The opportunity costs of informal care: does gender matter?

A New Approach for Assessing the Value of Informal Care in Alzheimer's Disease

OBJECTIVES

Given that most informal caregivers providing help for patients with Alzheimer's disease are retired spouses or unemployed people, there is no market value for their time. Most articles that tried to estimate the cost of informal care for Alzheimer's disease rely on the so-called "replacement" methodology, which assumes that 1 hour of informal care has the same value as 1 hour of professional care. Little attention has been dedicated to exploring the validity of this assumption. In this article, we determine the relationship between the price of informal caregiving and professional care from the first-order condition of a theoretical model that maximizes informal caregivers' satisfaction with providing care.

METHODS

This article formalizes the marginal substitution rate between informal and formal care. We assume that the caregiver's utility depends on the caregiver's burden and the patient's quality of life (QoL). After explaining the parameters of the marginal utility of caregivers, we estimate each of these parameters using PLASA data.

RESULTS

Our results show how the value of informal care increases as the care contributes to improving patients' QoL but decreases as the burden on the caregiver increases and professionals contribute to patients' QoL.

CONCLUSIONS

The central assumption of the replacement cost method of perfect substitution between informal and formal care leads to a misestimation of the value of informal care. The effects of informal care must be considered (direct effect on the burden and indirect effects on the patient's QoL).

Gendered life-course trajectories of childcare and informal care in the Netherlands

Unpaid caregiving remains highly gendered both in the context of childcare for young children and informal care provided to ill or ageing family members, friends, or neighbors. Using a life-course framework, this study expands previous research which generally treated these care types as separate life domains, by exploring the variety in caregiving trajectories including both childcare and informal care as integral parts of life courses. In addition to identifying and describing clusters of caregiving trajectories, we examine to what extent these are stratified by gender and education. We use unique retrospective survey data on informal caregiving combined with longitudinal data on childrearing, collected by the LISS Panel in the Netherlands (N = 1631). Using sequence and cluster analysis, we created caregiving trajectories covering up to 50 years of individual life courses and identified six clusters of caregiving trajectories that differed in care-heaviness, based on different combinations of the timing, duration, order, and intensity of care episodes. Our findings indicate path-dependency in care patterns, whereby most individuals who have engaged in unpaid care, provided both childcare and informal care at various points throughout their lives. In addition, while patterns of caregiving over the life course did not differ by gender, women were overrepresented in care-heavier clusters while men were more likely to follow the least care-heavy clusters. Theoretical expectations predicting educational differences based on opportunity costs and normative pressure were not supported. Given the anticipated rise in informal care due to population ageing and welfare state retrenchment, our findings suggest that while both women and men will be increasingly confronted with balancing unpaid care with other commitments, the gender gap in care-heaviness might persist and even widen.

Employment Responses to a Partner's Disability Onset ("Care Shocks"): Do Working Conditions Matter?

OBJECTIVES

This study examines employment responses to a partner's disability onset and how this is moderated by working conditions: job satisfaction and psychosocial job demands.

METHODS

We use longitudinal nationally representative data from the English Longitudinal Study of Aging. Following the health shock literature, we identify individuals whose partners report the onset of difficulties in activities of daily living (ADL) or instrumental activities of daily living (IADL) between 2 waves (n = 1,020) as experiencing a "care shock." We combine coarsened exact matching and entropy balancing, and logistic modeling to estimate the impact of such a "care shock" on the probability of leaving paid work, working part-time, changing jobs, or looking for a new job. We also explore the moderating effect of gender and working conditions (i.e., job demands and job satisfaction) on the impact of a "care shock" on work transitions.

RESULTS

Our findings show that "care shocks" significantly increase individuals' likelihood of leaving paid work. This effect is moderated by job demands and job satisfaction. Individuals who report high job demands and job dissatisfaction before the care shock are significantly more likely to leave paid work. In contrast, those with low job demands or job satisfaction show no significant difference in their likelihood of leaving paid work.

DISCUSSION

Our study highlights the role of working conditions in moderating the impact of care shocks on paid work. It informs workplace policies, as our results suggest that adapting working conditions may facilitate participation in the labor market in late career stages.

The influence of spousal care on the health of middle-aged and older adult caregivers in China-empirical analysis based on CHARLS data

Objectives

With the decrease of the number of children and the increase of population mobility, child care presents a phenomenon of "double shortage" of human and time resources, and spousal care is becoming an important care source for middle-aged and older adult people in China. However, less studies have taken middle-aged and older adult couples as research subject to explore the health effects of spousal care in the process of aging. This paper attempts to explore the effects of caregiving on the health of caregivers from the perspective of spousal care.

Methods

Using China Health and Retirement Longitudinal Study (CHARLS) database, this paper constructs a panel data fixed effect model to explore the effects of spousal care on the health of middle-aged and older adult caregivers. Further, instrumental variables (IV) estimation and propensity score matching (PSM) are used to minimize the impacts of endogeneity.

Results

Spousal care has no significant effect on the physical health of middle-aged and older adult caregivers, but it has a significant negative effect on their mental health. Providing spousal care has a stronger negative effect on the mental health of female or rural middle-aged and older adult caregivers. The mechanism analysis shows that spousal care affects the mental health by reducing the number of weekly exercise and increasing the family's non-food expenditure.

Conclusion

The provision of spousal care in the middle-aged and older adult groups does harm the mental health of caregivers. Vulnerable groups such as families in which both spouses need care, female or rural caregivers expect more attention and support.

Gender differences in later life: Labor supply responses to spousal disability

This study uses panel data from the 2011, 2013, 2015, 2018, and 2020 China Health and Retirement Longitudinal Study to examine the labor supply effects of spousal disability in later life. Employing a staggered difference-in-differences strategy, we provide causal evidence of gender-specific impacts, with a significant and enduring negative effect on female employment lasting over eight years, in contrast to minimal changes for males. The negative effect on female employment is particularly pronounced among low-educated individuals, those with agricultural hukou, and those influenced by stronger Confucian cultural norms. Mechanism analysis attributes the gender disparity to the caregiving effect and the health effect, with females experiencing increased caregiving responsibilities and health deterioration. We do not find enough evidence to support the added worker effect and the joint leisure effect. Furthermore, following the death of a disabled spouse, both genders exhibit an increased withdrawal from the labor market, with females increasingly assuming grandchild care responsibilities. These findings reveal the persistent gender differences in later life and suggest that policy interventions should prioritize the equitable allocation of social welfare resources to mitigate caregiving burdens faced by older women.

The Effects of Spousal Caregiving on Middle-Age and Older Caregivers' Health and Well-Being: Evidence From Vietnam

Background: Population aging is escalating globally, intensifying the demand for long-term care (LTC), primarily met by informal caregivers, notably spouses. Evidence from developed countries suggests potential adverse effects on caregivers' well-being. Yet, research on this topic is scarce in developing nations. We investigate the effect of informal caregiving on older spousal caregivers' health and well-being in Vietnam, a rapidly aging country with an early stage of LTC system development. Methods: Utilizing the national survey on aging in Vietnam with propensity score matching estimations to mitigate potential endogenous problems of the decision to provide care between caregivers and non-caregivers. Results: Findings showed caregiving increased poor psychological well-being, life dissatisfaction, and functional limitations by 7.3%, 9.7%, and 8.6%, respectively. The caregiving effects are heterogenous by demographic characteristics. Conclusions: We are the first to examine spousal caregiving in Vietnam, highlighting the urgency of addressing its negative impacts and suggesting several potential policy interventions.

Childhood Adversities and Caregiving for Older Parents: Building Capacity for a Caring Society

OBJECTIVES

This study investigates the relationships between childhood adversities and the provision of informal care for older parents in later life in China.

METHODS

The data came from 4 waves of the China Health and Retirement Longitudinal Study (N = 20,047). Using multilevel logistic regression models, we examined the relationships between adverse experiences in childhood and both the propensity and intensity of caregiving for older parents. Drawing on the regression results, we then estimated the total number of caregivers for older parents in China.

RESULTS

Experiencing 1 additional childhood adversity was associated with a decrease of 8% in the odds of providing informal care (p < .001). The association between childhood adversity and caregiving remained significant after sociodemographic factors and later-life outcomes were controlled for. We estimated that 58.3 million middle-aged adults in China were providing care for parents in 2020. Had people experienced 1 fewer adversity in their childhood, there would have been 2.2 million more caregivers in 2020. Had they experienced 2 fewer adversities, there would have been 3.4 million more caregivers.

DISCUSSION

The factors associated with informal caregiving can be traced back to early-life experiences. To address the shortage of informal care supply, it is crucial to foster a caring culture from the very beginning of human development.

The Association Between Grandchild Care and Biological Aging Among Middle-Aged and Older Adults in China

Background and Objectives

Substantial evidence documents grandchild care is associated with self-reported health, life satisfaction, and depressive symptoms among middle-aged and older adults. However, little is known about the relationship between grandchild care and biological aging, especially in China, which emphasizes the unique cultural value of family. The current study sheds light on the biological consequence of grandchild care by examining the link between grandchild care and biological aging among middle-aged and older adults in China, and how gender and spousal involvement in caregiving affect this link.

Research Design and Methods

In a representative sample of Chinese adults aged 45-80 from the third wave of China Health and Retirement Longitudinal Study in 2015 (n = 3,384), we calculate biological age using Klemera-Doubal Method, and Ordinary Least Square models are used to examine the correlation between grandchild care and biological aging.

Results

High intensity of involvement in grandchild care is related to biological aging, and caring for grandchildren alone predicts greater biological aging. Compared with grandfathers, grandmothers lose more from grandchild care regardless of whether their husbands are involved in the care.

Discussion and Implications

Providing grandchild care should be a way to cope with age-related role discontinuity or loss, rather result in extra stress or burden for grandparents. Reducing the intensity of caregiving or increasing family support may attenuate the extent of biological aging.

Parental health penalty on adult children's employment: Gender differences and long-term consequences

This study examines the gender-specific and enduring impacts of parental health shocks on adult children's employment in China, where both formal care and health insurance are limited. Using an event-study approach, we establish a causal link between parental health shocks and a notable decline in female employment, which persists for at least six years following the shock. Male employment, however, exhibits minimal change on average, although this conceals an increase among poor families, indicating a channel beyond heightened informal care. Our findings underscore the consequences of "growing old before getting rich" for developing countries.

The impact of informal caregiving on U.S. Veterans Health Administration utilization and expenditures

Few studies have examined the effect of informal care receipt on health care utilization and expenditures while accounting for the potentially endogenous relationship between informal and formal care, and none have examined these relationships for U.S. Veterans. With rapidly increasing investments in caregiver supports over the past decade, including stipends for caregivers, the U.S. Department of Veterans Affairs (VA) needs to better understand the costs and benefits of informal care provision. Using a unique data linkage between the 1998-2010 Health and Retirement Study and VA administrative data (n = 2083 Veterans with 9511 person-wave observations), we applied instrumental variable techniques to understand the effect of care from an adult child on Veterans' two-year VA utilization and expenditures. We found that informal care decreased overall utilization by 53 percentage points (p < 0.001) and expenditures by $19,977 (p < 0.01). These reductions can be explained by informal care decreasing the probability of inpatient utilization by 17 percentage points (p < 0.001), outpatient utilization by 57 percentage points (p < 0.001), and institutional long-term care by 3 percentage points (p < 0.05). There were no changes in the probability of non-institutional long-term care use, though these expenditures decreased by $882 (p < 0.05). Expenditure decreases were greatest amongst medically complex patients. Our results indicate relative alignment between VA's stipend payments, which are based on replacement cost methods, and the monetary benefits derived through VA cost avoidances due to informal care. For health systems considering similar caregiver stipend payments, our findings suggest that the cost of these programs may be offset by informal care substituting for formal care, particularly for higher need patients.

Does informal care delay nursing home entry? Evidence from Dutch linked survey and administrative data

We assess whether informal care receipt affects the probability of transitioning to a nursing home. Available evidence derives from the US, where nursing home stays are often temporary. Exploiting linked survey and administrative data from the Netherlands, we use the gender mix of children to retrieve exogenous variation in informal care receipt. We find that informal care increases the chance of an admission within a three-year period for individuals with severe functional limitations, and increases the costs incurred on formal home care. For individuals with mild limitations, informal care substantially decreases total care costs, whereas its effect on nursing home admission is unclear. Further, informal care results in lower post-acute care use and hospital care costs, and does not increase mortality. Promoting informal care cannot be expected to systematically result in lower institutionalization rate and care costs, but it may nonetheless induce health benefits for its recipients.

Do residential patterns affect women's labor market performance? An empirical study based on CHFS data

Based on China Household Finance Survey (CHFS) data from 2019, this paper explores the impact of the residential pattern of coresidence with parents on the labor market performance of women in married families with minor children. The study finds that coresidence with parents significantly increases the possibility of female labor market participation and positively impacts women's employment income. To overcome the potential endogeneity problem of residential patterns, this paper uses the Heckman two-step method and the conditional mixed process estimation method (CMP method) for regression, and the conclusions remain robust. The mechanism analysis shows that coresidence with parents has both grandchild care and elderly care factors, which have a spillover effect and a crowding-out effect on female labor market performance, respectively. Since the spillover effect is more significant than the crowding-out effect, coresidence with parents positively impacts women's labor market performance. The heterogeneity analysis shows that in terms of labor force participation rate, coresidence with parents has a more significant impact on women in families with children aged 0-6, women in families without boys, and women in families with employed husbands. In terms of income, coresidence with parents has a more significant impact on women in families with employed husbands. This study provides a new perspective for promoting female labor market performance and can serve as a reference for future policy formulation.

Informal caregiving and the allocation of time: implications for opportunity costs and measurement

Informal care requires a considerable time investment from providers that inherently involves trade-offs against various uses of time. We examine what other uses of time are forgone when individuals provide informal care. We further consider how caregiving is linked to a range of rarely explored time use characteristics relating to multitasking, the fragmentation and the timing of activities. We use data from 5670 adults across 11003 diary days from the 2014/15 UK Time Use Survey. Using a 'doubly robust' approach of entropy balancing and regression adjustment, we find carers spend an additional 49.0 min on non-market work, 2.9 min on personal care, 5.8 min on leisure and 2.9 min on miscellaneous activities on weekdays. They spend 46.1 min less on market work and 14.4 min less on sleep. Carers report more time stress, more multitasking, and more fragmented time. We estimate with attribution factors that 16% and 11% of reported household task activity is due to caregiving on weekday and weekend days, respectively. These findings provide evidence on additional opportunity costs faced by carers and possible channels through which carer labour market and health outcomes are realised. The attribution factors we calculate can be applied to total reported caregiving time to avoid overestimation when this is incorporated into economic evaluations.

Impacts of family care for children and the elderly on women's employment: evidence from rural China

Introduction

China's traditional culture makes rural women and men take on different family responsibilities.

Methods

Use "China Family Panel Studies" (CFPS) data and build Logit and propensity score matching models to empirically study the impact of children care and elderly care on rural married women going out to work. And explore the welfare effects of basic education public services in helping rural women take care of their families.

Results

The results show that caring for children has a significant hindering effect on rural married women's job hunting. Especially for those in low-income families, the employment inhibition is most significant among women aged 20-30 with multiple children. Contrary to previous cognition, supporting the elderly has a certain weak stimulating effect. The kindergarten public services in rural areas can help women take care of their children and relieve their work pressure. The primary school public services have not played a role in alleviating them.

Discussion

This shows that there are still a large number of female laborers in rural China who are unable to go out to work due to family care. The improvement of rural basic education public services can promote more rural women going out to work. This finding will provide a policy reference for the introduction of a formal care system and the establishment of basic education public services in China.

Does Caring for Parents Take Its Toll? Gender Differences in Caregiving Intensity, Coresidence, and Psychological Well-Being Across Europe

Given population ageing and the emphasis on in-home care, more working-age adults are facing the demands of providing unpaid care to the elderly with potential implications for their own well-being. Such effects likely vary across Europe because care is differently organized with a differing emphasis on public support, dependence on family, and orientation toward gender equality. We studied the relationship between unpaid caregiving for elderly parents and the psychological well-being of older working-age (50-64) men and women by analysing data from the Survey of Health, Retirement, and Ageing in Europe (SHARE), covering 18 countries between 2004 and 2020 (N = 24,338), using ordinary least squares (OLS). We examined risk of depression by caregiving intensity and tested whether coresidence mediated outcomes. Men and women providing care to parents experience important psychological well-being losses across Europe, especially when caregiving is intensive. A heavier caregiving burden associated with coresidence explains a regime gradient in depression, not least for women in Southern Europe. Results highlight the spillover costs of unpaid caregiving across Europe and the need to address caregiver psychological well-being, especially in contexts where state support for elder care is low and coresidence is common.

Monetary valuation of COVID-19 informal care: caregivers' willingness to pay and willingness to accept

BACKGROUND

Informal care can reduce hospitalization frequency and time, elevate bed turnover, and increase the health systems' capacity. This type of care has shown meaningful value in managing many cases through the COVID-19 pandemic. The present study aimed to identify determinants of monetary valuation of informal care and the burden of this care on the COVID-19 patients' caregivers.

METHODS

Through a cross-sectional phone survey from June to September 2021 in Sanandaj city, the west of Iran, COVID-19 patients and their caregivers (Each Group No. 425) were separately interviewed. A simple probabilistic sampling method was applied. Two questionnaires were developed and used after validation. Monetary valuation of informal caregivers was done using Willingness to pay (WTP) and willingness to accept (WTA). Double hurdle regressions were used to determine related variables to WTP/WTA. R software was used for the data analysis.

RESULTS

The total mean (Standard Deviation) of WTP and WTA were $12.02(28.73), $10.30(15.43) USD. Most respondents put a zero value on informal care by WTA (243(57.18%) and WTP [263 (61.88%)]. Caregivers' Employment, and being spouse/child of the care recipient increased the probability of reporting a positive value for WTP (p-value < 0.0001, p-value = 0.011 respectively) and WTA (p-value = 0.004, p-value < 0.0001 respectively). An increase in the number of caring days decreased the probability of reporting positive WTA (p-value = 0.001) and increased the mean of lnWTP (p-value = 0.044). Perceived difficulty in doing indoor activities and perceived difficulty in doing outdoor activities decreased lnWTA mean (p-value = 0.002) and lnWTP mean (p-value = 0.043) respectively.

CONCLUSIONS

Increasing caregivers' self-efficacy and facilitating their involvement in the caring process could be facilitated through flexible work status, educational programs, and interventions on decreasing their burnout.

Impact of Medicare eligibility on informal caregiving for surgery and stroke

OBJECTIVE

To assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at age 65.

DATA SOURCES

Health and Retirement Study survey data (1998-2018).

STUDY DESIGN

We compared informal care received by patients hospitalized for stroke, heart surgery, or joint surgery and who were stratified into propensity-weighted pre- and post-Medicare eligibility cohorts. A regression discontinuity design compared the self-reported likelihood of any care receipt, weekly hours of overall informal care, and intensity of informal care (hours among those receiving any care) at Medicare eligibility.

DATA COLLECTION

Not applicable.

PRINCIPAL FINDINGS

A total of 2270 individuals were included; 1674 (73.7%) stroke, 240 (10.6%) heart surgery, and 356 (15.7%) joint surgery patients. Mean (SD) care received was 20.0 (42.1) weekly hours. Of the 1214 (53.5%) patients who received informal care, the mean (SD) care receipt was 37.4 (51.7) weekly hours. Mean (SD) overall weekly care received was 23.4 (45.5), 13.9 (35.8), and 7.8 (21.6) for stroke, heart surgery, and joint surgery patients, respectively. The onset of Medicare eligibility was associated with a 13.6 percentage-point decrease in the probability of informal care received for stroke patients (p = 0.003) but not in the other acute care cohorts. Men had a 16.8 percentage-point decrease (p = 0.002) in the probability of any care receipt.

CONCLUSIONS

Medicare coverage was associated with a substantial decrease in family and friend caregiving use for stroke patients. Informal care may substitute for rather than complement restorative care, given that Medicare is known to expand the use of postacute care. The observed spillover effect of Medicare coverage on informal caregiving has implications for patient function and caregiver burden and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity.

Understanding the use of Flexible Work Arrangements Among Older New Zealand Caregivers

Flexibility in the workplace has been suggested to promote prolonged employment among older workers. This study focuses on the question of whether the use of flexible work arrangements (FWAs) differs between caregivers and non-caregivers and how potential differences can be explained. Participants were 296 carers and 1611 non-carers (aged 55-70 years) who completed the 2018 Health, Work and Retirement survey and were in paid employment. Hierarchical regression was used to investigate caregiving as an independent predictor of use of FWAs after controlling for demographic and work-related variables. Results show that caregivers on average used more FWAs than non-caregivers, including flexible work hours, flexible schedules and time off. Differences in FWAs use between caregivers and non-caregivers cannot be explained by differences in socio demographic and work characteristics. The use of FWAs warrants attention in discussions about prolonged employment and reconciliation of care and work among older adults.

'Investing' in care for old age? An examination of long-term care expenditure dynamics and its spillovers

We study the dynamic drivers of expenditure on long-term care (LTC) programmes, and more specifically, the effects of labour market participation of traditional unpaid caregivers (women aged 40 and older) on LTC spending, alongside the spillover effects of a rise in LTC expenditure on health care expenditures (HCE) and the economy (per capita GDP). Our estimates draw from a panel of more than a decade worth of expenditure data from a sample of OECD countries. We use a panel vector auto-regressive (panel-VAR) system that considers the dynamics between the dependent variables. We find that LTC expenditure increases with the rise of the labour market participation of the traditional unpaid caregiver (women over 40 years of age), and that such expenditures rise exerts large spillover effects on health spending and the economy. We find that a 1% increase in female labour participation gives rise to a 1.48% increase in LTC expenditure and a 0.88% reduction in HCE. The effect of LTC spending over HCE is mainly driven by a reduction in inpatient and medicine expenditures, exhibiting large country heterogeneity. Finally, we document significant spillover effects of LTC expenditures on per capita GDP.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s00181-022-02246-0.

Does retirement (really) increase informal caregiving? Quasi-experimental evidence from Australia

This paper analyzes the impact of retirement on informal care provision using nationally representative panel data from Australia. To establish causality, we exploit the gender and cohort specific eligibility age for the Australian Age Pension. We find no evidence of an impact of retirement (status or duration) on co-residential or extra-residential unpaid care provided by older individuals. The null effect of retirement on informal caregiving does not differ by the type of care recipient. Furthermore, we demonstrate that older people who postpone retirement reduce the amount of time they spend on other non-market activities to resolve the time conflict between unpaid care and extended employment. Our analysis indicates that the Australian Age Pension reform aimed at working career prolongation has not crowded out the supply of informal care.

Heterogeneity in informal care intensity and its impact on employment

Working-age individuals are under growing pressure to contribute unpaid time to the care of elderly family members and friends. Existing work has generally found informal care to negatively impact labor market outcomes, an effect that varies considerably by caregiving intensity, as defined by average hours of care or co-residence with the care receiver. I construct a new measure of caregiving intensity based on the length of caregiving spells. To do so, I use the Longitudinal and International Study of Adults, which provides data on the monthly caregiving status of respondents over a six-year period. I investigate how this dimension of caregiving intensity intersects with better-known measures, and show that results relying on the latter conceal substantial heterogeneity in the impact of caregiving on employment. These differences are particularly important to understand disparities in the impact of caregiving on female and male employment.

Inequalities in unpaid carer's health, employment status and social isolation

Providing higher-intensity unpaid care (higher care hours or care within the household) is associated with negative impacts on people's paid employment, mental health and well-being. The evidence of effects on physical health is mixed and carer's social and financial outcomes have been under-researched. The biggest evidence gap, however, is on how outcomes vary by factors other than type or level of care provision, in particular socio-demographic factors. Our study used two waves of data (2017/19 and 2018/2020) from the United Kingdom Household Longitudinal Study for people aged 16 and older. We investigated the effects of providing care for 10 or more hours a week or within the household in interaction with people's socio-demographic characteristics. Outcomes included mental and physical health, social isolation, employment status and earnings. We found that caring responsibilities interacted with gender, ethnicity, socio-economic status (as measured by highest educational qualification), or age to affect carers differentially in a number of areas of their lives leading to, and exacerbating, key disadvantages and inequalities.

The effects of supported housing for individuals with mental disorders

Societies face the challenge of providing appropriate arrangements for individuals who need living support due to their mental disorders. We estimate the effects of eligibility to the Dutch supported housing program (Beschermd Wonen), which offers a structured living environment in the community as an intermediate alternative to independent housing and inpatient care. For this, we use exogenous variation in eligibility based on conditionally random assignment of applications to assessors, and the universe of applications to supported housing in the Netherlands, linked to rich administrative data. Supported housing eligibility increases the probability of moving into supported housing and decreases the use of home care, resulting in higher total care expenditures. This increase is primarily due to the costs of supported housing, but potentially also higher consumption of curative mental health care. Supported housing eligibility reduces the total personal income and income from work. Findings do also suggest lower participation in the labor market by the individuals granted eligibility, but the labor participation of their parents increases in the long-run. Our study highlights the trade-offs of access to supported housing for those at the margin of eligibility, informing the design of long-term mental health care systems around the world.

The wage penalty for informal caregivers from a life course perspective

Caring for a friend or family member in need of care has been found to have negative consequences for wages. This study contributes to the literature by studying how three major life course factors, namely timing of first caregiving, duration of caregiving, and the number of caregiving episodes, help to explain the (hourly) wage penalty for informal caregivers (i.e., providers of health-related care to older or disabled people in the personal network). We used unique retrospective data of 1417 informal caregivers in the Netherlands that map start and end dates of up to seven caregiving episodes. Findings showed that a higher number of caregiving episodes was related to a stronger wage penalty, whereas timing of first caregiving was not associated with a wage penalty. Opposite to our expectation, we found that the wage penalty decreased the longer someone cared, potentially even resulting in a wage premium for long-time caregivers. We conclude that applying a life course perspective is relevant when examining employment consequences of informal caregiving and that caregiving possibly fosters skills that are beneficial for employment careers in the long run.

Hire or Care: The Effects of Aging Parents on Household Labor Supply

This paper analyzes how aging parents' health conditions affect household labor supply. I propose a time-use model with wage heterogeneity and assume that care responsibilities involve both time and budget constraints. When households can purchase care services, differences in secondary earners' wages and care requirements lead to heterogeneity in household responses to a parental health shock. Primary earners and high-wage secondary earners work more. I confirm the model's predictions by using panel data from the Health and Retirement Study to construct an exogenous shock from the change in parents' health conditions and estimate its impact on labor supply.

Do Public Caregiving Subsidies and Supports affect the Provision of Care and Transfers?

We study whether caregiving and intergenerational transfer decisions are sensitive to changes in economic incentives following the inception of a new unconditional and universal system of allowances and supports, after the introduction of the 2006 Promotion of Personal Autonomy and Care for Dependent Persons Act (SAAD in Spanish), and the ensuing effects of its austerity cuts after 2012. We find that whilst the introduction of a caregiving allowance (of a maximum value of €530 in 2011) increased the supply of informal caregiving by 20-22 percentual points (pp), the inception of a companion system of publicly subsidised homecare supports did not modify the supply of care. Consistent with an exchange motive for intergenerational transfers, we estimate an average 17 pp (8.2-8.7pp) increase (decrease) in downstream (upstream) transfers among those receiving caregiving allowances. Our estimates resulting from the reduction in the allowances and supports after the austerity cuts in 2012 are consistent with our main estimates, and suggest stronguer effects among lower-income families.

Caring trajectories and health in mid-life

Previous research has found varied effects of informal care provision on the carer's health status. Few studies have, however, examined this relationship dynamically. This paper is the first to analyse trajectories of care among men and women in mid-life and their impact on health outcomes using a nationally representative prospective cohort study. Data from three waves of the United Kingdom (UK) National Child Development Study (N = 7,465), when the respondents were aged 46, 50 and 55, are used to derive care trajectories capturing the dynamics of care provision and its intensity. Logistic regression investigates the impact of caring between the ages of 46 and 55 on the carers' report of depression and poor health at age 55. At age 46, 9 per cent of men and 16 per cent of women provided some level of informal care; rising to 60 per cent for both genders at ages 50 and 55. Just 7 per cent of women and 4 per cent of men provided care at all observation points, with the most common trajectory being ‘starting to care’ at ages 50 or 55. New carers experienced a lower risk of depression at age 55, reflecting that they may not have experienced the caring role long enough to have an adverse impact on their wellbeing. The findings highlight that the majority of individuals with surviving parents experience caring at some point during mid-life, underlining the need for further longitudinal research to better understand the complex relationships between care-giving and health for different groups of cares.

Economic Implications of Health Care Burden for Elderly Population

The implications of population aging for economic growth is not only the shrinking working-age population, but also the increasing health care burden of the elderly population. It is difficult to explain clearly the relationship between a country’s aging population and its economy without considering health effects. Based on the Solow economic growth model, the aims of this study are to estimate the economic effects of the health care burden for elderly population, and to access whether reducing effective labor input for economic production. The analysis employs a set of econometric approaches including fixed effects, generalized method of moments, instrumental variable, and mediation regression analyses using a multinational multi-database covering the years 2000-2019. The empirical evidence indicates that the health care burden was negatively correlated with economic growth during the study period, with every 1% increase in the health care burden leading to a 0.083% decrease in the GDP growth rate. The results of heterogeneity analysis and mediating analysis further confirmed that worsening health in the elderly population could be associated with the deceleration in economic development through the indirect pathway that lowering the employment rate of working-age population. This study provides new empirical evidence on the economic impact of population aging that the poor health of elderly population can be one critical factor of limiting economic growth, for the reason the labor inputs in household production are likely crowded out by family caregiving.

Who Works Less When a Parent Needs Long-Term Care? Gender Disparities in Labor Market Effects in Mexico

We use longitudinal data from the Mexican Health and Aging Study to analyze the effect of having a parent in need of long-term care on labor supply of men and women aged 50-64 in Mexico. After accounting for both individual and time fixed effects, we find that parents' need of long-term care is associated with both a significant drop in the likelihood of working (by 2.42 percentage points), and a reduction in the number of hours worked (by 7.3%) among women who remain employed. In contrast, we find no effect on the labor supply of men. In a context of rapid population aging, the increase in the need of long-term care risks to hinder the efforts to reduce gender imbalances in the labor market.

Gender and diet management in type 2 diabetes

INTRODUCTION

Type 2 diabetes is a chronic health condition that requires ongoing self-management. This often includes changes in diet, which may be open to influences from relatives. Family support in terms of diet may be linked with gender and the assumption that meal preparation is a traditionally female activity. This article looks at the role of gender in diet management in people with type 2 diabetes and their relatives.

METHODS

Seventeen semi-structured interviews were conducted with 23 participants (10 people with type 2 diabetes, 13 relatives of people with type 2 diabetes) in Scotland, UK. The aim was to uncover changes people have made to their diet following diagnosis of type 2 diabetes in oneself or a family member. Data were analysed using Framework Approach.Findings: Female relatives were more likely to manage the patient's diet while male relatives provided support but were less likely to monitor the person's diet. Female patients may prioritise the needs of their family while male patients are more likely to rely on their female relatives in terms of diet management.

DISCUSSION

The study findings have implications for family-based interventions as gender may play a crucial role in the management of type 2 diabetes.

The scope of carer effects and their inclusion in decision-making: a UK-based Delphi study

Background and objective

Health and social care may affect unpaid (family) carers’ health and wellbeing in addition to patients’ lives. It is recommended that such impacts (carer effects) are considered in decision-making. However, the scope of carer effects and range of decisions where carer effects should be considered is uncertain. This study aimed to identify: (i) how different categories of healthcare and social care were perceived to impact on unpaid carers; and (ii) whether there was consensus about when carer effects should be formally considered in decision-making contexts.

Methods

A two round, online Delphi study was conducted with 65 UK-based participants (unpaid carers, care professionals, and researchers) with expertise in dementia, mental health, and stroke. Participants considered two broad forms of ‘interventions’ (patient treatment and replacement care) and two broad forms of ‘organisational change’ (staffing and changes in timing/location of care). Participants assessed the likely impacts of these on unpaid carers and whether impacts should be considered in decision-making.

Results

Participants predicted interventions and organisational changes would impact on multiple domains of unpaid carers’ lives, with ‘emotional health’ the most likely outcome to be affected. Patient treatment and replacement care services (‘interventions’) were associated with positive impacts across all domains. Conversely, timing/location changes and staffing changes (‘organisational changes’) were perceived to have mixed and negative impacts. There was widespread support (80–81 %) for considering carer effects in research studies, funding decisions, and patient decision-making.

Conclusions

This study highlights a perception that carer effects are widespread and important to consider in economic evaluation and decision-making. It highlights the particular need to measure and value effects on carers’ emotional health and the need to use a societal perspective to avoid cost shifting to unpaid carers when introducing interventions and making organisational changes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06742-4.

Correlates of financial toxicity in adult cancer patients and their informal caregivers

BACKGROUND

Financial toxicity is commonly reported by cancer patients, but few studies have assessed caregiver perceptions. We aimed to validate the modified Comprehensive Score for Financial Toxicity (COST) in cancer caregivers, identify factors associated with financial toxicity in both patients and caregivers, and assess the association of caregiver financial toxicity with patient and caregiver outcomes.

METHODS

Using a convenience sampling method, 100 dyads of adult cancer patients and a primary caregiver visiting outpatient oncology clinics (Jan-Sep 2019) were recruited. We assessed the internal consistency and convergent and divergent validity of the modified COST. Multivariable analyses identified correlates of financial toxicity. Association of financial toxicity with care non-adherence, lifestyle-altering behaviors (e.g., home refinance/sale, retirement/saving account withdrawal), and quality of life (QOL) was investigated.

RESULTS

Recruited patient vs. caregiver characteristics were as follows: mean age: 60.6 vs. 56.5; 34% vs. 46.4% female; 79% vs. 81.4% white. The caregiver COST measure demonstrated high internal consistency (Cronbach α = 0.91). In patients, older age (B, 0.3 [95% CI, 0.1-0.4]) and higher annual household income (B, 14.3 [95% CI, 9.3-19.4]) correlated with lower financial toxicity (P < 0.05). In caregivers, lower patient financial toxicity (B, 0.4 [95% CI, 0.2-0.6]) and cancer stages 1-3 (compared to stage 4) (B, 4.6 [95% CI, 0.4-8.8]) correlated with lower financial toxicity (P < 0.05). Increased caregiver financial toxicity correlated with higher care non-adherence in patients, increased lifestyle-altering behaviors, and lower QOL in patients and caregivers (P < 0.05).

CONCLUSION

The COST measure can also be used to assess caregiver financial toxicity. Caregivers' financial toxicity was associated with negative outcomes for both dyad members.

How Do Middle-Aged Chinese Men and Women Balance Caregiving and Employment Income?

Unpaid family caregivers might suffer losses in income as a result of care provision. Here we used data from the baseline survey of the China Health and Retirement Longitudinal Study to assess the relationship between hours of weekly caregiving provided to grandchildren/parents/parents-in-law and individual's monthly employment income. Our study sample comprised 3718 middle-aged Chinese adults who were of working age (45-60 years). For women and men separately, we used a likelihood-based method to determine a caregiving threshold in a two-stage Heckman selection procedure. Instrumental variables were used to rule out the endogeneity of caregiving hours. Our analysis revealed a negative association between caregiving and income for women that depended on a caregiving threshold of 63 h per week. There was an absence of caregiving-income relationship among men. These results offer new insights into the opportunity costs of unpaid caregiving and support tailored policies to protect the financial well-being of female caregivers.

How work and family caregiving responsibilities interplay and affect registered dietitian nutritionists and their work: A national survey

Healthcare professionals provide paid care at work and potentially have caregiving responsibilities outside of work; work responsibilities in addition to child and/or elder care is considered double- or triple-duty care. Employees may experience conflict and/or enrichment as their work and family responsibilities interface. This study's purpose is to explore the work and family interface of Registered Dietitian Nutritionists (RDNs), determine the prevalence of work-family conflict and enrichment, and identify characteristics associated with higher work-family conflict and enrichment scores. A survey instrument assessing caregiving responsibilities and work-family conflict and enrichment was distributed electronically to 4,900 RDNs throughout the United States. Frequencies, means, correlative relationships, and ANCOVA were calculated using SAS software 9.04. Of 1,233 usable responses, nearly two-thirds of RDNs (65.5%) reported providing either double-duty or triple-duty care. About half of RDNs (47.2%) reported work-family conflict and fewer (14.8%) reported family-work conflict. Additionally, most RDNs (79.4%) reported work-family enrichment and even more (85.2%) reported family-work enrichment. Higher work-family conflict scores had correlative relationships with higher levels of burnout, lower life satisfaction, and higher intent to quit. Higher work-family enrichment scores had correlative relationships with lower burnout, higher job satisfaction, higher career satisfaction, higher life satisfaction, and lower intent to quit. Understanding the unpaid caregiving responsibilities of RDNs and the interface of work/family responsibilities may provide insight into career planning for RDNs and guide managers of RDNs in efforts to amplify the contribution of RDNs.

Unpaid Caregiving and Labor Force Participation among Chinese Middle-Aged Adults

Unpaid family caregivers must consider the economic trade-off between caregiving and paid employment. Prior literature has suggested that labor force participation (LFP) declines with caregiving intensity, but no study has evaluated this relationship by accounting for the presence of both kinks and discontinuities. Here we used respondents of the China Health and Retirement Longitudinal Study baseline survey who were nonfarming, of working age (aged 45-60) and had a young grandchild and/or a parent/parent-in-law. For women and men separately, a caregiving threshold-adjusted probit model was used to assess the association between LFP and weekly unpaid caregiving hours. Instrumental variables were used to rule out the endogeneity of caregiving hours. Of the 3718 respondents in the analysis, LFP for men was significantly and inversely associated with caregiving that involved neither discontinuities nor kinks. For women, a kink was identified at the caregiving threshold of eight hrs/w such that before eight hours, each caregiving hour was associated with an increase of 0.0257 in the marginal probability of LFP, but each hour thereafter was associated with a reduction of 0.0014 in the marginal probability of LFP. These results have implications for interventions that simultaneously advance policies of health, social care and labor force.

Establishing priorities for psychosocial supports and services among family carers of people with dementia in Ireland

INTRODUCTION

Many family carers, particularly those caring for people with dementia, report significant personal and social challenges associated with caring. The aim of this article is to identify the range of challenges experienced by family carers of people with dementia and to ascertain their preferences for various supports and services that address those challenges.

METHOD

Three modified nominal group technique (NGT) focus groups were conducted with family carers of people with dementia. The NGT groups were conducted with 17 participants in two stages, focusing separately on personal and social domains. Family carers identified challenges and individually ranked preferences for both existing and new services and supports. Data analysis consisted of qualitative content analysis and summative scoring of individual rankings.

FINDINGS

Family carers identified the following personal-level challenges: needing a break, social isolation and relationship changes. Family carers' combined preferences for personal-level supports and services to overcome these challenges were day care, family care support groups, short-term respite, long-break respite and social activities. Social challenges referenced by family carers included finances, rights and entitlements and stigma and awareness. Preferences for supports and services to address these social challenges were non-means-tested carer's allowance, legal recognition, carer's support grant, monthly wage and community awareness programmes.

CONCLUSION

Participants ranked day care and non-means-tested carer's allowance as their top priorities under personal and social headings. Increased government investment in these two areas would not only help to maintain family carers' contributions to community-based care in dementia but would also facilitate social inclusion, social connectedness and economic sustainability.

Economic burden of congenital athymia in the United States for patients receiving supportive care during the first 3 years of life

AIMS

Congenital athymia is an ultra-rare pediatric condition characterized by the lack of thymus in utero and the naïve T cells critical for infection defense and immune regulation. Patients with congenital athymia receive supportive care to minimize and treat infections, autoimmune phenomena, and autologous graft-versus-host disease (aGVHD) manifestations, but historically, die within the first 3 years of life with supportive care only. We estimated the healthcare resource utilization and economic burden of supportive care over patients' first 3 years of life in the United States.

METHODS

A medical chart audit by the treating physician was used to collect patient data from birth to age 3 on clinical manifestations associated with congenital athymia (clinical manifestations due to underlying syndromic conditions excluded). Using costs and charges from publicly available sources, the total economic burden of direct medical costs and charges for the first 3 years of life (considered "lifetime" for patients receiving supportive care) and differences in economic burden between patients with higher and lower inpatient hospitalization durations were estimated.

RESULTS

All patients (n = 10) experienced frequent infections and aGVHD manifestations; 40% experienced ≥1 episode of sepsis, and 20% had recurrent sepsis episodes annually. The estimated mean 3-year economic burden per patient was US$5,534,121 (2020 US dollars). The annual mean inpatient hospitalization duration was 150.6 days. Inpatient room charges accounted for 79% of the economic burden, reflecting the high costs of specialized care settings required to prevent infection, including isolation. Patients with high inpatient utilization (n = 5; annual mean inpatient hospitalization duration, 289.6 days) had an estimated 3-year economic burden of US$9,926,229.

LIMITATIONS

The total economic burden may not be adequately represented due to underestimation of some direct costs or overestimation of others.

CONCLUSIONS

Current treatment of patients with congenital athymia (supportive care) presents a high economic burden to the healthcare system.

Aging, Dependence, and Long-Term Care: A Systematic Review of Employment Creation

Population aging is an economic and social challenge in most countries in the world as it generates higher dependency rates and increased demand for long-term care. Undertaking the care of older dependent adults can result in new opportunities for job creation. There is limited knowledge of the impact of dependent care and long-term care on employment. We examined this impact through a systematic review. Countries with conditional cash benefits show job creation, and countries with unconditional economic benefits reveal the development of a grey care market with high participation of migrant labor. Migrant employment in developed countries affects the development of the labor market in the countries of origin. The employment created to care for dependent persons is generally precarious. In conclusion, global aging will increase long-term care worker demand, but the variations in policies can determine what kind of employment is created.

Women's Family Care Responsibilities, Employment and Health: A Tale of Two Countries

Persistently low employment of women in some countries can still be ascribed to a traditional perception of women's role in society. According to observed data and prevailing social and cultural norms, women have been bearing the primary burdens of housework, childcare, and other family responsibilities. The unequal share of care responsibilities between women and men further worsens the disadvantages of women in balancing public and private life, with an impact on their employment and health outcomes. In this paper we investigate the role of family responsibilities in shaping employment and health outcomes by gender, in Italy and France, during and after the economic downturn. We use data from the European Union Statistics on Income and Living Conditions for the time windows of 2007-2010 and 2011-2014. Our results support that gender differences in the share of responsibilities roles in the public and private sphere influence the employability and health perception of women.

Male/Female Differences in the Impact of Caring for Elderly Relatives on Labor Market Attachment and Hours of Work: 1997-2015

OBJECTIVES

Using representative samples of the Canadian labor market (N = 5,871,850), this study examined male/female differences in the impact of informal care on labor market attachment, and the extent to which differences in labor market participation and employment relationships explained these differences over a 19-year period.

METHODS

We examined four outcomes related to labor market impacts associated with caring for elderly relatives: leaving the labor market, working part-time, taking time off work in the previous week, and the amount of time taken off from work. Regression models examined differences between men and women, and the extent to which gendered labor market roles accounted for these differences.

RESULTS

We observed an increase in all labor market outcomes over the study period. Women were more likely than men to experience each outcome. Adjusting for labor market role variables did not change these estimates appreciably. After adjustment for differences in labor market roles women were 73% more likely to leave the labor market, more than 5 times more likely to work part-time, and twice as likely to take time off in the last week due to informal care. Further, for temporary absences to provide care, women took an average of 160 min more per week than men.

DISCUSSION

Taken together, these results suggest an increasing impact of informal care on labor market participation in Canada between 1997 and 2005, and it remains gendered.

Psychological Well-Being Among Informal Caregivers in the Canadian Longitudinal Study on Aging: Why the Location of Care Matters

Objectives

A caregiving stress perspective suggests that caregiving harms psychological well-being in informal caregivers, whereas a caregiving rewards perspective suggests that provision of care benefits psychological well-being. This research examines whether both perspectives apply to caregiving experiences, but differently by the primary location of caregiving (i.e., in-home, other residence, and institution), as well as by gender.

Methods

We analyzed depression and life satisfaction in the nationally representative Canadian Longitudinal Study on Aging (N = 48,648), first comparing noncaregivers (N = 27,699) to a combined caregiver group (N = 20,949) and then stratifying caregivers by the primary location of care.

Results

When considered as a single group, caregivers suffered relative to noncaregivers in terms of life satisfaction and depression. When stratified by the location of care, only in-home caregivers reported both greater depression and lower life satisfaction. Nonresidential caregivers did not differ significantly in levels of depression from noncaregivers and reported higher life satisfaction. Institutional caregivers reported greater depression than noncaregivers, but did not differ significantly in life satisfaction. These patterns were stronger among women than men.

Discussion

Both the caregiving stress and caregiving rewards perspectives are applicable to the caregiving experience, with the stress perspective more applicable to in-home caregivers and the rewards perspective more relevant to nonresidential caregivers. Recommendations include targeted practice focused on the location of care as well as the gender of the caregiver. Given that nonresidential caregivers actually benefit from providing care, interventions need to focus on identifying and bolstering positive aspects of the caregiving experience.

Transitions in Labour Force Participation over the Palliative Care Trajectory

BACKGROUND

Home-based palliative programs rely on family caregivers, who often miss time from employment. This article identified changes in caregivers' labour force participation over the palliative trajectory.

METHODS

Family caregivers (n = 262) were interviewed biweekly to measure transitions across four employment categories.

RESULTS

More than half of the caregivers had one employment transition and 29% had three or more. The highest proportion of transitions occurred for caregivers who were employed part-time.

INTERPRETATION

Understanding these transitions is critical to the development of strategies tailored to caregivers to contain labour force losses and to support caregivers during a time of high caregiving demands.

Family Caregiving for Older Adults

Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies to support caregivers. Caregiving as chronic stress exposure is the conceptual driver for much of this research. We review and synthesize the literature on the impact of caregiving and intervention strategies for supporting caregivers. The impact of caregiving is highly variable, driven largely by the intensity of care provided and the suffering of the care recipient. The intervention literature is littered with many failures and some successes. Successful interventions address both the pragmatics of care and the emotional toll of caregiving. We conclude with both research and policy recommendations that address a national agenda for caregiving.

Time to care? The effects of retirement on informal care provision

This paper analyzes the impact of women's retirement on their informal care provision. Using SOEP data, we address fundamental endogeneity problems by exploiting variation in the German pension system in two complementary ways. We find a significant effect of retirement on informal care provision, when using early retirement age thresholds as instruments. Heterogeneity analyses confirm the underlying behavioral mechanism, a time conflict between labor supply and informal care. We further exploit a sizable increase in the early retirement age for German women and find that affected women provide less non-intensive care. High intensity care is not impacted, which leads to a double burden and potentially negative health effects for caregivers. Exploiting the policy reform, we find evidence supporting the notion that formal care is no substitute for informal care. This implies that less overall care is received, which can be damaging to the health of the recipients of care.

Parental Caregiving and Employment among Midlife Women in Japan

In this paper, we examine how parental caregiving affects women’s employment in Japan. Drawing on the 2005–2014 Longitudinal Survey of Middle-Aged and Elderly Persons, we estimate logistic regression models for the employment status of middle-aged women in various types of employment as a function of caregiving intensity to examine when and in what context caregivers’ employment may be at risk for Japanese women. The results showed that working women who began providing 5 or more hours of care per week were significantly more likely to leave their jobs than non-caregiving women; those who began providing fewer than 5 hours of care per week did not show this likelihood. Among women in regular employment, those who began to provide 5 or more hours of care per week and those who provided care in the previous year were more likely to stop working or change jobs than their non-caregiving counterparts.

Changes in the balance between formal and informal care supply in England between 2001 and 2011: evidence from census data

Informal care plays a crucial role in the social care system in England and is increasingly recognised as a cornerstone of future sustainability of the long-term care (LTC) system. This paper explores the variation in informal care provision over time, and in particular, whether the considerable reduction in publicly-funded formal LTC after 2008 had an impact on the provision of informal care. We used small area data from the 2001 and 2011 English censuses to measure the prevalence and intensity (i.e. the number of hours of informal care provided) of informal care in the population. We controlled for changes in age structure, health, deprivation, income, employment and education. The effects of the change in formal social care provision on informal care were analysed through instrumental variable models to account for the well-known endogeneity. We found that informal care provision had increased over the period, particularly among high-intensity carers (20+ hours per week). We also found that the reduction in publicly-funded formal care provision was associated with significant increases in high-intensity (20+ hours per week) informal care provision, suggesting a substitutive relationship between formal and informal care of that intensity in the English system.

The cyclicality of informal care

This paper measures the cyclicality of an important input into elderly health: informal care. Using independent survey measures of informal caregiving and care receipt over the past two decades, we find that informal care from adult children to their elderly parents is countercyclical. By contrast, informal care from spouses is procyclical among individuals in their sixties. We find little corresponding change in the use of formal care, highlighting the potential for unmet care needs across the business cycle. These findings suggest that informal health inputs may play an important role in the interpretation of the cyclicality of elderly mortality.

The Impact of Informal Caregiving on Labour Supply Before and After a Parent’s Death

Most European countries are facing an ageing population, which points to a need for having as many people as possible of employable age working full time. The growing number of older people increases the pressure on health and care services as well as on family caregivers. Adult children are important care-providers in their parents’ final years. This study investigates how having a parent in need of care affects sons’ and daughters’ labour market participation. The question is investigated by analysing longitudinal data from the Norwegian life course, ageing and generation study. The empirical strategy is first to use register information about parents’ demise as an indicator for amplified care needs in the period prior to their death and explore patterns in labour market participation (employment and earnings) before and after the death of a parent. Then, register data are combined with survey data in order to separate caregivers from non-caregivers prior to the loss of a parent. The analyses show a negative employment trend in the years before and after the loss of a lone parent. They also show a different development in earnings between caregivers and non-caregivers. Caregivers have a weaker development in earnings both before and after the death of their parent compared to non-caregivers. The study concludes that caring for older parents has a negative impact on the children’s labour market participation in both the period with substantial caregiving needs and the period following the parents’ demise.