Theoretical background

1.2.1 Reverse substitution, complementarity and specialization The envisioned outcome of the reforms implemented in countries with a univer-salistic LTC approach is reverse substitution (Johansson et al., 2003): family members are expected to step in and take over the support tasks for which state supported services have been made less widely available. This is particularly the case for lighter forms of support, e.g. household help. Family support and state supported services are thus expected to be substitutes (cf. Greene, 1983).

Whether they effectively are has been highly debated among scholars. Already in the 1980s, Stoller (1989) called the idea of substitution a myth, after noting that older persons using formal care services in upstate New York typically also re-ceived personal care from informal providers. In a similar vein, Motel-Klingebiel, Tesch-Römer, and Von Kondratowitz (2005) claimed that the total amount of care that older persons received from state supported services and informal providers together was greatest in countries where state-supported services were widely available. This would imply that family support and state supported services are not perfect substitutes.

The two main theoretical models proposed by scholars challenging the idea of (reverse) substitution are the complementarity model (Chappell and Blandford, 1991; cf. Stoller, 1989) and the specialization model (Brandt et al., 2009; Igel et al.,2009). Chappell and Blandford’s (1991) complementarity model holds that state supported services encourage, rather than discourage, family members to provide support to parents in need. Barriers for family members to take on the caregiver role – and the risk that they have to relinquish this role again because of being overburdened – are assumed to be lower when there is the possibility to share the overall care load with formal caregivers. Applied to the LTC policy developments in universalistic countries, this reasoning would lead one to expect that the cutbacks in state supported services decrease, rather than increase, fam-ily involvement in caregiving.

The specialization model developed by Brandt et al. (2009; Igel et al., 2009) builds on Litwak’s task-specific theory. Litwak (1985; Litwak, Silverstein, Bengt-son, and Wilson Hirst, 2003; Messeri, Silverstein, and Litwak, 1993) has argued that support for older persons in need tends to be provided by the available source whose characteristics best match what is needed for the support task at hand.

For example, adult children typically have long-term, internalized commitment towards their parents, but they tend to lack the technical knowledge to provide

complex tasks. These characteristics make them suitable for, for instance, tem-porary help with household tasks when the parent is ill. Should 24 hour personal care, e.g. help with bathing or toileting, be needed, then formal care providers are more suited for the task at hand. Formal care providers have received formal training that equips them with the technical knowledge to provide such tasks, and they are prepared to take on tasks requiring extended time and effort be-cause they are economically motivated.

Proponents of the specialization model argue that when state supported LTC services are more widely available, the need for family members to provide oner-ous support tasks, e.g. personal care, to relatives in need is lower. This, in turn, presumably makes family members more able and willing to provide lighter forms of support, e.g. household support. According to this model, cutbacks in services would, thus, increase pressure on family members to provide more demanding support, as a result of which their ability and willingness to provide lighter forms of support would be undermined. In other words, cutbacks yield changes in the nature, rather than in the amount of support that adult children provide.

1.2.2 Differences across categories of children

Saraceno and Keck (2011) have argued that equal division of care tasks among family members calls for so-called “decommodified defamilialization” of care, i.e.

widely available, affordable, state supported LTC services that relieve family members of the responsibility to care for relatives in need (cf. Lister, 1994). In traditionally universalistic countries, such services have become less widely avail-able over the last decades. It is plausible that the shift of care responsibilities from the state to the family will have particularly strong consequences for daugh-ters and children lacking siblings.

The pressure to live up to the expectation to be responsive to the needs of others is particularly strong for women (Aronson, 1990). A recent study by Lee and colleagues (2015) on the gendered association between employment and care-giving among middle-aged persons provides a striking illustration. The authors show that men typically provide care when their work commitments allow them to do so, whereas women only remain active in paid work as long as their caring commitments allow them to do so (cf. Dykstra & Van Putten, 2010). Aronson (1992) posits that reduced provision of state supported LTC services can create material constraints shaping women’s sense of obligation. She argues that ideolo-gies and assumptions about care as a task for women manifest themselves more strongly when alternative sources of care are less widely available. Policy reforms yielding a stronger appeal for the family to take on care tasks may thus make the

Setting the stage 9 provision of intergenerational support even more gendered (Haberkern, Schmid, and Szydlik, 2015; Schmid et al.,2012; cf. Hagestad and Dykstra,2016).

Like daughters, children without brothers or sisters are known to be relatively likely to provide support to ageing parents (Knijn & Liefbroer, 2006; Rainer &

Siedler,2012). They are also more likely than their counterparts with siblings to live close to their parents, plausibly because the pressure to do so in response to parents’ need and desire for a child living nearby is greater for them (Malmberg &

Pettersson, 2007; Rainer & Siedler, 2009). Rainer and Siedler (2012) argue that residential choice differences between only children and children with siblings are more pronounced when state supported LTC services are less widely available, because parents’ need for a child living nearby is greater in such situations. This reasoning may also apply to differences between only children and children with siblings regarding the provision of support to ageing parents.

1.2.3 Moral plausibility

Ranci and Pavolini (2015) view the ongoing reforms as an attempt to redefine the relation between the family and the state, with the former taking on more and the latter taking on fewer responsibilities for the provision of support to those in need. It has been argued that reforms are more likely to achieve their intended effects when they are morally plausible, that is, when they are in line with peo-ple’s moral beliefs (Mau, 2004; Svallfors,2010).

Two decades ago, Hochschild (1995) wrote an essay in which she described four so-called care ideals, that, according to her, “set down the basic terms of political debate about care” (p. 332). The four care ideals capture four distinct, idealtypical perceptions of how care ought to be provided. They differ on three dimensions: (1) the level of responsibility assigned to the family, (2) the level of responsibility assigned to the state and (3) the sharing of tasks between men and women in families. Looking merely at one of these dimensions – as is typically done (e.g. Deeming & Keen, 2003; Gans & Silverstein, 2006) – does not suffice to fully grasp people’s moral beliefs with regard to care. Therefore, an approach in which the three dimensions are not assessed conjointly is not suited for deter-mining the moral plausibility of LTC reforms.

The universalistic LTC model, based on the extensive provision of state sup-ported LTC services, is a manifestation of the care ideal that Hochschild (1995) labels cold-modern. People adhering to a cold-modern care ideal expect women and men to focus on a career in paid labor. They expect the state to enable this by taking full responsibility for the provision of care for those in need, making

family caregiving unnecessary. The ongoing policy reforms in traditionally uni-versalistic countries imply a move away from an LTC approach that fits with this ideal (cf. Ranci & Pavolini, 2015). This is only morally plausible if it goes hand in hand with a decline in adherence to the cold-modern care ideal.