Care Gap: The Breach of Insufficient Care

In recent decades, there has been a growing social awareness regarding the gender inequalities caused by the unequal distribution of caregiving tasks between women and men. Mothers bear a greater burden of raising children. Similarly, the care of dependent individuals also largely falls on wives, daughters, or daughters-in-law. This second shift of labor, as informal caregivers, penalizes women in the labor market: leaves of absence, glass ceilings, reduced working hours, and unequal pay for the same work ultimately result in a gender wage gap, even in the most egalitarian economies.

When care becomes professionalized, the outlook is not much more encouraging. Despite recent legal advances, in particularly feminized sectors such as domestic work and long-term care, low wages and precarious working conditions prevail, compounded by the exhausting nature of the tasks performed. The contrast with many male-dominated sectors—characterized by higher incomes, developed career paths, and social recognition—also contributes to the gender wage gap. Worse still, all this translates into reduced social protection for women, especially, though not exclusively, in the form of lower pensions.

These inequalities systematically experienced by both formal and informal caregivers are the result of the low value our society assigns to care work—a task essential to life yet often rendered invisible. Given this undervaluation, it is unsurprising that we are far from ensuring we meet the support needs of many people of all ages in their daily lives.

According to Eurostat data, in Spain, 1 in 5 people over the age of 16 and 40% of those over 65 face long-term limitations due to health issues. These limitations are severe for 10% of the older population. However, only a portion of these individuals receive any public support to help them cope. This mismatch between the care needs of the population and the public services in place to address them constitutes another breach that runs through our societies: the so-called care gap, or the breach in insufficient care received by dependent individuals.

Although it is a single concept, the care gap consists of two dimensions: one absolute, and the other relative:

• The absolute care gap refers to the complete lack of access to public long-term care services.
• The relative care gap refers to the insufficiency of the support received by those who are indeed attended to by the public care system.

According to OECD data, in our country, 15% of the population over the age of 65 receives long-term care, most of them in their homes. That percentage has doubled in just a decade, managing to surpass the OECD average—an area in which we lagged significantly not long ago. However, it still falls far short of covering all those who face limitations in their daily lives.

The gap between those who experience limitations (40% of people over 65) and those who are served by the care system (15%) highlights the existence of a significant absolute care gap in our country. Specifically, this would affect approximately 2 out of every 3 dependent individuals. At the same time, according to data from the Spanish National Institute of Statistics (INE), among those who do receive care (in this case considering both formal and informal care), at least 1 in 4 people consider it insufficient for their needs—reflecting the existence of a relative care gap as well.

When analyzing the gender dimension of these gaps, a striking phenomenon becomes evident: as expected, among people over 65, a higher percentage of women than men report facing difficulties in daily life (8 percentage points more overall and 2.5 p.p. more when considering only severe limitations). However, according to our calculations, the absolute care gap is greater for men than for women, with 3 out of 4 men experiencing regular limitations without receiving support from the Long-Term Care System. Along with potential demographic factors, the most plausible explanation for this reality is that a significant portion of them is being cared for informally by women within their family environment.

If this is the case, the gap that men face in the realm of formal care would be the other side of the gap women face in informal care. As men assume a smaller share of caregiving responsibilities for their partners or mothers when they become dependent, women are more likely to turn to public care systems than the reverse. It is, of course, good news that, in such cases, the Dependency System attends to them. Nevertheless, it is important to note that the existence, in parallel, of a relative care gap suggests that such support is insufficient to meet their needs.

In recent years, financial resources invested in the System for Autonomy and Care for Dependency have increased substantially, which has allowed for many more people to be served than before. The amounts and intensity of benefits and services provided have also improved. However, the magnitude of existing care gaps—both absolute and relative—shows that there is still a long way to go.

It is therefore urgent to continue taking steps—both financial and in terms of the intensity and quality of services—to address the profound care crisis our society is facing. Closing the gaps that affect cared-for individuals will be the best way to ensure we also close the ones suffered by their caregivers.