Complementarity, Substitution or Something Else?

My final point of engagement is also with eldercare literature on the relative, but this time with a pervasive debate in the field concerning the relationship between public eldercare and the informal care given by families. I pursue this on the following pages.

A predominant theme in eldercare research is thus the interplay between formal public eldercare and informal family care and how this distinction has changed over time.¹⁵⁶ Concurring with the historical studies presented in the beginning of the chapter, these studies find that, since the

155 Almberg et al. 1997: 109, 115; Andershed 2006: 1158, 1162-1165; Andershed & Tennestedt 2001; Eika et al. 2013;

Ekstedt et al. 2014; Ekwall et al. 2005: 23, 31;Ekwall et al. 2007: 584-585, 594; Ericson-Lidman et al. 2015: 161, 162;

Gustafsson et al. 2012; Häggström & Kihlgren 2007: 692; Haggstrom et al. 2007; Hertzberg & Ekman 2000; Jacobsen et al.

2017:1-2, 5, 8, 9, 6; Jansson et al. 2001: 805, 694; Lundh et al. 2000: 1178; Munck et al. 2008: 582, 585; Öhlén et al. 2007:

383, 386-387; Ramvi &Ueland 2017: 2; Sandberg et al. 2001.

156 Daatland 1994; 2001; Ervik 2019; Jegermalm & Sundström 2015: 187; Kröger 2005; Lewinter 2005; Rauch 2007;

Rostgaard & Szebehely 2012; Sand 2005; Szebehely & Meager 2018, Szebehely 2005: 15; Szebehely &Trydegård 2012;

Ullmanen & Szebehely 2015.

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end of World War II, eldercare in Scandinavia has been a public concern handled by formal, public, professional care workers, thus leaving only marginal responsibilities to families, but the studies also find that changes are now taking place, and that the ensuing retrenchment of public eldercare is leaving a gap to be filled by families or the market.¹⁵⁷ Central to these studies is a debate concerning what is termed ‘the substitution thesis’ and ‘the complementary thesis’, also referred to as the ‘crowding in’ or ‘crowding out’ hypothesis. The research interest of this debate is whether the availability of extensive public eldercare substitutes for or complements informal caregiving. According to the substitution thesis, formal and informal caregiving substitute each other. An inverse relationship is expected between the two, such that an increase in formal caregiving is expected to lead to a decrease in informal caregiving. According to the complementary thesis, the two types of caregiving complement and supplement each other, with an increase in the one not leading to a decrease in the other.¹⁵⁸ While some studies have argued that no clear conclusions regarding substitution or complementarity in Scandinavian countries can be drawn,¹⁵⁹ a review by Kröger (2005) of Scandinavian studies concerned with the relationship between formal and informal caregiving has found that most studies lean towards the complementary thesis, thus showing how in Scandinavia, especially in Denmark, formal and informal caregiving supplement each other.¹⁶⁰ What comes to light is that, despite extensive public eldercare, relatives give a considerable amount of care to elderly family members requiring it, and that informal caregiving is rather robust and independent of changes in the formal public caregiving system.¹⁶¹ Rostgaard (2002), however, has pointed out that studying formal and informal caregiving as two clearly separate and distinct types of caregiving is unproductive, arguing that no such clear distinction can be made and calling for an understanding that the distinction between the two is often blurred and never pre-given or stable, and that it is more accurate to talk about ‘increased plurality of welfare provision’ than to debate a one-dimensional movement away from public eldercare to informal caregiving.¹⁶²

157 Erlingsson et al. 2012: 640; Häggström & Kihlgren 2007: 691; Hegli & Foss 2009: 23; Jansson et al. 2001: 805; Kröger 2005: 251-253, 255; Rostgaard & Szebehely 2012; Sand 2005: 213, 229-230; Szebehely 2005; Szebehely & Meager 2018;

Szebehely/TemaNord 2005: 14-15, 18, 22; Szebehely & Trydegård 2012; Trydegård 2005: 143; Ullmanen & Szebehely 2015.

158 Bosang 2009; Daatland: 1994, 2001; Jegermalm & Sundström 2015: 185-186; Kröger 2005: 245-155; Motel-Klingebiel et al. 2005; Rostgaard & Szebehely 2012; Sand 2005; Szebehely 2005: 15.

159 Daatland 1994; Daatland 2001.

160 Kröger 2005: 247-250, 251-252, 255; Lewinter 2005; Sand 2005: 213, 229-230; See also Szebehely 2005: 15.

161 Kröger 2005: 246; Szebehely 2005: 15.

162 Rostgaard 2002: 57. See also Kröger 2005: 271 for a presentation of studies holding similar notions

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Before moving on, I would like to underline that I recognize that the substitution versus complementarity debate is commonly addressed as a quantitative matter of the content, scale and number of tasks performed by public eldercare and families as well as of the time spent on such. My longitudinal historical study, on the other hand, offers some additional nuances to this debate by focusing on the expectations condensed into the role of the relative over time in eldercare policy. Thus I by no means question the utility of conceptualizing substitution and complementarity when one approaches the relationship as a quantitative matter of more or fewer public services and more or less family involvement, I merely offer my findings as supplementary insights coming about exactly because of my different approach. I will demonstrate how even within the stronghold and in the prime of the Scandinavian welfare state, with my approach one can observe the role of the relative and the relationship between the relative and public eldercare to have been cast in many variations of both complementarity and substitution. Such nuances and complexity are revealed when one approach eldercare and the roles and relationships of eldercare as contingent and changing and build a story on such changes and by paying attention to how changes come about not only with relation to the welfare state model but also with every change in the function of public eldercare over time.

Moreover, I will argue that the conceptualizations of complementarity and substitution do not easily capture all the relationships of eldercare that I find over time. I will do so with a demonstration of how the relative over time has been constructed in eldercare policy as a care user itself and as an opponent, that is, as someone that neither complements or substitutes for public eldercare nor is complemented or substituted by it, but that simply receives public eldercare or hampers its function. As such, I aim to demonstrate that an approach based on the expectations constructed for the relative and the relationship between the relative and public eldercare in eldercare policy over time produces a picture that more closely resembles a welfare mix, as suggested by Rostgaard. In particular, I propose that the partner role and partnership relationship I identify in the last decade challenges the explanatory power of such conceptualization. With the partner role, the conceptualization falls short: there is no stable ground on which to judge complementarity or substitution, for what care is, what the relative is and what relationship to expect between the relative and public eldercare are constantly up for renegotiation. Importantly, I cannot make any conclusions here about whether the partnership also challenges the conceptualization when approached quantitatively. It is beyond the scope of this thesis to determine whether the partnership can also be counted and measured as a

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complex allocation of efforts and responsibility differing on the basis of each care interaction.

I merely suggest that this could be a relevant theme for further research.