18. Formal vs informal care
The vast majority of older people living in the community who required help with self-care, mobility or communication (as the Australian Bureau of Statistics defines persons with a severe or profound handicap) received assistance from the informal care network (94%). Only a small proportion relied exclusively on formal assistance from a community organisation or a health professional, although around one-third received help from both informal carers and formal services.
Those living with family members were much more likely to be receiving help from the informal network only, than were those living alone. Persons living alone were more likely to be receiving help from formal services; almost two-thirds of older people living alone received formal assistance compared to around a quarter of those living in families. However, those who lived alone did receive informal assistance - 85% of older people living alone received informal assistance. This provides a timely reminder of the importance of assistance from family and friends for those living alone. Males were more likely to be receiving only informal assistance, while females were more likely than males to be receiving both informal and formal assistance (AIHW 1995). This is in keeping with the greater proportion of older women than older men who live alone, particularly at advanced ages.
The types of activities with which assistance is received provide some insight into the kind of support provided by the informal and formal networks. Interestingly, severity of handicap was found to influence both the type of help received, and the source of that assistance.
In the 1993 Survey of Disability, Ageing and Carers conducted by the Australian Bureau of Statistics, there were an estimated 683,500 persons aged 65 and over with a disability and living in the community who reported a need for help in at least one activity. Of these, 36% had a profound or severe handicap, 22% had a moderate handicap and 34% had a mild handicap.
The vast bulk of assistance required by older people with a profound or severe handicap was provided by the informal care network of family, friends and neighbours. For activities such as personal care, mobility, communication, meals, financial management and transport, over 80% of respondents reported that an informal carer was their main source of help. Between 73 and 74% reported a similar pattern with regard to home help and home maintenance, and even for health care 56% of respondents reported the informal care network rather than formal services as their main provider. Formal providers of assistance were most commonly reported with regard to health care assistance (40%), followed by home help and home maintenance (25%) and personal care (13%). Verbal communication (20%) and mobility (11%) were the areas where respondents were most likely to report that they needed, but were not receiving, help.
For older people with a moderate handicap, the patterns were somewhat different, although informal care still predominated. Older persons with this level of dependency were more likely than those with a profound or severe handicap to receive help from formal services or to receive no help, and less likely to have an informal carer. (Note that, by definition, people with a moderate handicap do not require or use assistance with personal care or mobility.) Nonetheless, informal carers remained the predominant source of care for most older people with a moderate handicap across most areas in which they received assistance.
For those older people with a mild handicap, home help, home maintenance and meal preparation were the activities where a provider of assistance was most commonly reported. Again, most of this assistance was provided by informal carers.
All persons aged 65 and over with a profound or severe handicap living in the community; type of assistance received by living arrangements, Australia 1993 (%)
|Living arrangements||Informal only||Formal only||Both||None||Total (N)|
|Lives in family||71.7||0.3||26.5||1.5||150,400|
|Lives with non-relatives||50.5||0.0||49.5||0.0||1,400|
Australian Bureau of Statistics 1995. Focus on families: caring in families - support for persons who are older or have disabilities. Cat No. 4423.0. Canberra: Australian Government Publishing Service (AGPS).
Australian Institute of Health and Welfare (AIHW) 1995. Australia's welfare: services and assistance. Canberra: AGPS.
Data presented here are drawn from unpublished data from the Australian Bureau of Statistics 1993 Survey of Disability, Ageing and Carers.
Prepared by the Australian Institute of Health and Welfare