Predictors of Perceived Benefits and Drawbacks of Using Paid Services among Dementia Caregivers

Purpose

Many studies document that dementia caregiving is demanding. Consequently, most dementia caregivers use some paid help. Yet, few studies have examined perceived benefits and drawbacks of using paid services among dementia caregivers. This study examined the types of benefits and drawbacks reported by daughter and daughter-in-law caregivers (CG) of people with dementia and explored the predictors associated with these benefits and drawbacks. Three research questions were posed: What kinds of benefits and drawbacks do caregivers perceive? To what extent do demographic characteristics of the CG, impairment of the care recipient (CR), caregiving uplifts, and characteristics of the paid and unpaid help predict what benefits and drawbacks are reported? Does CG depressive symptomatology predict what benefits and drawbacks are reported?

Method

A purposive sample of 102 daughters or daughters-in-law who lived in northeast Ohio and used at least 8 hours of paid help per week to care for their CR with Alzheimer's disease or other memory problem were interviewed using closed-ended and open-ended questions. Multivariate relationships between CG demographics (race, kin relationship, marital status, income), CR impairment (PADL needs, IADL needs, memory problems), perceived caregiving uplifts, type of paid help (formal, informal, or both), number of unpaid helpers, CG depressive symptomatology (the predictors) and types of benefits or drawbacks (the outcomes) were investigated through hierarchical logistic regressions.

Findings

Mean CG age was 51 years (range 34 - 90). Most (81.4%) were Caucasian;18.6 % were African American. About 75% were daughters caring for mothers, 10% daughters caring for fathers and 14% daughters-in-law caring for mothers-in-law. All CGs reported benefits of having paid help, but 51% reported drawbacks as well. Five types of benefits and four types of drawbacks emerged from answers to open-ended questions. Predictors of each type of benefit and drawback were different. For example, freedom for the CG was more likely to be reported as a benefit when there were higher PADL needs and more caregiving uplifts, and was less likely when CGs were using only informal paid help and were more depressed. Emotional benefits for the CR were more likely to be reported by married CGs and those experiencing more uplifts. Drawbacks related to the paid helper's behavior were more likely to be reported when the CR needed more help with IADLs. Overall, predictors showed stronger relationships to perceived benefits than drawbacks.

Conclusions/ Implications

A variety of benefits and drawbacks, for both CG and CR, were mentioned for paid help. CRs' impairment, CGs' demographics,perceptions of caregiving uplifts and depressive symptomatology, as well as formal versus informal paid help all predicted some type of benefit. Only CRs' IADL impairment predicted any drawbacks. Information about benefits and drawbacks of paid help and their correlates is useful for service providers to design better services for dementia CGs. Service convenience and staff training/supervision were areas identified by CGs as needing improvement. Future research should explore better predictors of drawbacks of paid help. More research also is needed on benefits and drawbacks of paid help from informal versus formal sources.