Unmet need, under-met need and public financing of home care in England

Abstract Despite the recognized importance of older adults ageing in their own homes, the role of public financing in mitigating unmet and under-met home care needs remains under-explored. This study addresses this gap by examining the impact of public financing on home care adequacy among English adults aged over 50, utilizing data from waves 6–9 (2013–2019) of the English Longitudinal Study of Ageing. Longitudinal fixed effects and pooled cross-sectional modelling are used to explore the impact of public financing of home care on the unmet and under-met needs of older people. Findings show that individuals with greater limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), as well as those experiencing cognitive decline, are more likely to receive home care. Importantly, while receipt of publicly financed care is associated with a reduction in unmet needs, it does not necessarily translate to fully met needs, resulting in under-met need and highlighting a crucial distinction between access to and adequacy of care. Comparatively, transitioning from use of publicly financed home care to exclusively informal care is linked with lower odds of reporting under-met needs, suggesting variance in the quality of care provided across funding types. This study not only enriches the existing literature by describing the specific impact of different home care financing mechanisms (publicly financed care versus other types of care) on the unmet and under-met needs of older adults but also underscores the need for policies that ensure care adequacy, not just accessibility.