The Interface Between Health and Social Services and Family Caregivers In the current debate over healthcare reform, an unresolved issue is Long Term-care coverage—whether it will be included in a reform package, and if so, to what extent, or whether deficit reduction and other economic considerations will make its cost prohibitive. Despite the uncertainty, extensive lobbying efforts continue to advocate linking acute and Long Term care in a reform package, and a number of plans to this effect have been proposed. The paradox is that while families currently are the unpaid yeomen of Long Term care and cost containment is a chief goal in healthcare reform, most plans ignore or give relatively little attention to the role of family caregivers. Read more
The Influence of a Diagnosed Mental Impairment on Family Caregiver Strain This study examines whether a diagnosis of mental impairment of a care recipient influences the strain of family caregiving. Two competing hypotheses, derived from labeling theory, provide alternative views. One posits that a diagnosis reduces strain by linking problematic characteristics of care recipients' impairment to an illness. The competing hypothesis suggests that a diagnosis increases strain by reifying the existence of a progressive chronic condition. LISREL analysis with data from a sample of 576 primary caregivers shows that the diagnosis has an important effect, but this influence varies for different types of strain. Relationship strain and restrictions in social activities are increased for caregivers of diagnosed care recipients. Functional impairment also causes a greater restriction of social activities when a diagnosis has been made. A different pattern emerges for depression, with caregivers in the diagnosed group being less depressed and less negatively affected by care recipients' impaired ability for social interaction, but more depressed by disruptive behavior and functional impairment. Read more
Relationships Between the Frail Elderly’s Informal and Formal Helpers Gerontologists have had a long-standing interest in the elderly’s social relationships and social support, particularly their integration in the family system and intergenerational exchanges. With the increasing number of chronically disabled aged, a substantial amount of recent gerontological research has focused on vulnerable or frail elderly and their use of assistance. Much of this research is confined to care by immediate family members (spouses and adult children), leading some to argue that caregiving research is characterized by an “ideology of intimacy” (Krause, 1990; Lee, 1985). This restricted focus detracts from the importance of other informal helpers, such as siblings, friends, and neighbors, and of formal service providers as the frail elderly’s caregivers (Krause, 1990; Penning, 1990). Read more
Differences in Service Attitudes and Experiences Among Families Using Three Types of Support Services One goal of support services for family members of Alzheimer's patients is to facilitate the use of other formal services. Few existing studies empirically test the relationship between support service use and the use of other community or residential services. This research describes the relationship between support and other service use by comparing families who used three types of support services: • Information and referral • Educational programs; and • Support groups. Data from in-person interviews with 127 family caregivers showed that families who used one of the three support services differed in the use of other services, service attitudes, past service experiences, and reasons for support service use. Results profile the characteristics of families who turn to different types of support services and illustrate the importance of past service characteristics for explaining current and future utilization. Information and referral (I & R), educational programs, and support groups are commonly provided support services for family members of Alzheimer's disease victims. These three support services share the common goal of facilitating and encouraging the use of other formal services for Alzheimer patients and their family members. Despite this goal, research on support services has seldom considered whether their use is related to the use of other services. Read more
Predictors of the Use of Respite Services by Caregivers of Alzheimer’s Patients Racial and Generational Differences This research applies one prominent model of service utilization (the Andersen Newman Model) to better understand the way in which family care givers utilize respite services when caring for older relatives. Specifically, this research examines racial (black and white) and generational (spouse and adult-child) differences between caregivers of Alzheimer's patients and the volume and type of respite services used. The sample (N= 359) is drawn from six Northeast Ohio programs in a consortium that uses a personal computer-based information system to collect intake, assessment, service use, and program satisfaction data from respite clients. Racial differences are found in client attrition and turnover. Results also show adult-child caregivers are the greatest users of day care. These generational differences persist despite the similarities in patient and caregiver need. Fee subsidy and relationship strain between the caregiver and elder predict the amount of service used. Findings suggest that practitioners need to take into account racial and generational factors in addition to traditional patient and caregiver needs when formulating care plans. Read more
Predictors of In-Home and Out-Of-Home Service Use By Family Caregivers of Alzheimer’s Disease Patients Few studies have examined whether the use of different types of services is predicted by different characteristics of elderly care recipients and primary kin caregivers. Most research aggregates services into a single category, thereby assuming that different services have the same predictors. This investigation differs from the aggregation approach by comparing four groups of elderly care recipients: in-home service of users, out-of-home service users, users of both in- and out-of-home services, and those who do not use services. Data come from personal interviews with 171 family caregivers of mild to moderate dementia patients who reside in the community. Using the modified Andersen framework and multiple group discriminant analysis, results show that care recipients who do not use services and those using only in-home services have inadequate informal supports, more emotionally strained caregivers, and more functionally impaired care recipients compared with users of out-of-home or both in- and out-of-home services. Read more
Respite Use and Caregiver Well-Being in Families Caring for Stable and Declining AD Patients The current controversy about respite's value centers on consistent reports of no significant reduction in caregiver strain with respite service use. In this study one explanation for the inability of prior research to document respite's impact is offered. This research demonstrates that respite may well reduce depression, reported health problems and family relationship strain in families caring for stable AD patients and may stabilize caregiver strain in families of declining AD patients. Read more
Involvement of Elders in Care-Related Decision A Black/White Comparison This research uses data from 244 family caregivers to examine racial differences in the composition of care-related decision-making networks. Analyses reveal blacks are significantly less likely to identify the older care recipient as involved or as the key decision maker when compared to whites. The older individual's physical and mental impairments are also important predictors of the involvement in decision making. Discussion addresses sensitivity to racial differences and elder cognitive capacity in assessing older individual decision-making involvement. Read more
The Influence of Caregiving and Bereavement Support on Adjusting to an Older Relative’s Death This study examines the influence of both caregiving social support to an impaired older relative and bereavement social support to a surviving caregiver on that caregiver's bereavement adjustment. Although past research has considered the link between bereavement support and adjustment to a loved one's death, the influence of support to the care recipient has not been investigated. Analyses of prospective panel data from 73 spouse and adult-child caregivers show caregiving support characteristics to be more important for bereavement adjustment than support provided to the surviving caregiver after their relative's death. Read more
