Racial/Ethnic Difference in Perceived Unmet Needs for Support Services Among Family Caregivers

Background and Purpose: Family caregiving for sick or older persons is a critical issue under the shifts of health care and long-term support system from institutional care to home-based care. Provision of support services can prevent burnout and other adverse effects of caregiving for caregivers and delay the institutionalization for care recipients. Some studies found that family caregivers from ethnic minorities tend to seek help from informal social network rather than formal support services due to cultural background and belief; other studies suggested that they have more unmet needs for services compared to white caregivers due to more barriers to access services. The purpose of this study is to investigate the racial/ethnic difference in perceived needs for support services among family caregivers. The findings will give guidance for social work practitioners and policy makers to raise awareness and promote the use of caregiver support services.      

Methods: This study used data from 2015 wave national survey of Behavioral Risk Factor Surveillance System (BRFSS). The sample included the respondents who self-reported to be family caregivers (n=20,168).

The independent variable is race/ethnicity, and the dependent variable is perceived unmet needs for caregiver support services, measured by whether respondents reported needing at least one of six types of services (classes about giving care, help in getting access to services, support groups, individual counseling to help cope with giving care, and respite care). Covariates controlled include caregiver-related factors (age, gender, education, poverty, health conditions), care recipient-related factors (diseases), caregiving-related factors (caregiving relationship, duration, weekly hours, and tasks). The analysis used stepwise multiple logistic regression with weight by Stata 13.

Results: Among people who reported to have unmet need (18% of total), over half needed “help in getting access to services” (51%). Compared with Whites, African American (OR =1.638, p<0.001) and Hispanic caregivers (OR =1.735, p=0.001) perceived more unmet needs for support services (OR =1.735, p=0.001). College and above education, female, aged 50 to 64, living in poverty and poor health predict higher unmet needs. Caregivers providing care to people with mental illness (OR=2.888, p<0.01), cognitive impairment disorders (OR=2.151, p<0.001) and developmental disabilities (OR=2.357, p<0.001) reported higher unmet needs than those caring for people with other diseases. Higher caregiving burden (more than six months, more than 8 hours a week, and/or managing both personal care and household tasks rather than single type tasks) also predicts higher needs.

Conclusions and Implications: The findings suggested that African American and Hispanic caregivers need more support services compared to white caregivers, and the preference of types of support services also differs across racial/ethnic groups. Health care practitioners and social workers should provide more information and linkage to support services to the African American and Hispanic caregivers. Providers should also tailor the support services to the specific needs of those who care for people with mental/cognitive problems. Future studies will explore the barriers to support services for family caregivers with higher unmet needs.