Hoe evolueert de zorg voor oudere familieleden in de tijd? Een analyse van de geleverde zorg aan ouderen door hun echtgenoot en kinderen in de Panel Study of Belgian Households 1992-2002

Population ageing has become one of the most burning issues on the agenda of the social policy-makers in the industrialised countries. In 2050, about a quarter of the population of Belgium will be aged 65+ and a tenth 80+. This change in the population structure is associated with an increase in the demand for community care. Therefore, the organisation of a sustainable long-term care system is one of the main challenges to address. So far, the family seems to remain the first, the main and the most stable source of elderly care. But family care has its limitations (it is not available for the family-less elderly and may have detrimental consequences for the care-givers if long-term and/or heavy care is needed). Social policies should be developed in order to support or to substitute family care and to provide sustainable long-term care for the elderly in the community. To do that, the first step is to have a good knowledge of the determinants and the dynamics of the care provided to the elderly by their family. This dissertation focuses on the care provided by the spouse and the children (the ‘family care-givers’) in Belgium. The approach is quantitative and, using the Life Course as theoretical framework, the dissertation tries to explore the ‘longitudinal’ and ‘contextual’ aspects of the study phenomenon. The main originality is to carry out a longitudinal analysis of the elderly family care characteristics in a representative sample of Belgian elderly. The three main research questions are addressed: Who is receiving family care? What are the characteristics of the received family care? How do these characteristics evolve over time? But before starting the analyses and answering those questions, the context and the methodology should be specified. Therefore the dissertation has been divided into three parts. The contextual part starts with a discussion of the concept of care and a presentation of the Life Course approach, continues with the review of the literature, then describes the Belgian context and ends with a comparison of the existing surveys dealing with elderly family care in Belgium. The methodological part begins with a presentation of the analysed survey (the Panel Study of Belgian Households-PSBH 1992-2002) and the study sample (the 1,123 respondents of Belgian nationality, who have answered - at least - both to the first and the third wave and are aged 65+ in 1994), afterwards, the preparation of the analysis file is detailed and the used variables are presented. The analysis part includes three chapters (one for each of the research questions). The family elderly care is a complex phenomenon which is part of an existing relationship. The risk of under-declaration is highlighted from the presentation of the care concept onward and many efforts were done in the data preparation to correct this declaration bias. But it still appears in the analyses results and can, therefore be considered as a main finding because it shows that the current terminology and its related question wording should be revised. In the conclusion, ‘close support’ is suggested as an alternative to ‘family care’. Being more positive and inclusive, it would favour care declaration and allow the development of more comprehensive preventive supportive policy measures.Another important finding is the presence of regional differences: elderly Flemish were more likely to receive intensive and long-term family care and Brussels inhabitants were the most likely to rely only on care services or to receive no care at all. These differences were explained by the differences in elderly care policy orientations which also reflect strong cultural differences. Finally, the longitudinal approach highlighted that once the family starts to care, it is often for a long time, and especially when the elderly is very old or if a child cares for a spouseless parent. In both cases, care services are often used in complement. The elderly having a spouse are less likely to use care services and this should be a major concern for social policy-makers: elderly couples are often both frail and, without external support, they would be at high risk of institutionalisation.

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