FCRP Policy Statement

Community services such as home health aides, adult day care, and skilled nursing services play an important role in assisting family caregivers of elderly. However, most researchers report low rates of use of governmental services among family caregivers of frail elders. One reason for the under use of services by the elderly includes a strong sense of commitment to self-sufficiency and a lesser willingness to accept publicly financed services. Yet older individuals may also find caregiving more physically demanding than their younger counterparts and find it impossible to shoulder the care task alone.

In a study conducted at Michigan State University, researchers found that attitudes toward service utilization were associated with caregiver gender, age and patient diagnosis. Male caregivers were found to be more concerned about the opinion of others in the care they provided and favored family independence in providing care. They rejected government provision of community services and were less confident with the services they did seek out. Female older caregivers were more likely to reject government services and were more concerned about the opinion of others in the family.

Caregivers of cancer patients, dementia patients and physically impaired elderly displayed differences in their attitudes toward service use. Dementia patient caregivers were the least likely to rebuff governmental service or to insist on independence, and seemed least concerned about the opinions of others. Caregivers of cancer patients were most confident in the service system, yet were found to most likely favor family independence and rejection of public financed services. Families of physically impaired older patients seemed least confident in the service system and most concerned about the opinion of others when making decisions about the use of community services. The caregiver relation to the patient (spouse or child) did not affect any of the measured attitudes toward use of community services.

Policy Implications

• Recognition that the under use of services may be related to attitudes and not lack of need
• Need to understand attitudes as prescription and plans of care are made
• Better public education about value of services
• Increase service utilization by targeting the needs of specific groups based on known common attitudes
• Develop education programs for service to help caregivers understand how services can benefit their patients.
• Fund research directed at understanding caregivers attitudes toward services, the changing needs in the family system, and how formal services can assist patients and families.

Changes in the health care system toward increased use of home health services demands an understanding of the needs of the caregiver and patient that are specific and individualized. Examining subgroups of caregivers for their unique service attitudes and needs rather than considering family caregivers as a homogenous group is essential when distributing limited health care dollars.

From: Stommel, Manfred, PhD., Collins, Clare E. , PhD., Given, Barbara, PhD., and Given, Charles, PhD (1997). Correlates of Community Service Attitudes Among Family Caregivers. Submitted for publication. Research funded in part by the following grants: NIMH RO1 MH41766 (C. Collins); NIA RO1 AG 06584 (C. W. Given) and NCI/NINR RO1 NR/CA 0191J (B. Given).