Family Choices with Managed Care for the Home Bound Elderly

Long-term care research has recently focused on the role of home health care as a substitute for the more expensive and impersonal nursing home care. To date, however, much of the work has centered on market-supplied home health care. The role and behavior of informal caregivers, usually spouses, grown daughters or daughters-in-law of the frail elderly [18; 8; 19], have received little attention. This is unfortunate because the significance and potential of home health care cannot be fully understood without a careful consideration of the role of informal caregivers and the relationship between the formal and informal care sectors. The purpose of this paper is to identify and empirically study the factors that influence the amount and types of geriatric care provided by informal caregivers. Recognizing that caregiving is influenced by many other activities that compete for the caregivers' time, we will develop a model which describes how informal caregivers allocate their time to caregiving, as well as to employment, production of ordinary household goods, and leisure. The paper hypothesizes that the time-allocation behavior of informal caregivers is planned, predictable, and hence can be influenced by government intervention strategies designed to help the frail elderly to stay in their own homes. The data from the 1984 National Long-Term Care Demonstration Project (known as the Channeling project) will be used to estimate the model. Of particular interest is the question of how well does the model explain and predict the amount and type of home health care provided by informal caregivers. Equally interesting is the question of how effective were the two different government intervention programs experimented by the Channeling project in influencing the caregivers' time allocation decisions.