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FAMILY VALUES: Evidence of cultural differences in how long-term care of the elderly happens at home

German-speaking seniors in Switzerland enter nursing homes when they are younger and fitter than their French-speaking counterparts

French-speaking Swiss families care longer for an elderly family member than their German-speaking neighbours before sending them to a nursing home. That is the central finding of research by Elena Gentili, Giuliano Masiero and Fabrizio Mazzonna, to be presented at the Royal Economic Society''s annual conference at the University of Bristol in April 2017.

The OECD estimates that in 2010 expenditure on long-term care accounted, on average, for 1.8% of GDP across the EU-27, which will double by 2060. But different nationalities have different care habits. The authors investigate one set of these cultural differences by examining the behaviour of neighbouring French-speaking and German-speaking communities in Switzerland.

They find that French-speaking people entered a nursing home in worse health and at an older age; they were also more likely to have been in hospital. But although German-speakers made use of care homes earlier, they were also less likely to use formal home-based care – by about three hours per elderly person per year.

The authors conclude that differences in family values between the two language groups best explain the differences: ''Since French-speaking people are characterised by stronger family values, they prefer to stay longer at home and receive and provide more informal care.''

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Culture has a substantial impact on long-term care (LTC) arrangements decisions, something that is usually neglected in public debate on LTC policies. But this argument can have important implications for observed choices.

According to OECD estimates, in 2010 LTC expenditure accounted, on average, for 1.8% of GDP across the EU-27. This figure is expected to double by 2060. Therefore, understanding the determinants of LTC arrangement decisions can be extremely important to target government interventions correctly in the LTC market.

Existing studies of the role of culture usually draw on cross-country comparisons, without reaching quantitative conclusions about the impact of culture on LTC use. In contrast, this paper is able to quantify differences in LTC use exploiting the rich cultural diversity of one country, Switzerland.

Switzerland is a confederation that counts distinct cultural groups corresponding to four different languages: German, French, Italian and Romansh. Since these language groups are geographically well-delimited, the study compares LTC arrangement decisions of people living on the two sides of the language border that separates German- and French-speaking people.

Although these two cultural and language groups face the same institutional settings and provider conditions (prices and bed availability in nursing homes), they substantially differ in LTC arrangements decisions. French-speaking people enter a nursing home in worse health conditions, at older ages and are more likely to enter after hospitalisation than their German-speaking Swiss counterparts.

The difference in health conditions at entry can be quantified as 36.5 more hours of care per elderly person in a nursing home in the first year of entry. Moreover, French-speaking elders use formal home-based care more intensively – around three more hours per elderly person in the population per year.

The paper investigates several alternative explanations for these findings and concludes that differences in family values between the two language groups best explain cultural differences in LTC choices. Since French-speaking people are characterised by stronger family values, they prefer to stay longer at home and receive and provide more informal care.

Thus, culture has a non-negligible impact on LTC arrangement choices and use. This is in contrast with the view of LTC as a supply-driven sector, according to which increasing LTC services automatically increases their demand.

But the relevance of culture implies that improving the provision of formal home-based care services, which are usually regarded as more cost-effective for mild adverse health conditions, may not necessarily trigger an increase in formal home-based care use.