Long-Term Care Impact on Family, Caregivers, and Society

Introduction

Long-term care can be needed for a variety of reasons, including accident injuries, debilitating or chronic illness, or simply the effects of aging. There are times when persons cannot care for themselves and must rely on others for their daily needs. Sometimes that care takes place in a facility designed to provide such services. However, in many cases the burden of caring for loved ones falls on family members or even friends. Long-term care places a significant strain on people financially, and this has historically been the primary focus of health care policy. Yet there is an often-overlooked dimension of long-term care.

Long-term care carries many emotional issues as well — not only for the patient, but for the caregiver. These issues can cause a variety of difficulties, including depression, fatigue, and stress, and can even contribute to family breakdown. Such issues place an even greater burden on the broader healthcare system and on society as a whole, and they must be considered when developing new long-term health care policies.

The problems associated with long-term health care for the elderly and the chronically ill have many facets. Long-term health care in facilities such as nursing homes is expensive, and the United States is facing a growing shortage of health care workers to care for the elderly — a trend that is expected to worsen. In many cases, families choose to care for the person at home rather than incur potentially devastating costs. When family care is not an option and the family lacks the resources to pay, the government must cover the cost. Caring for a patient at home is also costly and often places an incredible financial strain on the family. The following research explores these issues from multiple angles and discusses potential solutions.

Social Factors Affecting Caregiving

There was a time when long-term care facilities did not exist and the entire burden of caring for the elderly or sick rested with the family. Many still believe this is how it should be; however, family structures are changing, and this assumption has been shown to be a myth (Montgomery, 1999). This shifting family structure means that an increasing number of elderly persons are relying on long-term care facilities to replace the traditional family role.

Effects of Divorce

Divorce rates have been climbing for many years, and the traditional nuclear family is quickly being redefined. As a result, there are now more elderly people who are divorced. The effects of this trend are visible in the long-term care these elders are likely to receive from their children. Divorce can harm family ties and often creates feelings of resentment or rejection among family members. According to a study conducted by Shone and Pezzin (1999), divorce makes it less likely that families will help each other financially or in terms of physical care. The key findings were that adult children of divorced parents were less likely to receive financial assistance from those parents. In addition, stepparents were less likely to receive care from their stepchildren than biological parents were. The study also found that remarriage further reduced the likelihood that an elderly person would receive care (Shone and Pezzin, 1999).

Effects of Abuse and Neglect

A history of abuse or neglect in the family may also be a factor in whether elderly persons receive care from their children. Child abuse and neglect sever family ties and can have a lasting impact on whether a person receives care in their elder years (CASA, 2001). This is often an overlooked long-term effect of child abuse. While many focus on the immediate social costs, the willingness to provide eldercare is a downstream consequence of childhood abuse and neglect. Current studies tend to focus on the effects on the abused person alone, failing to account for the impact of broken family ties later in life.

Effects of Women in the Workforce

Studies have indicated that men and women near retirement age whose parents are still living are spending less time caring for them or assisting with daily tasks such as household chores (Johnson and Lo Sasso, 2000). Women's growing participation in the workforce may contribute to this trend. Parental health was found to be a key predictor of whether an elderly person would receive assistance from their children (Johnson and Lo Sasso, 2000). Health was a factor in determining whether children provided basic personal care, such as feeding or dressing, but was not a significant factor in help with daily chores and errands (Johnson and Lo Sasso, 2000).

Proximity and Other Factors

Geographic proximity was also identified as a predictor of whether children helped care for their parents. Children who lived closer to their parents were more likely to provide help than those who lived far away (Johnson and Lo Sasso, 2000). When both parents were alive, children were less likely to step in, as the surviving spouse typically provided primary care. Interestingly, mid-life children who had young children at home or faced their own family challenges — such as an ill spouse — were not significantly less likely to provide help to an elderly parent (Johnson and Lo Sasso, 2000).

Works Cited

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Johnson, R. W., & Lo Sasso, A. T. (2000). Parental care at midlife: Balancing work and family responsibilities near retirement (No. 9 in "The Retirement Project" series). Urban Institute.

Montgomery, R. (1999). The family role in the context of long-term care. Journal of Aging and Health, 11(3), 383–416.

Shone and Pezzin, Drs. (1999). Parental marital disruption and intergenerational transfers: An analysis of lone elderly parents and their children. Demography, 36(3), 287–297. In: Divorce reduces informal caregiving and economic ties between elderly parents and their adult children. http://www.ahcpr.gov/research/sep99/999ra15.htm

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