Chapter Overview

1. How does the type of care family members provide to an elderly relative differ depending on their gender?
Although men and women both feel a sense of obligation to provide care to their aging parents, women are more likely to be the primary caregivers to the frail el-derly and to provide the greatest amount of care. Men and women also tend to perform different tasks. Daughters typically provide hands-on care such as feeding, dressing, or bathing, while sons are more likely to help with household chores, financial management, and yardwork.

2. How do the responsibilities of caregiving affect a family member's work and personal life?
Although the majority of caregivers are not in the labor force, approximately one-third are employed. Caregiving affects work in several ways. Even if employed caregivers continue working full-time, caregiving responsibilities may force them to work fewer hours, rearrange schedules, and take time off. Some caregivers quit work or retire earlier than planned if their caregiving responsibilities create conflicts with their ability to perform their jobs. The psychological toll that caregiving takes on caregivers is measured in terms of stress and burden. Surprisingly, although women employed outside the home seemingly have a higher burden than nonemployed women, they report less stress. It may be that satisfaction from work and contact with the outside world reduces stress, despite greater responsibilities from dual roles.

3. How does an aged person's need for care affect family relationships?
Caregiving may strain family relationships, but it may also enhance them. A child may be disturbed by personality changes in an aging parent or by the role reversal that may occur when the parent becomes dependent. Siblings may quarrel over the division of caregiving tasks. Marriages may be strained when spouses have less time for each other because of caregiving burdens. When the burden is shared equally, however, family members may appreciate each other and feel that familial ties have been strengthened.

4. What kind of home and community-based services are available to the frail elderly?
Home and community-based services help the frail elderly remain in their own homes. Among the services most commonly provided are personal care, housekeeping, and case management. Some communities also provide respite care for caregivers, adult day care, medical or rehabilitative care, and hospice services.

5. Can private long-term care insurance help families to manage the expense and burden of caregiving?
Although currently only 2.5 percent of long-term care costs in the United States are paid by private insurance, this percentage is increasing as people learn that the government does not pay for most services. Yet there are many problems to be resolved before long-term care insurance fills the long-term care needs for most Americans. One problem is that many older people cannot afford to pay the premiums for long-term care insurance. Many let their policies lapse and lose thousands of dollars in payments. Another problem is that private insurers often turn down people who need insurance the most, those with major health problems.

6. How have government regulations and the rise of for-profit nursing home chains affected the availability and quality of nursing home care?
A growing number of nursing homes are owned by for-profit multinational chains that operate facilities in the United States and in other countries. These chains are businesses that are responsible to shareholders to show a profit. Research shows that the best care is provided by nonprofit homes, especially those that are attached to a religious group.

7. -What is life in a nursing home like for the frail elderly?
People dread the thought of moving to a nursing home, and the adjustment to institutional life is difficult. The monotonous daily routine demanded by bureaucratic procedures reduces the quality of life for residents and places pressure on the aides who provide care. Residents are often denied the small pleasures that make life worthwhile by aides who are required to maintain a dehumanizing schedule. Patient abuse is a continuing concern in nursing homes. Although physical abuse is rare, psychological abuse is unfortunately more common. Not so much intentional, abuse results from the frustrations of overworked and underpaid aides.