The increase in the average life expectancy and the number of years that people live with a greater or less degree of dependence translate into an increasing need for long-term care,which is provided in a formal or informal way. Among the formal responses we find, more commonly, elderly care homes and home support, but, both in Portugal and in other countries, the majority of people who need support in their day-to-day activities - from taking medicines to personal hygiene - depend on their family members (ie, informal caregivers).

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Taking care of a family member, for example, an elderly parent or spouse, can be a heavy burden, emotionally,physically and mentally, and beyond. Formal care can help to alleviate this burden.Understanding the impacts of different types of formal long-term care on informal caregivers is important to help design better support policies for informal caregivers. In a recent study with colleagues Luís Filipe and Francisco von Hafe, we explored the impact of using home support services on your spouse's health, using data for more than fifteen countries in Europe.

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On the one hand, being an informal caregiver can have harmful consequences for health, as it can involve heavy tasks, such as raising the caregiver and putting pressure on the caregiver's personal, social and professional life. On the other hand, being a caregiver,for example of a partner, in the case of retired couples, can represent a source of physical activity and can induce positive feelings such as self-esteem, pride in being able to help, feelings of usefulness and appreciation. Naturally, which factors weigh the most - favorable or unfavorable- depends on the intensity and type of support provided, the severity of dependency on the caregiver, among other factors.

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Home support for a dependent individual interacts with the provision of informal care by their family members, replacing or complementing them. By replacing some tasks, potentially the heaviest ones, home support can lighten the caregiver's burden — but it can also eliminate such positive feelings that some caregivers derive from this activity. In other cases, home care professionals may signal needs that were unknown and request more support from informal caregivers. That is, we cannot say in advance that starting to receive home support is favorable or unfavorable to the caregiver's health. While there is extensive literature on the impact of providing informal health care, there are almost no studies on the impact of using formal support services on caregiver health.

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We focus on spouses as they are not only responsible for most of the informal care provided but are also on average older and more fragile, that is, they are at greater risk of developing health problems themselves. We also consider not only those who call themselves caregivers but all spouses (potential caregivers) of individuals with limitations in their day-to-day activities, since living under the same roof,they are likely to help in some way.

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We used data from the European SHARE survey (Survey of Health, Aging, and Retirement in Europe). This survey makes it possible to track individuals aged 50 and over in various countries overtime, as well as their spouses regardless of age, in terms of their health and other characteristics. We do this to identify couples who, at some point in time, start using home support services and see what happens to the health of the spouse who is not the direct beneficiary (that is, the spouse who is likely to provide informal care to the other). We take into account several factors that can confuse the relationship between the use of home support services and the spouse's health - the goal is to determine a causal relationship.

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I leave here three main results. The first is that starting to receive home support has an adverse impact on the spouse's health. The following results can help you understand why.

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The second main result is that starting to receive home support increases the likelihood that the spouse will self-designate a caregiver. A possible interpretation of this result is that,in the presence of important unmet needs in the population - because the offer of formal care is not vast enough, for example -, what will tend to happen is that home support professionals identify these needs and request additional support cost by family members. In our sample, most individuals who receive home support receive a few hours of weekly support, suggesting that there is likely to be a complement by informal caregivers.

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The third main result is that the unfavorable impact on the spouse's health is especially strong in the mental health of the spouses who (potentially) care for them. Continuing with the previous reasoning, if you start receiving home support, you tend to require more support from your spouse, this can have a more negative impact on men, who are traditionally less prepared to perform domestic tasks, personal hygiene, etc.An alternative explanation is that for women, men who are caregivers tend to derive more positive feelings from the activity of caring, such as the feeling of pride in being able to “get the job done”. Starting to receive home support can eliminate these feelings, for example, by reminding the husband that he can no longer handle the situation alone.

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These results do not mean that increasing the offer of home support services would be bad for spouses' health.It may be that increasing the amount of support has benefits for the spouse's health among beneficiaries of home support. A French study finds the same result. Unfortunately, with the data we have, we can only look at the impact of receiving versus not receiving and not the impact of receiving more or fewer hours of home support. Furthermore, suppose the issue is that there is still a significant proportion of the population with unidentified and unmet needs,then as home support increases and reaches more people. In that case, the average health impact of the caregiver may become positive.

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The “working document” version of this study will soon be available on my personal page with all the results and all references to the previous literature (find the link below).

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This content was originally written in Portuguese and published in Netfarma

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