Academic journal article Care Management Journals

Older Case Management Clients with Younger Family Members in Need of Care: Interdependencies and Well-Being

Academic journal article Care Management Journals

Older Case Management Clients with Younger Family Members in Need of Care: Interdependencies and Well-Being

Article excerpt

This exploratory study investigated caregiving and interdependencies in families of frail older case management clients who coreside with younger individuals in need of care. Analyses were based on interviews with 78 older adults recruited from a large urban case management program. To be eligible for the study, the older adult had to coreside with an individual under age 60 who had disabilities or chronic health problems and/or with minors. Results indicated that the majority of older adults were primary caregivers for at least one younger individual. In a substantial number of families, the older adult depended on a younger adult with disabilities for primary care. Older adults who lived with both younger adults with disabilities and minors experienced more negative affect than those who lived with only one of these two kinds of younger individuals. Positive affect among elders living with younger adults with disabilities was positively related to the number of formal services received by the younger adults. The implications of these findings for service delivery to families with complex needs for care are discussed.

Keywords: caregiving; African Americans; disabilities; intergenerational

Case managers play a key role in obtaining, coordinating, and evaluating services for older adults at risk for institutionalization. Their role is emphasized in the Older Americans Act as well as many state Medicaid waiver Home and Community Based Services programs (Centers for Medicare and Medicaid Services, n. d.; Grants for Supportive Services, 2007). Because of this focus, case managers of the frail elderly center their assessments on the specific care needs of older adults and perhaps their caregivers and are likely to be most knowledgeable about those services that are available through service systems for the elderly, generally defined as individuals age 60 or above. In some cases, however, there may be a coresident adult under age 60 in need of care because of a disability or chronic health problem. For example, a son or daughter with a developmental disability, mental illness, or substance abuse problem coresides with his or her frail parent. In other instances, the case management client coresides with minors (under age 18), who need care and assistance by virtue of their developmental stage. Changing population and social trends, such as the increase in households headed by grandparents and the aging of baby boomers with chronic disabilities (Bryson & Casper, 1999; Fujiura & Braddock, 1992), suggest these situations have become increasingly prevalent. Complex household and family situations are particularly prevalent in low income urban areas and among ethnic minorities (Fuller-Thomson, Minkler, & Driver, 1997; Hooyman & Kiyak, 2002). In light of these changing demographics, case managers and other service providers need to increase their understanding of households with multiple generations in need of care.

In spite of their own frailty, some older adults whom case managers encounter may be involved in caring for younger individuals. A recent study based on a nation-wide probability sample of adults caring for adult family members or friends found that adults age 65 and above compose 13% of such caregivers in the United States (National Alliance for Caregiving [NAC] & AARP, 2004). Other research has documented the increasing involvement since the 1970s of older relatives, especially grandparents (Bryson & Casper, 1999; Casper & Bryson, 1998). Analyses based on the 1997 Current Population Survey revealed that 6.7% of families with children under age 18 lived in households maintained by grandparents. Of these households, the fastest growing group was skipped-generation families in which the children's parents were not present (Casper & Bryson, 1998) and grandparents therefore served as primary caregivers. According to the 2000 national census, the likelihood of coresident grandparents to carry primary responsibility for care of grandchildren varies by race and ethnicity, with caregiving most prevalent among African American and Native American coresident grandparents; fully 56. …

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