With modern medical and technological advances and the ensuing costs of institutional care, there has been renewed emphasis upon alternative community based care. Deinstitutionalization during the 1960's and 70's moved individuals with functional limitations into the least restrictive environment. Informal caregiving has again become a major factor in health management and maintenance of individuals in home and community settings. Among people 45 years of age or older, approximately two in five report some experience with long term care in their families. The true cost of caring is typically born by female family members, who are single, and the sole support of the family.
Many caregivers are older and have chronic health care concerns of their own.
They are most often poor or near poor, live in three generation households and either quit work or reduce their hours to fulfill the caregiving role. As the population ages, the demand for informal care will escalate over the next thirty years. Within the same decades, there will likely be fewer women available to provide care due to demands of employment, delayed childbearing, geographic dispersion, and divorce. Home managed care provides the client with more independence and responsibility for health decision making. Use of informal caregivers frequently reflects the individual's own beliefs, values and culture.