Search

Background and Objectives Home- and community-based services (HCBS) are underutilized, despite offering significant health benefits to both care recipients and caregivers. Drawing upon Andersen's extended behavioral model of health services use, we examined individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia. Research Design and Methods We analyzed data from telephone interviews with 123 dementia family caregivers in rural Appalachian counties (M age = 64.7, SD age = 12.2). Multilevel analyses were conducted to examine the effects of individual-level and county-level factors on the use of home-based services (home healthcare and personal care services) as well as community-based services (adult day care and transportation services). Results Results indicated that caregivers' receipt of informal support from family or friends was associated with more use of home-based services (B = 0.42, p =.003). Conversely, longer travel times to service providers were linked to use of fewer community-based services (B = −0.21, p <.001). Residing in counties with more home health agencies was associated with higher utilization of home-based services (B = 0.41, p =.046). However, higher county tax expenditures for HCBS were not linked to home-based or community-based service use. Discussion and Implications Findings suggest that informal support in caring for the person living with dementia enables HCBS use in rural Appalachia. In contrast, limited geographic accessibility and service availability can impede HCBS use in rural regions. Policymakers are urged to allocate direct public funding to service providers to expand service availability in underresourced rural regions. [ABSTRACT FROM AUTHOR]

Background and Objectives Behavioral expressions of dementia are often stressful for family caregivers to manage as they strive to ensure their relative's needs are met. Guided by Lazarus and Folkman's Transactional Model of Stress and Coping, we identified specific behaviors that disrupt daily routines and challenge the achievement of caregiving goals, and the approaches and strategies caregivers employ to address them. Research Design and Methods We conducted semistructured interviews with 30 family caregivers in rural Appalachia caring for a relative living with dementia. Analysis involved use of open and focused coding processes to identify the ways caregivers managed behaviors and bar graphs to examine management approaches relative to categories of behaviors and caregiver demographic and emotional well-being variables. Results Analyses revealed 10 types of behavioral expressions of dementia associated with confusion, irritability, and resistance to engaging in necessary activities of daily living. Caregiver approaches to managing behaviors included gentle persuasion, being harsh by yelling or threatening, being persistent in expecting the person with dementia to complete the tasks at hand, disengaging by postponing the activity, and employing a combination of strategies. Approaches differed across types of behavior and caregiver demographics and had varying effects on caregiver well-being. Discussion and Implications Uncovering specific behaviors family caregivers of persons living with dementia found bothersome, caregivers' adaptive strategies for managing behaviors, and the impact of those approaches provides new information to inform training on effective dementia caregiving practices and development of targeted intervention programs for dementia care. [ABSTRACT FROM AUTHOR]

In custodial grandfamilies, grandchildren often provide critical support and assistance to their grandparents. Less is known about the extent to which grandchildren may serve as caregivers to their custodial grandparents and how providing care may impact their well-being. Informed by the stress process model, the purpose of this study was to examine the nature of adolescent grandchildren's caregiving to their custodial grandmothers and the relationship of providing this care to grandchildren's perceived caregiving interference and internalizing and externalizing behavior problems. A survey was administered to 81 adolescents, aged 12 to 18, and their custodial grandmothers. Results suggest that grandchildren provide assistance with both instrumental activities of daily living (IADLs; e.g., housework, cooking) and activities of daily living (ADLs; walking, dressing). Results of a path analysis revealed that grandchildren's assistance with ADLs was associated with greater perceptions of caregiving interference in social and academic arenas, which was associated with increased externalizing behavior problems. Implications for practice, which underscore the necessity of interventions to support grandchild caregivers, and directions for future research, are addressed. Highlights: Grandchildren assisting grandmothers with instrumental activities of daily living, including household chores, was common. Grandchildren assist custodial grandmothers with activities of daily living (e.g., transferring, using stairs, and walking). When grandchildren assist with more activities of daily living, they report greater perceptions of caregiving interference. Grandchildren with greater perceived caregiving interference experienced more externalizing behavior problems. [ABSTRACT FROM AUTHOR]