Who
Needs Care Introduction
The field of research on family caregiving
extends back forty years, evolving from early studies
of the 1950s and 1960s looking at the family unit in
general; to studies in the 1980s and early 1990s focusing
on specific caregiving activities, roles and responsibilities;
to the current emphasis on understanding the processes
and impacts of caregiving across different physical
and mental conditions and ethnically diverse populations.
We have progressed from small descriptive studies of
available caregiving populations – usually service
utilizing – to larger local area and national
studies of random samples. Methodology and instrumentation
have similarly improved, with current study designs
and analyses being more sophisticated and comprehensive.
The result is that we have considerable knowledge about
who needs care, who receives care, who provides this
care, what care is provided, the costs of care, and
the impacts of this care on the caregiver. This paper
summarizes what we have learned from many studies on
informal caregiving, identifies issues in need of further
study, and discusses the implications of empirical data
for selected policy and practice issues regarding long-term
care for frail older individuals.
Who Needs Care
Nearly one-quarter (22.9%) of all
people aged 65 and over in this country are functionally
disabled or currently in need of some form of long-term
care (American Academy of Actuaries, 1999; Doty, 1986;
NCHS, 1987). According to a monograph recently released
by the American Academy of Actuaries (1999), the best
care scenario projects that by the year 2040 the population
of severely disabled (i.e., >3 ADLs) elderly will
increase by 90%. This means that they need help with
personal activities of daily living (bathing, eating,
dressing, toileting), with instrumental activities of
daily living (cooking, cleaning, laundry, transportation,
etc.), with transfer or mobility, or they require skilled
care of the sort provided by home health care agencies
or nursing homes. Data have revealed that 1.2 million
fewer older adults in 1994 were disabled than had been
expected based on previous rates, but the actual scenario
takes this recent trend into consideration. However,
although the rates are lower, persons turning 65 (in
1996) can expect 5.3 years of dysfunction characterized
by acute or chronic illness.
|
