Family Caregiving Systems: Models, Resources, and Values

Families are widely acknowledged to provide most of the caregiving received by older persons in this country. It should not be surprising, then, that families and caregiving are the focus of considerable research interest. Since a pioneering study refuted the belief that older people were abandoned by their families and socially isolated (Shanas & Streib, 1968), knowledge about family caregiving to dependent elders has expanded exponentially (see Horowitz, 1985). Families have been demonstrated to shoulder most of the care provision (Coward, Horne, & Dwyer, 1992; Schulz, 1990; Shanas, 1979). Types and amounts of caregiving activities have been quantified, and demographics of providers profiled (Horowitz, 1985). More recently, subjective aspects of caregiving--the motivations of caregivers and the meanings of the caregiving experience to persons involved--have begun to attract attention (see especially the work of England & Ganzer, 1993; England & UIC Collective, 1993; Matthews, 1987a, 1987b; Matthews & Rosner, 1988; Rubenstein, 1989). Within this emerging line of inquiry, the study reported here began as an examination of the division of caregiving labor in the family. Much is known about allocation of tasks and responsibilities; considerably less is understood about the perspectives of participants themselves on how this allocation came about. The present study was designed to gather data from all adult offspring in caregiving families in order to increase understanding of the complex subjectivities of family caregiving. Examination of the data suggests that families constitute themselves into a variety of caregiving systems, reflecting the importance of certain values to particular families. These values and resultant parent-care arrangements appear to have salience to the relationship among offspring, as well as between offspring and parent. As Sarah Matthews has observed, offspring view their parent-care activities "not only as contributions to their mother but to one another as well" (Matthews, 1987a, p. 434). In analyzing siblings' evaluation of the fairness of their caregiving roles, she distinguishes between those who anticipate a meaningful future relationship ("those who planned to grow old together") and those who did not ("just because we're related"). She concludes that the values that undergird caregiving arrangements vary depending upon sibling emotional investments in each other. LITERATURE REVIEW Currently, just as there is consensus about the central role of the family in caregiving, so there is also widespread agreement that one member of a caregiving family, often referred to as the primary caregiver, is likely to provide all or most of the care (Brody, 1990; Cicerelli, 1981; Horowitz, 1985; Maddox, 1991). The primary caregiver model dominates research findings and clinical reports (Cosbey, Bowman, McNutt, & Stull, 1989; Horowitz, 1985; Tonti, 1989) In fact, only a decade ago, Horowitz suggested that references in the literature to a family caregiving system might be somewhat idealistic, in view of consistent confirmation by research that one family member serves as the primary caregiver: "Shared responsibility is very much the exception to the rule" (Horowitz, 1985, p. 200). Recently, however, some researchers have pointed to the importance of looking beyond the primary caregiver to how other family members stand in relation to both the structures and the processes of providing care (Barnes, Given, & Given, 1989; Birkel & Jones, 1989; Dwyer & Coward, 1992; Finch & Mason, 1993; Horowitz, 1992; Matthews, 1987a, 1987b). Matthews and Rosner (1989) signaled this line of thought in subtitling an article "The Family as the Primary Caregiver. " Recently, Horowitz has noted the importance of this expanded perspective: "The movement toward the study of the family caregiving system, rather than the caregiving dyad, represents a significant development in caregiving research. …