Families and formal service usage: stability and change in patterns of interface

Understanding the relationship between formal and informal support is becom ing increasingly important for those involved in caring for the elderly (Ba ss et al., 1996; McAuley et al., 1990). As the elderly become more dependen t on formal services and changes in demographics result in more women in th e workforce and fewer available informal caregivers, there is a need for or ganized and efficient formal support networks that work well with, rather t han replace, family helpers (Aneshensel et al., 1995; Scott & Roberto, 1985 ). Several models of the interface of formal-informal support have been pro posed in the literature (e.g. Cantor, 1975; Edelman, 1986; Greene, 1983; Li twak, 1985). A sample of 305 primary family caregivers were interviewed at three points in time regarding their use of formal services and assistance from additional family members. It was possible to classify the sample init ially into three types of family/formal interface: isolates who receive no help from family or formal services, family dependent who are assisted by k in but not formal services, and formal who receive some assistance from pai d services. These groups were examined over time for stability of group mem bership and nursing home placement. Characteristics of caregivers and their relatives who fell in each category were also examined. There were differe nces in caregiver stress and rates of subsequent placement rates for people in the three initial categories of informal/formal interface (isolates, fa mily dependent, formal), but moving from one category to another during the course of the study was more strongly associated both with care-related st ress and placing the person with dementia into an institution than was stab le membership in the other categories.