Relationship between home care services and informal caregivers

Background: Home care services include: home health aides, visiting nurses, homemaking services, meals, volunteer work, physical therapy, occupational therapy, speech therapy, day care/hospital, social work and respite care. The users of home care services often receive family/informal care. This study examined the relationship between the frequency/quantity of each home care service and the hours of informal caregiving. It classified the relationship into substituting, complementary or norelationship. Method: Secondary data analysis of a cross-sectional data set. Data collected in 2000/01 from various sites in Ontario for the RAI-HIP (Resident Assessment Instrument-Health Informatics Project) were analyzed using 2 different hierarchical logistic regression models. The dependent variable was hours of informal care. The independent variables were frequency (model 1) and hours (model 2) of the 11 types of formal services. Variables also entered into the models were client demographics (gender, age, marital status, education), client physical/functional characteristics (lADL involvement scale, ADL Hierarchy scale. Cognitive performance scale, ability to understand others, wandering, resists care, diagnosis of dementia), caregiver characteristic (expresses client lives with, number of caregivers that live with the client, relationship between the caregiver and the client). Results: Clients with caregivers (n = 5308) received an average of 18.9 hours of informal care per week (s.d. = 32.4) with a median of 11 hours per week. Logistic regression demonstrated that greater hours of informal care were significantly associated with lower frequency and hours of home health aides, meals and respite care, but also significantly associated with higher frequency and hours of homemaking services, occupational therapy and day care/day hospital. There were no significant associations between hours of informal care and visiting nurses, volunteers, physical therapy, speech therapy and social work. Conclusion: The type of relationship between the formal care service and the informal caregiving varied among the different types of formal care services. Home health aides, meals and respite care had a substituting relationship with informal care. Homemaking services, occupational therapy and daycare/day hospital services had a complementary relationship with informal care. Visiting nurses, volunteers, physical therapy, speech therapy and social work had no-relationship with informal care. Data analysed was collected for the Resident Assessment Instrument - Health Informatics Project in 2000/2001 at various sites in Ontario including Thunder Bay (Northwestern Ontario), Hamilton, and Waterloo.

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