Utilisation of personal care services in Scotland: the influence of unpaid carers

Context: Unpaid carers may have an influence on the formal care utilisation of the cared for. Whether this influence is positive or negative will have important implications for the costs of formal care provision. Scotland, where personal care services are free to all individuals aged 65+, provides an interesting context in which to study this relationship. Moreover, the Scottish government is unique in its collection of administrative data on all social care clients. Objective: To investigate how the presence of an unpaid carer influences personal care use by those aged 65+ in Scotland. Methods: Two-part models (2PMs) are estimated using Scotland’s Social Care Survey (SCS) for the years 2014–2016. An instrumental variable (IV) approach is also implemented to deal with endogeneity concerns. Findings: The results suggest that unpaid care complements personal care services. In particular, the presence of an unpaid carer is associated with an increase in weekly personal care hours by 1 hour and 14 minutes per week, on average, other things being equal. Limitations: Concerns are noted surrounding the generalisability of results and lack of information available on client need and unpaid carers, arising from the very nature of conducting research using administrative data. Nevertheless, the findings are robust to a variety of sensitivity checks. Implications: Complementarity between unpaid and paid care may imply that unpaid carers are encouraging service use or demanding services on behalf of the cared for. Thus, policy interventions aimed at incentivising unpaid care could in fact lead to increased personal care costs to local authorities. Having said that, the complementary relationship might suggest that unpaid carers are being supported in their role and this might reduce pressure on formal care services longer term.