Use Of Formal Care Research Articles

Informal and formal home-care use among older adults in Europe: can cross-national differences be explained by societal context and composition?

ABSTRACTCross-national comparisons employed welfare state classifications to explain differences in care use in the European older population. Yet these classifications do not cover all care-related societal characteristics and limit our understanding of which specific societal characteristics are most important. Using the Survey of Health, Ageing and Retirement (second wave, 2006–07), the effect of societal determinants relating to culture, welfare state context and socio-economic and demographic composition on informal and formal care use of older adults in 11 European countries was studied. Multinomial multi-level regression analyses showed that, in addition to individual determinants, societal determinants are salient for understanding care use. In countries with fewer home-based services, less residential care, more informal care support and women working full time, older adults are more likely to receive informal care only. Older adults are more likely to receive only formal home care or a combination of formal and informal care in countries with more extensive welfare state arrangements (i.e. more home-based services, higher pension generosity), whereas the odds of receiving a combination of informal and formal care are also larger in countries that specify a legal obligation to care for parents. We tentatively conclude that the incorporation of societal determinants rather than commonly used welfare state classifications results in more understanding of the societal conditions that determine older adults’ care use.

Child Care and Early Education in Australia - the Longitudinal Study of Australian Children

Child Care and Early Education in Australia - the Longitudinal Study of Australian Children

Does informal care from children to their elderly parents substitute for formal care in Europe?

This paper analyzes the impact of informal care by adult children on the use of long-term care among the elderly in Europe and the effect of the level of the parent’s disability on this relationship. We focus on two types of formal home care that are the most likely to interact with informal care: paid domestic help and nursing care. Using recent European data emerging from the Survey on Health, Ageing and Retirement in Europe (SHARE), we build a two-part utilization model analyzing both the decision to use each type of formal care or not and the amount of formal care received by the elderly. Instrumental variables estimations are used to control for the potential endogeneity existing between formal and informal care. We find endogeneity of informal care in the decision to receive paid domestic help. Estimation results indicate that informal care substitutes for this type of formal home care. However, we find that this substitution effect tends to disappear as the level of disability of the elderly person increases. Finally, informal care is a weak complement to nursing care, independently of the level of disability. These results highlight the heterogeneous effects of informal care on formal care use and suggest that informal care is an effective substitute for long-term care as long as the needs of the elderly are low and require unskilled type of care. Any policy encouraging informal care to decrease long-term care expenditures should take it into account to assess its effectiveness.

Informal and formal care for elderly persons: How adult children's characteristics affect the use of formal care in Japan

Informal care by adult children remains the most common source of caregiving for elderly parents in Japan, even after the introduction of long-term care insurance in 2000. We estimate how the potential supply of child caregivers affects the use of formal care of elderly parents, focusing on the differences across children. We find that the effects of children's presence vary substantially with gender, marital status, and opportunity costs of children. The potential supply of daughters-in-law, as the traditional source of informal care, is less important in providing care than that of unmarried children. The opportunity costs of children make a difference in the use of formal long-term care.

Predisposing, Enabling, and Need Predictors of Community versus Institutional Long-Term Care

This research explored characteristics of the elderly that are associated with the use of long-term care services. Using the 1999 National Long Term Care Survey, logistic regression was employed to examine the relationship of race with the use of formal and informal long-term care. This study also examined the relationship of health insurance with the use of formal and informal long-term care. The Andersen Model on health services utilization was used as the theoretical framework. The findings indicated that race was not associated with the use of long-term care but rather with predisposing, enabling, and need variables. Health insurance was found to be associated with the use of long-term care even after controlling for predisposing enabling and need variables.

Migration and maternal health services utilization in rural Guatemala

This article examines the relationship between migration and the use of formal maternal health-care services among rural women in Guatemala. We identify assimilation, diffusion, and remittances as three potential pathways through which migration can affect health-care service utilization in rural areas. Using data from the 1995 Guatemalan Survey of Family Health and multi-level regression models, we estimate the impact of migration experience at the individual, household, and community level on the use of formal prenatal care and delivery assistance. We find that urban migration experience and having relatives abroad are associated with a greater likelihood of formal prenatal care utilization, after taking account of background characteristics and enabling resources. Migration experience at all levels is also strongly associated with formal delivery assistance; however, this association operates primarily through the positive association between migration and enabling resources. The differential effects of out-migration on maternal health-care service utilization reflect the different barriers to service use that exist for formal prenatal care and delivery assistance. Financial cost and geographic access are the most important barriers to formal delivery assistance, whereas awareness and acceptance remain as important barriers to the use of formal prenatal care in rural Guatemala. Urban migration experience and social ties to urban and international migrants lower the barriers to formal maternal health-care utilization through the acquisition and diffusion of new ideas and practices, and the return flow of financial resources.

Gender perspective on informal care for elderly people one year after acute stroke

The aim of the one-year follow-up was to evaluate formal care and the situation of informal caregivers from a gender perspective. The present study targeted elderly persons (n = 147) living in their own homes 12 months after acute stroke, 94 women and 53 men. The median age of the women was 81 years and the men 80 years. A statistically significant gender difference was seen in living conditions. Eighty percent of the women were living alone compared with 28% of the men (CI 48-56%). The informal care given far exceeded that provided by the community: 65% of these elderly people had some kind of informal care and 44% received formal care from the community. There was a gender difference in daily informal personal care, 24% of men and 16% of women (CI 2-18%), and in daily informal household assistance (CI 15-43%). Formal care was provided by the community significantly more frequently to women (56%) than men (23%) (CI 21-45%). The women more frequently had community-based help with house-cleaning (CI 23-39%) and they also more frequently received help with personal care (CI 1-10%). This study showed statistically significant gender differences in the use of informal and formal care. Elderly caregivers' situations must be given greater attention, since informal care to stroke survivors represents a far greater burden than the care that is provided by the community. Most of the caregivers were elderly women, and preventive intervention measures should be developed in order to enable them to manage their everyday lives.

Living arrangements and health status in later life: a review of recent literature.

The living arrangements of older persons play a key role in their use of formal and informal care, as well as in their health and well-being. Nurses engaged in primary care, discharge planning, and home care are strategically positioned to contribute to an optimal fit between older persons and their home environment. This article describes the demographic significance of late-life living arrangements and proposes a model for organizing the complex web of factors associated with household composition and late-life migration. The article then summarizes qualitative and quantitative evidence in support of the proposed model. Key areas for nursing research and strategies for applying available research are identified.

Spheres of care in the UK: separate and unequal

This article analyses recent developments in Britain in the use of formal and informal day care following the introduction of a National Child Care Strategy in 1997. It is argued that the government's focus on only supporting formal care ignores the crucial contribution made by the informal sector. A small study of the daycare arrangements of mature student parents compares the informal and formal daycare `markets' and shows how the firm line which government policy draws between formal and informal care is based on an incomplete understanding of the meaning of `care' and of `work'. The use of cash payments in the informal sector can sustain, rather than damage, the willingness and ability of carers to care — a choice does not have to be made between love and money. Rather, policies that support both are needed.

A family ecological analysis of child care use in Hong Kong

This study examines the views on and use of day care for young children among white‐collar working women from a family ecological perspective. Discrepancies between perceived ideal and actual choice of child care were observed. Care provided by family kin was an ideal used with reservation, the employment of foreign domestic helpers was a reluctant choice, while the use of formal care was largely unexplored. The findings of this study demonstrate how individual families' child‐rearing goals are supported and constrained by contextual factors within the ecology. Implications for policies on child care in Hong Kong are discussed. Copyright © 2001 John Wiley & Sons, Ltd.

Informal and Formal Care for the Elderly

ABSTRACT In this article, a model is developed of the determinants of elderly health care choice between the options of informal care (i.e., provided by family and friends) and formal care (i.e., care provided via the market). These determinants are: Expertise Capacity, Resource Capacity, Time Capacity, Economic Rewards, Psychic Rewards, Trust, and Control. This model is based on the theoretical work of Lusch, Brown, and Brunswick (1992) in the marketing literature and a variety of empirical findings in health care literature. The Lusch et al. (1992) framework models the general determinants of an entity's choice between fulfilling needs on their own (i.e., internal exchange or self-production) or going to the market to fulfill their needs (i.e., external exchange). The goal of this article is to develop understanding of formal care and informal care use decisions, and to create managerial recommendations based on a sound theoretical understanding of the issues.

Health care and the wayman A.M.E. church

Research conducted at the Wayman African Methodist Episcopal (A.M.E.) Church in Bloomington, Illinois, underscores the multifaceted role of the black church. Although the Wayman A.M.E. Church served as a religious center, medical artifacts from excavation suggest the church as an institution provided health care to segments of the congregation and local community during the late 19th and early 20th centuries. Historical information in combination with archaeological data illustrate a dual health care strategy was practiced by the congregation. This dual strategy was based on the use of both traditional, or folk, healing practices and formal medical care. More importantly, the health care artifacts highlight the inequality that blacks have experienced in obtaining adequate medical care. Corresponding temporally to a series of epidemics in Bloomington, the health care artifacts suggest the church congregation did not passively accept the inequality characteristic of the period.

The Effect of Channeling on Home Care Utilization and Satisfaction With Care

This study examined the relationship between participation in two home and community-based long-term care case management interventions (collectively known as the Channeling demonstration), use of formal in-home care, and satisfaction with care. Maximum likelihood estimation techniques were used to analyze the National Long-Term Care Demonstration data set. It was hypothesized that participation in the two Channeling interventions would indirectly (rather than directly) enhance satisfaction by operating through the increased use of formal in-home care. However, both Channeling models were found to have favorable direct and indirect effects on patient satisfaction.

The utilization of formal medical services for young children. The lack of impact of medical professionals in social networks.

The objective of this study was to examine the impact of medical professionals in social networks on the use of formal medical care for young children's minor illnesses. 795 Swedish mothers, with only one child 5-15 months of age, were randomly sampled. The mothers were interviewed by telephone and complete interviews were conducted with 92% of them. Of the 795 mothers, 84% had a relative or friend and 24% had a physician or nurse within their social networks whom they could contact for advice and support when their children became ill. No associations were found between the mothers' access to advice and support from medical professionals within their social networks and the number of formal medical contacts for their young children's illnesses. Similarly, no associations were found between the mothers' access to advice and support from lay persons in their social networks and the use of medical services for their children.

Gender Differences in Formal Care Use in Later Life

This article assesses gender differences in the use of formal versus informal sources of in-home care among impaired elders. Data from the 1984 panel of the Survey of Income and Program Participation are used in the analysis. The results suggest that married women are more likely to receive formal care than are married men, but this pattern does not hold for the unmarried. This result is consistent with gendered expectations regarding caregiving and receipt within the marital unit.

Period Effects on the Mix of Formal and Informal In-Home Care Used by Urban Elderly

Changes in the mix of formal and informal home care used by noninstitutionalized elderly between 1975 and 1987 are examined. This period saw many changes in health care policies, an increase in female labor force participation, and changes in demographic characteristics of elders, all of which could be expected to influence the pattern of care used by elders. Using data from the 1975 General Accounting Office study in Cleveland, Ohio, and its 1987 follow-up, cohorts of young-olds (ages 65-76 years) and old-olds (ages 77-88 years) were compared for their use of formal and informal care. There were no increases in the proportion of people using home care, and there was no observable trend toward increased reliance on formal care. Differences did emerge in the mix of formal and informal services used. For the young-old cohort, more persons received formal nursing services and informal supervision services in 1987. The mix of services used by the old-old cohort revealed no observable period effects. Implications of these findings are discussed in relation to the social changes mentioned earlier.

Alzheimer's care and service utilization: generating practice concepts from empirical findings and narratives.

Despite evidence of stress and strain, many of those who take care of relatives with Alzheimer's disease seem to resist using support services. Existing studies of the use of formal care by families of Alzheimer's sufferers are reviewed with special attention to findings relevant to access, particularly perceptions of appropriateness and acceptability or consistency with other needs and values. The conceptual model represented by these findings is then applied to a narrative that serves as a proxy for a real case that might confront a social worker. Viewed together, both the review of empirical findings and the narrative suggest that theoretical frameworks that take into account meanings attached to relationships and personal moral assessments of whether the duties of caregiving can or should be entrusted to others may offer promising alternatives to traditional psychological or psychoeconomic views of supportive service utilization.

The relationship between program participation, use of formal in-home care, and satisfaction with care in an elderly population.

This study used data from the Channeling Demonstration to investigate the relationship between program participation, utilization of formal in-home services, and client satisfaction in an elderly population. Age, being male, severe ADL dependency, living alone with no informal support, provision of basic case management services, and utilization of formal in-home services were significant predictors of satisfaction.

Care Seeking for Musculoskeletal and Respiratory Episodes in a Medicare Population

Responses to episodes of musculoskeletal illness, musculoskeletal injury, and respiratory illness are examined separately. Data are from a 1-year longitudinal study of the illness experiences of 885 Medicare recipients. Unlike studies examining aggregate use of medical services, this study examines both episodes for which medical care was sought and episodes for which no medical care was sought. Both factors associated with the decision to seek medical care for each type of episode and the illness response patterns associated with whether medical care is sought are analyzed. The three types of episode have different characteristics and profiles of illness response. Perceived seriousness and duration of the episode are the best predictors of physician visits for all episode types. However, the relative effect of predisposing and need variables on the decision to seek medical care is greatest for musculoskeletal illness episodes. These data also bear on the relationship between self-care, informal care, and the use of formal medical care. Use of nonprescription medications is shown to substitute for medical care in a significant number of illness episodes. Lay consultation and restricted activity are often linked with physician visits; however, they cannot be assumed to precede care seeking. The analytic strategy of examining responses to specific types of episodes suggests that both characteristics of the person and characteristics of the illness affect how people respond to illnesses and that the relative importance of each type of characteristic is specific to each illness type. Implications of these findings for health education are discussed.

LOCATIONAL PROBLEMS AND PREFERENCES IN PRESCHOOL CHILD CARE

With the increased use of formal child care, the number of child care alternatives has grown. The locational problems and preferences of University of Connecticut employees who use formal child care for children under age 6 are examined because an on-site program is available as one option. Difficulty finding care at a convenient location is related to residential location. Preference for worksite care decreases with increasing commuting distance. Variations in reported locational preferences by commuting zone are consistent with the notion of locating services within the activity spaces of the users. As commuting distance increases, worksite day care represents a greater displacement from the activity spaces of the child and possibly of other family members.