A stepping-stone towards sustainable long-term care in Europe

Europe is experiencing a major demographic shift toward an ageing population, driven by longer life expectancy and declining fertility. This transformation has prompted policy reforms across the continent, reducing institutional care while increasing reliance on informal caregiving. While aimed at easing financial pressures and meeting rising care demands, this shift burdens informal caregivers, leading to health and economic repercussions. Meanwhile, future demand for informal care remains uncertain, raising further concerns about the long-term sustainability of European long-term care (LTC) systems.

This PhD thesis examines the externalities of informal care on caregivers’ health, time, and employment, assesses their broader implications, and projects future demand for this essential care. To this end, we conducted a multinational survey on informal caregiving across eight European countries—Germany, Greece, Ireland, Italy, the Netherlands, Poland, Sweden, and the UK. Using these data, we investigated how caregiving relates to caregivers’ health and labour market outcomes. We found significant associations between caregiving and poorer health, reduced work hours, and lower productivity, with variations across countries, individual characteristics, and contextual factors.

Next, using nationally representative data, we applied state-of-the-art methods to estimate the societal costs of informal care in the Netherlands in 2019. Our findings revealed substantial costs, primarily in the form of time and productivity losses, amounting to 2.15%–3.71% of Dutch GDP—comparable to public LTC spending. Finally, leveraging SHARE survey data, we projected a universal increase in informal care demand among individuals aged 50+, alongside a trend of care provision towards older recipients with greater dependency.

Dissertation: https://hdl.handle.net/11370/b70a6003-ad2e-44c6-92c2-19c2a92ee96f