Observation of long-term trends within countries is needed to increase insight into how policy initiatives are reflected in the use of care over time in addition to individual determinants of care use. In the past decades, Dutch care policies have favoured homecare and reduced the availability of institutional care which extended the care responsibilities of formal and informal care-givers at home. This study investigates the changes in the use of informal and formal homecare, community services and residential care among cognitively impaired older adults over time in the Netherlands. In addition, of special interest here are the associations of the presence of a spouse, other family members or social network with care use, and the interdependency between the use of different types of care. The study employs the Longitudinal Aging Study Amsterdam (LASA) covering the years 1992–2012, analysed with generalised estimating equations. The data consisted of 1,022 observations gathered from 813 respondents aged 65–85. The respondents were cognitively impaired according to the age- and education-standardised Mini-Mental State Examination score. The analyses took into account several individual determinants of care use. The use of informal care and residential care decreased while the use of formal homecare and community services remained the same. Simultaneously, the proportion of those who did not use the studied care types increased. The contribution of partners in informal care decreased. Informal care and formal homecare use increasingly became complementary services. The findings suggest that the decreases in informal care and residential care have not been replaced by other types of care, as reflected in the increased number of persons receiving no care. Care policies should not rely excessively on the availability of informal help and should guarantee adequate formal help, especially for those in high need.

This article examines to what extent the presence or absence, adequacy or inadequacy of formal services impacts on the work trajectory of caregivers to elderly relatives. The article is based on a qualitative study with 20 employed caregivers' whose elderly relatives received homecare services from one of two Montreal CLSCs: Results reveal the key role played by formal services in caregivers' attempts to juggle caregiving demands with those of their employment. They illustrate how the presence or the insufficiency of these services, their adequacy or inadequacy, combined with the other accommodations which caregivers put into place, can be determinants in caregivers' decisions to continue working and in their capacity to function well in the work place.