Olena Nizalova and Julien Forder
When we think about people who require long-term care, there is a debate about how much care should be provided by family and friends (informal care) and how much – by the government and the private sector (formal care). If you look around the world, there is some research suggesting that these forms of care crowd out each other, so people who get more formal care have less informal care. Other studies, however, show that the two forms of care complement each other. In England, when the government decides how much formal care to provide and how much public funds to spend on it, they need to know what effect it will have on the informal care people get.
Our aim was to look at the relationship between formal and informal care and to find out whether if people use more formal care, they would use less informal care. The way we explored this was to analyse the data collected within the English Longitudinal Study of Ageing (ELSA) for the period 2000-2017. To see whether an increase in formal care causes a change in choices about informal care, we first estimated how people’s use of formal care is affected by its availability and, in turn, looked at how that affects informal care. People’s use of formal care based on availability was inferred from the use of formal care by other ELSA respondents living in the same local authority to reflect the generosity of the local provision.
We found that the use of formal long-term care reduces the use of long-term care provided informally by family and friends. We also found that this effect is bigger for women than for men. We did not find any meaningful difference in the effect between frail and non-frail people, but we did find that the effects are larger when formal care only consists of home care tasks (e.g., household maintenance, medications, etc.).
Informal care has an economic cost to society, e.g., through carers not being able to work. Our findings show that using formal care leads to reduced use of informal care. For people 75 years old and older, this means that one extra hour of formal care can save up to 40 minutes of time for informal carers. In money terms, this saves up to 67 pence of informal care ‘cost’ for each extra pound spent on formal care when we value both forms of care equally. These savings are in addition to other savings from providing formal social care, such as using NHS services less often. There are other benefits to giving informal care to a relative or friend that our research did not consider, such as feeling valued or giving back. To find out how much public funds should be spent by the government on formal social care, we need to conduct another research study where we combine all the costs and benefits that result from formal care.
