Supporting Family Caregivers

Although only five percent of older (60 years old and above) adults reside in long-term care facilities, it's estimated that twice that number are at risk of institutionalization.1 These frail elders depend on the support of family caregivers to remain in the community. The U.S. Bureau of the Census reports that the 85 and older age group is expected to double by the year 2000. This age strata is most likely to be physically and mentally impaired. Therefore, the rapid increase of this vulnerable group will likely create greater demand for family care.

Given Extension's commitment to designing programs relevant to the needs of families in the eighties and beyond, family members who care for their spouses, aged parents, grandparents, or other relatives deserve recognition as a growing audience with many needs and a limited support network. The Extension Homemakers (EH) organization is a significant resource for helping address the physical, social, and emotional needs of family caregivers.

This article describes: (1) the needs of family care-givers and attributes of Extension Homemakers that make them suitable candidates to address these needs and (2) how the Volunteer Information Provider (VIP) Program developed in Missouri2 forged a successful liaison between Extension-trained volunteers and family caregivers.

A myth about American families is that we abandon our older members when they become dependent. Numerous studies, however, document that families, particularly spouses, daughters, and daughters-in-law, provide as much as 80% of the care required by frail elders.3 Because family caregivers are most often mid-life and older women, it's not unusual for them to be caught between competing demands of two adjacent generations.4 Not only do those giving care to frail elders endure role strain and confusion,5 they often experience increased financial stress, depression, and lack of substitute caregivers, making it difficult for them to leave home.

Federal spending cuts, such as Medicare limits on hospitalization, have placed greater burdens on families and communities in caring for frail elders. Human service agencies, required to address needs of impaired older people, are often unable to deal with concerns of their caregivers. Targeting this group may delay or prevent institutionalization of elders by providing needed support to caregivers experiencing stress.

Results of both the National Extension Homemakers Study6 and the Virginia Extension Homemakers Study indicate that resources of Extension Homemakers7 and needs of family caregivers are complementary. Data from the Virginia study are cited here because a similar profile emerges for EH members in both studies and because Virginia data are more recent.

The Virginia survey shows that Extension Homemakers are likely to be middle-aged or older women whose children are adults. It also indicates that EH members are better educated than the general population, with a large number of members having education beyond high school. Further, Extension Homemakers are most likely to live in rural communities or small towns where access to community-based, long-term care services is often limited. Finally, data reveal that the overwhelming majority of EH members are unemployed or employed part-time, making them available to volunteer (see Table 1).

Virginia EH members are active community volunteers who, on the average, reported more than 140 volunteer hours a year, belonged to three community organizations, and disseminated Extension research-based information to 19 others during 1984.

The study also shows that Extension Homemakers view others similar to themselves as target audiences for their organization. The vast majority of respondents indicate that middle-aged homemakers (92%), retirees (90%), and community groups (89%) are likely to derive some or great value from Extension Homemakers. Thus, EH members perceive mid-life and older community residents as viable program audiences, thereby increasing the likelihood that EH volunteers and the family care-givers they target will be members of the same informal social network.

As Extension-trained volunteer teachers and leaders, these women have an established tradition of continued learning and sharing of information with the larger community. The perceived benefits of membership, shown in Table 2, suggest that EH members are community-oriented, caring leaders with a commitment to helping others. This characterization reiterates the appropriateness of EH members to provide information to family caregivers.

Having recognized the complementary nature of Extension Homemakers resources and family caregivers' needs, Missouri Extension professionals developed the Volunteer Information Provider (VIP) demonstration project in 1984 with funding from the Administration on Aging (AoA), Department of Health and Human Services.

During the 17-month demonstration phase, 63 Extension Homemakers from five rural Missouri counties were recruited and trained to be information providers to caregivers of older adults. Many EH members became involved because they were either caring for a spouse, parent, grandparent, or sibling; had been caring for someone in the past; or anticipated they'd be in the future. The volunteers ranged in age from 24 to 80, with 65% being more than 60 years old.

Referred to as Volunteer Information Providers (VIP's), these Extension Homemakers participated in three weekly sessions of seven hours each. Training covered: normal and abnormal aging, communication and stress management, personal care, health care consumerism, and community resource access.

Initially asked to work with a minimum of two care-givers each, 63 VIP's ultimately shared information with 739 caregivers during the demonstration phase. A follow-up study, conducted six months later, showed the Extension Homemakers were still functioning in the information provider role, having reached an additional 364 caregivers. The finding that this service provided by the VIP's delayed the institutionalization of at least two older adults is important, given that in Virginia the estimated monthly cost of nursing home care is $345 more than community-based care.8

Further, it was discovered that the recruitment of EH club members facilitated accessing and helping care-givers in rural areas. Caregivers, who were often family members, friends, or neighbors, were more receptive to help offered by the VIP than from community professionals.

An unanticipated outcome was heightened self-esteem experienced by volunteers. Because many had entered the training with great trepidation, having been away from school for as many as 55 years, their sense of accomplishment was great. EH volunteers also indicated the training experience helped allay fears about their own aging.

As a result of the success in Missouri, the VIP program is presently being disseminated nationally through a second AoA grant. Extension professionals and EH members from Virginia and 24 other states are working on replicating the program. Networking with state units on aging and area agencies on aging is currently under way to facilitate the implementation of the program. Of even greater significance is the fact that the National Extension Homemakers Council has given its full support to the VIP program.

The needs of families who care for their frail elderly members and the resources that Extension Homemakers have for addressing these needs are complementary. Data presented here show that EH members are usually well-educated, unemployed, mid-life women who have credibility as effective community volunteers. They're credible volunteers not only because they know how to negotiate both informal and formal community networks, but because they have an established tradition of disseminating research-based information from Extension. Therefore, Extension Homemaker volunteers have the resources of availability, expertise, and willingness necessary to provide useful information to family care-givers to help them deal with caregiving positively.

1. Ethel Shanas, "Social Myth as Hypothesis: The Case of Family Relations of Old People," Gerontologist, XIX (February 1979), 3-9.

2. Burton P. Halpert and Share D. Bane, Volunteer Information Provider Program (Kansas City: University of Missouri-Kansas City, Center on Aging Studies, 1986).

3. Elaine M. Brody, "Parent Care as a Normative Family Stress," Gerontologist, XXV (February 1985), 19-29.

4. Elaine M. Brody, "Women in the Middle and Family Help to Older People," Gerontologist, XXI (October 1981), 471-81.

5. Marjorie H. Cantor, "Strain Among Caregivers: A Study of Experience in the United States," Gerontologist, XXIII (December 1983), 597-604.

6. National Extension Homemakers Study: Program Benefits, Leadership Development, and Volunteer Outreach (Washington, D.C.: Extension Service, United States Department of Agriculture, 1981).

7. Extension Homemakers Study: Executive Summary (Blacksburg, Virginia: Virginia Polytechnic Institute and State University, Virginia Cooperative Extension Service, 1985).

8. Long-Term Care in Virginia: Public and Private Cost (Richmond: Virginia Commonwealth University, Virginia Center on Aging, 1985).