Family Care Partners and Paid Caregivers: National Estimates of Role-Sharing in Home Care

Chanee D Fabius; Joseph J Gallo; Julia Burgdorf; Quincy M Samus; Maureen Skehan; Ian Stockwell; Jennifer L Wolff

doi:10.1093/geront/gnae177

Family Care Partners and Paid Caregivers: National Estimates of Role-Sharing in Home Care

Gerontologist. 2024 Dec 9:gnae177. doi: 10.1093/geront/gnae177. Online ahead of print.

Authors

Chanee D Fabius¹, Joseph J Gallo², Julia Burgdorf³, Quincy M Samus⁴, Maureen Skehan⁵, Ian Stockwell⁶, Jennifer L Wolff¹

Affiliations

¹ Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
² Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
³ Center for Home Care Policy and Research, VNS Health, New York, NY, USA.
⁴ School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
⁵ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁶ Department of Information Systems, University of Maryland Baltimore County, Baltimore, MD, USA.

PMID: 39657690
DOI: 10.1093/geront/gnae177

Abstract

Background and objectives: We describe "role-sharing" in home care, defined as family care partners and paid caregivers assisting with the same task(s).

Research design and methods: We studied 440 participants in the 2015 National Health and Aging Trends Study (NHATS) receiving paid help with self-care, mobility, or medical care. We describe patterns in receiving paid help only, help from care partners only, and role-sharing. We examine whether sole reliance on paid help or role-sharing differs by Medicaid-enrollment and dementia status.

Results: Half (52.9%) of care networks involved role-sharing. Care networks involving role-sharing more often occurred among older adults with dementia (48.7% vs. 25.6%, p<0.001) and less often for those who were Medicaid-enrolled (32.1% vs. 49.4%, p<0.01). Those living with dementia more often experienced role-sharing in eating (OR 3.9 [95% CI 1.20, 8.50]), bathing (OR 2.7, [95% CI 1.50, 4.96]), dressing (OR 2.1 [95% CI 1.14, 3.86]), toileting (OR 2.9 [95% CI 1.23, 6.74]), and indoor mobility (OR 2.8 [95% CI 1.42, 5.56]), and less often received help solely from paid helpers with medication administration (OR 0.24, [95% CI 0.12, 0.46]). Medicaid-enrollees more often received paid help only in dressing (OR 2.0 [95% CI 1.12, 3.74]), outdoor (OR 2.4 [95% CI 1.28, 4.36]) and indoor mobility (OR 4.3 [95% CI 2.41, 7.62]), and with doctor visits (OR 2.8 [95% CI 1.29, 5.94]).

Discussion and implications: Role-sharing is common, especially among older adults living with dementia who are not Medicaid-enrolled. Strategies supporting information sharing and collaboration in home-based care merit investigation.

Keywords: Medicaid; dementia; family caregiving; paid caregiving; shared care.

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