Families and formal service usage: Stability and change in patterns of interface

Understanding the relationship between formal and informal support is becoming increasingly important for those involved in caring for the elderly (Bass et al., 1996; McAuley et al., 1990). As the elderly become more dependent on formal services and changes in demographics result in more women in the workforce and fewer available informal caregivers, there is a need for organized and efficient formal support networks that work well with, rather than replace, family helpers (Aneshensel et al., 1995; Scott and Roberto, 1985). Several models of the interface of formal-informal support have been proposed in the literature (e.g. Cantor, 1975; Edelman, 1986; Greene, 1983; Litwak, 1985). A sample of 305 primary family caregivers were interviewed at three points in time regarding their use of formal services and assistance from additional family members. It was possible to classify the sample initially into three types of family/formal interface: isolates who receive no help from family or formal services, family dependent who are assisted by kin but not formal services, and formal who receive some assistance from paid services. These groups were examined over time for stability of group membership and nursing home placement. Characteristics of caregivers and their relatives who fell in each category were also examined. There were differences in caregiver stress and rates of subsequent placement rates for people in the three initial categories of informal/formal interface (isolates, family dependent, formal), but moving from one category to another during the course of the study was more strongly associated both with care-related stress and placing the person with dementia into an institution than was stable membership in the other categories.