Implications for Policy and Practice

Major findings with important policy and practice implications include the following:

Patterns of Care

While family care is very common, most of the care is provided by one person.

Contrary to common assumption, there is little sharing of care. Even in cases where multiple caregivers are involved, they tend to supplement the care provided by the primary caregiver. We see little division of labor. Given that restrictions on personal and leisure time is the most frequently reported caregiving impact, working with the primary caregiver to identify both other informal and formal sources of care to provide respite in a timely manner is indicated. A second point is that we should not take for granted that minority elders have larger caregiving networks. Hispanic elders are a case in point. As the largest growing minority group and the most disabled in later years, Hispanic elders face social situations that could diminish caregiving resources – smaller family size, increased employment of women, and the economic necessity of living at a distance from adult children. Given a strong sense of familism, these adult children face considerable challenges if trying to provide care in light of these social circumstances.

Family care is generally stable. Few families voluntarily abandon their role in favor of community services or institutional care.

Research data do not support the policy concern that families will stop caring if more publicly funded services are available. Yet we do see disruptions in the informal care arrangements which result in increased service use on a temporary basis. I would argue that this is an appropriate and effective use of community services. Agencies should be sensitive to and prepared to respond in order to divert an undesirable nursing home admission. Research data can be used to develop client profiles to target service to at-risk elders.

Most caregivers are women. However, in the case of spousal caregiving arrangements, men are highly involved.

More attention should be directed to situations in which the primary caregiver is male, particularly if the care recipient requires extensive and personal care. Male caregivers in these situations are usually older. This current cohort of older men is least likely to be prepared and skilled to provide a range of help. They might also be challenged by their own health conditions or physical disability. These situations merit special attention. Men want to care for their wives but may need skill training or supportive services (especially personal care) in order to do so.