Academic journal article Generations

The Backbone of the Long-Term-Care Workforce

Academic journal article Generations

The Backbone of the Long-Term-Care Workforce

Article excerpt

Reform must focus on informal caregivers and paraprofessional workers.

Although this issue addresses workforce concerns, it must be emphasized that most long-- term care is provided by family members and friends. In the absence of family or friends or when the care recipients needs exceed the caregiver's ability or willingness to help, nursing assistants, homecare aides, and personal care attendants are the workers who become most involved in direct care. Together, informal caregivers and paraprofessional workers shoulder the lion's share of long-term care.

This article begins by reviewing recent research on informal caregivers and projected trends to explore the likelihood that informal helpers will continue to be the primary providers of long-- term care in the future. Next, new research findings on sources of stress experienced by paraprofessional workers caring for elderly nursing home residents and the impact stress on job satisfaction are presented. The article concludes with a review of interventions and supportive services to enhance the health and well-being of informal and paraprofessional caregivers.


Family members, primarily adult children, care for the majority of older people (72 percent) who have activity limitations, typically without the use of supplemental or paid care (National Academy on an Aging Society, 2000). An estimated 25 million family caregivers provide some assistance to an older relative, while about 6 to 9 million provide daily assistance with personal care or activities of daily living. In 1997, the estimated economic value of informal care was $196 billion, a figure that exceeds the $83 billion spent on nursing home care and the $32 billion spent on home healthcare (Arno, Levine, and Memmott,1999).

Car egiving can take its toll on the health, prosperity, and well-being of informal caregivers. The emotionally and physically demanding nature of the work, the many years over which it can occur, feelings of being captive in the role, and the lack of predictability and control over daily life exact their price. Depressive symptoms, for example, are more than twice as common among caregivers than in general community populations. While about 20 percent of depression scores for community samples are at a level indicative of possible clinical depression (Radloff, 1977), more than half of the caregivers in some study samples score at this level (Whitlatch, Feinberg, and Sebesta, 1997). Over half of the caregivers in one national study reported that their responsibilities had a negative impact on their family and leisure time (National Alliance for Caregiving and American Association of Retired Persons, 1997). Also, almost one-- third of those helping the most impaired care recipients experienced physical or mental health problems. While the majority of caregivers do not report financial hardships due to caregiving, those caring for the most impaired, minority caregivers, those with lower incomes, and nonworking caregivers experience the greatest financial hardships.


There is increasing concern about the ability of families and friends to continue meeting the needs of older people with chronic disabilities, partly because of the sheer increase in the size of the population that will need care and also because of sociodemographic changes that have occurred over recent decades (see article by Alecxih, this issue). According to a report by the National Academy on an Aging Society (2000), estimates indicate that the number Of peOple 70plus needing care will increase from 10 million in 2000 to 15 million in 2020 and to 21 million in 2030. Among the older people who currently have activity limitations and do not receive either paid or unpaid help, more than half (53 percent) do not expect that relatives (except for spouses) or friends will be able and willing to help in the future. …

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