6th November 2014 Tim Muir, OECD Help Wanted? Informal care in OECD countries

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1 6th November 2014 Tim Muir, OECD Help Wanted? Informal care in OECD countries An overview of the role informal care in OECD countries, the impact on carers and the policy implications

2 Understanding informal care is important but difficult Perhaps the most important source of long-term care in many OECD countries Lack of comparable international evidence Definitional problems Differences between studies Many may not see themselves as carers Difficult to make generalisations about international experience Help Wanted? OECD research conducted in 2011 brought together what we know about informal carers in one place p.2

3 My talk today Who are informal carers? The costs and benefits of informal care Policy implications Do we want more or less informal care? How carers can be supported? Sustainability of current care models? p.3

4 WHO ARE INFORMAL CARERS?

5 Informal carers are perhaps the most important providers of long-term care in OECD countries Proportion of over-50s providing informal care for IADL and ADL needs Source: SHARE p.5

6 Most informal carers are looking after a spouse or a parent Who informal carers look after in OECD countries Source: Help Wanted? (OECD, 2011) Average of 16 OECD countries. Does not sum to 100% since some carers look after more than one person. p.6

7 Those looking after their parents are mostly women The likelihood of a person aged being an informal carer, by gender Source: Help Wanted? (OECD, 2011) p.7

8 While older carers are just as likely to be men as women The likelihood of a person aged 75+ being an informal carer, by gender Source: Help Wanted? (OECD, 2011) p.8

9 The proportion of carers providing high-intensity care varies between countries The prevalence and intensity of informal care in OECD countries Greater intensity of caring More carers Source: Help Wanted? (OECD, 2011) p.9

10 THE COSTS AND BENEFITS OF INFORMAL CARE

11 Informal care can have benefits for the person being cared for and the carer Benefits for the person being cared for Familiarity Being cared for by someone they trust Maintain social contact Able to remain in community for longer Reduced out-of-pocket costs Benefits for the carer Many carers find the experience rewarding Reduced out-of pocket costs (where families sometimes pay for care) p.11

12 But caring can put a significant strain on the carer, leading to mental health problems Percentage of carers and non-carers with mental health problems in OECD countries Source: Help Wanted? (OECD, 2011) p.12

13 And working age carers may drop out of the labour force Proportion of carers and non-carers aged in employment Source: Help Wanted? (OECD, 2011) p.13

14 And working age carers may drop out of the labour force Proportion of carers and non-carers aged in employment High intensity of care Low intensity of care Source: Help Wanted? (OECD, 2011) p.14

15 Informal care also has wider impacts on the economy Savings to government budgets (since a lot of formal LTC is paid for by the state) Alleviate workforces issues in the LTC sector Reduced productivity Some carers may otherwise be doing higher productivity work Community care can be more resource-intensive than institutional care p.15

16 SO DO WE WANT MORE OR LESS INFORMAL CARE?

17 Countries take different views on whether to actively promote informal care Germany allows LTC users to take a cash payment instead of services with the aim of promoting informal care Japan has explicitly refrained from cash payments, in part to prevent women being pushed into caring roles Some other countries do not seem to have an explicit policy either way p.17

18 Many countries are actively promoting community care over institutional care Proportion of LTC users living in the community Source: OECD health statistics 2014 p.18

19 This is an implicit policy decision to increase informal care Estimated value of formal and informal services for people with dementia in England Source: Prince, Knapp et al. (2014) p.19

20 THE IMPLICATIONS OF AN INCREASING ROLE FOR INFORMAL CARE

21 Policies to support informal carers will be more important than ever Respite care At home, day care centres or temporary institutional care Available but underused? Netherlands: day care on farms provides respite to carers Counselling and support Can be effective at relieving stress Include peer support, e.g. dementia cafés in Japan NHS Dementia Carers Support Service in England Information and training Provide skills to care effectively and minimise negative impacts e.g. France: carers entitled to two days of training per year. Phone advice services in a number of countries Help with employment Germany: family caring time law helps carers reduce hours temporarily Canada: bringing together employers to explore how to help carers to keep working p.21

22 More people will be eligible for carers benefits, so it is important that they are well-designed Around half of OECD countries have cash benefits for carers Provide some compensation for the time spent and recognition of the important social role played by carers but don t always amount to a salary Nordic countries: effectively pay the carer an hourly rate (equivalent to the pay of a formal care worker) United Kingdom: carers allowance a week for people caring for more than 35 hours = 1.75 per hour (vs minimum wage) Germany: care recipient can take a cash benefit instead of services, which can be used to pay an informal carer although this is less than the value of the services required p.22

23 More research is needed to understand how the supply of informal care will change in future How many people will be willing and able to care for their parents or their spouse in the future? Converging male and female life expectancies might mean that more people are able to care for a their spouse in future. But fewer intergenerational households, greater geographical mobility and the changing role of women might mean fewer people are able to care for their parents. Risk that current models of community care may be unsustainable. Not well enough understood more research is needed in this area to help governments plan. p.23

24 Thank you Contact: Read more about our work Follow us on Website: p.24

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