calibrated.