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Hydra Revisited

Substituting Formal for Self- and Informal In-Home Care Among Older Adults With Disabilities

^a Department of Sociology and Centre on Aging, University of Victoria, British Columbia, Canada

Correspondence: Margaret J. Penning, PhD, Centre on Aging, P.O. Box 1700, University of Victoria, Victoria, British Columbia, Canada V8W 2Y2. E-mail: mpenning{at}uvic.ca.

Decision Editor: Laurence G. Branch, PhD

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.

Key Words: Substitution • Self-care • Informal care • Home care