Different patterns among caregivers in their utilization of formal services and the influence on caregiver burden and health

This study examined how older adults and their primary family caregivers utilized formal services; and how formal service utilizations were associated with the caregiver's burden and health status. Conceptually, the caregiver's stress/appraisal model was modified by adopting a relation between formal and informal care from health economics or policy.;Using data has drawn from the 2004 wave of National Long Term Care Survey, this study firstly attempted to examine effects of two types of service provisions on consequences of caregiving in the context of 1997 Balanced Budget Act and 2000 National Family Caregiver Support Program being implemented. The study sample comprised 1,456 pairs of community-based disabled older adults and their primary family caregivers. A multiple group structural equation model was used to assess invariance of measurements and paths of relationships among stressors, appraisals, service utilizations and the caregiver's health between adult child and spouse caregivers.;Findings indicated that older adults were more likely to receive the formal assistance for activities of daily living (ADLs) and instrumental activities of daily living (IADLs) when primary caregivers were adult children than spouses. Moreover, adult child caregivers were more likely to utilize services than spouse caregivers. Compared to adult child caregivers, spouse caregivers were less likely to utilize the following services: home delivered meals, requests for information of financial assistance and adult day care.;The two group path model revealed that the adaptation of a relation between formal and informal care in the caregiver's stress/appraisal model fits the data well. Adult child caregivers spent less time on caring for elderly parents and indirectly felt less burden associated with caregiving when elderly parents received the formal assistance for limitation of ADLs and IADLs. No significant findings associated with the formal assistance for ADLs and IADLs were found for spouse caregivers. The formal assistance for ADLs and IADLs was not significantly associated with the caregiver's physical health.;Unexpectedly, this study revealed that the caregiver's formal service utilization was positively associated with the caregiver burden and indirectly associated with the caregiver's poor health. Discussion and implications for research and social work policy and practice were presented.