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Longitudinal Changes in the Amount of Informal Care Among Publicly Paid Home Care Recipients

Correspondence: Address correspondence to Lydia Li, School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109-1106. E-mail: lydiali{at}umich.edu

Purpose: This study examined how the amount of informal care received by disabled elders changes when they are receiving publicly paid home care, and whether formal service use, disability, caregiving arrangements, and demographic characteristics of older adults predict changes in the amount of informal care. Design and Methods: Hierarchical linear models were estimated, using 3-year data (12 repeated observations) collected from elderly participants (N = 888) in Michigan's Home- and Community-Based Medicaid Waiver Program. Results: The amount of informal care declined in the beginning period when publicly paid home care was received, and then it stabilized. Changes in activities and instrumental activities of daily living and caregiver residence predicted changes in the amount. The living arrangement and age of elders predicted different patterns of change over time. Neither formal service amount nor its change significantly predicted the amount of informal care. Implications: Informal caregivers do not relinquish caregiving when publicly paid home care is available. Expanding community-based long-term care is a means of fostering partnerships between formal and informal caregivers.

Key Words: Home- and community-based care • Substitution • Longitudinal study • HLM • Community-dwelling frail elders • Caregiving • Long-term care

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