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New Study Shares Changing Face of Family Caregivers

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New Study Reveals Number of Unpaid Caregivers in America Grew by 9.5 Million in Five Years to Total 53 Million

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The Surprising Health Bonus of Caregiving

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Could caregiving actually boost your longevity?

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As the older population continues to expand, the demand for caregivers grows exponentially. Rather than moving into a retirement community or group home, many seniors and people with disabilities opt to live in the comfort of their own homes.

For many people, living a fulfilling life at home requires in-home skilled care, which can be medical or non-medical in nature. If you've ever asked yourself, "why be a caregiver?", this blog is the perfect place to start. Let's start by defining the role of a caregiver and the services they provide for clients.

What is An In-Home Non-Medical Caregiver?

In-home caregivers assist seniors, people with disabilities, and individuals recovering from injuries or illnesses with activities of daily living (ADLs). In other words, they help those facing physical and/or mental challenges live more fulfilling, independent lives in their homes and communities.

Some caregivers also provide personal care services to individuals in a ssisted living facilities, retirement communities, and skilled nursing facilities. It's important to understand that in-home caregivers do not live in their client's home. Instead, they visit clients on a regular basis (daily or weekly) and assist them with ADLs and other tasks.

In some cases, family members (such as adult children) care for their elderly parents or relatives with disabilities. However, the responsibilities of caring for loved ones can be overwhelming, stressful, and lead to strained relationships. Professional caregivers provide specialized, experienced care that brings families valuable peace of mind.

Services Provided By In-Home Non-Medical Caregivers

In-home caregivers provide a variety of services for people who want to live more independently in their own homes. This includes (but is not limited to) the following:

Companionship. Caregivers spend time with their clients and build relationships with them. This can boost their overall well-being and improve relationships with family and friends.

Light housekeeping. This includes things like taking out the trash, doing laundry, vacuuming, and cleaning the kitchen and bathroom(s).

Meal preparation. Caregivers are responsible for ensuring their clients receive the nutrition they need to stay healthy.

Medication reminders. One of a caregiver's most important jobs is making sure their clients take the right dosage(s) of their medication(s) at the right time(s).

Personal care. This includes things like assistance with bathing, toileting, personal hygiene, grooming, and dressing/undressing.

What Skills Are Needed to Be a Caregiver?

Wondering how to be a caregiver for the elderly or people with disabilities? The majority of skills required to be an in-home caregiver are not technical in nature. Instead, you'll need a desire to help others and a passion for spending time around people. Let's take a closer look at the soft skills necessary to provide the highest levels of care at home.

Selflessness & Empathy

Selflessness, empathy, and compassion are perhaps the most important aspects of being an in-home caregiver. Always put the client first and think of how you can elevate their quality of life. The best caregivers form personal relationships with their clients and are invested in their well-being not because they have to be, but because they want to be.

Patience & Tolerance

The best in-home caregivers possess patience, tolerance, and understanding. Dealing with seniors can be difficult due to the effects of aging, and clients with disabilities may become frustrated easily. Demonstrating empathy while remaining calm and patient allows you to provide care that eases any stress your clients may be experiencing.

Friendliness

While it almost goes without saying, an in-home caregiver should also be a friendly, outgoing "people person." You'll be interacting with clients for much of the day, so it's crucial to enjoy one-on-one interactions with others.

Trustworthiness & Reliability

Being an in-home caregiver also requires high levels of reliability and trustworthiness. Your clients are depending on you to assist them with everyday activities where and when they need you. And because they're inviting you into their home, it's crucial that you're honest and trustworthy.

Good Communication Skills

Caring for seniors and people with disabilities requires finely-honed communication skills. Your clients may have trouble expressing their feelings, so it's crucial that you pay attention to other cues. You'll also need to listen carefully to what they say, pay close attention to what they do, and act respectfully in their best interests.

Organization & Time Management

Staying organized and paying attention to the little things is also crucial to being a caregiver. This is especially important if your client experiences some sort of emergency. You'll also need to have good time management skills since you're essentially your own boss. Prioritizing tasks and making sure everything is completed by the end of your shift ensures that your clients are well taken care of.

Flexibility

The final important soft skill you'll need to be an in-home caregiver is flexibility. No two clients are the same, and their needs can change on a daily basis. Staying flexible and prepared for sudden changes ensures you're ready to handle any challenge that comes your way.

Benefits of Being a Caregiver

There are many benefits of being an in-home non-medical caregiver for seniors, people with disabilities, and individuals recovering from illnesses or injuries. We'll answer the question, "why be a caregiver?" in the following section.

Rewarding & Satisfying Career

Taking care of those who need it most is extremely rewarding and can provide you with a sense of fulfillment and purpose. You can be proud of the work you're doing by truly making a difference in the lives of others and the world at large. Nothing feels better than seeing your clients smile and knowing you're having a positive impact on their mental and emotional health.

Caregiving also provides the satisfaction of making an impact that's far more important than furthering someone's business interests. You'll see the tangible effects of your work on a daily basis and know that you've lessened the burden on people living with significant challenges. And you're giving back to the larger community by enriching it with people who may otherwise be excluded.

Active Job with a Variety of Tasks

If you like doing different tasks during the day and don't want to be tied to a desk, caregiving is an ideal career. You'll never have the same day twice, and you'll benefit from the opportunity to develop new skills, techniques, and practices. Ultimately, caregiving keeps you on your toes and allows you to build connections across many different circumstances.

Opportunities for Growth

Caregiving also provides a variety of opportunities for personal and professional growth on the job. You'll improve your self-confidence and sense of self-worth by making decisions that significantly impact the lives of other people. And listening to your client's needs can help you boost your interpersonal skills both within and beyond the workplace.

Valuable Respite for Families

In some cases, family members take on the responsibility of caring for aging parents or loved ones with disabilities. This can be exhausting, frustrating, and often leads to caregiver burnout. Stepping in and giving tired relatives a break can be very rewarding and helps you bond with your client's family. Knowing their loved ones are well cared for also provides peace of mind for adult children and frees up more time for them to focus on their other responsibilities.

Flexible Schedule & Independence

Another benefit of being an in-home caregiver is a flexible schedule and the independence to manage your own schedule. You'll enjoy flexible hours that work around your family and responsibilities in a comfortable environment that's essentially like working from home.

These benefits are only scratch the surface of being an in-home caregiver but despite these benefits, there is currently a caregiver shortage in the US since the onset of COVID-19.

Do You Need Certifications to Be a Caregiver?

In most cases, in-home non-medical caregivers don't need many professional or technical certifications. However, this varies based on a state-by-state basis. Regardless, you won't be expected to know everything upfront, and you'll have the opportunity to develop new skills on the job. Most agencies require a background check, drug screening, and transportation verification, though.

Learn About In-Home Personal Care Services from UDS

Independent Living Services (ILS) is a division of Accessing Independence, which is a UDS Foundation company. ILS has over 25 years of experience providing vital in-home, non-medical personal care for seniors and people with disabilities.

At ILS, our goal is to provide high-quality at-home care that enhances independence and enriches lives. We also offer personal care services for individuals in retirement homes, assisted living communities, and skilled nursing facilities.

Who Can Benefit from In-Home Personal Care?

A wide range of people can benefit from our compassionate in-home personal care, including:

Individuals with disabilities

People suffering from chronic illnesses

Seniors looking for companionship

People recovering from surgery

Primary caregivers seeking respite

Services We Provide

Independent Living Services caregivers provide their clients with a variety of services, such as:

Ambulation and transfer assistance

Appointment escorts (doctors, dentists, therapy, rehabilitation, etc.)

Assistance with bathing, toileting, grooming, and dressing

Errands and transportation

Companionship (reading aloud, playing games, chatting, etc.)

Light housekeeping (cleaning, yard work, laundry, etc.)

Medication reminders

Meal preparation

Becoming an ILS Caregiver

If you're looking for a rewarding career that allows you to make a difference in the lives of others, consider becoming an ILS caregiver. There are many benefits to joining our team, including:

Flexible, part-time schedule

Competitive wages

Opportunity to participate in a 401(k)

Ability to care for family members

Paid initial orientation training on how to be a caregiver

Paid optional quarterly/ongoing training

Opportunities for career advancement

On-staff Safety Mentor to handle questions or concerns

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Why Be A Caregiver? Explore The Benefits Of Helping Others

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There are many reasons to become an in-home non-medical caregiver for the elderly, people with disabilities, and others. Explore the pros and cons.

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Colorado families caring for disabled adults to see cut in Medicaid pay

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For years, family caregivers received a higher reimbursement from Medicaid than “host homes” where a handful of people with disabilities live with one or more people in charge of their …

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‘Lives are on the line’: Families fight to preserve Arizona’s Parents as Paid Caregivers program

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Arizona disability caregiver program cuts advanced by GOP lawmakers despite parents’ pleas to maintain funding for children with extraordinary needs

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Caregiver Compensation | Arizona Resources

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Learn about financial compensation options for family caregivers. Explore programs and resources that provide financial support to help ease the burden of caregiving responsibilities.

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Parents as Paid Caregivers (PPCG) | Arizona Department of Economic Security

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Caregiver Burnout; Causes, Symptoms & Prevention

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Caregivers tend to burn out from being overstressed from caring for an ill or elderly loved one. There are ways to help prevent burnout, such as talking to a friend or therapist.

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The annual turnover rate in the home caregiver profession is around , and while the reasons for that figure are complex, burnout is a top cause. Agencies that hope to and retain caregivers will need to understand the factors that contribute to caregiver burnout and look for ways to address them.

In this post, we'll look at the signs of caregiver burnout and the main causes of burnout. Then we'll share some tips on how to avoid caregiver burnout and the input we received from nine home care agency experts.

What is caregiver burnout?

Caregiver burnout is a state of physical or mental exhaustion resulting from job-related stress or excessive work. It's a problem that seems to perpetuate itself in the caregiving profession - workers experiencing burnout leave their jobs, which in turn leaves agencies even more short-staffed, increasing individual workloads.

About 56% of professional caregivers work more than 40 hours per week, which is why caregiver fatigue is so common. In addition to long hours, challenges of the caregiving profession include low wages, a lack of benefits, and the isolation that comes with working independently. A combination of these and other factors leads to caregiver exhaustion, which is a predecessor of burnout.

Caregiver burnout signs

Burnout tends to develop gradually. Caregivers experiencing burnout may exhibit signs such as:

Physical symptoms - Headaches, indigestion, and frequent illness are often associated with burnout.

Withdrawal from work-related activities - Caregivers typically work independently, without much peer interaction. When they're experiencing burnout, they may be less likely to communicate with office staff or seek support, even if they need it.

Difficulty performing tasks - Poor work performance is one sign of burnout, but burnout can also affect one's personal life. Employees who are experiencing burnout may have trouble following through with household responsibilities and personal care.

Emotional exhaustion - In many ways, burnout can resemble depression. Caregiver burnout may cause hopelessness, irritability, and a loss of interest in usual activities or relationships.

With severe caregiver burnout, employees may become dangerously negligent in their work, raising the risk of harm for clients.

Main causes of caregiver burnout

Every person has unique responses to stressful situations, but in general, the following stressors are known to raise the risk of burnout:

Difficult working conditions

Home care work can be physically demanding, with unpredictable hours and a heightened risk of illness or injury. Many workers also feel significant pressure, as they may be the only caregiver for a client whose life literally depends on them being on time and providing proper care.

Caregiver-family relationships

Home care clients may live with family members who increase stressful working conditions. For example, family members may be critical of caregivers, ask questions that caregivers are not qualified or able to answer, or refuse to listen to caregivers' advice.

Feeling isolated

Caregivers generally work alone, traveling between homes during working hours. That means they may have no connection to other agency employees, aside from their manager, and may experience feelings of isolation.

Lack of appreciation

Caregiving is an important job, but too often, caregivers receive little to no recognition for their efforts. Because agency managers don't witness firsthand the work caregivers do, they might not realize when caregivers are "going above and beyond" in their work.

The median annual income for home care workers is , and about one-quarter of professional home caregivers live in households that are below the federal poverty threshold. Financial difficulties can contribute to stress, in general, which may increase the likelihood of burnout.

Inadequate training

Because many agencies struggle with staffing levels, they may not have the time to conduct ongoing training . As a result, caregivers may have few opportunities for advancement and may be ill-prepared to handle new on-the-job challenges .

How home care agencies can reduce caregiver burnout

Before we dive into our experts' detailed responses, we'll share some of the general ways agencies can mitigate caregiver burnout:

Regular touchpoints

Checking in with caregivers regularly may help prevent burnout. One of the agency experts we spoke with mentioned using daily, weekly, and monthly touchpoints to convey that the agency will "always have their back."

Open communication channels

One agency leader said that their agency provides a dedicated phone line caregivers can call for support and advice. In addition to checking in with caregivers, some agencies offer additional support, such as the services of a chaplain who is available to listen when caregivers need to talk.

"I feel this has proven to be a valuable service to our caregivers; to listen, encourage and support, so that they can fulfill their calling." - Marian McGunagle, Caregiver Trainer & Volunteer Chaplain, Visiting Angels Caregiver Training Center

Support resources

One professional said her agency provides support through an organization called Life Matters, which provides free counseling for post-traumatic stress disorder, mental health issues, and substance abuse.

"This is confidential information, which hopefully promotes a feeling of a safe place by those who seek their help." - Gloreen M. Heft, BS-HCA, LPN, Behavioral Health-Nursing Support, Integrity Residential Services

Flexible scheduling

One agency expert said that accommodating caregivers' schedules is a strategy they use to minimize burnout and alleviate the stress that comes with managing other obligations.

"For example, if they have school age children, we will start their schedule at 8 and have them off by 3 if they have to drop off and pick up children at school." - Kathy Frames, Home Care Manager, East Ark Area Agency on Aging

Client rotations

Because routine and monotony could contribute to caregiver burnout, some agencies rotate caregivers between homes as much as possible. One agency professional said that if caregivers are "experiencing a hard time" with a given client, management looks for opportunities to move that caregiver to a different home, or at least provide them with an extended break.

Positive feedback and recognition

Two agency leaders said their organizations offer recognition or kudos for caregivers whose work is exemplary. One agency awards additional time off to caregivers who earn the employee of the month award.

Paid sick leave for mental health days

Recognizing that caregiving can be stressful work, some agencies encourage workers to use their paid time off for mental health days.

Competitive pay and benefits

One agency mentioned providing hiring bonuses, as well as a company-wide bonus in acknowledgment of the staff's dedication through the COVID pandemic.

Ongoing training

Regular training is beneficial for both caregivers and their employers - it helps caregivers grow their skills and potentially advance their careers, and it helps agencies ensure they're offering the highest quality of care.

Agencies that don't have the staff or resources to offer training may choose to partner with an organization like CareAcademy, which provides a variety of online training for home caregivers and . CareAcademy include compliance-specific topics, training on emerging issues in home care, and administrative training for agency leaders.

What the experts said

Now it's time to hear from our experts. Read what they said about caregiver burnout.

Reduce caregiver burnout

Burnout doesn't have to be part of the caregiver experience. With competitive pay and bonuses, the right support, and ongoing training, the caregiver occupation can be a rewarding long-term career.

Find out how CareAcademy has helped agencies throughout the United States create a better working environment for their employees. Sign up for your free trial today !

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9 Experts Reveal How Agencies Can Reduce Caregiver Burnout | CareAcademy

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The annual turnover rate in the caregiver profession is around 65%, and while the reasons for that figure are complex, burnout is a top cause.

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Understanding Caregiver Burnout and Compassion Fatigue

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Caregiving, while rewarding, can often lead to intense emotional and physical strain. As a caregiver, you may find yourself juggling responsibilities for an extended period, which can result in either caregiver burnout or compassion fatigue. Understanding these terms is crucial for identifying the signs and taking steps to ensure your well-being.

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Introduction

Caregiving for a loved one can cause stress in many ways. To manage the stress-which we know can be dangerous to a caregiver's health-we must first know what the problem is. Surprisingly, many caregivers of individuals with memory disorders or dementia report that the main problem is not the illness itself, but the ambiguity and uncertainty it causes.

It's a difficult challenge to care for someone who is here, but not here-here physically, but gone mentally and psychologically. You feel alone, and in some ways, you are. For many caregivers, it's as if there's a stranger in the house.

Adding to the stress, disorders such as Alzheimer's disease or traumatic brain injury cause unpredictable memory loss that comes and goes-one moment here, the next moment gone. This roller coaster of absence and presence is a very stressful kind of loss-what author Pauline Boss calls ambiguous loss. Unlike death, there is no closure, no official validation, and sometimes little community or religious support. You feel you are left to cope on your own; even the strongest caregivers feel anxious and depressed. The challenge is to learn strategies to cope with this ambiguity that is so much a part of memory loss.

Symptoms of Overwhelming Stress

Caring for someone with a cognitive impairment-and the ambiguous feelings that arise-can create a constancy of sorrow that can immobilize caregivers. For example, decisions are put on hold, tasks pile up, chores delayed. Doubt, confusion, helplessness, and hopelessness set in, and caregivers can feel anxious and depressed. Friendships are in limbo as caregiving takes more and more of your time. Conflict increases with spouse, children/stepchildren, siblings. Family gatherings and rituals that were the glue of enjoyable family life are cancelled or changed. When a caregiver feels increasingly isolated, the possibility of depression, anxiety, abuse, guilt, shame, lack of self-care, illness, or substance abuse increases.

Tips for Coping with the Ambiguity of Memory Loss

To manage the stress of caregiving, try to connect with other people: if possible, join a support group either in person or on the Internet, attend a book club, social event, or faith-based group. Here are some ideas, questions and tips to help:
1. Name your problem.
Know that one real culprit causing your stress is the ambiguity from a loved one being here, but not here. Call it "ambiguous loss." It is neither your fault nor the patient's. It is caused by an illness.
2. Practice both/and thinking.
It helps to think "both/and" rather than in the extremes of "either/or." Instead of thinking the care recipient has to be either here or gone, think of him or her as both here and gone. This means balancing two different ideas at the same time-present, and also absent. Both/and thinking is less stressful than continuing to search for an absolutely perfect solution.

Here are some examples:

"I am both a caregiver-and a person with my own needs."

"I take care of both him-and myself."

"I both wish it was over-and that my loved one could keep on living."

"I am both sad at my loved one's illness-and joyful with my new grandchild."

"I am both sad about my lost hopes and dreams-and happy about some new plans and goals."

Now add your own examples. "Both/and" thinking may come faster if you practice with another person.
3. Know your "family" and community information and support systems.
You need predictability (not ambiguity) about whom you can talk to and count on for help. Have some other people become "like family" to you? Does your community offer help and social support? Spiritual support? Recreation and respite? Information support? Talk with your Caregiver Resource Center about what help is available to you. Check the web-a quick online search for "caregiver" offers a wealth of information and online communities. If your biological family offers no help, perhaps you can create a "psychological family" that will be there for you when you need help. Talk about how to divide up the work among a "care team." Make a written plan to know who will do what and when. Who will come once a week so that you can take some time off to do as you wish? Who will come for a week twice a year so that you can take a vacation from caregiving? Several websites can help you establish your caregiving community (see Resources list below).
4. Continue-but revise-family holidays, celebrations, and rituals.
Do not cancel, but rather, simplify the gatherings with the people you care about to celebrate birthdays, holidays, and religious events and rituals. Families, friends, and communities connect to celebrate life's transitions. Human connection can help lower your stress in times of sadness. It can help you and a person with dementia feel the spirit of life around you. This is essential to staying strong when the person you care for is not able to connect fully with you. Think and talk about this: what family rituals did you celebrate as a couple or family before the memory loss? Now? How can you simplify your family rituals and celebrations to fit the circumstances now? Young people can be especially helpful in answering these questions, because of their strong imaginations and new perspectives.
5. Revise family roles.
To manage the stress of caring for someone with severe memory loss, alterations are needed in what you and other family members previously did. There are changes in family roles as a result of the memory loss. What tasks are you now responsible for? What tasks have you lost? How do you manage these changes? What would help? Is there agreement in the family about who should do the caregiving? Are you resilient enough to change or do you feel you have to do it all as before? Talk about who plays what roles in the family.

Finally, based on roles, think about how you see yourself now. You might ask: Is it right for me to take time off to go out with friends when my spouse is suffering from Alzheimer's disease? Do I still feel like a son or daughter or more like a parent to my parent? If my spouse has memory loss, do I still feel married? How should I act?
6. Be aware of family rules.
Who is allowed to do what in your family? Is there a team approach or are you expected to do all the work alone? Become aware of your family's rules and question them. They can change. Do your family's rules about race, religion, class, age, or gender get talked about? For example, is there an unspoken rule in your family that only females can be caregivers? Are certain people excused from helping? Why are they excused? There may need to be a new family rule about "teamwork" so that caregiving does not fall to one person alone. Include children and teenagers in the circle of information about the illness, its effects, its unclear prognosis, and your need for help and teamwork.
7. Understand that anger and guilt are normal, but avoid harmful actions.
While mixed emotions are an understandable outcome of memory loss, the negative feelings can come out as anger or, worse yet, abuse-and that is not acceptable. Talk with someone-a professional or another caregiver-about your negative feelings to prevent acting out your anger. Remember, feeling angry about the ambiguity in memory loss is normal, but acting out that anger against the patient or yourself is not.
8. It seems contradictory, but imagine something new to hope for.
To stay healthy, everyone needs hope. When your loved one is ill, and you are tied to caregiving, you must discover new hope. It helps to talk about this with other people-and again, with young people. They might help you imagine new dreams for your future-new connections, new hobbies, new travel plans, new skills, new relationships.

Given the stress from caregiving and the ambiguity of memory loss, what can you plan for the future that is clear and certain? How about an outing, a firm date for dinner with a friend, a hobby that has clear outcomes, a TV program that you clearly enjoy? New hopes and dreams will emerge when you can balance the ambiguity with some activities that have clear outcomes, no matter how small.
9. Check on your own health.
Seek professional help if you:

Feel depressed, physically sick, or hopeless.

Feel like hurting yourself or hurting or yelling at the person you care for.

Depend too heavily on alcohol or recreational drugs.

Fight with your spouse, children, stepchildren, or other family members and friends.

No longer take care of yourself.

When you are a caregiver for someone with memory loss, the stress of ambiguity adds to the usual pressures of caregiving. You have a duty and a right to take care of yourself.

Summary

This fact sheet is a caregiver's guide to managing the extra stress from ambiguous loss. To sum it up, think of managing the ambiguity as learning to walk in the fog. Keep moving forward, despite the stress of not knowing what lies ahead. But at the same time, reach out for support and human connections to stay resilient and strong.

Resources

Family Caregiver Alliance
National Alliance on Caregiving
(415) 434-3388 | (800) 445-8106
Website: www.caregiver.org
E-mail: info@caregiver.org
FCA CareNav: https://fca.cacrc.org/login
Services by State: www.caregiver.org/connecting-caregivers/services-by-state/

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy. Through its National Center on Caregiving, FCA offers information on current social, public policy and caregiving issues, provides assistance in the development of public and private programs for caregivers, and assists caregivers nationwide in locating resources in their communities. For residents of the greater San Francisco Bay Area, FCA provides direct family support services for caregivers of those with Alzheimer's disease, stroke, ALS, head injury, Parkinson's and other debilitating health conditions that strike adults.

​FCA Fact and Tip Sheets

A listing of all facts and tips is available online at www.caregiver.org/fact-sheets.
Depression and Caregiving
Caregiver Health
Caring for Adults with Cognitive and Memory Impairments
Dementia: Is This Dementia and What Does it Mean?
Grief and Loss
Taking Care of YOU: Self-Care for Family Caregivers
Other Organizations and Links

Lotsa Helping Hands
https://lotsahelpinghands.com/
Lotsa Helping Hands is a free online tool for caregivers to organize care and communicate with other family members, friends, and neighbors.

AgingCare.com
https://www.agingcare.com/topics/60/caregiver-support

This fact sheet was prepared by Family Caregiver Alliance and written by Pauline Boss and based on her books, Ambiguous Loss (Harvard University Press, 2000), Family Stress Management (Sage, 2002), and Loss, Trauma, and Resilience (W. W. Norton, 2006). ©2008 Family Caregiver Alliance. All rights reserved.

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Caregiving and Ambiguous Loss - Family Caregiver Alliance

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Caregiving for a loved one can cause stress in many ways. To manage the stress-which we know can be dangerous to a caregiver's health-we must first know what the problem is. Surprisingly, many caregivers of individuals with memory disorders or dementia report that the main problem is not the illness itself, but the ambiguity and uncertainty it causes.

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A Brief History of Caregiving - Kiddocare

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America’s Caregiving Crisis | Full Documentary | PBS

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Rates of caregiving vary somewhat by ethnicity. For example, among the U.S. adult population, approximately one-fifth of both the non-Hispanic White and African-American populations are providing care to a loved one, while a slightly lower percentage of Asian-Americans - 18 percent - and Hispanic Americans - 16 percent - are engaged in caregiving (National Alliance for Caregiving (2009). In a national survey which looked only at people 70 years of age or older, however, 44 percent of Latinos were found to receive home-based family caregiving compared to 34 percent of blacks and 25 percent of non-Hispanic Whites (Weiss et al, 2005).

Studies show that ethnic minority caregivers provide more care than their White counterparts and report worse physical health than White caregivers (McCann et al, 2000). Several studies have found that African-American caregivers experience less stress and depression and garner greater rewards from caregiving than White caregivers (Cuellar, 2002; Haley et al, 2004). Hispanic and Asian American caregivers, however, exhibit more depression than white caregivers (Haley et al, 2004).

Additional findings reported in a 2005 meta-analysis of 116 empirical studies, conducted by Pinquart & Sörensen, suggest further ethnic differences among caregivers:

Asian-American caregivers made less use of professional support services than did White caregivers.

Ethnic minority caregivers had a lower socioeconomic status, were more likely to receive support from family members and friends, provided more care than White caregivers, and had stronger filial obligation beliefs than White caregivers.

All ethnic minority caregiving groups reported worse physical health than the White caregivers experienced.

African-American caregivers had lower levels of caregiver burden and depression than White caregivers. Hispanic and Asian-American caregivers were more depressed than White caregivers.

Ethnic differences are also found with regard to the care-recipient. Among people aged 70 and older who require care, Whites are the most likely to receive help from their spouses, Hispanics are the most likely to receive help from their adult children and African Americans are the most likely to receive help from a non-family member (National Academy on an Aging Society, 2000).

Research also shows that Americans also vary from caregivers in other countries. Among caregivers for older adults with disabilities, Americans appear to have spent less time with a care-recipient than their Swiss counterparts before assuming the caregiver role (Karlin, O'Reilly & Williams, 1997). In addition, while family caregivers of loved ones with Alzheimer's disease and other forms of dementia in the U.S. and China were found to have similar coping styles, the Americans reported experiencing more depression and anxiety (Shaw et al., 1997).

The main reason for all of these divergences, research suggests, is that cultural perspectives differ across ethnic groups and may impact caregiver experiences in several domains, including perceptions of the caregiving role, utilization of support services, and clinical presentations and interactions. In addition, psychological characteristics often predict adjustment among family members in a theoretically consistent and interpretable manner (Chan, Lee & Lieh-Mak, 2000).

Lesbian, Gay, Bisexual and Transgender Caregiving

An estimated 1.75 million to 4 million older adults are lesbian, gay, bisexual or transgender (LGBT), and this number is expected to double by 2030 (Administration on Aging, 2010). About one in three LGBT older people lives alone (as compared to one in five non-LGBT people), while 40 percent of LGBT older people say that their support networks have become smaller over time. African-American LGBT adults are three times as likely as White or Hispanic LGBT adults to say that people from their churches or faith are part of their support systems (SAGE, 2014).

LGBT older adults are more likely to have provided care for an adult friend or relative in the past six months (Family Caregiver Alliance, 2012).

LGBT older adults are also more likely to face poverty or economic difficulty, and they deal with significant physical health and mental health disparities; despite this, many supports in place for the aging in America do not cater to the special needs of LGBT seniors (SAGE, 2014).

An extensive review of caregiving for aging LGBT adults with HIV, including the impact of HIV on caregiving among older LGBT adults, community-based services and cultural competency, resources and references is also available.

Rural Caregiving

While caregiving occurs everywhere in society, rurality likely affects caregiving. Factors related to caregiving in a rural community, to some extent, are responsible for differences in the nature and outcomes of caregiving. For many rural caregivers, poverty combines with lack of health services, fewer resources and living in an underserved area to negatively impact caregiving. Often family members, neighbors and friends provide both direct and indirect caregiving services. However, family members may migrate to other areas seeking education, employment and other opportunities. This often reduces the number of family members or paid caregivers available to provide care for rural elders.

Although caregivers of varying ages and backgrounds may need to perform similar activities, living in an underserved area may influence the way rural caregivers perceive and respond to their responsibilities. Caregiver reactions, coping strategies, distress levels, acceptance of symptoms and attitudes toward clinicians and outside help may vary considerably across different cultures ("Culture and Caregiving," 1992) and potentially within rural areas as well.

References

Administration on Aging (2010). Diversity. Retrieved from http://www.aoa.acl.gov/AoA_Programs/Tools_Resources/diversity

Chan, C.K., Lee, P. & Lieh-Mak, F. (2000). Coping with spinal cord injury: Personal and marital adjustment in the Hong Kong Chinese setting. Spinal Cord, 38, 687-696.

Cuellar, N.G. (2002). Comparison of African American and Caucasian American Female Caregivers of Rural, Post-Stroke, Bedbound Older Adults. Journal of Gerontological Nursing 28, 36-45.

Easter Seals & National Alliance for Caregiving (2006). Caregiving in Rural America. Retrieved from: http://es.easterseals.com/site/DocServer/Caregiving_in_Rural-saveas-compress.pdf?docID=49463

Family Caregiver Alliance (2012). Selected Caregiver Statistics (Fact Sheet). Retrieved from https://www.caregiver.org/selected-caregiver-statistics

Haley, W.E., L.N. Gitlin, S.R. Wisniewski, D.F. Mahoney, D.W. Cood, L. Winter, M. Corcoran, S. Schinfeld,& M. Ory (2004). Well-being, Appraisal, and Coping in African-American and Caucasian Dementia Caregivers: Findings from the REACH Study. Aging and Mental Health, 8, 316-29.

Karlin, N.J., O'Reilly, B.K. & Williams, S. (1997). Cross-cultural differences between Swiss and American caregivers of Alzheimer's disease family members. Journal of Clinical Geropsychology, 3, 257-265.

McCann, J.J., L.E. Hebert, L.A. Beckett, M.C. Morris, P.A. Scherr, & D.A. Evans (2000). Comparison of Informal Caregiving by Black and White Older Adults in a Community Population. Journal of the American Geriatrics Society 48,1612-1617.

National Academy on an Aging Society (2000). Caregiving: Helping the Elderly with Activity Limitations. Challenges for the 21st century: Chronic and Disabling Conditions, No. 7. Washington, DC: Author.

National Alliance for Caregiving (2009). Caregiving in the U.S. Retrieved Nov. 1, 2010 from: http://www.caregiving.org/data/Caregiving_in_the_US_2009_full_report.pdf

Pinquart, M. & Sörensen, S. (2005). Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: A meta-analysis. The Gerontologist, 45, 90-106.

SAGE (2014). Out and Visible: The Experiences and Attitudes of Lesbian, Gay, Bisexual and Transgender (LGBT) Older Adults, Ages, 45-75. Retrieved from http://www.sageusa.org/resources/publications.cfm

Shaw, W.S., Patterson, T., Semple, S., Grant, J., Grant, I., Yu, E., Zhang, M., Hi, Y. &Wu,W. (1997). A cross-cultural validation of coping strategies and their associations with caregiving distress. Gerontologist, 27, 490-504.

Weiss, C.O., H.M. Gonzalez, M.U. Kabeto, and K.M. Langa (2005). Differences in Amount of Informal Care Received by Non-HispanicWhites and Latinos in a Nationally Representative Sample of Older Americans. Journal of the American Geriatric Society 53,146-151.

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