Improving Family Dynamics With In-Home Care

Today’s family structure is more diverse than ever before. Families come in all shapes and sizes, from traditional nuclear families to multigenerational households to collections of people who choose to live as a family. Just as families are changing, caregiving also is changing. But one thing never changes: Older adults value their independence. Yet many seniors need help from others to be safe at home. They rely on spouses, adult children and other relatives who provide hands-on assistance and coordinate their care.

In past years, family members usually lived nearby. A group of siblings, often including stay-at-home daughters or daughters-in-law, would band together to care for elderly loved ones. Some families still reflect this very model—but it is less and less the norm. Our lower birth rate means that the caregiving load is spread among fewer siblings. The higher divorce rate means many more seniors live alone, without a spouse caregiver to help if they become disabled. Some adult children even find themselves serving as primary caregiver for both their divorced parents—and perhaps a stepparent or two. The number of seniors who need care is growing, but the ratio of family caregivers to people needing care is widening every year.

Who is stepping in to fill this gap? Brothers and sisters are helping out. A recent study from Easter Seals found that almost a quarter of adults with a disability are cared for by siblings. These caregiver brothers and sisters often join the ranks of "compound caregivers"—people caring for a disabled sibling as well as a senior parent.

In addition, the National Alliance for Caregiving reports that today close to 1.5 million children under 18 are caring for elderly loved ones who have Alzheimer’s disease or other dementia; heart, lung or kidney disease; arthritis; diabetes and other disabling conditions. These children assist with hands-on care and even with medical tasks. A troubling report by Civic Enterprises for the Bill & Melinda Gates Foundation revealed that almost one-quarter of children who drop out of school do so to provide care for a family member—often a disabled or elderly relative. Caregiver associations are taking note of these children and are working to assist them.

Caregiving offers many emotional rewards for family members. But it can be stressful for people of any age. And when we talk about caregiver stress, we need to remember that receiving care also can be stressful! The old saying "You cared for me when I was a child and now it is my turn to care for you" isn’t always comforting for either party in the care relationship. Depression, guilt and friction between family members may result from the workload and changed circumstances.

Help is available for these overextended families. Employed caregivers should talk to their employers about assistance programs. The local Area Agency on Aging can match families with support resources. Families also can enlist the services of a professional geriatric care manager, and should hold a family meeting to discuss care needs with siblings and other family members. Adult day services, respite care, assisted living and other supportive living services are a good choice for some families. And for day-to-day support and supervision in the home, more and more families are supplementing informal family care with professional in-home care.

In-home care offers many benefits for senior clients, and is often the key to improve the quality of life of the whole family. In-home care enables a "normalization" of generational relationships in several ways:

Home care lessens the day-to-day workload for families. Home-care professionals keep the house clean and in good order, prepare nourishing meals, help manage medications, take senior clients to healthcare appointments and provide companionship and supervision. Families who are balancing jobs and other responsibilities are grateful for the help and peace of mind, and senior clients usually feel better about not having to impose on loved ones for tasks they could once manage on their own—so often evidenced when seniors say, "I don't want to be a burden."

Home care preserves the dignity of seniors. When adult children must bathe, shave, toilet and dress a formerly independent elder parent, it can be uncomfortable for everyone. Family caregivers may put their own health at risk by lifting and maneuvering a disabled loved one. The assistance of a professional in-home caregiver with these hygiene tasks saves seniors’ pride and creates a more normal, comfortable parent-child dynamic. It allows the whole family to focus less on the senior’s limitations and more on their ongoing relationship and doing things they enjoy.

Home care helps families avoid the trap of "old business." Though many families find that elder care creates intimacy and closeness, it also can reignite old power struggles. For some parents and children with ongoing personality conflicts, caregiving often amplifies differences. A recent study from Purdue University examined the ways family dynamics influence the emotional health of disabled seniors. Seniors receiving care from an adult child with whom they felt incompatible exhibited higher levels of depression than those who received no care from an adult child. In other words, some caregiver duos have a more positive dynamic than others. Said Purdue sociology professor Jill Suitor, "This is especially important when people are under a lot of stress and in situations where they relinquish control to another person. And who do you want to give up control to? To someone who has the same outlook on life and who you think is very much like you, and, therefore, can respond to your needs and be a source of reassuring support." When the long-time parent-child dynamic is challenging, assistance from a neutral professional caregiver may provide a buffer. "Dad balks every time I tell him to use the handrail on stairs," reports one daughter. "But when his caregiver Carl reminds him, he just nods and does it. He and Carl don’t have any 'baggage,'" she laughs.

In-home caregivers are professionals. Many caregivers report feeling unprepared for the caregiving tasks they are faced with. Trained home health aides and home caregivers are experienced with the challenges of caring for a senior with mobility, cognitive or other disabilities. It is important to choose a caregiver from an agency that provides training in a client’s special needs, such as dementia care. The daughter of a senior with Alzheimer’s disease said, "Mom was becoming frustrated and aggressive during mealtimes and refused to eat. Our in-home caregiver Wendy showed us that cutting Mom’s food in the kitchen before bringing it to the table and turning off the TV made for a better mealtime experience. She helps Mom—and she helps us, as well!"

What about the cost of in-home care? Many families try to go without help because they think home care is too expensive. But when you consider the impact of caregiving on careers, children’s schooling and the health and well-being of caregivers, home care can be a financially wise choice. Talk to other family members about this issue; they may be willing to share the cost.

Today there are 44 million family caregivers in the United States, and the number will grow as the large baby boom generation ages. Of the 15 percent of people who will be providing care, those who do their homework, make a plan and arrange for support have the best chance of maintaining an elder care system that lets them continue spending rewarding time as a family.

Learn More

Older and younger people can reap rich benefits from living together. Read "Online Buzz: How to Keep the Peace in a Multigenerational Household" in this issue of Caring Right at Home for tips on making the arrangement work for family members of every age.

The AARP Caregiving Resource Center offers online information for caregivers, including tips for handling family dynamics.

The National Alliance for Caregiving provides information for caregivers, including the 2005 survey "Young Caregivers in the U.S."

The University of South Florida’s Center for Inclusive Communities released the study "Compound Caregivers: Overlooked and Overburdened."


Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.