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Decreases in Swedish home help services have not resulted in increased rates of unmet need. To understand these changes, we identified predictors of home help services and rates of institutional care and how these effects changed over time using longitudinal data (1994–2000) from 286 Swedish municipalities. Outcomes were home help coverage rates, intensity of home help per recipient, and rates of institutional living. Predictors reflected availability and need for services. Services decreased over time, but not uniformly. Coverage rates were higher in municipalities with a greater proportion of population 65 and older and greater proportion of unmarried elders. Decreases in coverage rates were greater in municipalities with a higher proportion of unmarried elders, greater ratio of older women to men, with more home help staff workers, and more expensive services. Home help was provided more intensively in municipalities with higher median incomes, higher unemployment rates and municipalities spending more per inhabitant on child care. Decreases in intensity were greater in municipalities with lower proportions of unmarried elders and fewer home help staff workers. Rates of institutional living were higher in municipalities that spent more on old age services and with a greater proportion of unmarried elders. Decreases in institutionalization were greater in municipalities with a greater proportion of unmarried elders and lower ratio of older women to men. Variability in how municipalities responded to these changes may explain continued low rates of unmet need. Results are consistent with both increased efficiency and more effective targeting, but cannot capture service quality. [ABSTRACT FROM AUTHOR]

Given its relative ethnic and socio-economic homogeneity, Sweden is an ideal nation for the study of variations in formal and informal care as a function of gender, disability and advanced age. This paper reports an analysis of the relationships between gender, disability and age and the formal care delivered to more than 1,200 people aged 75 or more years in Sweden in 1994 and 2000. In municipalities that provided above-average home-help hours per recipient, and that had high institutional placement rates, women were relatively less likely to have been receiving informal assistance alone, those with greater disability were more likely to have been receiving all forms of assistance, the oldest-old were less likely to have been receiving either informal or formal help alone, and rates of formal assistance and of no informal care were relatively low. In municipalities with high rates of institutional placement, the oldest-old were relatively more likely to have been receiving both formal and informal assistance. Sweden's system of old-age care appears broadly equitable although the quality of care could not be fully assessed. Although home and community-based service provision (HCBS) has recently decreased, variations in the volume and mix of delivered formal services reflect differences in need. [ABSTRACT FROM AUTHOR]