Care and financial support in ageing families : the changing shape of inequality

Background: Sweden is often seen as a place where older adults and their families are well supported, thanks to comprehensive social policies such as generous pensions, universal healthcare, and publicly funded old age care. These pillars of the Nordic welfare model are designed to ensure equity and relieve families of extensive care and financial responsibilities. However, recent developments such as population ageing, growing socioeconomic inequality, welfare retrenchment, and care marketisation have begun to challenge this model, potentially reshaping how support is provided and received in families. Little is known about how families are adapting to these shifts, especially when it comes to important intergenerational support, such as care for older parents and financial help to adult children and grandchildren. Although prior research has contributed valuable insights, less attention has been paid to the oldest-old, the inclusion of grandchildren, and shifts in multiple care sources over time. Moreover, families may adapt in different ways depending on their gender, social circumstances and socioeconomic position, as access to resources and capacities to provide or seek support vary.

Aim: The aim of the thesis was twofold: (1) to deepen understanding of how patterns of care and financial support within ageing families are evolving in the Swedish context, with a focus on intergenerational exchange, and (2) to explore gender and socioeconomic disparities that may both shape and result from these patterns, in light of broader societal change.

Data: This thesis addresses the knowledge gaps using nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), which includes those with the greatest care needs and allows for analysis at the parent-child dyad level, including financial support to grandchildren.

Study I: Using data from the sixth wave of SWEOLD from year 2021 and parent- child dyads, findings showed that half of the pairs had some form of support exchange. One-third involved only care from adult child to parent, 14 percent involved only financial support from older parents to adult children and/or grandchildren, and 7 percent engaged in both exchanges. Mothers were more likely to be involved than fathers in any support exchange, even after adjusting for family characteristics and geographical proximity. A higher parental social class belonging increased the likelihood of giving financial support, regardless of the child's social class. Gender differences appeared only among working-class families: fathers were least involved in any support exchanges, mothers were most likely to receive care, and sons were particularly absent from support roles. Bidirectional support was not patterned by gender or social class.

Study II: Using SWEOLD waves from the years 1992, 2002, 2011 and 2021, this study examined care trends among older adults needing support with instrumental activities of daily living (IADL). Results showed a significant decline in formal care over time, while informal care, particularly from partners, increased. Support from adult children showed no consistent trend over the period. While men were the only ones whose access to formal care remained stable, all other groups, including those most likely to need it, such as women, individuals living alone, those with greater functional limitations, and those with basic education, experienced a marked decline in informal care. By 2021, the use of privately paid care was as common as formal care, with women and those with higher education being most likely to rely on privately financed services.

Study III: Drawing on SWEOLD data from 2011, this study used parent-child dyads to examine which groups of adult children were reported to provide care, and to what extent, using a typology of care tasks ranging from personal to practical care. About one-third of adult children provided any care, mostly in the form of transportation in combination with tasks such as shopping for clothes or repairs. One in ten adult children also provided tasks such as food shopping, cleaning, cooking and bathing or showering. Gender differences in care provision appeared mainly among working-class children, where daughters provided more care tasks than sons. Overall, working-class daughters were the most active caregivers among all children regardless of of gender and social class.

Study IV: Using parental-level data from SWEOLD conducted in 2002, 2011 and 2021, this study examined the occurrence and amount of financial transfers provided by older parents to children and grandchildren. About one in four parents provided downward financial support overall, with an increasing proportion directed toward grandchildren over time. By 2021, the earlier differences between children and grandchildren as recipients of financial support were erased. No consistent gender differences were found in the likelihood of providing financial support. However, fathers' involvement declined somewhat over time, whereas mothers' contributions remained stable. Notably, mothers' contributions of larger amounts increased, unlike fathers'. Social class differences became more pronounced by 2021, with higher social classes being more likely to give any financial support and to give larger sums compared to manual workers.

Conclusion: These findings lead to three key takeaway messages. First, they show how families are adapting to a changing welfare landscape by leaning more on each other, often at the risk of negative health and social consequences, while those with greater financial means increasingly turn to private solutions. Second, as populations age and socioeconomic inequalities grow, the foundation of universal support is at risk of erosion. Third, the results highlight how disparities in family-based support, both in terms of care and finances, contribute to inequalities that are increasingly passed down across generations. Acknowledging these shifts is essential for shaping policies that ensure more equitable and sustainable support for all.

Keywords: intergenerational support, informal care, formal care, privately paid care, financial support, gender, socioeconomic inequalities, Sweden

List of scientific papers

The thesis builds upon the following studies, which are referenced in the text using their respective Roman numerals.

I. von Saenger, I., Silverstein, M., Dahlberg, L., Fritzell, J., & Lennartsson, C. Intergenerational care and financial support in families of older adults - a social inequality perspective in a Nordic Welfare State. [Manuscript]

II. von Saenger, I., Dahlberg, L., & Lennartsson, C. The changing landscape of old age care. Subgroup variations in sources of care over three decades in Sweden. [Submitted]

III. von Saenger, I., Dahlberg, L., Augustsson, E., Fritzell, J., & Lennartsson, C. (2023). Will your child take care of you in your old age? Unequal caregiving received by older parents from adult children in Sweden. European Journal of Ageing, 20(1), 8. https://doi.org/10.1007/s10433-023-00755-0

IV. von Saenger, I., Dahlberg, L., Silverstein, M., Fritzell, J., & Lennartsson, C. (2025). Gender and social class dynamics in intergenerational financial transfers among older adults: national trends over two decades in Sweden. Ageing and Society, 1-25. https://doi.org/10.1017/S0144686X24000825