Association for Public Policy Analysis & Management

Doctors are highly professionalized street-level bureaucrats, who regularly interact with individuals on Medicare and Medicaid requiring caregiving assistance. They exercise wide discretion in decisions about citizens with whom they interact. In the coming decades, as the population ages, elderly Americans will increasingly rely on the assistance of fewer family members who are torn between the responsibilities of raising their own families and the responsibilities of family caregiving. Promoting the well-being of these individuals is a worthy policy goal. Motivated by a need to understand the implications of medical team discretion in frontline interactions with informal elderly caregivers, this project examines the relationship between the frequency and quality of these interactions and caregiver emotional well-being and perceptions of the caregiving experience.

This analysis utilizes cross-sectional data from the third wave of the National Study of Caregiving (2017). Physician discretion is measured both as the frequency of interactions (e.g. whether and how often caregiver speaks or emails medical providers in last year, consistency of medical providers) and the quality of interactions (e.g. how helpful communication with medical providers is to caregiving, difficulty of communicating with medical providers, whether medical provider listens to caregiver, whether medical provider asks if caregiver understands care recipient’s health treatments, whether medical provider asks if caregiver needs help managing care recipient’s health treatments). I hypothesize that less frequent and lower quality communication is associated with worse emotional well-being (e.g. self-reported emotional health) and perceptions of the caregiving experience (e.g. whether caregiver enjoys being with care recipient, how much caregiver thinks their care recipient appreciates what they do, whether care recipient argues with caregiver or gets on caregiver’s nerves, difficulty in providing various care tasks).

This study also explores how interactions with medical teams vary by caregiver demographic characteristics (race/ethnicity, gender, relationship to care recipient, age), and how caregiver emotional well-being and perceptions of the caregiving experience vary by caregiver demographic characteristics.