Differences in the Use of Formal and Informal Care Services among Older Adults after the Implementation of the Dependency Act in Spain

Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the aim of this study is to infer the impact that the Spanish System for Personal Autonomy and Dependency might have on formal and informal care use through the performance of logit random-effects regression models by applying a differences-in-differences approach. Dependency levels were created depending on the limitations on the performance of instrumental and basic activities of daily living. Formal care consisted on home help and nursing home care, whereas informal care referred to the reception of care by relatives or friends, from inside or outside the household. Additional covariates, such as socioeconomic characteristics and health status variables, were included. Our results show that the negative dependency effects on informal care reception are intensified after the implementation of the Dependency Act, as the interaction between being a moderate dependent and wave 4 (year 2010) is significant and positive. In case of formal care, the joint assessment of the implementation of the DA and the different dependency levels did not report a significant effect, although they were significantly associated with formal care use independently. Bearing in mind the demographic ageing, our results highlight the need for the efficient planification of long-term care systems and social support services, especially for informal caregivers, in order to satisfy the care demands and reduce the caregiving burden.