The care received by millions of older adults comes from a variety of sources. Although informal caregiver is the most preferred and frequently used source of assistance for older adults, formal care services also supply a great deal of support, especially for the millions of older adults who live alone or have no family or friends available to assist. Older adults who have a choice, however, prefer that family and friends help them once assistance becomes necessary.
When assistance becomes necessary, families often go through a period of reorganization as they restructure their lives. Frequently, one individual, whether by choice, availability, or convenience, becomes the primary caregiver. The job of the primary caregiver, although rarely specified, is to be the direct provider and/or manager of the elder’s care. The stressful and long-term nature of providing care causes many primary caregivers to seek assistance from other family members, friends, or service providers. However, it is understood, though not necessarily made explicit, that the primary caregiver is the main person in charge of the relative’s care.
A naturally occurring hierarchy seems to exist within families that often leads to a designated primary caregiver. When care recipients are married, spouses will most likely become the primary caregiver. Adult daughters are also likely candidates. According to Spector et al., approximately 13.4% of family caregivers are wives, 10.0% are husbands, 26.6% are adult daughters, 14.7% are sons, and another 17.5% and 8.6% are ‘other’ female or male relatives, respectively. In addition, the quality of the caregiver’s relationship with the care receiver is associated with who will provide care. Family members who have contentious or antagonistic relationships with the care receiver are less likely to provide care than those relatives who are more compatible. Unfortunately, when the caregiver and care receiver are not compatible, it is common for both to experience heightened distress.
The health of family members, proximity to the care receiver, and demands of their daily lives are additional factors that influence whether or not a family member will become the primary caregiver. These factors also influence the level of involvement family members have in the provision of care. If a family member is in poor health or is at risk for worsening health, he or she is less likely to become a primary caregiver. About one-third of primary caregivers assume the role because they live closer to the care recipient, although an increasing number of family members are assuming care responsibilities from long distances. Relatives with multiple or competing family demands (e.g., employment, child care needs) are also less likely to be caregivers. However, even under demanding and stressful conditions, family members are still more likely than service providers to provide care.
In contrast to the primary caregiver, secondary caregivers typically provide unpaid supplemental or intermittent assistance. Most older adults have more than one informal caregiver, although informal caregiving networks tend to be relatively small, averaging two in number. Secondary caregivers typically supplement the help provided by primary caregivers, particularly in the areas of household tasks, personal care, and socialization. In contrast, assistance with money management and medical care appears to remain the responsibility of one caregiver, generally the one who has more expertise in the area. Secondary caregivers also supply important assistance to the primary caregiver as well as the care receiver. They are a prominent source of companionship and emotional support for the primary caregiver as well as a source of respite or relief from caregiving responsibilities. In total, informal caregiving networks supply an average of 7 hours of help daily to community-residing impaired older persons.
