Adults receiving some support from paid caregivers felt more mastery over their lives than those receiving support from only family or friends.
Most middle-aged and older adults wish to stay at home as they age. Yet, many older adults may still need substantial help with daily tasks while aging in the community. Receiving assistance with essential activities such as bathing, dressing, and eating can pose a threat to an adult’s feelings of autonomy and control.
To better understand how home care recipients feel about receiving support from family or friends as opposed to professional aides, researchers at the LeadingAge LTSS Center @UMass Boston conducted a national-level study exploring how the type of home care a person receives affects that person’s perceptions of control.
LTSS Center Research Associate Molly J. Wylie co-authored “Type of Home Care – Informal Versus at Least Some Formal – Matters for Recipients’ Perceived Control” with Kathrin Boerner, Edward Alan Miller, Kyungmin Kim, and Jeffrey A. Burr. The Gerontologist published the paper on Sept. 29.
FAMILY AND PROFESSIONAL CARE IN THE HOME
“Informal” caregivers, including family members, friends, or neighbors, provide the bulk of in-home support that older people receive. However, because caring for a loved one can lead to stress and burnout, many informal caregivers rely on “formal” caregivers, including professional home care aides, to supplement the care they provide.
Previous research suggests that care recipients prefer to receive help with instrumental activities of daily living (IADLs) from their children. They also prefer to receive more personal assistance with activities of daily living (ADLs) from a professional aide. IADLS include housekeeping, shopping, and emotional support, while ADLs include bathing and dressing.
Older adults may feel shame when asking family members for help with highly personal tasks and guilt that they cannot repay a loved one for the care provided. On the other hand, paying a professional caregiver might enable older adults to feel they are still in control of a fair exchange.
Although there is some evidence about adults’ preferences for caregiver arrangements, very little is known about how adults feel when they receive informal and formal support. To shed light on these feelings, Wylie and her colleagues analyzed Health and Retirement Study (HRS) data from 884 adults 50 years and older who reported receiving help with at least one ADL.
ANALYZING MASTERY AND CONSTRAINTS
The authors used HRS data to determine whether a care recipient received informal support from a family member, spouse, partner, or friend; formal support from paid caregivers; or a mix of both. Researchers also:
- Measured care recipients’ functional impairment by documenting the number of each respondent’s reported ADL limitations.
- Analyzed care recipients’ sense of mastery: the belief that their actions could help them accomplish a goal.
- Examined care recipients’ constraints: the barriers that might keep them from achieving the goal.
STUDY FINDINGS: MASTERY AND CONSTRAINT
Wylie and her colleagues found that adults receiving at least some instrumental support from paid professionals felt a higher degree of mastery over their lives compared to those receiving support only from family or friends. This was true regardless of the severity of their disability.
Researchers found no difference in feelings of constraint among adults receiving support from formal or informal caregivers.
CONCLUSIONS
The authors concluded that receiving paid care can:
- Help alleviate the caregiving burden of family, friends, or neighbors.
- Give care recipients the feeling that they still have the power to direct their services and reciprocate by paying for services.
- Help older adults feel they can still accomplish daily actions even in the face of disability because professional caregivers may be better trained to assist with ADLs.
“This study helps lay the foundation for policy advances around home care,” the authors write. “Understanding the potential benefits of professional in-home care may help fuel government spending on such services and secure higher provider reimbursement rates. … As policymakers and advocates push for workers’ fair compensation, career ladders, and improved supervision, the current study’s findings can help bolster the case for investment in this sector.”