Service use barriers' influence on heterogeneous service use patterns among informal caregivers

Purpose. Despite low rates of service use by informal caregivers, little research examines determinants and patterns of service use. A lack of consensus on the best measures of service utilization has led to exploration of a new device to identify overall service use patterns. This study aims (1) to conceptualize caregiver service use patterns and (2) to determine caregiving resources and service use barriers that are related to these patterns.

Methods. The Andersen model (1995) was expanded to include service barriers in the enabling domain. The 2004 National Long-Term Care Survey and Informal Caregiver Supplementary Survey provided data on dyads of older adults and their informal caregivers (N=1,908). Latent Class Analysis classified subgroups for service use patterns among ten services: day care/senior center, house modification, assistive devices, financial information, support group, respite service, personal/nursing care, housework service, meal delivery, and transportation. Predictors of service use included nine barriers (availability, awareness, affordability, staff quality, concerns for privacy, bureaucracy complexity, language barrier, eligibility, and consideration), personal resources, and network compositions.

Results. the study sample consisted of older adults aged 65 to 107 years and their primary caregivers aged 15 to 97 years (N =1,908). Around 32% of older adults and 34% of their caregivers were males. While 38% of the older adults were married, relatively greater numbers of caregivers were married (70%). Both were primarily Whites (87%). Despite high levels of education (e.g., 54% high school graduate or higher), nearly a quarter of the older adults (23%) earned an annual household income of less than $25,000. For their caregivers, 80% received education greater than high school, but only 34% were currently employed. Older adults were almost evenly split by residential area (45% urban residents). On average, the caregivers provided six caregiving tasks for 26 hours per week. Fairly large numbers of caregivers (16%) had performed caregiving for longer than 10 years. Service use patterns were classified as none (8%), light (33%), selected (36%), multiple service users (23%). The most prevalent barrier was that caregivers were not aware of the services (19%). Enabling factors contributed more than need factors in explaining service utilization, with most service barriers being significant determinants, except bureaucracy or eligibility. Private insurance significantly predicted classification as a selected or multiple user. Family cooperation and social support of caregiver were significant facilitators to service use.

Implications. As a valid measure of service use, this study may extend the knowledge on service use patterns and identify determinants to differenticate service use patterns. Typologies of service use and their determinants can provide the groundwork for accurately assessing access barriers, efficiently distributing program resources, and effectively planning interventions through differentiation and targeting of services. Differentiation of services may be important for gerontological practitioners to meet caregivers' needs and identify target populations for intervention. This typology process may tailor specific interventions to support caregivers.