Schouwenaar, C., Koning, P., Krabbe-Alkemade, Y., Lindeboom, M. and Portrait, F.R.M. (2026). Long-Term Care at Advanced Ages: The Effect of Spousal Bereavement on Institutional Care Needs Health Economics, 35(1):118--134.

With populations aging, long-term care (LTC) needs and costs rise, intensifying the reliance on informal care. Since spouses predominantly provide such care, it is crucial to understand the transition dynamics from widowhood to institutional LTC, which is the main driver of the public LTC costs in most OECD countries. Our study examines the causal effect of widowhood on the onset of needs for institutional LTC. For this we use recently developed event-time models that accommodate for variation in treatment time and dynamic effects of treatment. Our results show that partner loss significantly increases the need for institutional LTC. The average effect of partner loss on the need for institutional LTC peaks at a 1.5 percentage point rise 3 months after widowhood and disappears after 10 months. The effect is strongest for individuals with psycho-geriatric disorders, the oldest old and the frail. Addressing the immediate need for institutional LTC after widowhood remains critical for effective aging-in-place strategies.