Diversification and Strengthening of Services for Older People in Spain andSweden

Abstract

Information on public services for older people is often limited to institutional care and Home Help/Home Care, be it for individuals in surveys, statistics for a specific country or for international comparisons. Yet, these two major services are in many countries supplemented – or substituted – by other, minor services. The latter include services such as transportation services, meals-on-wheels, alarm systems and day care. This diversification is the outcome of a rationing of services to achieve a more rational allocation of resources and attempts to keep down costs. In this presentation we use various data sources to provide information on all these types of support for Spain and Sweden. When all of them are considered, service coverage is much higher than by basic services alone, indicating further consolidation of services. Data suggests a high targeting in Sweden, but fragmented delivery in Spain, where – we suspect - users get what is available, with little differentiation between needs. With higher service rates, as in Sweden, there is greater overlap between family care and public services; with lower coverage rates, as in Spain, family care and public services are more often substituted for each other. It is suggested that a range of services, major and minor, may suit the varying needs of older people better – and more efficiently - than the choice between nothing, Home Help or institutional care, but that minor services may also be used as an inexpensive – and sometimes inferior -substitute for full support.