Changes in population and family structures are altering the provision of care for dependent older people. In Southern European countries like Spain, such care is still largely provided by family, typically spouses and adult daughters. However, an increasing proportion of women have entered the labour force, thereby affecting their availability. To study the demand and supply balance of informal care and to quantify the need for formal care when there is a deficit, we have developed a mixed microsimulation–agent-based model (ABM). Based on nuptiality, fertility and mortality levels of cohorts born at ten-year intervals between 1908 and 1968, the model starts with a microsimulation of the lifecycle of individuals and their close relatives until death. The ABM then determines the amount of time available or needed to care for family members, starting from age 50. Estimates are derived from Spanish survey data on employment, disability and time of care received. Surprisingly, results show that the family care deficit was greater in the older cohorts due to higher mortality and thus a greater impact of widowhood. However, for future elderly persons, we foresee that persistent below-replacement fertility and, paradoxically, the prolongation of the lifespan of couples will increase the demand for formal care as there will be more couples with both members incapacitated but without children to take care of them.

This article deals with old-age care facilities in Poland which are aimed at people from Germany. These facilities emerge against the background of severe criticism of old-age care facilities in Germany. The media projects a widespread use of these facilities, claiming this is mainly due to the lower costs as compared to Germany. Against the backdrop of normative discussions about old-age care in Germany, doubts about a widespread use of facilities abroad may arise. Indeed, we will show that in quantitative terms, the facilities in Poland are a marginal phenomenon. Drawing on neo-institutional organisation theories, we demonstrate that the facilities face legitimisation challenges that consist of being able to align with the socially shared values and norms of old-age care in Germany to position themselves as a legitimate option. We analyse whether and how the facilities deal with these challenges. We particularly focus on the only facility we found that has a substantial number of residents from Germany. We show how the facility takes on the legitimation challenge by its motto ‘Just like in Germany – only better’, while other facilities position themselves as ‘low-cost facilities for people from Germany’. The low take-up of the latter indicates that low prices alone do not attract a substantial number of residents from Germany into the facilities.

Old-age care has frequently been conceptualised as being either family-based or publicly-provided. This article analyses the overlap in provision from the two sources and their relationship in the Swedish welfare state. Many older people and their carers rely on both sources of help rather than on just one, and prefer to do so. The empirical evidence on patterns of care in Sweden supports a joint family-state conceptualisation of care. Its realisation may depend on general coverage rates of public services and the efficient targeting of frail elderly people who live alone. Most older people in need of care rely on help only from their family, but many are helped by both the family and the state, particularly those with the greatest needs. Dynamic concepts like ‘substitution’ and ‘complementarity’ are hard to apply in cross-sectional studies: there may be complementarity in individual cases but long-term substitution or its reversal in successive cohorts. Yet again, both sources of care may increase simultaneously in individual cases. The need for care varies considerably among Swedish municipalities, with implications for the levels of both public services and family support. High coverage rates of the public services may facilitate and support family care.

Substitution among the providers of old-age care has usually meant a process whereby the state ‘takes over’ what families used to do, but during the 1980s and 1990s, both home help and institutional care were cut back substantially in Sweden as elsewhere. Comparable, nationally representative surveys in Sweden of the provision of care for older people living in the community enable analysis of the effects of these cutbacks on the sources and patterns of care. It emerges that increased inputs from families match the decline of public services, that is, a ‘reverse’ substitution has recently been taking place. Local studies, of older people who have been followed over time as the provision of home help has changed, support these conclusions. Of the increased informal care, most has been provided by daughters, but sons have also contributed. A problematic aspect of these shifting patterns of care is that an increasing number of family carers with increasingly heavy care commitments are now without formal or informal support, whereas in the recent past many could expect their responsibilities to be shared with the state. The evidence from this study also calls into question common metaphors and assumptions about the assumed interdependence between informal care and public services for older people, and challenges the so-called substitution thesis.

The aim of this article is to illustrate the changes in the Swedish system of old-age care during the 20th century by tracing and analysing the history of the job of supervisor or manager of this care. The main sources that have been researched are public and educational documents as well as articles from the occupation's professional journal. Development through different periods is described. During the first decades of the century, supervisors had a controlling function in strictly disciplined poor-relief institutions. The period 1920–1950 was dominated by a strong belief in institution-based old-age care, and the supervisor's role had a variety of profiles, e.g. matrons of home-like institutions, geriatric nurses, and manageresses of increasing numbers of care-staff. The decades 1950–1980, were characterised by expansion and new arenas, chiefly the home-help services. In the 1990s, with a strained public economy, the financial control became a central feature of the work of the managers. Finally, some of the changes and trends are analysed and discussed.

In both Spain and Sweden the most important public support for older people that is provided in their own homes are home-help services. In Sweden, these programmes were expanded in years of economic growth but recently have radically declined. Spain still strives to expand them in spite of financial problems. Both countries ration these services but in different ways. Spain provides relatively few hours of help with household tasks, primarily to poor old people. At present, one to two per cent of the 65-plus population is covered. Local government is still trying to reach more people to relieve pressure on limited institutional care. Sweden continues to cut down the service from the present coverage of nine per cent of the 65-plus population. It is focusing on the oldest and frailest people of all social classes who live alone. It is gradually being transformed into home health care. Institutional care has not been cut back to the same degree. Spain uses strict needs assessments and eligibility criteria to target clients. Sweden has sharpened its needs assessments and raised fees to discourage users with lesser needs.