Caregiving: A Public Health Priority

Byline: K. Shaji, M. Reddy Health-care is often seen as a service provided by doctors, nurses and other health professionals. Individuals with health problems, especially those with chronic illness or disability, need constant care and assistance from others. Such is often home-based and provided almost entirely by co-resident family members, who are not part of the formal health-care system. This unpaid care, given voluntarily to ill or disabled persons by their families or friends is called This is the back bone of long-term care. Contributions of informal caregivers go unnoticed, except by those who benefit from their care. However, we must recognize that the contributions of informal caregivers are irreplaceable. No society, rich or developed, can afford to replace all informal caregivers with paid workers. Caregiving is an issue, which affects the quality of life of millions of people world-wide. Providing informal care, particularly for a person needing assistance for activities of daily living, is a demanding task, which requires time, dedication and perseveration. Most caregivers derive personal satisfaction while caring for someone close to them and that enables them to cope with the stress and burden of care. Until recently nobody considered caregiving as a public-health matter. [sup][1] Instead, caregiver research focused only on psychosocial dimensions and the burden of care. Historic Evolution The nature and function of caregiving has evolved over the last two centuries. Life expectancy has increased and there is a definite change in the profile of illnesses. Communicable disorders are less prevalent than before. Non-communicable disorders are emerging as public health problems. The proportion of people with functional impairment and disability are also on the increase. Caregiving was typically short-term in the 19 [sup]th century and until the early part of the 20 [sup]th century. Now in the 21 [sup]st century, we have more people with chronic disabling conditions and they need care over longer periods of time. The demand for long-term care is likely to increase in the future. Demographic aging is not the only reason for the world-wide increase in the demand for long-term care. Escalating costs of hospitalization and institutional care is leading to briefer hospitalizations and increased need for community care. Medical advances are also leading to better survival of infants with life-long disabilities. Survival of adults with brain damage and other serious injuries also add to the need for long-term care. Human Resources There is tremendous pressure on families to take on the care of disabled. As the need for care keeps on increasing, the human resources seem to be dwindling. More women are taking up employment outside their homes to supplement the family income. Even now, the majority of caregivers are women. Many men and women continue to be caregivers while being part of the work force. This can be very stressful and demanding. They may be forced to cut-down on work or make suitable adjustments to accommodate their caregiver responsibilities. Burden and Impact A survey conducted in 2004 in the United States found that caregivers were present in one in five households and 21% of the U.S. population older than 18 years were engaged in providing care for an adult. The majority of these caregivers (an estimated 34 million or 16% of the U.S. population) provided care to someone at least 50 years old, and some provided care for more than one person. (Caregiving in the U.S. Available : 0 http://www.caregiving.org/data/04finalreport.pdf). The majority (83%) were family caregivers-unpaid persons such as family members, friends, and neighbors of all ages. Though, we do not have comparable data from India, it is reasonable to presume that things could be similar in India and elsewhere. The provision of informal care over prolonged periods of time can have profound consequences for the caregiver. …