Informal care substitution: what we don't know can hurt us

Empirical studies focusing on the relationship between formal and informal home care do little to quell the fears of policymakers that expanded access to public home care services will result in the withdrawal of informal support. A close examination of the studies designed to measure the withdrawal of informal support justifies this skepticism. Concerns about the withdrawal of informal care may hinder the introduction of more extensive home care benefits. Researchers have come some distance in trying to address this policy question. The conflicting nature of empirical findings, thus far, demonstrates that the answer depends heavily on how the question is framed, how home care is measured and over what time frame, and what sorts of analytic approaches are used to model the relationship between formal and informal community-based care. This article discusses these issues in greater detail and suggests strategies to address these problems in future research.     

Social Support and the Mental Health of Family Caregivers: Sons and Daughters Caring for Aging Parents in Japan

The prevalence of depressive symptoms among family caregivers has been documented as a serious social problem that could threaten the lives of the elderly and their family caregivers. Social support is considered to be a promising remedy for this problem, although a comprehensive examination of the availability and effectiveness of social support that includes both formal and informal support across multiple dimensions remains limited. In addition, little research has been conducted in Japan on gender differences in stress processes. This study tried to fill those gaps by analyzing recent survey data on sons and daughters who are caring for their elderly parents. The results indicate that sons and daughters have similar levels of formal and informal support for daily care and advice, while there are some gender differences in regard to the availability of other types of social support. It was also found that many types of informal support were significantly associated with a lower caregiver burden for daughters, although this was not necessarily the case for formal support. General instrumental support from formal sources was even associated with higher levels of distress. For sons acting as caregivers, daily caregiving support was the only formal support that was significantly associated with their lower level of distress. Issues of formal support are discussed, in order to reduce the psychological burdens borne by sons and daughters who care for their parents at home.     

Dementia Problem Behavior and the Production of Informal Caregiving Services

Informal caregivers of individuals with Alzheimer's disease spend a considerable amount of time providing care. In this paper, we use Grossman's health production and Becker's time allocation models to develop a model of informal care provision to elderly dementia patients. In our model, time inputs produce caregiving services, which provides utility to the caregiver, but reduces leisure. We assume that time is less productive of services on the margin as the disease progresses. In this framework, an increase in patients' disease severity does not necessarily increase informal caregiver time input. The cost of formal care establishes a reservation price for informal caregiving. When the costs of informal caregiving rise above this reservation level, the patient is institutionalized. We test empirically the effect of deterioration in the patients' condition, proxied by both disease severity and dementia problem behavior, on informal caregiving time. We find that dementia-related problem behaviors and functional limitations significantly increase inputs of informal caregiving time. Patients' problem behavior exerts a modifying effect on functional limitations, and patients' comorbidities have no effect on informal caregiving time.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

Preservation of self in the nursing home: Contradictory practices within two models of care

Researchers have identified several aspects of nursing home care that interfere with residents' preservation of self. This paper examines how different models of care shape residents' opportunities for preserving a sense of self, adult identity, and agency. Using ethnographic data, I analyze staff practices in two facilities that reflect the contrast between the home and hospital models of long-term care. Previous research on long-term care suggests that an informal, “home-like” approach to care creates more opportunities for residents to preserve a sense of self-identity, whereas a formal, “institutional” approach fosters depersonalizing practices that interfere with residents' psychosocial well-being. My research suggests, however, that both approaches can have contradictory effects on residents' preservation of self. I analyzed patterns of objectification and infantilization that emerged in the social interactions between residents and staff members, as well as practices that mitigated these patterns. This study highlights how a larger culture of ageism and stigma surrounding dependency can become embedded in micro-level practices and underscores the challenges of defining and implementing “good” care.     

Idealist thought, social policy and the rediscovery of informal care

Recent work in the history of welfare has suggested a need to reconsider the status of some conceptual frameworks within sociology and social policy studies regarding the meaning of 'social welfare' and the 'welfare state'. In this context, the present article argues in particular that the marked upswing of interest in informal care in the UK beginning in the 1970s reflected, at least in part, a reaction, itself not so far adequately understood, to some features of the work of Richard Titmuss and 'traditional social administration', work which, on examination, reveals a distinctive 'idealist' core, unsympathetic to research into familial patterns of caring. Similarities with 'classic' British idealism, broadly defined, at the end of the nineteenth and beginning of the twentieth centuries are reviewed. This idealist thought emerges too as unresponsive to informal care, even though contemporary non-idealist thought had discussed it. The article concludes that the (unacknowledged) persistence and influence of idealist modes of social thought diverted attention away from informal care; informal care was in fact not 'discovered' in the 1970s, it was rediscovered as idealist preconceptions about the nature of 'real' welfare were discarded. The sense of 'discovery' reflected prevailing and dubious historigraphical interpretations of the meaning of 'social welfare' and the status of the ('classic') 'welfare state'.     

Informal care and support for carers in Sweden: patterns of service receipt among informal caregivers and care recipients

This study describes and analyses the kinds of support received by different categories of informal carers, and the kinds of help that care recipients receive in addition to that provided by various categories of carers. Data were collected in a Swedish county in 2000, by means of telephone interviews. The net sample consisted of 2,697 individuals 18–84 years old, and the response rate was 61%. The results showed that relatively few carers in any care category received any kind of support aimed directly at them as carers. The most widespread form of support received by providers of personal care was relief services. Those most likely to be receiving care from the public care system were people also receiving personal care from an informal caregiver. Nevertheless, the majority of those receiving personal care from an informal carer did not receive any help from the public care system or from voluntary organizations or for-profit agencies. These results indicate that social policy and social work need to clarify the aims of the services they provide. They also need to take the needs of both caregivers and recipients into account when discussing support systems.     

Informal care vs. formal services: changes in patterns of care over time

Longitudinal data from a representative sample of community-residing older persons were used to document changes in patterns and costs of care, both informal and formal. It was found that use of formal services was usually in conjunction with, and secondary to, informal care. Limited availability of informal care as well as increased disability raised the odds of using services. Substitution of formal services for informal care was limited and usually temporary. Total costs of community care, including living expenses, were generally less than the cost of nursing home care.     

Informal Care Substitution:

Empirical studies focusing on the relationships between formal and informal home care do little to quell the fears of policymakers that expanded access to public home care services will result in the withdrawal of informal support. A close examination of the studies designed to measure the withdrawal of informal support justifies this skepticism. Concerns about the withdrawal of informal care may hinder the introduction of more extensive home care benefits. Researchers have come some distance in trying to address this policy question. The conflicting nature of empirical findings, thus far, demonstrates that the answer depends heavily on how the question is framed, how home care is measured and over what time frame, and what sorts of analytic approaches are used to model the relationship between formal and informal community-based care. This article discusses these issues in greater detail and suggests strategies to address these problems in future research.     

A review of the biopsychosocial aspects of caregiving for aging family members

With the ever-increasing growth in the aging population, the need for care providers will also continue to rise. Many of these caregivers will provide informal care to family members and friends at a price to their own physical, psychological, and social well-being. This article examines the phenomenon of caregiving and provides a review of the biological, psychological, and social impacts of caregiving to care providers. George Engel’s biopsychosocial model is explored to examine the biological, psychological, and social factors that can affect a caregiver’s health and well-being. This article further explores social work practice implications and strategies for future intervention to reduce caregiver burnout and aid in their self-preservation.     

A Social Networks Approach to Public Relations on Twitter: Social Mediators and Mediated Public Relations

This study proposes theoretical and practical frameworks to systematically examine mediated public relations in social media spaces. We applied a social network conceptual framework to identify and characterize social mediators that connect the US State Department with its international public. The results showed that social mediators vary in terms of their formality and interdependence. Formal social mediators were primarily US government agencies while informal social mediators were nongovernmental organizations (NGOs) and individuals. Notably, relationships with populations in the Middle East and North Africa were mediated primarily by informal actors, and formal mediators played a key role in connecting the public with everywhere else in the world. Government-related formal mediators and informal social mediators showed similar levels of bilateral relationships. In contrast, news media, the most traditional public relations mediators, were rarely found as social mediators and demonstrated the most unilateral relationships.     

Kinship care and service utilization: A review of predisposing,enabling, and need factors

Research has shown that relative caregivers are less likely to use formal supports and services than non-relative foster parents. However, less is known about factors influencing kinship caregivers' help-seeking behaviors and service use. This systematic review identified research studies examining factors associated with service use among kinship caregivers using key search terms in five computerized bibliographic databases and four journals. The search identified 337 potentially relevant studies. After screening and study eligibility assessments, a final sample of 13 studies was reviewed. Findings suggested that although children and their kinship caregivers were clearly in need of services, service use was low. Results suggested a need for more rigorous research designs and that the following factors may influence service use: child behavioral problems, caregiver mental health status, resources, provider characteristics, caregiver perceived need, and social support. More research examining help-seeking behaviors, perceptions of formal services, and effectiveness of kinship caregiver services in relation to child outcomes is needed to improve the wellbeing of kinship families in the child welfare system.     

An Empirical Examination of Formal and Informal Volunteering in Canada

Using data from the 2008 General Social Survey of Canada, this study examines the factors associated with individuals’ propensity to engage in formal and informal volunteering. The results show that social networks increase the likelihood of both formal and informal volunteering, but social trust and human capital increase only the likelihood of formal volunteering and not of informal care. The findings also reveal interesting cultural influences and regional differences in the propensity to engage in formal and informal volunteering, especially between French-speaking Canadians and English-speaking Canadians, and those living in Quebec and outside of Quebec. Native-born Canadians are more likely to volunteer than their immigrant counterparts, but they are similar to immigrants in the propensity to provide informal care. Additionally, women are found to be more likely to engage in formal volunteering and informal care than men. Theoretical and practical implications of the findings are discussed.     

A Review of Peters,S. F. (2008). When prayer fails: Faith healing,children, and the law.

Sibling relationships are an important, yet underinvestigated dimension of foster care research. Despite the fact that a majority of children in care have brothers or sisters, only recently have child welfare researchers begun to explore the complex and dynamic nature of sibling relationships in substitute care settings. Although cross-sectional and longitudinal studies suggest differences in stability and permanency outcomes for siblings placed together versus those placed separately, exactly how and under what conditions do sibling relationships positively influence placement stability, permanency, and well-being in foster care settings remains unknown. This article provides a substantive review of the research on sibling foster care, placement stability, and well-being; identifies two theoretical frameworks that may be particularly useful to help explain the intersection of these constructs; and proposes a multilevel conceptual model for advancing research and practice with siblings in foster care.     

Home care for the elderly: the role of relatives,friends and neighbors

We use data from the Survey of Health, Ageing and Retirement in Europe to examine the hours of home care received by the elderly. The existing empirical literature has mostly examined informal home care from children and formal home care. We identify two additional informal home care providers, namely, relatives (other than children) and friends (including neighbors) who provide about 30 % of the hours of informal home care. Our main new empirical finding is that single elderly persons who can rely less on children—and in particular daughters—for their home care receive not only more formal care but also more care from friends and neighbors. These findings suggest that policymakers need to take into account not only home care provision from children but also home care provision from friends and neighbors to obtain accurate projections concerning the increasing costs of formal care programs due to an aging population.     

Dignity in dementia: Person-centered care in community

Drawing on Kitwood's [Ageing Soc. 13 (1993) 51] theory of person-centered care and the interpersonal process of caregiving, this article offers an alternative to the image of the family caregiver as victim through an exploration of the lived experience of caring for a person with dementia in community. Extending care beyond coping, the act of giving care is promoted as a worthy activity and reciprocal social opportunity. Three nonfamily caregiver “portraits” are offered in an arts-informed representational form. The relational processes of caregiving are explored from the vantage point of personal experience and theoretical knowledge. Dignity emerges as the resonant quality, essential value, and guiding principle in an ethic of dementia care. Implications about the direction of research about care and caregiving and research accessibility and usefulness are explored.     

Shaping social situations: A hidden aspect of care work in nursing homes

A significant aspect of care work in nursing homes involves dealing with emotional responses such as anxiety, fear, pain, depression and anger on the part of residents and their families. Previous care and nursing research on this topic centers around dyadic relationships and does not provide useful conceptualizations of how care workers actively deal with the social situations they encounter as part of their work. Drawing on ethnographic field work and interviews conducted in two Norwegian nursing homes, this article aims to describe and conceptualize a previously neglected aspect of good care work: the active shaping of social situations in order to lessen uneasy feelings of residents and their families. Three episodes of good work are described to illustrate how social situations can be shaped. Strategies include such actions as timing events, regulating one's presence, and composing social groups. The concluding section discusses some implications for nursing home management.     

A part of,yet apart from the team: Substantive membership and belonging of trans and nonbinary athletes

Increasingly, bills and policies prohibit the participation of trans women in competitive sport. The current sociopolitical moment begs the following question: how do interpersonal interactional moments function alongside formal policies and rules to shape trans athletes’ experiences of belonging in sport? Although formal institutional rules govern trans athletes’ ability to compete in sport, informal social sanctioning also denies these athletes equitable, or even de facto, membership in sport. I draw upon two case studies to explore trans athletes’ experiences of membership in elite “women's” sport. I apply Evelyn Nakano Glenn's work on citizenship to consider how trans athletes’ experiences of belonging are influenced by both formal rules imposed by organizations as well as informal social interactions with members of their sporting communities. Inclusion is not synonymous with membership. Trans athletes render visible the ways in which this system functions to contain the diversity of humanity's gender expression.     

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

Abstract

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.