Social inequality in home care: A scoping review on the impact of socio-economic resources on home care arrangements

Abstract

Introduction: Inequalities in long-term home care are still rarely considered in the discourse on health inequalities, although there is reason to assume that opportunities for a successful home care arrange-ment are not equally distributed among those in need of it. This paper pursues the question how socio-economic resources of people in need of care and their family caregivers are influencing the utiliza-tion of care services in Germany. Methods: A scoping review has been conducted to analyse the current state of research. To identify rele-vant papers the online databases CINAHL including MEDLINE, PubMed, LIVIVO and Web of Science were searched and supplemented by internet research. According to Bourdieu, the research studies included were arranged in economic, educational and social resources. Results: 29 qualitative and quantitative research papers were included in the analysis. 14 papers repre-sent quantitative research results, nine papers are based on qualitative research. Six further papers are analyses based on an international data record. The utilization of care services increases with the level of income and wealth as well as education. On closer examination of individual care services, however, the evidence is inconsistent and only the so-called 24-hour care service is distinguishable as a care arrangement for high-status groups. A compensation of the lower utilization of professional care by informal support cannot be described in quantitative terms. Caregivers with low income and education levels seem to be more likely to not only provide care but also to provide higher-intensity care. Discussion: Despite increasing research reflected in the literature, the evidence remains incomplete and shows inconsistencies so that a valid statement on the degree of inequalities in care provision is not pos-sible. A conceptual basis for the definition of social inequality in the context of long-term home care is lacking as well as a common understanding of equity in care provision. The perspective of people in need of care and their caregivers has hardly been addressed. Conclusion: Home care is not only determined by individual need but seems to be decisively influenced by socio-economic restrictions. For a more targeted approach, further research on the use of care services depending on socio-economic resources is needed, explicitly taking into account the user perspective.