Care for Elderly Parents: Do Children Cooperate?

Do children cooperate when they decide to provide informal care to their elderly parent? This paper assesses which model drives the caregiving decisions of children. I compare the predictive power of two models: a (joint-utility) cooperative and a Nash noncooperative model. I focus on families with two children and one single parent. The model allows caregiving by one child to have a direct externality on the well-being of the sibling. The results suggest that the cooperative model overestimates the level of care received by the parents observed in the data and its predictive power is outperformed by the noncooperative model. This suggests that children are more likely to behave according to a noncooperative model. I also find that children’s participation in caregiving has a positive externality on the well-being of the sibling. I construct an indicator of the degree of noncooperativeness between children and show that it is positively correlated with the number of unmet needs the parent has. I conclude that, because children do not internalize the positive externality when they behave noncooperatively, the current level of informal care provided to parents appears to suffer from a public good problem

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.</p

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 points towards informal care decreasing the chance of admission but it only derives from the US, where nursing home stays are often temporary. Exploiting linked survey and administrative data on the 65+ in the Netherlands, we use the gender mix of children to retrieve plausibly exogenous variation in informal care receipt. Our results suggest that nursing home admissions within a three-year period are reduced with informal care for individuals with mild limitations, while they are increased for individuals with severe limitations. For the latter, although informal care increases formal care costs, it also results in lower post-acute care use and mortality. Therefore, policy makers should not expect that promoting informal care systematically results in lower institutionalization rate and care costs. Still, informal support can well be welfare-enhancing: a timely admission may come along with benefits in terms of well-being and survival that may outweigh additional costs

The Consequences of unmet Health Care Needs during the first Wave of the Covid-19 Pandemic on Health

The first wave of the covid-19 pandemic led many people to have unmet health care needs, which could have detrimental effects on their health. This paper addresses the question of the effect of unmet needs during the first wave of the pandemic on health outcomes up to one year after. We combine two waves of the SHARE survey collected during the covid-19 pandemic (in June/July 2020 and 2021), as well as two waves collected before the pandemic. Our health outcomes are four dummy variables for having troubles with fatigue, falling, fear of falling and dizziness/faints/blackouts issues. Finally, we use an OLS regression with individual and time fixed effects for our difference-indifference analysis, as well as a doubly robust estimator to condition the parallel trend assumption on pre-pandemic covariates. We find substantial short-term effects on the probability of having troubles with fatigue and dizziness. We additionally observe that one year later, June/July 2021, having had unmet health care needs in 2020 increased the probability of having troubles for each of the health measures. We particularly find strong effects for general practitioner (GP) and specialist care

Care for Elderly Parents, Siblings’ Interactions and Gender

We analyze how siblings interact when deciding informal care provision to their elderly parent. We consider a non-cooperative model of the children’s care decisions, allowing productivity of care provision to vary with the child’s gender. We show that this implies that the strategic interaction effects depend on the siblings’ gender composition. The theory leads to a simultaneous bivariate tobit model. Estimation results suggest that sons’ and daughters’ free-riding behavior is significantly larger when the sibling is a sister. This is in line with a higher care provision productivity for women and can explain why women more often provide informal care than men do

Essays on the supply of informal care to elderly parents and its allocation

La population de la majorité des pays vieillit et les principaux apporteurs d'aide sont les enfants. Les décideurs publics promeuvent aussi de l'aide apportée par les proches afin de repousser l'entrée en institution des personnes âgées. Nous étudions l’offre de soins des enfants, la façon dont l’aide est répartie entre eux et son efficacité pour repousser l’entre en institution des personnes âgées. Les principales contributions peuvent être résumées de la manière suivante. Les politiques de retraite peuvent avoir des conséquences néfastes pour les personnes en perte d’autonomie avec un grand nombre de besoins en aide et qui ont besoin d’une attention quotidienne. Les enfants ne se coordonnent pas lorsqu'ils décident qu'ils apportent à leur parent, et l'allocation de l'aide qu'ils apportent est alors inefficace. Les résultats suggèrent que les enfants sont des substituts stratégiques, mais aussi que l’effet stratégique est plus grand pour une sœur qu’un frère. Ce qui peut être expliqué théoriquement par une plus grande productivité dans l'aide des femmes par rapport aux hommes. Les décideurs publics doivent s'attendre à ce que la stimulation de la prise en charge informelle puisse accélérer l'admission des personnes âgées ayant un mauvais état de santé.The population is aging and children are currently the main source of care. In addition, governments further promote care provided by relatives to keep longer the elderly out nursing homes. I study the children’s supply of care, its allocation and effectiveness in delaying the parents’ nursing home use. The contributions can be summarized as follows. The current waves of increasing statutory retirement age could harm the elderly who need care on a daily basis, since retirement increases the intensity of the care provided by children. Children do not coordinate when they decide upon providing care to their parent, and the subsequent allocation is inefficient. Women are more involved in care because their siblings have a stronger strategic behavior with them than with a brother. And this can be explained by a gender difference in productivity in caregiving. Policy makers - from the Netherlands and other institutionally similar countries - should not merely expect that promoting informal care will result in a lower rate of NH admission. For individuals with higher needs, more informal support could even be a driver of an anticipated permanent nursing home admission

The heterogeneous effect of retirement on informal care behavior

It is often argued that the increased labor market participation of seniors threatens family support provided to dependent elderly people. The purpose of this paper is to assess the causal effect of retirement on the frequency of care provided by individuals aged 55–69 years to their elderly parent. Using data from the Survey of Health, Aging and Retirement in Europe (SHARE), we estimate an endogenous switching model that allows the retirement effect to be heterogeneous with respect to observed and unobserved characteristics. To tackle the possible endogeneity of selection into retirement, we use the heterogeneity of retirement rules between and within European countries. On average, being retired does not significantly impact the probability of providing care but significantly increases the frequency of care conditional on being caregiver. The same pattern is observed regardless of the individual observed characteristics, even if the provision of informal care appears to be less sensitive to the retirement status when the child cannot rely on the other parent to provide care or when both parents are in poor health. These results suggest that pension system reforms should not affect the number of caregivers. Some adverse effects on the intensity of involvement among caregivers are nevertheless expected

Risk, time preferences, trustworthiness and COVID-19 preventive behavior: evidence from France

We analyze how far-sightedness and risk aversion as well as the perceived trustworthiness of others correlate with COVID-19-related protective behaviors in France. We leverage individual-level data from the corona survey of the Survey of Health Aging and Retirement in Europe linked with a paper questionnaire survey about preferences conducted in France just before the coronavirus outbreak. Our results suggest that far-sightedness and risk aversion are strong predictors of individuals' protective behavior. More far-sighted individuals are more likely to not visit their family members anymore, wear a mask, and keep their distance from others when outside, wash their hands more regularly and cover their cough. Risk aversion increases the likelihood of not meeting more than 5 other people and not meeting with family members anymore. Concerning the perceived trustworthiness, we find that a higher level of trust in others reduces compliance with the recommendations about meeting with 5 or more people and family gatherings. We interpret this result as a sign that individuals with trust in others perceive a lower risk of being infected by friends and family members. Hence, they are more willing to take risks when they engage in social interactions when they perceive their relatives as trustworthy. The government should therefore consider individuals' heterogeneity in preferences and beliefs when implementing a strategy to encourage people to comply with its COVID-19 protective recommendations

The impact of unmet health care needs on self-assessed health and functional limitations during the first wave of the Covid-19 pandemic

International audienceThe first wave of the COVID-19 pandemic left many people with unmet health care needs, which could have detrimental effects on their health. This paper examines the effects of these unmet needs during the first wave of the pandemic on health outcomes one year later. We combine two waves of the SHARE survey collected during the COVID-19 pandemic (in June/July 2020 and 2021), as well as four waves collected before the pandemic. Our health outcomes are four dummy variables: fatigue, falling, fear of falling and dizziness/faints/blackouts issues. Finally, we use OLS regression with individual and time fixed effects for our difference-in-difference analysis, as well as a doubly robust estimator to condition the parallel trend assumption on pre-pandemic covariates. We find substantial effects of having had unmet healthcare needs during 2020 on the probability of having trouble with fatigue and fear of falling one year later. We particularly find strong effects for general practitioner (GP) and specialist care, and in lower extent of physiotherapist, psychotherapist, and rehabilitation care

Impact of the first wave of COVID-19 epidemy on the surgical management of sigmoid diverticular disease in France: National French retrospective study

International audienceObjective: To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19.Methods: From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21).Results: A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity.Conclusion: This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality