Informal care substitution: what we don't know can hurt us

Empirical studies focusing on the relationship between formal and informal home care do little to quell the fears of policymakers that expanded access to public home care services will result in the withdrawal of informal support. A close examination of the studies designed to measure the withdrawal of informal support justifies this skepticism. Concerns about the withdrawal of informal care may hinder the introduction of more extensive home care benefits. Researchers have come some distance in trying to address this policy question. The conflicting nature of empirical findings, thus far, demonstrates that the answer depends heavily on how the question is framed, how home care is measured and over what time frame, and what sorts of analytic approaches are used to model the relationship between formal and informal community-based care. This article discusses these issues in greater detail and suggests strategies to address these problems in future research.