Title: Informal1 Care Networks of Canadian Seniors with Long-Term Health Problems
Investigator Name: Professor Norah Keating
Project Completion Date: December 2002
Research Category: Research
Institution: University of Alberta
Project Number: 6609-09-1999/2590121
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Summary
Throughout the past decade there has been a policy focus on the
contributions of family/friend caregivers to the continuing care
of frail seniors. Questions about the nature and caring capacity
of the family/friend sector formed the basis for this project.
There is considerable controversy over these questions. While some
believe that there is unused capacity in this sector and that families
and friends should pool their resources and do more, others have
argued that family/friend caregivers often care alone and are expected
to do work that exceeds their personal resources. Unfortunately,
we have relatively little evidence to inform the debate. We know
a great deal about individual caregivers. Yet knowledge of care networks is
necessary to understand both the breadth of family/friend caring
resources and their need for support.
Data on seniors' care networks were derived from the 1996 Canadian
General Social Survey on social support. We utilized the subset
of 1,107 respondents aged 65 years or older who received assistance
with one or more care tasks2 during
the previous year from a family member, friend or neighbour because
of their own long-term health or physical limitation(s). Networks
were counts of all those who provided one or more care tasks to
a target senior. Network characteristics were: network size, gender,
relationship and age composition, and proximity. Descriptive statistics,
multiple and logistic regression, and K-means cluster analyses
to derive network typologies were utilized to achieve our objectives.
All analyses were weighted to ensure that estimates are representative
of the Canadian population.
Objective 1: To clarify conceptual differences among social, support and care networks. The purpose of this element of
the project was to develop a common language for terms such as
care and care network in order to better understand the needs
and capacities of the family/friend care sector.
Fundamental to the question of the caring capacity of the family/friend
care sector is an understanding of the ways in which social networks
of older people might evolve into care networks when needed. We
addressed this objective by undertaking a review and critique of
current knowledge of social, support and care networks. Based on
this review we argued that these types of networks are distinct.
While social networks are sets of social ties to others
(such as neighbours, friends and family members), support networks are
subsets of these people who provide emotional and tangible assistance
with everyday activities. However, in the face of long-term health
problems of older adults, support network members may be called
upon to increase the range, amount or intensity of assistance -
exhausting the resources of the support network. The subset of
support network members that provides this more intense help is
the care network.
The work done for this objective provides a basis for our assessment
of the caring capacity of the family/friend sector. While having
kin and friends is a necessary prerequisite to receiving care,
it is not sufficient. Care networks likely are a small core group
of the larger social network.
Objective 2: To describe the characteristics of family/friend care networks of Canadian seniors with long-term health problems/disabilities.
To address this objective, we studied the caregiving network
rather than individuals. We described characteristics of care
networks including size, proximity to the cared-for person, gender
and kin relationship.
We found that frail seniors' care networks are predominantly small
in size, female and kin dominated, mostly young to middle aged,
and living in separate households from the care recipient. However,
network characteristics also are notable in their variability.
While more than 25% have three or more members, 40% have only one,
suggesting that many care networks do not have sufficiently large
membership to share caring responsibilities. Substantial minorities
of networks are entirely men, non-kin, over age 65, and co-resident.
Findings on the relationship between network characteristics and
receipt of care showed that size, gender composition and proximity
are most important network characteristics. As network size increased,
recipients received more hours of care, more care tasks, and had
greater odds of receiving each care task. While networks comprising
only women received about two hours more care per week than those
whose networks were entirely men, mixed gender networks provided
the widest range of tasks. Seniors whose entire care network lived
in the same household received about 9 more hours of care per week
than those with no co-resident caregivers, while those with geographically
proximate caregivers received a large number of care tasks.
Objective 3: To develop typologies of care networks of these seniors. The purpose of this objective was to develop evidence
concerning the most common types of care networks represented
by clusters of network characteristics.
We identified six types of care networks. Three are kin-based
(Restricted, Caring, and Fragile), two are non-kin based (Restricted
and Fragile) and one is Diverse. The three kin-based networks comprise
71% of all care networks, while 16% of networks are predominantly
non-kin. The finding that there are two network types with predominantly
non-kin and a third mixed network highlights the importance of
friends and neighbours.
Network types differed in size. Most had one or two
people, while Diverse networks had 3 to 8 carers. In all network
types except Diverse and Restricted Friends & Neighbours, the
majority of networks comprised only women. However, Diverse networks
had a mix of women and men, while substantial minorities of Caring
Kin and Fragile Kin networks (30% and 38% respectively) comprised
only men. Proximity composition also was related to receipt of
care. From the perspective of the care recipient, few network members
lived more than ½ day away. Further research is needed to
determine if there are more distant members who do care management
and whose work is invisible to the care recipient because it is
not done face-to-face.
Objective 4: To determine consequences to senior recipients of having different types of care networks. A key question
in this project was how well frail seniors are served by their
care networks. Thus we investigated a number of health and care
outcomes for recipients of different types of care networks.
We found that all frail seniors who need care are at some risk
of receiving inadequate care not
enough or of the wrong type. We also found that seniors' outcomes
differ by network type, leading us to conclude that some network
types are likely to be more fragile over the long-term than others.
Seniors with Diverse, Fragile Kin, and Caring Kin networks received
the most hours and types of care. Diverse networks may be robust
since they are large, gender balanced, comprise kin and non-kin,
and can share the care among more people than other networks. However,
only 13% of seniors had this type of care network. Seniors with
Fragile Kin networks had the poorest health and were the least
happy despite or perhaps because of receiving
the most hours of care and widest range of tasks. Fragile Kin networks
comprise mainly elderly spouses caring alone, who also are aging,
and may themselves become (or be) frail. Their care responsibilities
also may cause them to become isolated and lonely, making the care
network even more fragile.
Seniors with Fragile Non-Kin and Restricted Non-Kin care networks
received the least amount of care, and the fewest number of tasks.
However, while all seniors in the study reported long-term health
problems, seniors with these two network types were the healthiest.
The two non-kin network types may also be extremely fragile because
they lack the normative obligations to care usually associated
with kinship. As seniors in these types of networks become increasingly
frail, it is unlikely that the Fragile Non-Kin and the Restricted
Non-Kin networks would persevere over the long-term.
Policy implications. The assumption made by policy makers
that seniors are surrounded by large networks of family, friends,
and neighbours who provide care if needed, is not supported by
our research. Care network type is strongly related to outcomes
such as type and amount of care received, health, and quality of
life, suggesting the importance of providing different kinds of
supports to seniors depending on their care network type. Policies
to support this goal could include:
- targeting home care policies to enhance sustainability of the
variety of care networks.
- broadening the conditions of the Caregiver Tax Credit to benefit
members of care networks, across a wider set of residency/relationship
criteria.
- providing financial support for a finite period or eldercare
allowances within the Canada Pension Plan to the 83% of care
networks that have employed caregivers if they take a temporary
leave of absence from the labour force because of heavy eldercare
responsibilities.
Finally, it is important to recognize that some care networks
seem better positioned to meet the needs of frail seniors than
do others. Networks that provide high levels of care need particular
attention. Policies meant to support caregivers would benefit from
an analysis of how public policies are supportive to different
care network types.
1 Since beginning this project, we
have begun to use the term 'family/friend' caregiver in preference
to 'informal' caregiver. 'Informal' has connotations of casual,
intermittent or voluntary, which do not reflect the enormity of
the job.
2 Care tasks include meal preparation
or cleanup; housekeeping; shopping; transportation; home maintenance
and repair; assistance with banking or bill-paying; personal care;
and emotional support or checking-up to make sure the senior is
all right.
The views expressed herein do not
necessarily represent the views of Health Canada
In addition to the above Summary, the full report can be accessed
in the following ways:
- The print version of the full report can be obtained in the
language of submission from the Health Canada Library through
inter-library loan.
- An electronic version of the report in the language of submission is available upon request from Health Canada by contacting the Research Management and Dissemination Division.
This research has been conducted with a financial contribution
from Health Canada's Health Policy Research Program. For permission
to reproduce all or part of the research report, please contact
the Principal Investigator directly at the following address:  norah.keating@ualberta.ca.
The Health Policy Research Program (HPRP)
funds research that provides an evidence base for health Canada's
policy decisions. The HPRP is
a strategic and targeted program with a broad socio-economic orientation
and connections to national and international endeavours. The research
can be primary, secondary or synthesis research, a one-time contribution
to a developing research endeavour, or a workshop, seminar or conference.
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