Geography, Income Complicate Critical Role Of Family Caregiving

Family caregivers play a critical role in coordinating care and improving outcomes for older adults receiving home-based care services – but family dynamics complicate how family support systems function.

Birth order, income and geography influence which family member cares for an older adult, according to a new survey from Burd Home Health. Despite the intricate dynamics, 42% of people describe caregiving as stressful but manageable when communication is clear – creating an opportunity for home-based care providers to ease family caregivers’ burdens.  

“Providers see caregiving challenges every day and can help families understand realistic needs, available support and where professional care can lighten the load,” Justin Colline, director of marketing at BURD Home Health, told Home Health Care News in an email.

Rochester, New York-based Burd Home Health helps families arrange for paid, self-directed in-home care, including through state Medicaid programs like New York’s Consumer Directed Personal Assistance Program (CDPAP).

Burd surveyed 1,000 Americans who are a sibling and provide in-home care or who plan to do so in the future, to determine trends in family caregiving. Of the 1,000 respondents, 71% said they have been involved in family caregiving and 29% stated that they have not yet cared for a family member, but expect to in the future.

The survey found that caregiving typically falls onto one sibling by default.

“More than half said they carried more of the workload than their siblings,” Colline said. “Only one in three felt responsibilities were shared fairly. When families have not discussed expectations, the work typically goes to whoever is closest or most available.”

Over a third of respondents reported that the sibling who lives closest to an aging parent typically takes on a primary caregiving role. Birth order and gender also factor in, with 38% of men reporting that birth order should determine who provides care, compared with 21% of women.

The majority of respondents also reported expectations around gender, with 62% saying that it’s an unspoken expectation that daughters will be their parents’ primary caregivers.

“This “daughter default” highlights deeply rooted societal norms that still exist today, reflecting long-standing traditions where women often serve as the primary caregivers,” a report from Burd Home Health read. “This places a disproportionate amount of family responsibility on women well before the need for care even arises.”

Expectations also exist based on family caregivers’ income status. Just under one-third of respondents earning $150,000 or more said that if a sibling cannot contribute time, they should contribute financially.

Home-based care providers have increasingly recognized the role of the family caregiver. Companies that educate or train family members, sometimes at no cost to the family, have found that the investment pays off with improved outcomes.

“It keeps people out of the hospital longer,” Peter Ross, CEO and co-founder of Senior Helpers, previously told Home Health Care News. “It keeps families in the home, happier and healthier longer.”

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