2.1. Typology of Task Division
A large volume of literature addresses the task division between formal and informal carers, usually distinguishing between several models of task division along the lines of who provides home help tasks or support with IADL (Instrumental Activities of Daily Living), and/or personal care tasks or support with ADL (Activities of Daily Living). The main models of task division discussed in the literature are:
Informal care only model: Also termed kin independence [7
], in which care tasks are provided solely by informal carers, who are often the closest and most available individuals and thus assumed to be preferred by older people [13
Informal specialization model: At least one type of task is provided by the informal carer alone, while other tasks are performed by the formal and informal carer together [8
Supplementation model: One or more tasks are performed jointly by the formal and informal carer, with the former topping up or supplementing the care provision with the latter, usually when the increase in care needs or overburdening of the informal carer may render her/him unable to fully address the care needs [14
Complementation model: In this model of task division, formal and informal carers each perform different non-overlapping tasks [15
]; or both carers share one type of task and the other task is carried out by the formal carer alone [7
Formal care only model: Based on Green’s [16
] substitution model in which care tasks are provided only by formal carers who fully substitute informal caregiving.
The previously described complementation model combines a model with a complete division of tasks between formal and informal carers—also termed dual specialization [15
]—with one in which formal carers perform one task alone and other tasks are performed by both formal and informal carers—also referred to as formal specialization [7
]. A defining characteristic of both models is that they completely outsource at least one task to formal carers. In addition, empirical evidence indicates that both models share the same determinants [8
], namely the longer duration of care provision (more than 3 months), but with lower intensity of care (i.e., number of hours) and with a lower associated caregiver burden. Figure 1
summarizes the typology of task division based on the previously described models and used in this study.
2.2. Care Regimes and Inequalities in Care
The differences between formal and informal care in Europe have been framed around the concept of care regimes or varieties of familialism, distinguishing between defamilialism, in which the state reduces the family’s care obligations by providing public services, and familialism, in which public policies explicitly support the family as sole or main care provider [4
]. A number of intermediate forms can be identified along the familialism–defamilialism continuum. Saraceno [6
] distinguishes familialism by default, in which family care takes place in a context where there are no formal care alternatives; prescribed familialism, with obligations to care or provide financial support to pay for care by the family being reinforced through law; and supported familialism, in which public policies actively support the caring role of the family, usually through cash benefits or care leave schemes. Other authors distinguish between the coexistence of public policies supporting family carers (namely cash benefits) with no or weak service development from the coexistence of such policies with care services developed through the market that at least provide some possibility to outsource care—dubbing the latter optional defamilialism through the market [18
Familialism has been associated with the reinforcement of both class and gender inequalities in the use or provision of different forms of care, as households must rely on their own resources to meet care needs [6
]. However, familialistic policies may impact the traditional gendered division of care roles in a non-uniform way. Supported familialism, with high levels of generosity, can also contribute to the reduction of gender and social inequalities in care by providing additional financial resources for households to purchase care services—thus providing families with an option to defamilialize care through the market—or by financially compensating women for caregiving [4
]. The use of the market nexus to achieve defamilialization, may, however, foster greater gender equality among middle-class families with sufficient financial resources to outsource care, whilst leaving poorer families without that option [19
]. The existing evidence points to larger social inequalities favoring the more affluent in the use of formal care in countries with predominantly familialistic care policies [11
]. As regards gender, the available research concurs that higher reliance on the family for the fulfillment of care needs is associated with a higher burden for female carers, specifically wives and daughters [21
]. Legal obligations to care, rather than cash benefits, seem to be associated with larger gender inequalities among siblings providing high-intensity care [23
However, some of the evidence on inequalities across different care regimes is based on studies that group countries into clusters according to their degree of familialism/defamilialism [20
]. While this approach may enhance sample size for empirical purposes, it risks grouping together quite dissimilar countries [25
]. The few existing comparative studies have counterposed familialism with defamilialization (i.e., in-kind public provision). These ‘most dissimilar case’ studies attribute outcomes to different public policies that may actually result from the interplay of differences in culture as well as public policies [26
]. The policy relevance of the findings of these studies may also be limited, as recent policy developments seem to rely increasingly on different forms of familialism rather than on defamilialization through public services [10
], making comparisons within different types of familialism more relevant. Differences between varieties of familialism remain underresearched, especially from the perspective of gender and SEC inequalities within different forms of familialism. This paper seeks to address this gap by comparing two neighboring countries that can be deemed similar in terms of their care culture (i.e., their preferences regarding state and family roles in care), but dissimilar enough in terms of public policies. This ‘most similar case’ design focuses on Austria and Slovenia as neighboring countries with different forms of familialism. Moreover, in choosing these countries, the empirical analysis includes one case (Slovenia) from a region (Eastern Europe) that is underrepresented in both the care regime and inequalities of care literature.
As regards care for older people, Austria and Slovenia share a strong tradition of family values that emphasize the family as the main caregiver [27
]. In both countries, carers live in relative proximity to their dependent relatives due to general low housing mobility within the population and the majority of the regions in each country have a similar share (25–30%) of older people living alone [28
]. Both countries also have similar demographic aging and health profiles. The population group aged 65–79 represents 14.4%and 15% of the total population for Austria and Slovenia, respectively, while the 80+ group accounts for 4.9% and 5.2%, respectively [29
]. Life expectancy and healthy life expectancy at 65 is nearly identical for Austria (20.1 and 7.4, respectively) and Slovenia (20.0 and 7.4, respectively) [30
]. They markedly differ, however, in terms of the public care policies in place. Informal carers in Slovenia receive little support in the form of either specialized care services (e.g., respite care) or cash benefits [31
]. Family members who opt for part-time employment because of their caring responsibilities cannot retain the full level of social security benefits nor do they receive any compensation for lost income, except under specific conditions of the status of family assistant that enables partial or full-time withdrawal from the labor market. The take-up of the latter was at the time of the study however marginal. Children are legally obligated to contribute to the costs of their parent’s care if the latter cannot afford the costs on their own [33
]. Slovenia’s care regime is best described as prescribed familialism with an underdeveloped formal care sector [32
]. Data for 2015, show that only 1.1% of the population received formal home care in Slovenia [36
Austria, on the other hand, has been defined as an example of supported familialism, with the family retaining the role of main care provider, supported by a universal cash benefit (Pflegegeld) provided to dependent older adults, which is usually used to compensate informal family carers [5
]. In addition, informal carers are entitled to an income-related care leave of up to 3 months and to health and pension insurance if they need to reduce their working time to provide care [38
]. As for formal care services at home, the overwhelming majority of which are non-profit, data for 2015 indicate that 32.2%of Pflegegeld beneficiaries receive some form of care services at home, corresponding to 2.3% of the total population [39
]. Apart from formal care services, migrant live-in carers (known as ‘24 h carers’) play an important role in the context of long-term care in Austria [40
]. Additional means-tested benefits are available for users who rely on self-employed 24-h carers or who employ them directly. Both the development of 24 h carers and services at home by non-profit organizations have provided families in Austria with the option of defamilializing through the market [18
]. There is scarce information on inequalities in the use of care in both countries. Still, the existing evidence points to gender inequalities in Austria in both caregiving (share of women among informal carers is 73% [41
]) and care receiving (married older women more likely to receive home care services than married older men [42
2.3. Determinants of Task Division
At the individual level, several factors have been found to influence the division of tasks between formal and informal carers. Lower care needs and geographic proximity of carers and users are associated with informal care only or kin independence [7
], while higher care needs increase the chance of using formal care for specific tasks [7
]. SEC seems to be positively associated with the use of formal care only and mixed forms of task division [44
], particularly the complementation model [8
]. The supplementation model, which has been linked to overburdened informal carers or users with very high care needs, seems to be the exception to this as it is more likely to be found amongst individuals with lower SEC [8
]. When viewed together, this body of evidence points to formal care only and the complementation models as those associated with individuals who enjoy a greater degree of choice, namely those with greater access to economic resources. For informal care only, existing studies show contradictory evidence as to the effect of SEC [7
]. Thus, some studies associate this model with low SEC, as a result of financial constraints in accessing formal care, while in other studies the association is non-existent or goes in the opposite direction, possibly as bequest motivations may be stronger in the presence of wealth.
As regards the gender of the carers, male carers are overrepresented in the complementation model, while female carers are linked with the supplementation and informal care only models [7
]. Overall, daughters are more likely to be carers than sons [23
], but in contexts of greater availability of services, children tend to specialize in particular tasks (e.g., home help), regardless of gender (i.e., complementation) [50
]. As for the gender of the user, there is pervasive evidence that frail older women are more likely to receive formal care only or mixed forms of care [42
Reflecting on the existing evidence, we hypothesize that:
Hypothesis 1 (H1).
The socio-economic gradient will be steeper in the context of prescribed familialism (Slovenia) than in supported familialism (Austria) (. SEC would be a better predictor of the use of formal care in Slovenia, as the cash-for-care benefit available under-supported familialism enhances the ability of Austrian households to pay for formal care. More specifically to the task division models, socio-economic inequalities are expected to be particularly large for the formal care only and complementation models in Slovenia, as these are the models more closely associated with the ability to choose.
Hypothesis 2.1 (H2.1).
We also hypothesize that supported familialism, which enables households to pay for formal care, is more conducive to a wider distribution of care within families, rendering the gender of adult children (the potential caregivers) less relevant for the type of care tasks model and thus to increased gender equality. A less pronounced association between the gender of adult children (e.g., whether daughters are available) would thus be expected in Austria, particularly in the informal care only, complementation, and supplementation models.. This would be further reinforced by the higher availability of formal care in Austria.
Hypothesis 2.2 (H2.2).
Conversely, if the nature and generosity of the provided support are insufficient to motivate sons to take on additional care tasks, the opposite effect would be observed, whereby the benefits under-supported familialism would create additional incentives for women (i.e., daughters) to care. In this case, we hypothesize that the additional support available in Austria would reinforce the association between having daughters and the probability to receive care from task division models more closely linked with female carers in the literature: informal care only and supplementation models. Given the dearth of guidance from the literature on the expected gender gradient in care-receiving across care regimes, we do not articulate a specific hypothesis for gender inequalities in care-receiving, but nonetheless present the results for these, as well as an exploratory study.
Hypothesis 3 (H3).
Finally, following the above-cited interplay of gender inequalities with cash benefits, we hypothesize that defamilialization through the market, afforded by the Pflegegeld in Austria, would have a differentiated impact on gender inequalities across socio-economic groups. In other words, we expect that if there is an association between the availability of daughters and informal care only and supplementation models, this association would be most pronounced among the lower SEC groups, particularly in Austria.