Rethinking the conceptualization of formal and informal care for the elderly

This chapter discusses the varying conceptualizations and interrelationshipbetween formal and informal care; critically and systematically reviews currentcaregiving models relating to the interrelationship between formal and informalcare; and suggests implications for future theory development and practice.Employing a modified systematic literature review method, it critically reviewsthe main theoretical conceptualization of formal and informal care, and identifies gaps, strengths, and limitations of the existing models of care. Furthermore, the chapter exposes the social implications for policy and practice relating to carers, elderly care recipients, and other related service providers. By examining changes in the global context of care for community-dwelling adults, it is argued that formal, and informal care, as conceptualized, has not kept up with the changes in practice. When community-dwelling older adults experience infirmity associated with the aging, it calls for formal and/or informal care to help manage their conditions. Informal care is historically the preferred traditional approach to care for community-dwelling older adults. However, changing lifestyles and the introduction of state-funded formal care, particularly in Western countries, pose challenges to contemporary care models. For instance, it is unclear whether this state-funded formal care is compensatory, substitutionary, complementary or is introduced as task-specific role to support informal care. The chapter further argues that because of the interrelationship between the two types of care, their mix in day-today living and lack of clarity about it and lack of access to either or both types of care, pose practical and logistical challenges to the elderly and their caregivers. The current policies and programs do not adequately address this dilemma and therefore community-dwelling older adults may experience inadequate care, inequality, loss of dignity, and potential violation of their human rights. The analysis has theoretical, policy, and practice implications for caring for the elderly.