Rhonda J. V. Montgomery

Gender And Elder Care In China: The Influence of Filial Piety and Structural Constraints

The authors explore the changing dynamics of gendered familial caregiving in urban China within the context of economic reforms and the continued cultural influence of xiao (filial piety). Data collected in China through interviews with 110 familial caregivers were used to examine cultural and structural influences on the caregiving behavior of adult children. Results from multiple regression analyses provide evidence of a gendered division of parental care tasks, a decline in the patrilocal tradition of caregiving, and a strong social pressure that influences caregiving behavior. Structural factors linked to caregiving performance included family size, lack of pensions for elders, and caregivers’ employment status and income. Findings portend deleterious effects for the women who are now caregivers as they are likely to live longer but be more financially dependent and have fewer children available to help them.

Family involvement in the nursing home: family-oriented practices and staff-family relationships.

Staff-family cooperation in caring for elders in nursing homes is recommended but poorly understood. Family involvement and staff-family interactions in nursing homes with differing family orientations were investigated. Friedemanns (1995) system-based family theory guided the study. Of all 208 licensed nursing homes in southern Michigan, 143 completed a survey about their family-oriented practices. Family orientation was ranked accordingly. Twenty-four nursing homes were randomly selected to conduct semistructured telephone interviews with 177 family members. Data were analyzed by thematic interpretation. Findings showed a wide range of involvement patterns that promoted family connectedness, maintenance of control, growth, and learning. Families desired various types of staff cooperation and were given such opportunities in homes with high family orientation.

A Dimensional Analysis of Caregiver Burden Among Spouses and Adult Children

PURPOSE OF THE STUDY Caregiver burden is a multidimensional construct, addressing tension and anxiety (stress burden), changes in dyadic relationships (relationship burden), and time infringements (objective burden) resulting from caregiving. The study aims were to assess (a) whether the dimensions of burden were the same for caregiving spouses and adult children, (b) the role of assisting with problem behaviors (PBs) and activities of daily living (ADLs) on each dimension of burden, and (c) the role of each dimension of burden on self-rated health and intention to institutionalize the care receiver. DESIGN AND METHODS This study included 280 spouse/partner and 243 adult child caregivers of persons with chronic illnesses. RESULTS Analysis using 2-group structural equation modeling showed that the factor structure of burden was equivalent for spouses and adult children. For both groups, assisting with ADLs was directly related with objective burden, whereas PBs were directly related to all dimensions of burden. For both groups, stress burden was the only predictor of self-rated health, whereas PBs were significantly linked with intention to institutionalize. However, stress burden among spouses and relationship burden among adult children were significantly linked with intention to institutionalize. IMPLICATIONS We discuss the research and practice implications of the differing needs of spouses and adult children.

Differences in the Perceived Need for Assistive Services by Culturally Diverse Caregivers of-Persons With Dementia

Various explanations have been advanced to explain why older members of ethnic minority groups in the United States tend to use proportionally fewer assistive social and medical services than nonminorities. One possibility is that culturally based differences in attitudes toward need for particular services affect the likelihood of use. Data were analyzed from 2,947 Black, His panic, and White caregiving dyads participating in the Demonstration Grants to States program. Hierarchical logistic regression models were estimated separately for three discretionary ser vices (adult day care, in-home respite, and meal services) and one nondiscretionary service (home health care). Hypothesized outcomes were observed in all of the service models tested

The Family Role in the Context of Long-Term Care

Current long-term care policy and practices are built on the premise that family is and should be the primary party responsible for impaired older persons. This article presents evidence that this premise and the resulting policies and practices are (a) built on myth; (b) fueled by gender, income, and ethnic inequalities; and (c) largely responsible for the creation of a service system that has inadequate capacity to meet current and future needs. An alternate paradigm, which places primary responsibility for long-term care needs on the individual, is proposed here and implications for newpolicy direction are outlined. The projected benefits of this shift in paradigm will be the development of a more viable and more equitable long-term care system that has the capacity to provide high quality care to meet the expanding need.

Utilization of Respite Services: A Comparison of Users, Seekers, and Nonseekers

Four hundred fifty-eight family caregivers of Alzheimers patients in Michigan were interviewed to identify factors associated with respite use. Of these caregivers, 176 were using respite (users), 128 had inquired about the service but had not yet used it (seekers), and 154 had neither used nor inquired about respite services (nonseekers). Separate logistic regression models were evaluated to identify users versus nonusers (n = 458) and seekers versus nonseekers (n = 282). Need for assistance with activities of daily living, availability of other caregivers, concern with cost, and adherence by the respite programto an established service schedule contributed significantly to the model distinguishing service users from nonusers. Caregiver burden, the presence of other caregivers, and the availability of transportation services made significant, unique contributions to the model distinguishing seekers from nonseekers.

The Effects of Respite on Caregivers of Alzheimer's Patients: One-Year Evaluation of the Michigan Model Respite Programs

The impact of respite care on informal caregiversforparticipants in the Michigan Model Respite Programs was evaluated Using a nonequivalent control group design, 72 caregivers were assessed prior to program participation and again 6 months later on three dimensions: subjective, or felt, burden; objective burden; and morale. Caregivers who had used respite had a significantly lower level of subjective burden and significantly higher morale compared to controls. No differences between groups of caregivers were observed for objective burden. The findings are discussed within the context of recent research that has generally failed to document the effectiveness of respite programs for family caregivers.

Family Involvement in the Nursing Home

The focus of this study was the influence of pre established family behavior patterns, family orientation of nursing home policies, and practices and caregiver and elder characteristics on the family members’expectations for involvement in the nursing home and the actual involvement 6 months later. The conceptual model was based on findings of Montgomery’s nursing home study and open systems principles applicable to families. Data were collected through telephone interviews with 216 family members of residents in 24 nursing homes in southern Michigan. Regression analyses revealed that measures of pre established patterns of family behavior accounted for 19% to 31% of variance in measures of expected family involvement. Expected family involvement, resident activities of daily learning (ADL), and caregiver relationship accounted for 11% to 23% of variance in measures of actual family involvement. Opportunity for family leadership in resident care had a mild effect of moderating the amount of family direct care and learning activities in the nursing home.

Impact of Role Discrepancies on Caregiver Burden Among Spouses

Using caregiver identity theory, the authors investigated whether role discrepancies mediated the relationships between illness-related stressors (activities of daily living [ADLs] limitations and problem behaviors) and burden (stress, relationship, and objective burden) for spouse caregivers. Participants completed measures of identity standards for spouse and caregiver roles and behaviors, burden, assistance with ADLs, and problem behaviors. Structural equation modeling analyses revealed that role discrepancies completely mediated the relationships between ADLs and stress and relationship burden. Although role discrepancies mediated the relationships between problem behaviors and all forms of burden, there were direct relationships between problem behaviors and burden. Finally, participants who exceeded their relationship identity standards experienced greater burden. Supporting caregiver identity theory, the results suggest that ADL assistance is burdensome for caregivers when it highlights inconsistencies between their behaviors and their relationship expectations. However, unpredictable stressors such as problem behaviors are both inherently burdensome and highlight role discrepancies.

Profiles of Respite Use

SUMMARY Profiles of long-term respite use are reported for a diverse sample of 4, 369 families from seven states who participated in the Alzheimers Disease Demonstration Grant to States program. Data from service records spanning a period of seven years were analyzed using hierarchical linear modeling techniques. Respite use was examined in both day care and in-home settings using three different measures of use. Client characteristics related to use include the caregivers gender and relationship to the elder, and the ethnicity, income, functional level, and problem behaviors of the elder. Provider characteristics linked with different patterns of use include level of service, fee structure, and level of capitation. Implications for service delivery are discussed.