Hydra revisited: substituting formal for self- and informal in-home care among older adults with disabilities.

ABSTRACT

PURPOSE: In response to concerns among policymakers and others that increases in the availability of publicly funded formal services will lead to reductions in self- and informal care, this study examines the relationship between the extent of formal in-home care received and levels of self- and informal care. DESIGN AND METHODS: Two-stage least squares regression analyses were conducted, using data drawn from interviews conducted with a sample of 661 older users and nonusers of publicly subsidized home care services. RESULTS: No evidence was found to indicate that more extensive use of formal services is associated with less extensive self- or informal care. This is true among those receiving publicly subsidized services as well as those required to pay part or all of the cost of the in-home services they receive. IMPLICATIONS The findings provide little support for the substitution hypothesis that an increase in the use of formal in-home services will tend to erode levels of informal or self-care.