Family Caregiving

Family caregivers play a key role in delaying and possibly preventing institutionalization of chronically ill elderly persons. Although neighbors and friends may help, about 80% of home health care services (physical, emotional, social, and economic) are provided by family caregivers. When the patient is mildly or moderately impaired, a spouse or adult children often provide care, but when the patient is severely disabled, a spouse (usually a wife) is more likely to be the caregiver. Family caregivers may experience considerable stress and subsequent health problems. In addition, couples in which one partner cares for the other tend to be disproportionately poor.

The amount and type of care provided by a family depend on economic resources, family structure, quality of relationships, and other demands on the family members' time and energy. Family caregiving ranges from minimal assistance (eg, periodically checking in) to elaborate full-time care. On average, family caregiving consumes about 4 hours a day.

Although society tends to view family members as having a responsibility to care for one another, the limits of filial and spousal obligations vary among families and among individual family members. The willingness of family members to provide care may be bolstered by supportive services (eg, technical assistance in learning new skills, counseling services, family mental health services) and supplemental services (eg, personal care [assistance with grooming, feeding, dressing], home health care, adult day care, meals programs). Supplemental services may be provided on a regular schedule or as respite care for a few hours or days.

Changes in demographics and social values have reduced the number of family members available to care for impaired elderly relatives. Because life span has increased, the population of the very old is increasing; their children, who are potential caregivers, are likely to be old also. Moreover, delayed procreation combined with increased longevity have created a sandwich generation of caregivers who care simultaneously for their children or spouse and their parents. The increasing mobility of U.S. society and the increased divorce rate have contributed to the geographic separation of families and have weakened family ties. Nonetheless, 80% of persons >= 65 years live within 20 minutes of one child. There has been a steady growth in single-parent households, most headed by women, and in two-income households. Consequently, increasing numbers of women, who previously may have functioned as caregivers for elderly parents, have entered the workforce. The demands of a job may diminish or eliminate a person's ability to provide informal geriatric care. These factors, combined with the increasing number of dependent and sicker elderly, predict an increasing demand for home health care services provided by someone other than family, friends, and neighbors.