By Ursula Henz (London School of Economics and Political Science) and Michael Wagner (University of Cologne)

This post highlights new research on how people aged 80 and over in Germany and England access care. It shows how wealth, income, education, and national care systems shape access to formal and informal help —and how these dynamics shift as care needs grow more intense, drawing on rich new data from both countries.

What Inspired Our Research

In ageing societies, more people than ever are reaching 80 and beyond. This achievement comes with new challenges. This age group often faces high and persistent care needs yet tends to receive relatively little focused attention in research and policy discussions.

Our study was driven . Many people aged 80 and older live alone or with a spouse of similar age. Although the majority of older people have children,  g . This makes people aged 80+ particularly reliant on formal care systems — services that are themselves under pressure.

At the same time, we’ve long been interested in social inequalities. Past studies have shown mixed findings about whether or not better-off individuals are more likely to receive care. But rarely have studies looked specifically at people aged 80 and over, or considered how intensity of care needs might change the patterns we observe. This gap was the starting point for our work.

Our Approach: a Comparative Lens

To explore these issues, we focused on people aged 80 and over who had care needs. We analysed data from two rich sources: the English Longitudinal Study of Ageing (ELSA) and the NRW80+ study from Germany. These datasets allowed us to compare two distinct care regimes:

• England: A means-tested system where public support is limited to those below a financial threshold.
• Germany: A universal insurance-based model offering both in-kind services and flexible cash benefits.

Crucially, we considered the intensity of care needs, hypothesising that socioeconomic status (SES ) differences might play out differently for people with a few needs versus those requiring substantial daily support. And that’s exactly what we found.

Key Findings

• Socioeconomic Status Inequality Emerges When Needs Are Low

Among those with lower care needs, wealthier and more educated individuals were more likely to go without any care compared to those with lower wealth or education. In both countries, people with lower SES were more likely to receive informal support, which might reflect differences in values and closeness of family ties. However, better-off individuals did not make up for this lack of care by greater use of formal care. We suggest that the reason could be a greater ability to cope alone (with better housing, equipment, or paid solutions outside of “care”) among high-SES individuals.

• High Needs Change the Game — But Differently in Each Country

Among people with many care needs, national context mattered:

• • In Germany, higher SES was linked to greater use of formal care, while lower SES individuals leaned more on informal help — a pattern possibly shaped by Germany’s flexible cash-benefit system.
  • In England, SES differences largely disappeared. When care needs were high, most people — regardless of background — seemed to access whatever help was available. Public services stepped in for those who passed the means test, and those above the wealth threshold purchased care privately. However, overall use of formal care remained lower than in Germany.

• Unmet Needs Persist, Especially for the Affluent with Low Needs

Surprisingly, unmet care needs were not confined to disadvantaged groups. In both countries, individuals with higher education were more likely to report receiving no help despite needing it—especially when their needs were mild. This challenges the assumption that vulnerability in old age is solely a function of economic disadvantage.

Policy Implications

Our findings underscore the need for more nuanced care policies that reflect the complexity of later-life care:

• Don’t ignore the oldest old: Policy and research must address the specific needs of this group, especially those living alone.
• Intensity matters: One-size-fits-all assumptions about inequality in care use don’t hold. Patterns change as needs increase.
• Mind the middle: Some people with savings above the public care threshold may not be wealthy enough to buy private care, leaving some without any care in England.
• Cash vs. services: Germany’s cash-based system seems to promote flexibility but may also increase inequality in who provides care. In contrast, England’s targeted services may better reach those with higher needs, but at the cost of wider coverage.

Looking Ahead

As societies continue to age, we need to better understand and address care inequalities among the oldest-old .  Future research should explore not just whether care is received—but whether it is adequate.

You can find more details about the research in the article on “Socio-economic Differences in Receiving Care by the Over-80s in Germany and England: Intensity of care needs as a moderator”.