Running head: UTILIZATION OF FORMAL AND INFORMAL SERVICES







Utilization of Formal and Informal Health Services
by Rural Elderly African Americans
Constance Hall
University of Phoenix Online
Joann Zerwekh
February, 2005













Abstract
This exploratory descriptive study will present rural elderly African American?s utilization of formal and informal services. The social systems theory will be used to explain the interrelatedness and impact of various systems upon the rural elderly African American. Examined will be factors that determine why some rural elderly African Americans choose not to utilize formal and informal services and why other rural elderly African Americans choose to utilize both services. Formal and informal services are used to assist people with chronic health related conditions with their daily activities which include Activities of Daily Living (ADL?s) and Instrumental Activities of Daily Living (IADL?s).






















Utilization of Formal and Informal Services by Rural Elderly African Americans

Rural elderly African Americans with functional limitations will sometimes utilize informal and formal services to remain independent. Reduction in a person?s capacity to perform the usual activity of daily living associated with his or her age group due to a chronic condition is the basis for use of informal and formal delivery services. According to the National Center for Health Statistics 9 activities of daily living (ADL?s) are activities related to personal care and include bathing or showering, dressing, getting in or out of bed or a chair, using the toilet, and eating. Instrumental activities of daily living (IADL?s) are activities related to independent living and include preparing meals, shopping for groceries or personal items, performing light or heavy housework, and using a telephone. Formal delivery service support is provided by agencies, hospitals, and trained professionals. Informal delivery services are from the support of extended family, friends, neighbors, church groups, and service clubs. Various factors or conditions impact on and are significant in the context of care giving relative to rural elderly African Americans, including demographics, functional status, and socioeconomic status.
This study will examine the factors that may cause rural elderly African Americans to utilize formal and informal services. This study will also explore why some rural elderly African Americans choose not to utilize formal and informal services and why other rural elderly African Americans choose to utilize both services.
Utilizing formal and informal services is vital in order for rural elderly African Americans to remain independent. Population estimates for the year 2050 indicate that the number of African American aged will almost quadruple from the present figure of 2.5 million to 9.4 million6. At the beginning of this decade, changes in the demographic profile of the United States population, and specifically the "graying" of the African American population11, directed the policy interest of the Gerontological community to the long-term care needs of the frail and at-risk rural elderly African American. America?s elderly men and women who live in rural areas receive fewer services per home health care episode, and they have poorer outcomes than their city-dwelling counterparts. Depending on how broad the definitions of informal caregiving are, estimates of the amount of informal care and formal care can vary. A major study of long-term care trends has found that households with at least one caregiver for an elderly person have tripled since 1987, compared with a 21 percent rise in the elderly population11. However, caregivers today are less likely to help with essential ADL?s and are more likely to do lighter tasks associated with IADLs. Some of the reasons suggested include the fact that people are living longer but are in healthier condition and that people may be quicker to define themselves as caregivers than in the past11.
Older people who have close access to family or surrogates (such as neighbors, friends, and church or other community organizations) often continue to live in the community much longer than those who do not have such support. It has been demonstrated that social support networks have a positive impact on physical and mental functioning status and a preventive effect on the need for institutionalization4. For those who do not have adequate means of informal support, the availability of community-based services provided by formal agencies becomes and important factor for living independently. Most people have a strong preference for receiving services at home rather than in a nursing facility.
Literature Review
Many of the studies that have investigated the correlation of formal service have been grounded in Andersen & Aday?s 2 behavioral model of health services in which predisposing, enabling,