This study examined preferences for LTC financing models among unorganized caregivers in Ghana who simultaneously provide and finance care for older adults. It explored how these preferences vary with the intensity of caregiving tasks, personal care, household support, mobility or errand support, and emotional support, and how caregiver beliefs, relationships with care recipients, and income levels shape these preferences. Given the cross-sectional nature of the data, the findings should be interpreted as associations rather than causal relationships, as reverse causality and unobserved factors cannot be ruled out.
A key finding of this study is that caregivers who provided more intensive personal care were more likely to prefer insurance-based LTC financing. Personal care tasks, such as bathing, feeding, and assisting with daily living, are typically the most physically and emotionally demanding aspects of caregiving. In the Ghanaian context, where formal long-term care systems remain limited and families bear most caregiving responsibilities, caregivers providing intensive personal care may view insurance-based mechanisms as a potential strategy to mitigate the financial risks associated with prolonged care needs.
This finding aligns with evidence from recent Ghanaian studies showing that intensive caregiving, particularly in cases of dementia, can lead to significant financial strain and emotional burnout19. Insurance-based models may therefore be perceived as a way to spread the financial burden of care across a broader risk pool. Interaction results further suggest that this association was stronger among higher-income caregivers. This may reflect the higher opportunity costs of caregiving among wealthier individuals as well as their greater financial capacity to contribute to insurance premiums. Prior studies have similarly shown that private insurance uptake in Ghana tends to be concentrated among wealthier populations who are better positioned to navigate formal financial systems1.
Interestingly, caregivers who reported health deterioration due to caregiving were also more likely to prefer LTC insurance. This supports previous findings that caregivers experiencing physical or mental health decline may be more inclined to seek financial protection mechanisms, such as insurance, to mitigate the long-term implications of caregiving burdens5.
In contrast, caregivers who spent more time providing household support were less likely to prefer tax-financed LTC models. Household support tasks, including cooking, cleaning, and other domestic chores, are often culturally normalized in Ghana and may not be perceived as burdensome enough to justify formal public intervention.
This finding is consistent with earlier research suggesting that domestic caregiving tasks are strongly embedded within traditional gender roles, particularly among women (Mba, 2010)20. As a result, these activities may be viewed as routine household obligations rather than forms of care requiring institutional support. Moreover, a study using WHO SAGE data shows that poor living conditions, including unimproved cooking and sanitation facilities, are associated with increased LTC needs in Ghana21. Despite these structural challenges, caregivers may still perceive household tasks as part of ordinary family life rather than as care responsibilities warranting public financing.
The interaction analysis further showed that both low- and high-income caregivers were less likely to support tax-based LTC financing as their personal and household caregiving intensity increased, with the effect being stronger among low-income caregivers. This may reflect broader concerns about the effectiveness and reliability of public welfare programs in Ghana, where low tax compliance and perceptions of inefficiency in government service delivery often shape attitudes toward publicly funded programs22.
Another important finding is that caregivers who provided more emotional support were more likely to prefer tax-financed LTC models. Emotional caregiving, such as companionship, reassurance, and psychological support, is often less visible than physical caregiving but plays a crucial role in maintaining the well-being of older adults.
In Ghana’s extended family system, emotional caregiving is culturally expected but frequently underrecognized in formal policy discussions. As caregivers face increasing social and economic pressures, publicly funded support mechanisms may be perceived as necessary to sustain long-term caregiving roles. This is particularly relevant given the limited availability of mental health and psychosocial support services in Ghana23.
Interaction results provide further insight into this pattern. Caregivers engaged in high levels of emotional support expressed stronger support for tax-financed LTC regardless of income level, suggesting that emotional caregiving may be widely perceived as a collective societal concern. Among caregivers who believed that caregiving should be the government’s responsibility, support for tax-financed models increased markedly with emotional caregiving burden, particularly among higher-income caregivers. This finding echoes international evidence that emotional caregiving demands are associated with increased use of publicly funded services24.
Notably, caregivers providing emotional support to parents consistently favored tax-financed LTC regardless of income. Filial caregiving relationships are often characterized by strong emotional bonds and heightened psychological strain25. In Ghana, where life expectancy is increasing and formal psychosocial support services remain limited, adult children caring for ageing parents may be particularly supportive of state involvement when emotional caregiving becomes prolonged or demanding26,27.
Caregivers’ beliefs about caregiving responsibility emerged as a key factor shaping financing preferences. Caregivers who believed that caregiving should remain primarily a family responsibility were consistently less supportive of both insurance- and tax-financed LTC models. This finding reflects the strong cultural norm of familialism in Ghana, where caring for older relatives is often considered a moral and kinship obligation28.
However, these beliefs interacted with socioeconomic circumstances in important ways. Among caregivers who believed in family responsibility but had higher incomes, increasing personal care intensity was associated with greater support for insurance-based financing. This suggests that some caregivers may seek ways to reconcile cultural expectations with the financial realities of intensive caregiving by supporting financing mechanisms that complement rather than replace family care. Policy efforts aimed at developing long-term care financing mechanisms in Ghana should be sensitive to prevailing beliefs surrounding family responsibility. Communication strategies and co-designed interventions with communities could frame LTC insurance not as a replacement for family care but as a complementary mechanism that enables families to sustain caregiving responsibilities and honor older relatives by ensuring reliable and dignified care.
The caregiver-recipient relationship also played an important role in shaping financing preferences. Caregivers supporting parents or spouses were more likely to prefer insurance-based LTC financing, possibly reflecting both the intensity of these relationships and the long-term financial implications of caring for close family members. While caring for elderly parents remains a deeply embedded cultural expectation in Ghana, growing financial and emotional pressures on middle-aged caregivers may be increasing openness to formal support mechanisms29.
Finally, several demographic factors also influenced financing preferences. Age was negatively associated with preference for insurance-based LTC models, possibly reflecting reduced perceived benefits from long-term financial instruments among older caregivers and stronger adherence to traditional family-based care arrangements. Marital status was positively associated with preference for LTC insurance, perhaps reflecting greater long-term financial planning among married individuals and the desire to protect spouses from caregiving burdens in later life30.
Contrary to expectations, higher income was associated with a lower overall preference for LTC insurance. One possible explanation is that wealthier households may rely more on privately arranged care, such as paid domestic workers or other informal arrangements, thereby reducing perceived reliance on pooled-risk financing systems. However, the present dataset does not include variables capturing the use of paid care services or broader measures of household wealth, limiting the ability to empirically test these mechanisms. Future research should therefore examine how private care arrangements, wealth, and insurance literacy shape LTC financing preferences in Ghana.
Employment status, on the other hand, was positively associated with preference for insurance-based LTC financing. This may reflect higher opportunity costs among working caregivers who must balance employment with caregiving responsibilities. Familiarity with insurance mechanisms through formal employment benefits or pension systems may also make insurance-based LTC financing more attractive to employed caregivers31.
The findings also contribute to emerging discussions on the care economy in Ghana. Unorganized caregivers provide substantial unpaid labor that supports the functioning of health and social systems, yet this contribution remains largely unrecognized in policy and financing frameworks. The observed associations between caregiving intensity and financing preferences highlight the economic pressures experienced by caregivers who simultaneously provide and finance care. As Ghana’s population ages, strengthening LTC financing mechanisms will be critical not only for improving the well-being of older adults but also for sustaining informal caregiving within the broader care economy.
The predominance of female caregivers in the sample reflects the gendered nature of caregiving in Ghana and many other low- and middle-income countries. Women continue to shoulder a disproportionate share of unpaid caregiving responsibilities, often balancing these roles with income-generating activities and other household duties. This imbalance has important implications for labor market participation, financial security, and well-being. Policies aimed at strengthening long-term care systems in Ghana should therefore adopt gender-sensitive approaches that recognize and support the contributions of women caregivers while addressing the unequal distribution of unpaid care work.
Although this study focuses on Ghana, the findings also contribute to broader global discussions on long-term care financing in low- and middle-income countries, where rapid population ageing is occurring in contexts characterized by limited formal care systems and strong reliance on family caregiving.
The findings carry several implications for the development of long-term care systems in Ghana. First, the association between intensive personal caregiving and support for insurance-based financing suggests that caregivers facing higher care demands may be more receptive to contributory LTC insurance schemes. Second, the role of cultural beliefs about family responsibility highlights the need for policy approaches that complement rather than replace existing familial caregiving traditions. Finally, the observed income differences in financing preferences suggest that equitable LTC systems may require mixed financing models that combine contributory insurance mechanisms with targeted public support for lower-income households.
These findings should also be interpreted within Ghana’s broader social protection landscape. Existing schemes such as the National Health Insurance Scheme and pension programmes administered by the Social Security and National Insurance Trust provide important foundations for financial protection in health and old age but do not currently cover long-term care needs. As Ghana’s population ages, integrating LTC financing mechanisms within these existing structures could provide a feasible policy pathway. For instance, contributory LTC insurance schemes could potentially be linked to existing social insurance platforms, while tax-funded community care services could complement current social protection programmes targeting vulnerable older adults.
This study employed a quantitative design to assess LTC financing preferences among caregivers in Ghana, which represents one of its key strengths. The approach enhanced generalizability across a broad sample, enabled subgroup comparisons, and generated policy-relevant quantitative evidence. However, one limitation is that the dependent variable measuring LTC financing preference was based on a single survey item with three response options (family/self, LTC insurance, and tax financing), which may limit measurement precision. In particular, the category “LTC insurance (private and social)” combines conceptually distinct financing arrangements that respondents may have interpreted differently, potentially introducing heterogeneity in responses. Although brief explanations of financing options were provided, they may not have fully standardized respondents’ understanding of key features such as premiums, eligibility, or coverage scope. Consequently, variation in interpretation could affect response validity and should be considered when interpreting the findings.
Another limitation is the absence of a qualitative component, which restricts the ability to explore the deeper motivations, beliefs, and meanings underlying these preferences. As a result, the study provides limited insight into the contextual and experiential perspectives of caregivers and care recipients. Future research should adopt mixed-method approaches that integrate both quantitative and qualitative techniques to provide a more comprehensive understanding of LTC financing preferences.
Additionally, the study did not include variables capturing the use of paid domestic help, household wealth, or respondents’ understanding of long-term care insurance. This limits the ability to examine potential mechanisms underlying the observed income-related differences in financing preferences. Furthermore, the study focused exclusively on caregivers who both provided hands-on care and contributed financially to care expenses. By excluding caregivers who provide only time-based support, the study narrows its generalizability. Including this group might yield different insights; for example, time-only caregivers may prioritize respite services or care provision rather than financing mechanisms. As such, the findings primarily reflect the perspectives of dual-role caregivers, and future research should incorporate diverse caregiver types to provide a more comprehensive picture of LTC financing preferences.
While the findings provide important insights into caregivers’ preferences for long-term care financing in Ghana, they should be interpreted as associations rather than causal relationships, given the cross-sectional nature of the data. The policy implications should therefore be viewed as indicative rather than definitive and considered alongside the study’s limitations. Future research should build on these findings through mixed-methods studies that explore the motivations and contextual factors shaping caregivers’ financing preferences. Also, key variables such as caregiving hours and health impacts were self-reported and may therefore be subject to recall or reporting bias. In addition, discrete choice experiments could help assess caregivers’ willingness to pay for different long-term care financing options, while pilot testing alternative LTC financing models would provide valuable evidence on the feasibility and acceptability of such schemes in Ghana.
Overall, the findings point to the potential value of a mixed LTC financing model that combines contributory insurance mechanisms with targeted public support while also strengthening caregiver support programmes and community-based services to ensure sustainable care provision in the context of population ageing.
In considering the development of formalized LTC financing in the future, these findings suggest several practical policy directions for strengthening long-term care systems in Ghana. First, policymakers could consider piloting contributory LTC insurance schemes targeting caregivers who simultaneously provide and finance care for older adults. Second, caregiver education on available LTC financing options could be embedded within community health programmes to improve awareness and understanding of financing mechanisms. Finally, including caregiver representatives in the design and development of LTC policies could help ensure that emerging financing models reflect the lived experiences and needs of those most directly involved in caregiving.