Process utility from informal caregiving;

While the attention in studies of the impact of informal care has traditionally been on outcomes, in recent years the process of informal caregiving and its impact on health and well-being is gaining attention. Not only the outcomes but also the processes, in which the outcomes are achieved, are important for both the informal caregiver and care recipient. It is not only that the needed care is adequately delivered, but also how the informal care is provided to the care recipient that matters. The manner in which informal care is given bonds the caregiver and care recipient; allowing utility to be gained or lost. Process utility places importance on the way care is provided to a patient, assuming that (dis)utility can be derived by a process in which the same outcomes are reached. The study by Brouwer et al. (2005) was the first in its kind to show that caregivers derive process utility from informal care giving. We examine whether process utility from providing informal care is different for two residence situations. The first group consists of informal caregivers that provide care to care recipients which reside in their own homes (n 936). The second group consists of informal caregivers that provide informal care to nursing home admitted care recipients (n 182). Empirical evidence of process utility on the basis of a sample of Dutch caregivers (n 1244) is presented. The main focus of this study is to determine if an association exists between: process utility and motivation to start to provide informal care and caregivers’ preference for performing certain care tasks. Other background characteristics of the informal caregiver and care recipient are also presented and associated to process utility. Our results showed that process utility was present in both home caregivers and nursing home caregivers; mean process utility was not found to be different for either groups. About two thirds of the caregivers derived positive utility from informal care. Neither a ‘forced’ nor a free choice to start informal caregiving was associated to process utility. We found that process utility was negatively associated to help with outdoor mobility and social support (compared to no extra care task) for home caregivers. Multivariate regression analysis for the home caregivers group showed that process utility was positively associated with caregivers’ rated health and objective burden. Process utility was negatively associated for subjective burden for home caregivers. For the nursing home caregivers we found that only subjective burden was negatively associated to process utility. Our research suggests that home caregivers prefer different care tasks that nursing home caregivers. More research into this subject can provide further information on which care tasks are (un)likely candidates to be taken over by formal care. Concluding, this study provides more evidence for the existence of process utility derived from informal care giving. Process utility in informal care is an independent source of utility. It influences the utility gained or lost by informal care giving, independent of the outcome. Average process utility did not differ for home caregivers and nursing home caregivers. However, positive process utility was higher among home caregivers. Home caregivers therefore might derive marginally more happiness from informal care giving. Since the Dutch health care system already heavily relies on informal care it is important to support caregivers that experience high burden. Ideally this support is balanced with the utility that is derived from informal care giving. We therefore advice Dutch policymakers to strike a balance between supporting (highly) burdened informal caregivers and retaining the benefits that are derived from the process of informal caregiving, while acknowledging the difference between informal caregivers that provide informal care in nursing homes or in the care recipients own home. This would benefit the informal caregiver and care recipient, while lower the use (and financial cost) of formal care.