FCRP Policy Statement
Volume-4- Edition-1
THE DIVISION OF LABOR BETWEEN PRIMARY CAREGIVERS AND
OTHER CARE-PROVIDERS*
Over 84 % of elderly patients who need assistance with
self care activities reside at home with families. When
caring for their elderly relatives, how do families divide
up the labor? To address this issue, the Family Caregiver
Research Program composed of faculty from the College of
Nursing and the Department of Family Practice in the College
of Human Medicine asked several questions of over 500 spouse
and adult child caregivers; of patients with Alzheimer's
Disease and those caring for elderly patients with a variety
of physical impairments.
First, they sought to learn how the tasks of caring are
divided among the primary family caregiver and other caregivers
(formal and informal). Second, they wanted to know if, as
the number of tasks required increases, care is divided
differently among caregivers. Third, they examined how factors
such as the employment of the primary caregiver and the
living arrangements of the patient and primary caregiver
influenced the manner in which care tasks were distributed.
The amount of care required by patients was determined
by asking caregivers how often they performed each of 25
care activities during a typical week. The care activities
included activities of daily living such as dressing, bathing,
shopping, or cooking and various health care activities
requiring special skills such as giving injections or tube
feeding. In order to determine the division of labor, the
care received by the patient: was divided into four groups:
(1) Cam provided exclusively by the primary family caregiver,
(2) care provided by the primary family caregiver in conjunction
with others, (3) care provided exclusively by persons other
than the primary family caregiver, (4) care provided by
others in conjunction with the primary family caregiver.
The following table shows how care was divided among the
four groups.
| Type of Care |
% |
| Care exclusively provided by primary
caregivers |
40.5% |
| Care provided by the primary caregiver
jointly with others |
39.2% |
| Care exclusively provided by all other
care providers. |
1.4% |
| Care provided by other care providers
jointly with the primary caregiver. |
18.9% |
The data clearly indicates the central role of the primary
family caregiver. As the number of tasks increases, primary
caregivers still remain involved in all tasks even though
they may do a smaller proportion of the care required. In
this study, primary family caregivers provided about 80%
of the care, either alone or in cooperation with other providers.
Only 1.4%,of all care was provided exclusively by persons
other than the primary caregiver.
No differences occurred between male and female caregivers.
However, employed caregivers clearly provided a lower proportion
of care themselves (12% less). Likewise, caregivers not
living in the same household participated at a lower level
(by 14%) in direct care than caregivers who lived with patients.
However, the pattern of caregivers being involved in all
aspects of care did not change.
Important implications for family caregivers include the
psychological burdens that result from involvement in an
ever expanding number of care giving tasks. Also, primary
caregivers shoulder this responsibility without foregoing
employment or other family responsibilities. Home care policies
should consider assessments that help families to allocate
caregiving labor among available members and to assist them
in working through issues in the organization of the care
for their relative.
*From Stommel, M., Given, B.A., and Given,
C,W. The division of labor between primary caregivers and
other care-providers. This research was supported by Grant
No. IR01 AGW84, 'Caregiver Responses to Managing Elderly
Patients at Home, * Charles W. Given, Ph.D., Principal Investigator;
and Grant No. R01 MH41766, 'Impact of Alzheimer's Disease
on Family Caregivers,' Clare Collins, Ph.D., RN, FAAN, Principal
Investigator. ksJ59.-poficy.feb 217194
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