Rural Family Caregiving

1
Rural Family Caregiving
Gail Gibson Hunt National Alliance for Caregiving

• AgrAbility Conference
• Burlington, Vermont
• November 2005

2
Family Caregiving in the US

• Latest research shows
• 44.4 million caregivers (1 in 5 people)
• 34 million caring for those 50
• Profile 46-year-old baby boomer woman who works
  and cares for her mother who lives nearby
• Nearly 40 are men

3
More About Caregivers In General

• 80 of care provided to older people is unpaid
  care by family and friends
• Economic value of caregiving to society 257
  billion/year
• 15-20 of the workforce
• Average 200/mo. out-of-pocket

4
Who are the care recipients?

• 83 are relatives, most often mother,
  mother-in-law, grandmother
• Average age of older care recipient 75
• 23 have Alzheimers or other dementia
• Principal problems or diagnoses old age,
  cancer, diabetes, heart disease

5
Intensity of Caregiving

• Average of 21 hours per week
• Those who say constant care (40 hours per
  week) tend to
• Be co-resident
• Be in fair or poor health themselves
• Care for someone with Alzheimers
• Have lower income
• ADLs and IADLs

6
Helping with IADLs
7
Helping with ADLs
8
Unmet Needs
9
Impacts of Caregiving

• Financial 200 per month out-of-pocket
• Emotional One-third report caregiving is
• somewhat or very stressful
• Physical Only 15 report strain
• Health
• 17 of all caregivers report fair or poor health
• 35 of those doing most intense caregiving
• More physician visits

10
Caregiving and Work

• About 60 of caregivers work
• Percent of those who make any workplace
  accommodation 62

11
MetLife Studies

• 1997 Employer Costs for Working Caregivers
• 11.4b to 29b per year
• Juggling Act Study
• 659,000 loss in terms of wages, pensions and
  social security over a career of caregiving

12
Who are the rural caregivers?

• 27 of caregivers live in rural areas approx 12
  million people
• Demographically, look very similar to
  urban/suburban caregivers
• Some differences rural caregivers are more
  likely to
• Be married have kids under 18 living with them
• Be Caucasian
• Have less formal education and lower income
• Less likely to be employed

13
Some other differences of rural caregivers

• More likely to use prayer as a coping mechanism
• Less likely to turn to the Internet for
  information more likely family and friends
• Less likely to use support groups, adult day care
  services, transportation services
• More likely to be Level 5 in intensity 20 are
  doing constant care

14
Who are the rural care recipients?

• 27 live in rural areas
• Typically a mother (23) grandmother (10) or
  father (9)
• More likely to still be married
• Most common illnesses arthritis blindness
  diabetes mobility less dementia
• Somewhat less likely to need incontinent care
• Two-thirds live nearby or in the same house as
  the caregiver

15
More characteristics of rural care recipients

• Their caregivers are more likely to experience
  financial hardship between 24-34/month more in
  out-of-pocket
• More likely to be a vet
• More likely to report home modifications
• Their caregivers are less likely to get unpaid
  help other than themselves

16
Interface between formal and informal care not
well understood

• Presumption that limited access to formal care
  increases importance of informal care
• Shenks view that rural elders may be more
  independent and hesitant to seek help vs.
  Buckwalter Daviss view that they lack
  information on services and hesitate to use
  because of welfare stigma

17
Important factors in designing rural services

• Recognition that rural communities are diverse in
  population characteristics, values and culture.
• Initiatives that involve local residents during
  the design, planning and implementation stages.
• Recognition that geographic distance is not only
  a geographic barrier, but a psychological barrier
  as well.
• Initiatives that recognize the importance of
  fictive kin, neighbors and friends in rural
  support systems that may contain few close
  relatives because of out-migration.

18
More important factors in designing rural services

• Service and access hours that reflect the needs
  of working caregivers on a variety of work
  shifts.
• Outreach and service design factors that do not
  stigmatize the caregiver or the care recipient.
• Mobile options that bring assessment, services
  and support to the caregivers and their care
  recipients.