Informal Caregiving for Older Americans: An Analysis of the 2011 National Study of Caregiving. Types of Assistance and Hours of CARE

04/01/2014

Table 3 provides detail on breadth of assistance informal caregivers provide, grouped into five domains: more traditionally examined self-care or mobility (ADLs) and household activities (IADLs), transportation, assistance with medical system interactions, and health or medical care activities, ordered from most to least common. A somewhat larger proportion of self-care or mobility helpers reported assisting with each activity, indicating the broad scope of activities they typically undertake.

TABLE 3. Types of Help Provided in the Last Month to Recipients Age 65 or Older Living Outside of Nursing Homes, 2011

  All Caregivers Caregivers Helping with Self-Care or Mobility
Number (000s) Percent Number (000s) Percent
Self-care or mobility 13,768 76.8 13,784 100.0
    Mobility 12,826 71.6 12,826 93.2
    Self-care 8,806 49.2 8,806 63.9
Household activities 17,319 96.5 13,496 97.9
    Shopping 16,023 89.5 12,622 91.9
    Laundry, housework, meals 14,212 79.2 11,613 84.3
    Help with bills, managing money 10,471 58.3 8,413 61.1
    Keep track of medicines 8,726 48.7 7,477 54.3
Transportation 15,503 86.4 12,284 89.1
Health system interactions 13,848 77.2 10,987 79.7
    Make appointmentsa 10,859 60.5 9,009 65.4
    Speak to doctora 9,859 55.0 8,150 59.2
    Order medicine 8,653 48.4 7,074 51.5
    Other insurance issuesa 6,033 33.7 5,045 36.6
    Add or change insurancea 4,523 25.2 3,721 27.0
Health/medical care 10,243 57.1 8,997 65.5
    Diet 4,916 27.4 4,257 31.0
    Foot care 4,857 27.1 4,456 32.4
    Skin care 4,158 23.2 3,823 27.7
    Exercises 3,808 21.2 3,602 26.1
    Dental care 2,675 14.9 2,515 18.2
    Manage medical tasks 1,899 10.6 1,723 12.5

SOURCE: Data from the baseline 2011 NHATS and the companion NSOC. NHATS functional level is taken from the NHATS. Hours of care and caregiver characteristics are taken from the NSOC. Of the full sample of 2007 information caregivers, 11 who reported helping in the last year, but not the last month are excluded.

NOTE:

The reference period is "in the last year" for these activities, which may be performed less frequently.


Mobility assistance is provided by 71.6% of all informal caregivers, and more than 90% of those assisting with any self-care or mobility activity, while nearly half of all caregivers and almost two-thirds of those helping with self-care or mobility are providing some self-care help. Nearly all caregivers are helping with at least one household activity (96.5%). About 90% of caregivers assist with shopping, the most common household activity for which help is received, and about half assist with keeping track of medications, which is the least common among the activities traditionally included in this domain.

Nearly 90% of caregivers assist with transportation, more than three in four were assisting with at least one health system interaction task. Just under 60% of all caregivers and nearly two-thirds of those assisting with self-care or mobility were helping with at least one health or medical care task. The most common health system interactions were helping with appointments and communications with health care providers, and the least common were helping with insurance issues. Not surprisingly, the proportion of caregivers assisting with ordering medications is very similar to the proportion helping keeping track of medications, which is included in household activities, following the traditional IADL grouping. The most common health or medical care tasks were assistance with diet and foot care, and the least common were giving injections and managing medical tasks, such as ostomy care, IV therapy assistance, or blood tests. To give a sense of the extent to which help with activities in these last two domains is concentrated among caregivers who help with self-care or mobility, among those not assisting with self-care or mobility, 69% helped with any health system interaction task and only 30% helped with any health or medical care activity (not shown).

To explore the dispersion of tasks across caregivers, Table 4 examines the proportion of informal caregivers helping with at least one activity in each of the five domains of care (self-care or mobility, household activities, transportation, health system interactions, and health or medical care) by recipient-reported assistance level, dementia status, and residential setting. The number of domains with which caregivers assist depends both on the individual needs of the care-recipient and on how labor is divided among members of the care network--whether there is specialization. The far right columns provide the proportion and mean hours provided by caregivers who help in all domains of activities and by specialized caregivers helping with activities in a subset of domains.

Generally similar proportions of caregivers provided assistance with household activities (95% or more) and transportation (81%-88%) across recipient-reported assistance level, dementia status, and residential setting. More variation is evident in the proportion of caregivers providing self-care or mobility assistance (59%-92%), help with health system interactions (68%-86%), and health or medical care assistance (37%-72%). These differences may be explained in part by recipient need and in part by greater sharing or delegation of responsibilities across caregivers. The proportion of caregivers helping with self-care or mobility is significantly higher with higher recipient-reported assistance levels and also is significantly higher for those with probable dementia. A similar pattern is evident for assistance with health system interactions and health or medical care, with higher proportions of caregivers helping as the level of recipient-reported assistance increases and for care-recipients with possible or probable dementia.

Overall, 74% of caregivers assist with activities in all domains, with little variation across recipient-reported assistance level and dementia status. However, 81.2% of caregivers to those living in a supportive setting assist with all activities, compared with 72.7% of those helping recipients in traditional community residence.

Informal caregivers who performed all tasks provided substantially greater hours of care in the last month, generally at least twice the hours provided by caregivers specializing in a subset of activities. For example, among caregivers assisting recipients reporting help with 3+ self-care/mobility activities, those helping with all tasks provided an average of 131 hours in the last month compared with 50 hours for those not helping with all tasks; for caregivers assisting recipients with probable dementia, the difference was 110 hours versus 44 hours.

TABLE 4. Types of Help Provided by Informal Caregivers in the Last Month by Characteristics of Recipients Age 65 or Older Living Outside of Nursing Homes and Care Network Size, 2011

  >Number of Caregivers (000s) Domains of Assistance Caregivers Helping with All Activitiesa Specialized Caregivers
Self-Care or Mobility Household Activities Transportation Health System Interactions Health or Medical Care Percent Mean Hours Provided Percent Mean Hours Provided
All 17,949 13,768 17,319 15,503 13,848 10,243 74.0 87 26.0 39
Percent of all caregivers 100.0 76.7 96.5 86.4 77.2 57.1  
Recipient-reported assistance level
    Household/other activities only 5,581 59.1 95.8 88.3 70.3 39.4 73.0 58 27.0 32
    1-2 self-care/ mobility activities 6,823 78.7 96.9 88.9 77.1 59.8 72.3 74 27.7 37
    3+ self-care/ mobility activities 5,545 92.3 96.7 81.3 84.2 71.6 77.1 131 22.9 50
Recipient dementia status
    No dementia 9,369 70.7 96.5 88.5 71.8 52.1 74.9 74 25.1 37
    Possible dementia 2,741 81.2 96.3 87.4 77.4 62.6 73.5 86 26.5 33
    Probable dementia 5,838 84.5 96.6 82.4 85.7 62.5 72.9 110 27.1 44
Residential setting
    Community 15,129 77.5 96.7 87.3 76.2 60.8 72.7 97 27.3 41
    Supportive care setting 2,820 73.0 95.6 81.6 82.4 37.0 81.2 44 18.8 20

SOURCE: Data from the baseline 2011 NHATS and the companion NSOC. NHATS functional level is take from the NHATS. Hours of care and caregiver characteristics are taken from the NSOC. Of the full sample of 2007 informal caregivers, 11 who reported helping in the last year, but not the last month are excluded.

NOTE:

Percent of caregivers providing at least one type of help in the last month in all five domains (self-care/mobility, household activities, transportation, medical care, or health system interactions) with which the care recipient receives assistance.

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