Collaboration needed to bolster home care.

To survive financially and better meet the needs of the elderly, hospitals must take the lead and collaborate with community leaders to enhance home healthcare, which can help the elderly maintain their independence and prevent institutionalization. Informal home healthcare is provided mostly by women, primarily wives, daughters, and daughters-in-law. These care givers often take the elderly person into their own homes, which can increase tension and conflicts, crowd the home, and propagate adverse perceptions by the spouse or children. Many care givers quit their jobs, thereby forfeiting income and relinquishing the mental stimulation of co-workers. Care givers who remain employed sacrifice their free time, family time, and other social opportunities. Other factors that influence the degree of stress and burden on the care giver include the type, extent, and duration of care needs; the location of home care; use of formal services; and the care giver's age, health status, and relationship to the elderly patient. Without help from formal home care agencies and local support groups, informal care giving at home may diminish rapidly due to physical and emotional exhaustion, sometimes resulting in abuse of the elderly patient. Government intervention is necessary if informal home care is to continue as a viable source of long-term care. In addition, local community medical societies must develop a team approach involving physicians, social workers, and nurses to adequately supplement home care givers or help single homebound elderly. Hospital administrators must work with community leaders to implement formal networks of home care services, such as respite care, adult day care, meals on wheels, and nursing care.