Schmidt, Andrea E. (1,2)
1: European Centre for Social Welfare Policy and Research; 2: Vienna University of Economics and Business, Austria
_Background_: With increasing life expectancy in European societies, the group of active older people is growing. At the same time, however, Europe is seeing a rise in the prevalence of chronic diseases and multi-morbid conditions in old-age. Disproportionally, these affect people of lower socio-economic status (SES). Reasons are that the latter face less favorable living conditions over the life course, and are less able to compensate health limitations at an early stage, for example through the use of formal long-term care (LTC) services or adaptive devices. Some groups, such as older women and single-living older people, are more affected by severe living conditions than others, making them particularly vulnerable to be confronted with complex health needs and less capable to identify the right support services. At a policy level, there is a tendency to regard older LTC users as consumers of care, for example by providing them with cash benefits instead of making services directly available to them (in-kind benefits), which can compound inequalities between users of different SES. _Rationale and objectives_: Previous studies have identified some of the key individual determinants of the use of (home and residential) LTC services for older people, yet have often overlooked the linkages between socio-economic status, gender, and care. Others have focused mainly on health care services, or neglected the role of policy instruments in LTC. The objective of this paper is to address these gaps by adapting the Resource Triangle, developed by Arber and Ginn, as a theoretical framework to analyze (i) the ways in which health resources, material resources, informal caring resources, and gender impact on the use of formal LTC services, and (ii) which interdependencies exist between these factors. In addition, the narrow geographical scope of the study allows us to contextualize the findings within the Austrian policy context, in which unconditional cash benefits for older people in need of LTC are provided. _Research question_: This paper addresses the question how socio-economic status, informal caring resources, and gender impact on differences in older people’s use of formal LTC services in Vienna against the backdrop of the Austrian system of LTC cash benefits. _Methods_: We apply a Mixed Methods and Research Design (MMRD) approach, which consists of two parts. Firstly, we perform multivariate analyses of administrative data on older beneficiaries (60+) of the Austrian LTC cash benefit to identify patterns of LTC use, by comparing domestic LTC services to other forms of support (residential care and co-residential informal care). Methods of logistic regression and ordinary least squares analysis are used, and interaction terms are calculated between (a) gender and co-residence of a spouse, and (b) income and co-residence of a spouse. Secondly, 15 semi-structured interviews with LTC users are held in order to reveal mechanisms underlying differences in the use of LTC cash benefits. We use a maximum variation sampling strategy with regard to socio-economic status and gender. Interviews are transcribed and analyzed using the Framework Approach following Ritchie and Spencer. _Findings_: Firstly, we find that higher care needs as well as being female are strong predictors of the use of domestic LTC services in Vienna, thus confirming results from other countries. In addition, we show that there is pro-rich inequality in the decision to use home care services, but pro-poor inequality in the amount of hours of home care use, when compared to residential care. Secondly, we find some interdependence between the availability of different forms of resources in old-age. The importance of material resources varies by co-residential status for the amount of hours of home care used. While single-living older people receive more hours of home care than single-living older people in high-income groups, we find no pro-poor inequality among those co-residing with a spouse, which could indicate that informal carers in high-income groups act as ‘agents of care’ while those in low-income groups tend to provide care themselves instead. Also, there is evidence of interdependence between gender and the availability of informal caring resources, confirming results from other countries. Women use more intensive LTC services than men, even when they have access to informal caring resources, such as a co-residing spouse, whereas men living alone use more of these services than single-living women. This highlights the importance of women as informal carers for their spouses, as is well-known from the academic literature. Finally, the interviews reveal that gender stereotypes are influential for our findings, but SES per se appears to be a less decisive factor. Older people interviewed did not perceive cash benefits as an instrument of choice in the Austrian context, and no SES differences were found. Besides, the MMRD approach provides insights into the appropriateness of SES indicators in old-age. _Conclusions_: We conclude that there are complex pathways between the availability of material resources, informal caring resources, and gender, which may impact on the use of formal LTC services. These interdependencies have not been fully explored hitherto, and deserve some further research. While cash benefits in the Austrian context do not seem to compound existing SES inequalities in the use of formal LTC services, they do contribute to gender inequalities in the use and provision of informal care.