Family caregivers play a key role in delaying and possibly preventing institutionalization of chronically ill elderly patients. Although neighbors and friends may help, about 80% of home health care services (physical, emotional, social, 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.

The amount and type of care provided by family members 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, and 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 of the following:

• Increased life span: As a result, the population of the very old has been increasing. Thus, their children, who are potential caregivers, are likely to be old also.
• Delayed procreation: Combined with increased longevity, this delay has created a sandwich generation of caregivers who care simultaneously for their children and their parents.
• Increasing mobility of US society and the increased divorce rate: As a result, families are more likely to be geographically separated, and family ties are more likely to be weakened. Nonetheless, 80% of people ≥ 65 live within 20 min of one child.
• An increasing number of women entering the workforce: This increase reflects the increased number of single-parent households, most headed by women, and 2-income households. Previously, such women may have provided care for elderly parents, but the demands of a job may diminish or eliminate their ability to do so.
• The number of dependent and very sick elderly people is increasing.

These factors predict an increasing demand for home health care services provided by someone other than family members, friends, and neighbors.

Effects: Although caregiving can be very rewarding, it can also have negative effects. Family caregivers may experience considerable stress (called caregiver burden) and subsequent health problems, isolation, fatigue, and frustration, sometimes leading to a sense of helplessness and exhaustion (caregiver burnout) or elder abuse (see Elder Abuse).

Caregiving may also become a financial burden. Couples in which one partner cares for the other tend to be disproportionately poor.

Caregivers can often obtain reassurance or learn helpful information or strategies for caregiving from physicians, nurses, social workers, or case managers. Caregivers can also take the following measures to prepare themselves for caregiving and to avoid caregiver burnout:

• Not taking the patient's anger, frustration, or difficult behavior personally
• Attending to their own physical, emotional, recreational, and financial needs
• When appropriate, asking for help with caregiving or psychologic support from other family members and friends
• Investigating outside groups that can offer psychologic support (eg, support groups) or help with caregiving (eg, counseling, home health care, adult day care, meals programs, respite care)

Last full review/revision September 2009 by Barbara J. Berkman, DSW/PhD; Daniel B. Kaplan, MSW

Content last modified February 2012