In contrast with the case of health care, distributional fairness of long-term care (LTC) services in Europe has received limited attention. Given the increased relevance of LTC in the social policy agenda it is timely to evaluate the evidence on inequality and horizontal inequity by socio-economic status (SES) in the use of LTC and to identify the socio-economic factors that drive them. We address both aspects and reflect on the sensitivity of inequity estimates to adopting different definitions of legitimate drivers of care need. Using Survey of Health, Ageing and Retirement in Europe (SHARE)data collected in 2013, we analyse differences in home care utilization between community-dwelling Europeans in nine countries. We present concentration indexes and horizontal inequity indexes for each country and results from a decomposition analysis across income, care needs, household structures, education achievement and regional characteristics. We find pro-poor inequality in home care utilization but little evidence of inequity when accounting for differential care needs. Household characteristics are an important contributor to inequality, while education and geographic locations hold less explanatory power. We discuss the findings in light of the normative assumptions surrounding different definitions of need in LTC and the possible regressive implications of policies that make household structures an eligibility criterion to access services.

Unmet care needs are usually defined in terms of receiving sufficient help in instrumental activities and activities of daily living. Research on unmet needs is mostly based on quantitative data. Older persons' and informal carers' views and experiences have received less attention. In this paper, we rely on a definition of unmet needs which includes both unmet needs due to insufficient care and those situations where informal carers experience undue strain. Using theory-driven content analysis, we examine community-dwelling older adults' and their informal carers' experiences of unmet needs: what kind of unmet needs they have, why and in which ways these needs are left unmet and what would they want to do to improve the situation. The data consists of interviews gathered in Austria, Finland and Slovenia. Results of the analysis reveal that unmet needs are largely psychosocial in nature. The predominating task-oriented care systems often do not consider these as care needs. Using methods of qualitative content analysis, we conclude that care users' unmet psychosocial needs are related to lacking a personal relationship with care workers; means to maintain or develop social contacts and pursue activities and interests; and adequate home care services or respite care. Excessive responsibilities are put on informal carers as they top up and fill in the insufficient care. This study contributes to a broader understanding of unmet care needs: the relational aspects of care and the universal nature of psychosocial care needs should be addressed in care services.