Family and friends are the most important source of care for people with long-term care (LTC) needs in OECD countries. Because of the informal nature of the care they provide, it is not easy to get comparable data on the number of people caring for family and friends across countries, nor on the frequency of their caregiving. The data presented in this section come from national or international health surveys and refer to people aged 50 years and over who report providing care and assistance to family members and friends.
On average across OECD countries for which data is available, around 13% of people aged 50 and over report providing informal care at least weekly. The share of people aged 50 and over providing informal care is close to 20% in the Czech Republic, Austria, Belgium, the United Kingdom, France, and Germany, and less than 10% in Portugal, Sweden, Poland, the United States, Ireland, and Greece (Figure 11.20). There is also variation in the intensity of the care provided. The lowest rates of daily care provision are found in Sweden, Greece, Switzerland, Denmark and the Netherlands – in most of which the formal LTC sector is well developed and public coverage is comprehensive.
Intensive caregiving is associated with a reduction in labour force attachment for caregivers of working age, higher poverty rates, and a higher prevalence of mental health problems. Many OECD countries have implemented policies to support family carers with a view to mitigating these negative impacts. These include paid care leave (e.g. Belgium and France), flexible work schedules (e.g. Australia and the United States), respite care (e.g. Austria, Denmark, France, and Germany) and counselling/training services (e.g. Sweden). Moreover, a number of OECD countries provide cash benefits to family caregivers or cash-for-care allowances for recipients which can be used to pay informal caregivers, or periods of paid leave for informal carers (OECD, 2018[1]). In France, evidence suggests that even short-term respite care solutions for older people with Alzheimer’s disease may significantly reduce informal caregivers’ psychological burden (Rapp, Apouey and Senik, 2018[2]).
On average across OECD countries, 61% of those providing daily informal care are women (Figure 11.21). Greece and Portugal have the greatest gender imbalance, with over 70% of informal carers being women. Around two-thirds of carers are looking after a parent or a spouse, but patterns of caring vary for different age groups. Younger carers (aged between 50 and 65) are much more likely to be caring for a parent (Figure 11.22). They are more likely to be women and may not be providing care every day. Carers aged over 65 are more likely to be caring for a spouse. Caring for a spouse tends to be more intensive, requiring daily care, and men and women are equally likely to take on this role.
The fact that fewer people provide daily care in countries with stronger formal LTC systems suggests that there is a trade-off between informal and formal care. Declining family size, increased geographical mobility and rising participation rates of women in the labour market mean that there is a risk that fewer people will be willing and able to provide informal care in the future. Coupled with the effects of an ageing population, this could lead to higher demand for professional LTC services. Public LTC systems will need adequate resources to meet increased demand while maintaining access and quality.
