Programming for family care of elderly dependents: mandates, incentives, and service rationing

In response to a demographic imperative, many countries have established policies to increase family involvement in the care of their dependent elderly relatives. Reflecting fiscal constraints and cultural norms, these policies are often designed to place the burden of care on family rather than government. This article offers a survey and critique of three approaches to increasing family care of elderly people: filial support legislation, incentives for family caregivers, and service rationing provisions. Drawing in part on the results of a survey with respondents from 33 countries, it concludes that policies that require or encourage relatives to provide care may have adverse consequences for elderly people and their families. Human services advocates should support policies and interventions that provide universal access to a continuum of care alternatives that facilitate rational health care decision making by families and that empower and sustain family members who choose to care for elderly relatives.