Community services and caregivers of a demented relative: Users and those perceiving a barrier to their use

This study aimed at identifying the factors associated with caregivers' use of three community services (day care centre, attendant care at home and h ome help), and those associated with caregivers' nonuse of these services d ue to a perceived barrier. The sample consisted of primary caregivers (n = 265) cohabiting with a demented relative. Using polychotomous nominal logis tic regression analyses, a group of users and of nonusers perceiving a barr ier was contrasted with a group of nonusers reporting no need for these ser vices. Across the three services, under high relatives' needs (high ADL imp airments or frequent dysfunctional behaviours), caregivers with high psycho logical distress, compared to those with low psychological distress, were m ore likely to be nonusers reporting no need for a service than to be users or nonusers due to a barrier, suggesting that psychological distress may im pede service utilization, despite a relative's high needs. Vulnerability fa ctors (caring for a relative with frequent dysfunctional behaviours or expe riencing high psychological distress and caring for a relative with low ADL impairments) were associated with the use of day care centre or attendant care. These factors were also associated with nonuse due to a barrier, mean ing that some caregivers with the same characteristics of vulnerability did not draw on these two services. In addition, caregivers with less informal support who were caring for a relative with high ADL impairments were more likely to be nonusers perceiving a barrier to attendant care.