As the setting for many forms of long-term care has shifted from health care institutions to the home, there has been increasing focus on the role of the informal caregiver and their personal health and wellbeing. This study sought to measure and explain caregiver satisfaction with support services in Montreal, Quebec and also compared satisfaction between caregivers whose care recipient received a newly designed integrated care program versus those who did not. Results indicate that services that respond to caregivers' informational and emotional needs are more likely to influence general satisfaction than those that serve instrumental support needs such as respite or direct help with caregiving tasks. Furthermore, the integrated care model for care recipients was shown to have an indirect positive effect on caregivers.

Background: As the setting for many forms of long-term care has shifted from institutions to the home, there has been an increasing focus on the role of the informal caregiver and their personal health and wellbeing. Many studies have noted the perceived burden resulting from care giving as well as the health risks to the caregiver. In response to this situation, health care providers have sought to develop services targeted at caregivers including information and advice; emotional support; respite from care responsibilities; and provision of home care services. This study sought to measure and explain caregiver satisfaction with support services in Montreal, Quebec. The study also compared satisfaction between caregivers whose care recipient received a newly designed integrated care program versus those who did not.

Methods: Data were obtained as part of a larger study that evaluated an integrated service program for frail seniors, based on a model of care developed by a group of researchers and health care managers. The model was applied to participants recruited at two different care access centers (CLSCs) in Montreal. Under regular care, clients were referred to health care organizations by primary respondents who had caseloads as high as 100. Under the integrated care model case managers had caseloads of 40 or less and assumed clinical responsibility as well as the responsibility for optimal resource use for the client. Telephone service was also available 24/7 for this model. For this study, care recipients had to be over 65 years of age and not residing in an institution. Recruiting took place between January and August 1999 and data were gathered in interviews between May and October 2000. Satisfaction with services was compared with socio-demographic characteristics of caregivers; health and functional status of both caregivers and care recipients; formal support services received; and quality of social support networks available to caregivers.

Findings: The final sample consisted of 291 caregiver-care recipient dyads: 163 dyads received the integrated model and the remaining 128 received regular CLSC care. Satisfaction responses were grouped into three categories: low, average, and high. Caregiver satisfaction with support services averaged 26 out of a possible score of 32. Caregivers with excellent or very good self-rated health and whose care recipient had 5 or fewer health problems were more likely to have high versus low satisfaction than those whose self-rated health was good to poor and whose care recipients had 6 or higher problems. The availability of high-quality social support networks to caregivers also significantly improved the likelihood of high caregiver satisfaction. Support services that improved the odds of high general satisfaction among caregivers included information and advice, and emotional support. Finally, the integrated care group was more likely to report high caregiver satisfaction than those where the care recipient received regular care.

Conclusions: This study provides useful information to policy makers and planners seeking to improve the living conditions of individuals engaged in caring for frail seniors. Results indicate that services that respond to caregivers' informational and emotional needs are more likely to influence general satisfaction than those that serve instrumental support needs such as respite or direct help with caregiving tasks. Furthermore, the integrated care model for care recipients was shown to have an indirect positive effect on caregivers. With respect to the integrated care model further research will be needed to determine if the sum of benefits to each of the caregiver, care recipient, and health care system are sufficient to offset the higher costs associated with providing this program.

Reference: Savard, J, Leduc, N, Lebel, P, Beland, F, Bergman, H. Caregiver Satisfaction with Support Services. Journal of Aging and Health 2006, 18(1), 3-24

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