ANN ARBOR—Family and friends who care for elderly people do not tend to bail out once publicly paid home care is established, a new study shows.

A study by the University of Michigan says that formal care complements, not replaces, informal care to support older people with relatively severe disabilities living in the community.

“This research should quell fears that family caregivers withdraw from caregiving in response to the availability of publicly funded home care,” said Lydia Li, an assistant professor in the School of Social Work.

Li’s research examined how the amount of informal care changes after publicly paid home care is provided, and whether the pattern of change varies by recipients’ amount of formal service use, disability, caregiving arrangements and demographic characteristics. She also studied how changes in formal service use, disability and caregiving arrangements affected informal care.

Data came from participants of Michigan’s Home- and Community-Based Medicaid Waiver program, designed to maintain low-income elderly who were at risk of nursing home placement in the community by providing services such as home health aide, personal duty nursing and personal emergency response systems.

The study used 888 elderly participants who stayed in the Medicaid Waiver program for at least three years as the sample. The amount of informal care was the outcome variable, which was indicated by number of hours per week that the elder received help with basic and instrumental activities of daily living, such as dressing, bathing, housekeeping and shopping, from informal caregivers.

Li examined four sets of predictors: formal service use, disability, caregiving arrangements and sociodemographic characteristics. Formal service use involves the total hours received weekly in several categories, including home health aides, visiting nurses, homemaking, meals, adult day care and in-home social workers.

During the first three years that community-dwelling disabled elders received publicly paid home care, the amount of informal care they received declined typically in the first year after elders received Medicaid Waiver services. The amount of informal care became more stable, with almost no change during the third year. At the end of the third year, informal services remained at about 18 hours per week on average, suggesting that informal caregivers did not withdraw from caregiving even after three years of receiving formal help.

The amount of formal service use is not related to changes in the amount of informal care. “Such finding suggests that formal services do not substitute for informal care,” Li said.

Multiple reasons may account for the decline in informal care, Li suggested, and one is changes in the caregiver living apart from the elder. About 16 percent of the sample experienced change in living arrangements during the study period, with more participants changing from living with to living apart from the caregiver.

The study appears in the August 2005 issue of The Gerontologist.

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