Can informal care help preserve mental health in nursing homes? Evidence of gender effects

Informal care, defined as unpaid care provided by relatives, plays a major role in long-term care provision. While much attention has been paid to informal care provided to older persons in the community, little is known on the role of relatives as caregivers in nursing homes. Evidence, however, suggest that relatives are still providing concrete care for people living in nursing homes. This paper analyzes the causal effect of informal care provided by children on mental health for individuals living in nursing homes. We take into account gender differences, considering both the gender of caregivers and the gender of care recipients. We exploit the cross-sectional French survey Care-Institution (2016) which provides a sample of 2,382 individuals representative of the 60+ individuals living in a nursing home and having children. Mental health outcomes are the probability of declaring depression, sleep disorders, poor appetite and feeling of weariness. To deal with the endogeneity of informal care to health variables, we exploit an instrumental variable strategy where the probability of receiving informal care is instrumented by the geographical proximity of children. Results show that in general, informal care provided by children positively affects women's mental health (poor appetite, weariness) while it has no effect on men. It conceals important effects that appear when taking caregiver gender into account. Care provided by daughters has no effect on mental health while care provided by sons is effective in improving mental health of both women (poor appetite) and men (weariness). Public policies should thus take into account the role played by relatives in nursing homes and pay attention to the gender gap in long-term care provision.