As the population ages rapidly, the UK is facing a social care crisis. Understanding how unmet care needs vary across different social groups is critical to tackling care-related inequalities and improving the planning of social care services. Current efforts largely focus on individuals in need of care, often overlooking the important role that spouses and households play in caregiving. In this article, Dr Jingwen Zhang outlines research from The University of Manchester examining how spouses’ characteristics influence an individual’s experience of unmet care needs, how the relationship differs by gender, and how policymakers can design more effective and comprehensive care support packages in response. 

• It was estimated that 2 million older people in England have some unmet need for social care. 

• Having a spouse with poorer health increased the risk of unmet care needs. Men were more likely to have unmet care needs if their spouses worked.  

• To effectively address unmet care needs and provide better support for those requiring care, it is essential to view couples as a unit and to incorporate a gender-sensitive approach when designing intervention programmes. 

What is an unmet care need? 

Unmet care needs refer to the gap between a person’s care needs and the actual support they receive, both in terms of quantity and quality, as well as their perspectives on how satisfactory that support is. People with unmet care needs have been found to have higher increased risks of hospitalisation, mortality, and depression. Therefore, it is important for policymakers and local authorities to understand who are at risk of unmet needs to provide more targeted support.  

There are two common approaches to measure unmet care needs. The objective approach focuses on the absence of support, defining unmet needs as having care needs but receiving no support. The subjective approach gauges the inadequacy of support, defines unmet needs as the perception that the care received does not fully meet their requirements.  

Applying both approaches can offer a more comprehensive evaluation of different forms and levels of unmet needs. 

Gendered patterns of unmet care needs 

Research led by The University of Manchester wit heterosexual couples shows that women reported more subjective unmet care needs, while men reported more objective ones. The proportion of women with subjective unmet needs was 30.7%, which is higher than that of men (24.1%).  

However, the gendered patterns were the opposite for objective measures. The proportions of men reporting unmet needs were 8 percent points higher than those of women with some care needs.  

This pattern may be associated with gender norms and masculine ideals, which can assume and encourage men to be self-reliant and emotionally and physically strong.  

Spouses’ characteristics, spousal relationships and unmet care needs 

Spouse’s functional health (the ability to participate in basic self-care tasks, such as bathing and dressing) emerge as a significant predictor of unmet care needs.  

This might be related to the fact that people with poor physical health may struggle to perform essential care tasks, thus failing to meet the needs of their spouse. Additionally, spouse’s mental health status is associated with the adequacy of care received. Previous studies from the US have indicated that depression in a spouse can weaken the social support necessary for effective caregiving and may lead to potentially harmful caregiving behaviours.  

Employed women had a higher likelihood of having spouses with unmet care needs whilst this was not found among men. This disparity may be due to different gendered caregiving roles and tasks typically assumed by women and men. With women more likely to be involved in personal care, whilst men are more likely to take a managerial role to coordinate care resources. 

The study also found spousal relationships were significantly associated with unmet care needs. Specifically, women having closer relationships with spouses reported fewer unmet care needs, highlighting the importance of mutuality and relationship quality in effective caregiving.  

These findings highlight that it is important for policymakers and practitioners to consider the relationship between individuals in need of care and their spouses when addressing unmet care needs. To more effectively identify those with unmet needs, it is crucial to develop an approach which considers both spousal and household characteristics in addition to individual’s characteristics. 

Recommendations for policy, support and intervention 

The Department of Health and Social Care can support the NHS and social care providers with legislation and measures to guide how care interventions are developed and delivered. 

To enhance support for those who need care, policymakers should implement strategies to ensure that support packages target the couple or the household as a whole, rather than just the individual requiring care. Support should be prioritised when their spouses are physically incapable of providing quality care.  

The University of Manchester research observed gender differences associated with unmet care needs. This suggests that social norms shape expectations regarding spousal care and caregiving responsibilities assumed by men and women across the life course. When developing interventions for care recipients and their spouses, these gender differences should be considered and embedded into policy frameworks. 

Furthermore, this study provides insights for practitioners and researchers in assessing unmet care needs among middle-aged and older people. Currently, the objective approach is more commonly adopted in care needs assessment. However, it is also important to capture the subjective unmet needs (such as self-evaluation of the sufficiency of care) to comprehensively identify unmet care needs that affect people’s well-being and quality of life.  

The government has pledged within its missions to reform social care and implement reforms to create a National Care Service. ‘Home first’ principles of encouraging people to live at home for as long as possible are integral to this. In order to underpin the success of this approach, policymakers need to devise and enact strategies that minimise unmet care needs. By taking steps to develop care packages that target whole households, being mindful of gendered approaches and applying both subjective and objective approaches as part of the assessment process, policymakers can work towards this mission.