Is family care on the decline? A longitudinal investigation of the substitution of formal long-term care services for informal care

UMMS Affiliation

Institute for Studies on Aging

Publication Date


Document Type



Aged; *Caregivers; *Family; Female; Forecasting; *Frail Elderly; Health Policy; Health Services Needs and Demand; Health Services Research; Home Care Services; Home Nursing; Humans; Institutionalization; Long-Term Care; Longitudinal Studies; Male; Massachusetts; Social Change


Life Sciences | Medicine and Health Sciences | Women's Studies


The focus on rising costs of long-term care now encompasses community as well as institutional care. Policy makers cite the potential impact of changing social trends on informal caregivers' availability to continue as the main source of care and the possibility that formal services will then replace this informal care. They fear that families will relinquish their caregiving role if publicly funded home care services are available. Longitudinal data from a sample of disabled elders were used to investigate the substitution of formal services for informal care over a seven-year period. The substitution that was detected could be traced to the limited availability of informal care, and it represented a temporary change in the informal care pattern rather than a permanent replacement for it. Instead, use of formal services has supported the elderly person's continued residence in the community.


Milbank Q. 1993;71(4):601-24.

Journal/Book/Conference Title

The Milbank quarterly

Related Resources

Link to article in PubMed

PubMed ID