Maintaining equity in social care-related quality of life amidst declining public long-term care: evidence from Denmark

Universalism has long been the cornerstone of long-term care (LTC) provision in Nordic welfare states. However, population ageing has led to a decline in public care services, prompting some service users to seek support from alternative sources, such as privately financed and informal care. This raises concerns about increasing inequities between those with access to financial and social resources and those without. We take a novel approach to examine whether reductions in public care have exacerbated inequities in a central care outcome: Social Care-Related Quality of Life (SCRQoL), assessed via the Adult Social Care Outcomes Toolkit (ASCOT). Drawing on comprehensive registry and survey data, we explore the relationship between service users’ social and financial resources and their SCRQoL. Specifically, we investigate whether disparities in SCRQoL between service users with and without resources have grown over time. Our findings reveal limited evidence for social and financial resources contributing to service users’ SCRQoL and no evidence of increasing inequity over time. These findings suggest that service users do not mobilize financial assets or family networks to compensate for retrenchment in public services. Instead, our results underline that physical functioning and social participation are crucial for sustaining SCRQoL. As pressure on public LTC services is expected to intensify over the next two decades, resource-related disparities in SCRQoL may become more pronounced, meaning that preserving and enhancing older adults’ functioning and SCRQoL through preventive strategies and reablement interventions should remain a key policy priority.