The current examination of intergenerational care perceptions requires a structural understanding of contemporary formal-informal care delivery models.
Participant discussions of family care inherently connect with formal care services and entail an interface between the two systems; as adult child caregivers frequently interact with various formal care actors (e.g., community nurses, home-support staff, doctors, and social workers). In addition, the health policy reforms shaping BB aging contexts place participants as active agents in prospective care arrangements. Accordingly, a range of potential care models, or spectrums of formal/informal care involvement may be present in participant perspectives.
Theoretical development of care models has undergone considerable change, as care arrangements and the healthcare systems evolve to meet the needs of aging populations. Early conceptual models of care, also known as “conventional” care models, have been critiqued for framing informal and formal care as distinctly separate spheres and largely ignoring the wider contextual forces shaping care experiences (Ward-Griffin & Marshall, 2003). For example, Cantor’s (1979, 1991) hierarchical compensatory model posited that a preferred ordering of chosen caregivers was based on closeness in social networks, with family recognized as the most desired caregiver, and formal/paid caregivers as the least desirable. Greene’s (1983) substitution model suggested that formal care acts as a replacement for informal care, whereas Litwak’s (1985) task specificity model proposed that care tasks dictate caregiver type required. Over time, more integrated approaches such as Chappell and Blandford’s (1991) complementary model theorized that formal care can both compensate for, and
supplement, informal care in the event of an older adults’ escalating care needs. These conventional models have been critiqued for providing an oversimplified understanding of informal and formal care as separate spheres, and for excluding care recipients as active participants in their own care processes (Ward-Griffin & Marshall, 2003; Sims- Gould & Martin-Matthews, 2010; Kemp, Ball, & Perkins, 2013).
Kemp and colleagues (2013) integrated critiques of these conventional care models and key elements from the life course, social-economist, socialist-feminist, and symbolic interactionist perspectives to propose a convoys of care model that
model, Kemp et al. (2013) support the idea that care collaborations consist of both formal and informal members, whereby care relationships and arrangements are unique, complex, and dynamic in response to multi-level factors. Specifically, they define
convoys of care as
Evolving collections of individuals who may or may not have close personal connections to the recipient or to one another, but who provide care, including help with activities of daily (ADLs) and instrumental activities of daily living (IADLs), socio-emotional care, skilled healthcare, monitoring, and advocacy (Kemp et al., 2013, pp. 5-6).
Furthermore, Kemp et al. (2013) suggested that care convoys shape care recipients' experiences and outcomes, as well as their ability to age in place.
Applicable across various care settings (i.e., from community care to institutional LTC sites), the convoy of care model accounts for macro-level influences, as well as industry-, community-, agency-, and individual-level forces (Kemp et al., 2013). Elder’s (1998) life course concept of linked lives also emerges in the convoy model, as lives are considered inherently interconnected and viewed as long-term exchanges over time. Convoys are portrayed as dynamic networks of relationships, with members added or removed, often in conjunction with life course transitions (Antonucci, 1985). In the context of intergenerational family relations, health-related transitions might require support or assistance from convoy members in response to an older relative’s needs. Convoys demonstrate various properties, including structure (i.e., size and stability), function (i.e., support given, received, or exchanged), and adequacy (i.e., satisfaction with support), all of which are influenced by personal and situational characteristics (Kemp et al., 2013).
Similarly, Sims-Gould and Martin-Matthews (2010) suggested that formal and informal (or family and paid) care systems are inextricably linked and overlap to meet the needs of older adults. Within the increasingly popular Canadian home health-care
context, the integration of formal and informal services is necessary to ensure safe and reliable care for older adults who are aging in the community. The integrated care model proposed by Sims-Gould and Martin Matthews (2007) conceptualizes care processes as interactive between formal care providers, informal care providers, and older care recipients. This focus on bidirectional exchanges proposes an intertwined understanding of supporting older adults, through processes of assistive care (care provided together
by formal and informal caregivers) and direct care (care provided by formal caregiver to older client). Sims-Gould and Martin-Matthews’ (2010) integrated care model posits that care processes may demonstrate reciprocal collaborations between the paid and unpaid systems, characterized as ‘caring together’ (e.g., family caregivers preparing meals or baths prior to the arrival of paid care workers). Alternatively, more unidirectional assistive care between formal and informal systems is represented in family caregiver
experiences of care management, quality assurance, and monitoring. Essentially, the integrated care model assumes that formal and informal care systems rely on each other and “combine efforts and work in synchrony with one another in providing care that meets the most basic and intimate needs of frail older people” (Sims-Gould & Martin- Matthews, 2010, p.422).
Together Kemp et al.’s (2013) conceptualization of care convoys with Sims- Gould and Martin-Matthews' (2010) integrated care model provide a background to how care of older adults consists of multiple actors over time. In the case of adult children acting as the primary caregiver for aging parents, family care can represent a myriad of tasks and roles, performed in parallel to or supplemented by formal care supports. In the current study, these care models provide a means to understand the perceived
caregiving options, while recognizing the interactions between formal and informal systems that seek to meet the changing needs of older adults and their caregivers.
Methods
This chapter includes the research methods that the researcher applied to examine intergenerational perspectives on future care in aging boomer families. This qualitative study consisted of semi-structured cohort specific focus groups. In total, four unrelated groups of BBs and ACBBs gathered to discuss their various perceptions of family care and related supports. The following sections outline the study design,
participant recruitment and demographic details, as well as the methods applied for data collection and analysis.