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Understanding the Roles of Formal and Informal Caregivers

Formal caregivers are typically paid providers but they may also be volunteers from a government or nonprofit organization. Where care is being provided in the home there is often a mix of formal and informal care provided. And the trend is towards using more formal care since, unlike the past, more informal caregivers are employed.  They choose to remain employed but must juggle limited time between caregiving and maintaining a household and a job.

These added responsibilities often make it necessary to hire non-medical home care aides to provide supervision and help when the primary caregiver cannot be present. Or as adult day services become more common, caregivers may pay for this form of formal caregiving to get rest or to allow for maintaining some employment.

When care is no longer possible in the home, then formal caregivers come into play on a full-time basis. This may be in the form of a congregate living arrangement, assisted living, a continuing care retirement community or a nursing home. It is at this point that long term care can have a significant impact on the finances of the care recipient and a healthy spouse living at home. 

Care facilities are quite expensive and the cost for maintaining a spouse in such a living arrangement may rob a healthy spouse at home of an adequate standard of living. It’s quite possible the healthy spouse may end up with food stamps and subsidized housing where, before the need for a care facility, this may not have been the case.

Or it is more often the case that the couple recognizes this dilemma of splitting living arrangements in two locations and an attempt will be made to keep the spouse needing care at home as long as possible. This may help with the finances but often results in destroying the physical and emotional health of the caregiver by creating a situation where the caregiver has difficulty coping with the responsibilities and physical demands.

Another reality of providing informal care services in the home is the increasing need for physical and emotional support that often goes unrecognized until too late. As care needs increase, both in the number of hours required and in the number or intensity of activities requiring help, there is a greater need for the services of formal caregivers.

Unfortunately, many informal caregivers become so focused on their task they don’t realize they are getting in over their heads and they have reached the point where some or complete formal caregiving is necessary. Or the informal caregiver may recognize the need for paid, professional help but does not know where to get the money to pay for it.

Other members of the family should be aware of this burden and be prepared to step in and help their loved one who is providing care recognize the possibility of becoming overloaded. It is also the job of a care manager or a financial adviser or an attorney to recognize this need with the client caregiver and provide the necessary counsel to protect the caregiver from overload. The advisor can also likely find a source for paying for formal care that the caregiver may not be aware of.

An overloaded caregiver is likely to develop depression and/or physical ailments and could end up needing long term care as well. The consequences of not being able to cope with the burden of caregiving might even result in an early death for the caregiver.