Americans still expect families to shoulder most elder care, research finds
Americans believe that the family as a whole—especially a spouse or partner—is responsible for caring for an older adult. Biological and stepchildren have the next highest levels of obligation, according to a new University of Michigan study. Even though with lighter responsibilities, many believe that lifelong friends should also pitch in.
And when an older adult has dementia, the family unit’s level of responsibility is seen as even higher, according to the research, published in Alzheimer’s & Dementia: Behavior & Socioeconomics of Aging.
“Our findings show that the public continues to see the family as highly responsible for the care of older adults, but that levels of responsibility vary by relationship type,” said demographer and sociologist Sarah Patterson, a research assistant professor at the Survey Research Center and an affiliate at the Population Studies Center, both at the U-M Institute for Social Research.
“The expectations for care networks of older adults are much larger when an older adult has dementia compared to when they do not—results mirroring what we find in the literature regarding actual behavior.”
Patterson and colleagues say family structures are changing with people having fewer children; on the other hand, there is a higher demand for care as the population is living longer.
“Given that families are often the frontline caregivers for older adults, we were interested in understanding more about the public opinion about levels of caregiving responsibility for an older adult among a series of potential caregivers,” Patterson said. “We also wanted to know whether the older adult having dementia, compared to only physical limitations, like difficulty with lower body movement, would impact beliefs about levels of care responsibility.”
Researchers asked these questions on the RAND American Life Panel survey—a nationally representative sample of nearly 2,000 individuals—in October 2024.Public programs and health care settings should be inclusive of caregivers without a biological or legal relationship to an older adult, said co-author Kelsi Caywood, U-M doctoral student in sociology.
“These policies should make it easier for caregiving to be shared across multiple people rather than assuming care will come only from family members or a single caregiver,” she said. “Our survey found that people typically attribute caregiving responsibility to several relationships and describe that responsibility in degrees, such as none, some, most, almost all, rather than an all-or-nothing obligation.”
Expectations: For families, older adults
The intersection of an aging population and changing family structures reveals a complex puzzle. A key piece missing is clarity around expectations: Do we still expect families to be the primary caregivers for older adults when older adults’ families are changing?
Another study by Patterson and colleagues, recently published in the Journal of Family Theory & Review, goes hand in hand with the survey on public perceptions.
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