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|
|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|
|Health system interactions||13,848||77.2||10,987||79.7|
|Speak to doctora||9,859||55.0||8,150||59.2|
|Other insurance issuesa||6,033||33.7||5,045||36.6|
|Add or change insurancea||4,523||25.2||3,721||27.0|
|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.
a 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|
|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|
|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.
a 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.