Long-Term Services and Supports Utilization of Older Adults: Does Caregivers' Employment Matter?

Background/Purpose: The number of individuals using formal care is expected to increase from 15 million in 2000 to 27 million in 2050. This increase is mostly driven by the growth of older population in need of care. Traditionally, dependent elders have received the majority of support in the family. Today, families do not relinquish their caregiving role to formal systems but may share eldercare load with formal care providers in the community or in a facility.

This study explores whether and how informal caregivers(also called as ‘caregiver’) employment status along with other predisposing, enabling and need factors of older adults as well as of caregivers may explain the type of eldercare load sharing. Putting the main focus on caregivers’ employment status is because it may limit their availability and raise the possibilities of formal help seeking of their disabled family members. Given that formal help seeking patterns are different across gender and race/ethnicity, this study also considers how gender and race/ethnicity moderate the association between caregivers’ employment status and older adults’ long-term services and supports (LTSS) utilization.

Methods: This study used 2010 and 2014 Health and Retirement Study and generated a sample of 2,106 respondents aged 65 and older who had a primary informal caregiver for analysis. The dependent variable was three patterns of LTSS utilization: (1) informal care alone (reference), (2) a combination of informal and community-based services, or (3) a combination of informal and institutional care. Independent variables included predisposing (i.e., age, gender, marital status, employment status), enabling (i.e., education, income, assets, home ownership, proximity to children, sole caregiving status), and need factors (i.e., health, functional level). Multinomial logistic regression estimated the association between caregivers’ employment status and older adults’ LTSS utilization by considering predisposing, enabling, and need variables of both older adults and caregivers.

Results: Full-time employment had significantly higher likelihoods of using a combination of informal and institutional care, although caregivers’ employment status was not significantly associated with older adults’ use of a combination of informal and community-based services. The significant association differed by older adults’ gender and race/ethnicity. Moreover, older adults’ age, education, income and assets, chronic illnesses and functional limitations in relation to activities of daily living, and caregivers’ sole caregiving status were significantly associated with the use of informal care in combination with either community-based services or institutional care. Having fewer co-resident children or having cognitive impairments significantly increased the likelihoods of using a combination of informal and institutional care.

Conclusions and Implications: Based upon the findings that older adults with full-time employed caregivers were more likely to be institutionalized and those of racial/ethnic minorities and in the middle income/assets group were less likely to use the shared care model than to use informal care alone, this study calls for strengthening home and community-based service delivery systems, promoting quality care for all groups, and endorsing family-friendly employment policies where social workers can play pivotal roles. Making these improvements will enhance support for employed caregivers and older adults who seek to age in place.