Plans for the Future Care of Relatives with Serious Psychiatric Disorders Held By Older Caregivers

Background and Purpose: As a result of deinstitutionalization and inadequate community supports, much of the care for persons with serious psychiatric disorders (SPD) is provided by family members, particularly parents.  SPD are often chronic with family caregivers providing care for extended periods of time.  Consequently, evidence indicates that at least one-third of caregivers for persons with SPD are 60 years of age and older.  It is known that many older caregivers do not have plans in place for the care of their relatives with SPD when they are no longer able to provide such care.  The absence of said plans has repeatedly been found to be associated with increased psychological distress for caregivers and surely places the well-being of persons with SPD at risk when older caregivers discontinue providing care.  Unfortunately, little research has examined factors related to the presence or absence of such plans.  To fill this gap, the association of factors in four domains with the absence of plans for future care of relatives with SPD were examined: 1) Relatives with SPD, 2) Older caregivers, 3) Interactions between relatives with SPD and older caregivers, and 4) Treatment-related factors.  The objective of the present investigation is to determine the extent to which proposed factors are associated with the absence of plans for the future care of relatives with SPD, held by older caregivers.

Methods: The present analysis employs a cross-sectional design and uses secondary data obtained from the National Alliance for Caregiving.  The subsample used in the present analysis is 717 older (60+) family caregivers for persons with SPD recruited from across the U.S. in September 2015.  Multivariate logistic regression was used to examine the association of factors with the absence of plans for the future care of relatives with SPD, held by older caregivers.

Results: Sixty three percent of older caregivers (n = 451) reported not having a plan for the future care of their relative with SPD.  While controlling for significant covariates, absence of plans for future care was significantly more likely when caregivers were the sole caregiver, had more difficulty talking with others about the care recipients’ mental illness, had feared that the care recipient would intentionally damage their property, and experienced more emotional distress as a result of caregiving.  Inversely, the absence of plans was significantly less likely when caregivers served as legal guardians for persons with SPD. 

Conclusions and Implications: Social workers and policy makers should be aware of how common it is for older caregivers of persons with SPD to not have plans in place for the future care of their relatives with SPD. Practitioners working with persons with SPD are encouraged to offer inclusion of caregivers in the treatment of persons with SPD.  Practitioners should assess with persons with SPD and older caregivers whether plans are in place for future care, especially when multiple factors associated with absence of plans are present.  When necessary, social workers should assist persons with SPD and caregivers in creating plans for future care.