The Use of Formal Services as a Moderator of Caregiving Stress

Purpose: Formal care services are important because they can help alleviate the stress of family members who provide care for frail older adults. Previous research has focused on the impact of a limited number of services on caregiver burden and stress. However, this research has not taken into account that there are a number of different types of service utilization patterns among caregivers of older adults (Hong, 2010). Thus existing research on use of services among caregivers does not provide an accurate portrayal of the relationship between the variety of service utilization patterns and caregiver stress. The purpose of this study is to determine whether different types of service use among caregivers moderate the relationships between the demands of caregiving and caregivers' stress. The present study uses Pearlin et al.'s (1990) stress process model as a theoretical framework and considers multiple types of service use as well as multiple dimensions of caregiver stress.

Method: Data on informal caregivers were collected as part of the 2004 National Long-Term Care Survey (N=1536). The respondents from this national probability sample were caregivers for persons aged 65 or older who lived in the community. Using Hong's (2010) method of categorizing service use, indicators of service utilization were combined into three types: light service users (e.g, use of no services and one service), selective in-home care service users (e.g., use of two or three services, specifically home modification and personal care), and multiple service users (e.g., use of four or more services). Caregiver stress was measured using three items representing different dimensions of stress (i.e., physical, emotional, and financial). The demands of caregiving were assessed according to the functional dependency of care recipients, their problem behaviors, and hours spent on caregiving. Control variables included caregivers' gender, education, health status, and relationship to care recipients. Hierarchical multiple regression was used to test the direct effect and moderating effect of type of service use on type of caregiver stress.

Results: Type of service use had both direct effects on stress and interaction effects with caregiving needs. With respect to interactions, type of service use moderated the relationship between the functional dependency of care recipients and the emotional stress of caregivers. In particular, multiple service use decreased the impact of functional dependency (B= -.170, p<.01) and caregiving hours (B= -.099, p<.01) on caregivers' emotional stress. However, type of service use did not have a significant moderating effect on the relationship between the demands of caregiving and caregivers' physical and financial stress.

Implication: The results indicate that service use patterns moderate the relationship between caregivers' needs and their emotional stress. Our findings highlight the importance of a specific pattern of service utilization, i.e, the use of multiple services, in reducing the adverse effect of caregiver needs on their emotional stress. We suggest that future research should focus on understanding the mechanisms by which the use of multiple services alleviates caregivers' emotional stress and on identifying other kinds of services patterns that could reduce their physical and financial stress.