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Old age and caregiving in a Black community

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Old age and caregiving in a Black community
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Lawson, Sylvia Cicily Claire, 1936-
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xiv, 270 leaves : ill. ; 29 cm.

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Academic communities ( jstor )
African American culture ( jstor )
African Americans ( jstor )
Black communities ( jstor )
Caregivers ( jstor )
Children ( jstor )
Families ( jstor )
Medical conditions ( jstor )
Older adults ( jstor )
Towns ( jstor )
Older African Americans -- Florida -- Eatonville ( lcsh )
Older people -- Care ( lcsh )
Town of Eatonville ( local )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Thesis:
Thesis (Ph. D.)--University of Florida, 1990.
Bibliography:
Includes bibliographical references (leaves 252-268).
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Typescript.
General Note:
Vita.
Statement of Responsibility:
by Sylvia Cicily Claire Lawson.

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University of Florida
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Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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OLD AGE AND CAREGIVING IN A BLACK COMMUNITY


By

SYLVIA CICILY CLAIRE LAWSON


















A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY


UNIVERSITY OF FLORIDA


UNIVERSITY OF FLOI:A LIDlMJES


1990



































Copyright 1990

by

Sylvia Cicily Claire Lawson

















In Memory Of My Parents

Eunice E. Earle
(1899 1983)

Stanford A. Earle
(1884 1959)

and My Sister

Rowena E. Earle Mitchell
(1920 1980)















ACKNOWLEDGEMENTS


I would like to express my appreciation to the many

persons who provided me with their help, time, and moral

support in the production of this dissertation. These

persons include friends, family members, faculty members at

the University of Florida, and the government and people of

the Town of Eatonville, Florida.

Special thanks are extended to my chairperson, Dr. Lee

Crandall, whose patience and support were above and beyond

the call of duty. Without his guidance, critical comments,

and constant encouragement this dissertation would have taken

much longer to complete.

I am also very grateful to all the other members of my

committee. Dr. Akers has been a special tutor, mentor and

friend who has encouraged me throughout my graduate career.

His critical comments and helpful suggestions ensured that

the dissertation was satisfactorily completed. Dr. Vera has

been a special friend, teacher and mentor throughout my

graduate career. Dr. Paul Duncan steered me on the original

path to Medical Sociology. Dr. Kelso has given me support

and many ideas throughout my graduate career, and Dr. Gubrium

sowed the seeds of caregiving for the elderly. I owe a








special debt of gratitude to Dr. Faye Gary Harris for her

encouragement and for willingly stepping in at the last

minute as a substitute committee member. Thanks also to Drs.

Felix Berardo and Joseph Vandiver for their support and

encouragement, and to Dr. Michael Radelet for supervising the

pilot study and encouraging me to proceed with the research

project.

Collecting the data for this dissertation would not have

been possible without the assistance of the people of the

Town of Eatonville, who, without reservation, opened their

doors and their hearts to me. To them all I say thank you.

Some support for this research was provided by the

Office of Affirmative Action, University of Florida. I am

especially grateful to Dr. Jacqueline Hart for her assistance

and encouragement.

Thanks to the American Sociological Association for

providing me with a Fellowship, and to the University of

Florida for providing me with a Fellowship. Several other

persons at the University of Florida including Dr. Madeline

Lockhart, Dean of the graduate school, and Dr. Art Sandeen,

Vice President for Student Affairs, have been very supportive

and encouraging.

Thanks to Ms. Connie Sadler for her assistance in

transcribing the taped interviews and to Ms. Nadine Gillis

for the final product. To my dear friend Barbara Cohen I

will always be grateful for her love, caring, and support.








Special thanks to Revd. Dr. Gary Crawford and my church

family at the Westside Baptist Church for their love and

caring over the years. I could not have survived without

them.

The support and encouragement of my close-knit family

sustained me daily. I am grateful for the support of my

sisters and brothers-in-law, Mary and Vernal Dyce, Agnes and

Augustus Wright, and Monica and Clive McKenzie; my brothers

and sisters-in-law, Joseph and Pearl Earle and Jonathan and

Yvonne Earle; and my brothers John and James Earle. Special

thanks to my brother Jonathan who was always there for me

with his daily words of encouragement and for all his

assistance. Thanks also to my cousin Iretta for her support

and encouragement.

My two children Deirdre and Peter took on the

responsibility of parenting their mother during the long

arduous years of graduate school. I can only hope that they

will be proud of and benefit from my accomplishments.















TABLE OF CONTENTS



ACKNOWLEDGEMENTS........................................ iv

LIST OF TABLES.......................................... xi

LIST OF FIGURES......................................... xii

ABSTRACT................................................ xiii

CHAPTERS


INTRODUCTION..................................


America's Elderly: An Overview....
Marital Status ....................
Health Status .....................
Living Arrangements...............
Housing Alternatives............
State of Health .................
Visitation by Family and Friends
Racial Constraints...............
Geographic Distribution...........
Standards of Housing..............
Income of the Elderly.............
Plan of Research...................


BLACK FAMILIES--BLACK ELDERLY PERSONS.........

Definition of Family...........................
Black Families.................................
Socio-Demographic Profile of Black Families...
Education...................................
Economics...................................
Marriage and Divorce.........................
Living Arrangements of Children.............
Young Adults Leaving Home...................
Conceptualization of Black Families...........
Kinship and the Extended Family...............
Black Elderly Persons..........................
Marital and Living Arrangements.............
Housing.....................................


vii


ONE


TWO









Health Status ............................... 58
Economic Status ............................. 60
Religion.................................... 63
Kinship Relations and Family Support........... 66
Summary ....................................... 67

THREE CAREGIVING.................................... 69

A Review of the Literature..................... 69
Caregivers and Caregiving..................... 71
The Formal Support System..................... 73
The Informal Support System................... 75
Impairments of the Elderly..................... 77
Visual Impairment ............................. 79
Mental Impairment ........................... 80
Activities of Daily Living.................... 88
Instrumental Activities of Daily Living........ 89
Support Systems for Elderly Black Persons..... 90
Caregiver Stress and Burden................... 93
Caregiver Stress.............................. 93
Felt Burden.................................. 94
Caregiving and the Black Elderly ............ 96
Summary........................................ 99

FOUR METHODOLOGY AND RESEARCH SETTING............. 100

Methodology.................................... 100
The Research Setting........................... 105
Demographic Profile ........................... 109
Education.................................... 111
Economics................................... .112
Politics ...................................... 115
Housing. ...................................... 115
Religion. ..................................... 115
Recreation. ................................... 116
Caregiving in Eatonville ...................... 119
Sample for Interviews and Quantitative
Analysis ................ ................... 120
Measurement of Variables...................... 123
Operationalizing the Major Variables.......... 124
Age of Respondent............................ 124
Gender of Respondent... ..................... 124
Marital Status .............................. 124
Residential Status .......................... 125
Living Arrangements......................... 125
Disability.................................. 125
Health Status ............................... 125
Number of ADL Tasks.......................... 126
Number of IADL Tasks......................... 127
Socio-Economic Status....................... 127


viii









Family ..................................... 129
Care Receiver................................ 129
Caregiver.................................... 129
Formal Support............................... 129
Informal Support ............................ 132
Agency Awareness............................. 133
Indication for the Need for More Help........ 134
Summary....................................... 134

FIVE FINDINGS AND DISCUSSIONS...................... 136

Vignette #1.................................... 139
Vignette #2.................................... 145
Vignette #3................................... 147
Vignette #4 ................................... 154
Vignette #5.................................... 156
Vignette #6.................................... 163
Quantitative Descriptive Analysis............. 170
Family....................................... 173
Children, grandchildren and siblings...... 173
Migration.................................. 176
Occupation and work........................ 178
Income source.............................. 180
Marital and living arrangements............ 183
Home and land ownership.................... 183
Household composition ..................... 186
Impairments................................. .191
Activities of Daily Living-ADLs........... 191
Instrumental Activities of Daily
Living (IADLs) .......................... 193
Caregiving. ................................ 196
Cross Tabulations of Quantitative Data...... 198
Need help by caregiver.................... 201
Formal support by informal support......... 202
Agency awareness by formal support......... 203
More help needed by age.................... 204
More help needed by sex................... 204
More help needed by disabled status....... 204
More help needed by formal support......... 209
More help needed by number of health
problems. ................................ 210
More help needed by informal support ..... 214
More help needed by other agency
awareness. ............................... 217
Discussion. ................................... 218
Summary .................................... 220









SIX CONCLUSIONS AND IMPLICATIONS.................. 221

Implications for Future Research.............. 222
Policy Implications............................ 223


APPENDICES

A CODING........................................ 237

B SURVEY OF CAREGIVING RESPONSIBILITIES......... 239

C INFORMATION SHEET. ............................ 247

D CHARACTERISTICS OF EATONVILLE'S ELDERLY
ACCORDING TO AGE COHORT....................... 249

E POSITION OF ORANGE COUNTY IN THE STATE
OF FLORIDA. ................................... 250

F POSITION OF THE TOWN OF EATONVILLE............ 251

REFERENCES............................................. 252

BIOGRAPHICAL SKETCH. .................................. 269















LIST OF TABLES


Table Page

4-1 Population Figures--Eatonville--1980........... 110

4-2 Age Distribution--Eatonville--1980............ 110

4-3 Number of Households--Eatonville--1980........ 110

4-4 Average Number of Persons per Household--1980. 111

5-1 Characteristics of Eatonville's Black
Elderly Sample................................. 171

5-2 Summary Table of Elderly Sample by Offspring
and Siblings ................................ 174

5-3 Current and/or Previous Occupation............ 179

5-4 Summary Table of Marital, Residence and
Household Status .............................. 184

5-5 Summary Table of Activities of Daily Living... 193

5-6 Summary Table of Instrumental Activities of
Daily Living................................. 195

5-7 Summary Table of Caregiving Characteristics
of Eatonville's Elderly Sample ................ 197

5-8 Means, Standard Deviations and Other Values
of Major Variables............................. 199

5-9 Results of Tests of Significance and Measures
of Association................................ 200

5-10 Degree of Help Needed Based on the Number
of Health Problems............................. 213

5-11 The Need for More Help Based on Type of
Informal Support Received..................... 215

5-12 The Need for More Help Based on Type of
Community Support Received.................... 216















LIST OF FIGURES


4-1 Schematic Representation of the Place
of the town of Eatonville in the East
Orlando Community .............................. 118

5-1 Diagram showing the combinations of level of
dependence and type of support described in
each of the six vignettes of elderly persons
in the community ................................ 169


xii














Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

OLD AGE AND CAREGIVING IN A BLACK COMMUNITY

By

Sylvia Cicily Claire Lawson

August, 1990

Chairman: Lee A. Crandall
Cochairman: Jaber F. Gubrium
Major Department: Sociology

Currently existing formal and informal support systems

necessary for providing a better quality of life for

noninstitutionalized elderly persons, especially those who are

poor and Black, may be inadequate. This research employs a

conceptual framework and methodology designed to examine

knowledgeability, accessibility, and use of services among

noninstitutionalized elderly Black persons. The social and

cultural situations of Black elderly persons are examined to

assess whether these elements determine and or contribute to

their participation in, and knowledge about, available formal

sources of assistance for instrumental activities of daily

living (IADLs). The analytical model differentiates elderly

persons who are users from non users of formal services and

assesses their knowledgeability regarding formal and informal


xiii








services which are in place to assist them with various IADL

functions.

Information was gathered, over a period of approximately

twelve months, on a convenience sample of 71 elderly persons in

an all black community in central Florida, using in-depth

interviews and participant observation. This approach provides

process data rather than the typical snapshot supplied through

one-shot survey interviews. The nature of the design of the

study allowed for the cross-checking and rechecking of what

people say and do, increasing the reliability and accuracy of

the data.

The data gathered by this research do not support

assumptions about kinship patterns of informal caregiving that

place great emphasis on the role of the black extended family.

A large proportion of the elderly studied were living alone.

The findings suggest that black elderly persons have limited

awareness of the various services available through government

agencies to assist them with their IADL functions. They

instead utilize informal agency sources of help or do without

needed services. The informal system of caregiving in this

community also appears to fall short of providing the

assistance needed by black elderly persons.


xiv














CHAPTER ONE
INTRODUCTION


Caregiving in its simplest form refers to care provided

to someone who, because of physical or other limitations, is

unable to perform certain functions unassisted. The concept

of caregiving to the elderly is well defined by Horowitz

(1985), as care provided to persons over the age of 65 with

some degree of physical, mental, or emotional impairment

which limits independence and necessitates ongoing

assistance. This is the concept of caregiving used in the

present research.

Insufficient caregiving for functionally disabled

elderly persons in the community has become a serious social

problem in American society. The responsibility of caring

for persons 65 years of age and over, which has been for

centuries primarily the responsibility of the family, one

segment of the informal support system, has now become a

joint venture between the state (the formal system) and the

family. The informal support system consists of all unpaid

help provided by family, friends, neighbors, or others who

are not part of a group formally organized to provide long-

term care assistance (Branch and Jette, 1983). Formal

support on the other hand, refers to organized care provided









by government or voluntary organizations or agencies that

exist to provide long-term care services to the

noninstitutionalized impaired elderly (Branch and Jette,

1983). Once responsibility shifts to or involves the state,

there are social as well as moral obligations to be

addressed. The question becomes: are those who are in need

receiving the care needed to lead a reasonably satisfactory

level of daily living? Where the formal system of caregiving

falls short, the burden shifts to the informal system to give

needed support. Where the informal system falls short,

governmental assistance is needed.

This research focuses on the informal system of

caregiving to elderly black persons in need. The literature

on black families has continued to expound on the primary

role played by these families in taking care of their elderly

relatives in the extended family setting. The general

consensus is that the informal system is especially strong in

the black community. The question is: to what extent is this

image of elderly care in the black community accurate? That

is: are black families still playing the role of caregivers

to their elderly relatives in these final decades of the

twentieth century? In spite of the consensus in the

literature, there has been very little empirical research on

the role of the extended family and other informal caregiving

for black elderly persons. Although the gerontological

literature is replete with studies concerned with caregiving









for the elderly, there is very little research on caregiving

for black elderly persons. This research takes a careful, in-

depth, qualitative approach to locating and describing the

state of care, informal and formal, provided for elderly

persons in one black community. To the knowledge of the

researcher this is the first study to do so. The purpose is

to contribute to our knowledge of how needy elderly persons

are cared for in the black community.

This study, then, is an attempt to help fill some of the

gaps in research on elderly black persons. The problem is

mainly one of supports for this population of persons. Black

elderly persons in need of assistance are more likely than

white elderly persons to be in residence in the community

than in institutions. The general question that needs to be

answered is: what are the systems in the community that do or

do not provide care for black elderly persons who are in

need? The systems that are available for providing care to

elderly black people fall into two distinct but interrelated

categories of the formal and the informal caregiving systems.

The major part of the study was conducted through visits,

observations and interviews concentrated on the informal

system mainly during the year the researcher spent in

residence in Eatonville, historically, an all black

community in Florida. Data were also gathered on the formal

system through interviews with government officials,

published data, and record archives.









As noted, the central reason for embarking on a study

such as this is to see to what extent black family

traditions, and community traditions have an impact on

caregiving to elderly persons. Is the traditional view of

the importance of the extended black family myth or reality?

It is possible to obtain answers to this question in a

variety of ways, but the researcher opted to conduct the

study in Eatonville for several reasons. It was felt that a

predominantly black community would present a more

homogeneous group of elderly persons. Also, it was believed

that black traditions and social support systems would be

most viable and visible in a community which had a long-

standing identity as an autonomous community rather than

being just a semblage of neighborhoods. Eatonville was

selected because it closely fit the model of a community

which was nearly all black with some historical identity as a

separate community of black citizens.

Answers to the above questions have implications for

policy makers. A study such as this should also have

implications for the discipline of sociology, especially to

the fields of social gerontology and medical sociology, since

black elderly persons and their need for health and other

care as a group represents a source of potential research

interest and constitutes a segment that has received very

little study. However, the focus is primarily applied and

descriptive social research addressing the physical, social,









mental, and financial welfare of noninstitutionalized black

elderly persons, (aged 65 years and over). There is little

theoretical development in the literature on which to build,

and neither testing nor construction of theory is a goal of

this research. Rather, the goal of this research is to

provide a description of the informal and formal care given

to black elderly persons based on their perceptions and

descriptions and on the researcher's own observations. The

notion of caregiving having been introduced, an overview of

the elderly in America will be presented.

America's Elderly: An Overview

There are today approximately twenty-seven million

persons aged 65 and over in the United States, comprising 12

percent of our population (U.S. Bureau of the Census, 1984).

This translates into approximately one in nine Americans who

are aged 65 years and over. Older persons today are

categorized as falling into three groups: the young-old, 65

to 74; the old-old, 75 to 84; and the oldest-old who are

those aged 85 years and over. Demographic shifts are evident

due to the rapid graying of America in the decades of the

1970s and the 1980s as well as projections for the 1990s and

well into the twenty-first century. The trend is toward a

progressively older society. By the year 2030, when the core

of the baby boom generation reaches retirement age, the

projection is that over one in five Americans will be aged 65

or older (U.S. Bureau of the Census, 1984). It is also









estimated by the Census Bureau that the very old, those 85

and older, will increase from 2.7 million today to 8.6

million in 2030 and 16 million in 2050. These shifts have

forced the polity into the realization that there is need for

the creation of more support systems to care for these

elderly persons.

The proportion of people who are elderly varies by race,

ethnicity, and sex. People aged 65 and over make up 12

percent of all whites, 8 percent of blacks, 6 percent of

Asians, and 5 percent each of the Hispanic and American

Indian populations (Hess, 1986). Despite the goal of the

1965 Older Americans Act to enable the aged to maintain

independence and to improve the quality of their 1ives, the

practice of institutionalizing functionally impaired older

people continues unabated (Olson, 1982). The problem is not

so much with current numbers of persons institutionalized,

but with the rate of institutionalization. This is, a 2

percent rate of institutionalization in 1910 amounted to

80,000 persons, whereas the 1980 rate (at 5.0 percent

institutionalized) translates to over one million elderly

persons living in institutions, a better than tenfold

increase (Olson, 1982). If the rate of institutionalization

continues to increase as the population ages, then by the

early twenty-first century the numbers of persons in such

care will grow still further. Despite increases in the rate

of institutionalization, there still remains a large









percentage of elderly persons (95 percent to 98 percent) who

are not institutionalized at any given time. Blacks make up

11.69 percent of the United States (US) population. That is

26,488,218 persons (U.S. Bureau of the Census 1980). Of the

population of black persons in the United States,

approximately 2.2 million are over the age of 65 years.

Elderly black people have many problems that elderly white

people do not have. This situation is referred to by some as

double and triple jeopardy (Jackson, Kolody, and Wood, 1982;

Kart, 1985). That is, they have the problem not only of

being elderly, but complicating this are the features of

being black and, for the majority, of being poor. Black

females have quadruple jeopardy, that is, of being old,

black, poor, and female.

Because of the uniqueness of their situation, blacks

should be studied separately as a subgroup of the elderly

population who have special needs and who need special

attention from researchers. As early as 1968, Billingsley

pointed out that, even though the black family system is one

institution in a complex of various American institutions,

the black family cannot be totally understood or interpreted

from a general (white) analytical framework. The limits of

using a general analytical framework have been evidenced

through various studies. Areas such as poverty and kinship

patterns are very important in any study relating to black









families. The same does not hold for the general U.S.

population.

Poverty is suffered by large numbers of elderly black

people today; in 1981, 39 percent of elderly blacks lived

below the poverty level (U.S. Bureau of the Census, 1981).

The systematic racial discrimination tolerated in the United

States during the early decades of this century resulted in a

lack of education for this cohort of individuals leading to

lack of professional qualifications for the majority and

hence the impossibility of procuring high-paying jobs. This

led to marginal occupations and dependence on social services

agencies throughout the life of many blacks, and gave them

little access to private pensions. In the case of black

elderly people, this helps to explain the fact that few of

them are found in retirement villages, retirement

condominiums or such. Institutionalized racism exacerbates

the economic situation. Most blacks still feel uncomfortable

in white dominated communities.

Kinship patterns among blacks also contribute to the

preference that blacks have for remaining at home to the end

of their days. It has been claimed and it is generally

acknowledged that the black kinship network is more extensive

and cohesive than kinship bonds among the white population

(Staples, 1981). Research shows that for blacks the kinship

network serves its members most effectively as a functional

mutual aid system (Mindel, 1986). Numerous studies have









shown the positive effects of kinship networks among blacks,

but there are others that have found relatively few

differences by race among elderly people in participation

with family and kin (Heiss, 1975).

Most black elderly people have experienced extended

family arrangements. The offspring of black elderly persons

have traditionally felt responsible for their care and

welfare, whether they be parents, grandparents, or other

blood relatives. Even close family friends are ofttimes

afforded the same treatment as family in black communities;

sometimes such persons are termed "fictive kin."

Blacks have always been known to be religious. Churches

and friendly societies all cater to elderly black persons,

filling the gaps left void by government. Out of these

informal institutions have sprung such organizations as

Dorcas Societies and similar groups which have taken care of

clothing the poor. Black elderly women especially, while

benefiting from these organizations, also contribute a great

deal to them in terms of service. They voluntarily do sewing

and craft as means of helping each other.

The survival pattern for whites has always been better

than that of non-whites. However, the difference in life

expectancy at birth for whites which was 15.9 years higher in

1900-1902 than it was for blacks had, by 1982, decreased to a

4.9 year difference for females, and a 6.6 year difference

for males (U.S. Department of Health and Human Sciences,









National Center for Health Statistics, Monthly Vital

Statistics Report, 1983). In 1983 life expectancy at birth

for white males and white females in America was 72 years and

79 years respectively, while for black males and black

females it was 65 years and 74 years, respectively (U.S.

Department of Health and Human Services: Report of the

Secretary's Task Force on Black and Minority Health, 1985).

The lower life expectancy of blacks has been attributed to

their generally lower socio-economic status in the United

States (Butler and Lewis, 1983).

It has, however, been found that reversal occurs at a

certain age. At that age which has been termed the

"crossover point," blacks begin to show a greater survival

rate than whites (Cornely, 1970; Heiss, 1975; U.S. Dept. of

Health and Human Services, 1985). In 1976 the crossover was

found to occur at age 65 for men and 72 for women. This

"crossover" was first reported in 1968 (Heiss, 1975), but the

explanation for it was unclear and it was attributed to the

"survival of the strongest." This is still used to explain

this phenomenon (Manton, 1982; Markides, 1983). Although

blacks comprise about 11.69 percent of the total population

in the United States, black people make up only 8 percent of

the older age group. Black older women outlive black older

men. The.ratio of black women per 100 black men increased

from 115 in 1960 to 131 in 1970 and black females make up









56.7 percent of the total black aged population (Butler and

Lewis, 1983).

Marital Status

The majority of men over 65 years in the United states,

even those aged 75 and older, are married (79.8 percent in

1983), and living with their wife. In contrast, the majority

of women over 65 are not currently married (U.S.Bureau of the

Census, 1984a). Several factors contribute to the

probability that an older man will have a wife with whom he

will be living. One well known factor is that men typically

marry women who are younger than themselves while society

still discourages women from marrying men who are younger

than they are. This difference is exacerbated by the lower

life expectancy of males. Another factor is that the

remarriage rates of older men are higher compared to women

(U.S. Department of Health and Human Services Survey

1983b:7). In 1980, among nonmarried persons aged 65 and

over, men remarried at nine times the rate of women. The

result of this situation is that most older women are widows.

There are at least three times as many widows as widowers to

be found in the U.S. (Hess, 1986).

Among black elderly persons whether male or female, a

lower percentage are married both in the young-old period and

in the old-old period when compared to white elderly persons.

Substantially more black elderly persons are widowed and

divorced than are white elderly persons (Mindel, 1986). For









black women, aged 75 years and over, 78 percent are reported

as widowed in 1983 (U.S.Bureau of the Census, 1984). The

shorter life expectancy of black men is an important

contributory factor, leaving a black woman widowed much

earlier than a white woman.

Health Status

As people get older their resistance to new diseases

declines. Verbrugge (1986) states that chronic diseases

developed earlier in life tend to deteriorate, and although

acute conditions are less frequent in older persons, the

recovery period for them is longer. "Health status refers to

measures of illness, injury, and symptoms, including people's

own evaluations of their health, interview reports of health

problems, and data from medical examinations" (Verbrugge,

1986:182). Closely associated with, or linked to, health

status is "health behaviors." It is common knowledge among

health care professionals that health behaviors impact very

strongly on health status. "Health behaviors refer to all

curative and preventive actions, relating to short-term

disability ('restricted activity'), long-term disability

('functional limitations'), use of health services, and use

of medications" (Verbrugge, 1986:182). Culture plays a major

role in any analysis of health behaviors in that "cultural

patterns and typical ways of life give substance to the

manner in which illness is perceived, expressed, and reacted

to" (Mechanic, 1978:55).










There are some health problems which are common

companions to old age. These are heart disease, cancer,

cerebrovascular disease and hypertension. Heart disease has

been identified as the principal cause of death among the

elderly and accounts for a great deal of morbidity,

disablement, and inactivity in older people (Kart, 1985).

The incidence of cancer increases with age; hence, older

people should be encouraged to have periodic preventive

medical examinations. Cerebrovascular disease which

manifests itself as a stroke is the result of impaired brain

tissue. Cerebral thrombosis is a main cause of stroke in the

elderly. Kart (1985) notes that as many as one in four older

people have hypertension, or high blood pressure. Other

prevalent elderly-related health problems, which are

bothersome though less life-threatening, are arthritis,

digestive disorders, foot and skin problems, and chronic

respiratory symptoms (Verbrugge, 1986). Other health

problems associated with aging are the decline of sensory

(vision, hearing, balance) and mental faculties and the

weakening of bones and muscles. A popular manifestation of

bone weakening is osteoporosis especially in elderly females.

Elderly black persons demonstrate different

configurations regarding certain chronic diseases. There is

a higher incidence of hypertension among elderly black

persons. The incidence of diabetes is also reported to be

higher in elderly black persons. The same is true for









certain types of cancers (lung, esophagus, prostate, stomach,

cervix, uterus, multiple myeloma, pancreas and larynx). In

fact, it is reported that blacks have the highest overall age-

adjusted cancer rates (for both incidence and mortality) of

any U. S. population group (Report of the Secretary's Task

Force on Black and Minority Health,1986a. 1986b).

Health data confirm that older men are more seriously

ill than older women, but the data also indicate that older

women are more frequently ill than men. "Data on subjective

perceptions of health status, acute and chronic conditions,

and disability for acute and chronic conditions support this

conclusion" (Verbrugge, 1986:185).

When the health problems of elderly persons are analyzed

according to gender, older women are found to have more acute

and more chronic conditions; they are bothered more by their

chronic conditions, but these diseases are seldom life-

threatening. Older men have higher rates of life-threatening

conditions, which lead to employment restrictions and earlier

death. Attitudes and behavior toward illness may be very

important in explaining sex differentials in short-term

disability, limitations and death among older people

(Verbrugge, 1986).

The overall level of health of America's aged has not

changed greatly since 1970: "while there are proportionately

more chronically ill very old people, the younger aged are

reported to be in better health than in the past" (Hess,









1986:17). Nine-tenths of the elderly describe their health

as fair or better compared with other people their age

(U.S.Bureau of the Census, 1983), and over half report no

limits on any major activity because of health

considerations. By age 85 years and over these figures

shift, with half reporting themselves unable to carry out a

major activity because of poor health. In 1980, as in 1965,

four of five older people reported having at least one

chronic condition, although in most cases this did not

interfere with major activities (Hess, 1986).

Health status plays a major role in caregiving for

elderly persons. It is a key determinant in their living

arrangements.

Living Arrangements

The 95 to 98 percent of America's older people who are

not institutionalized live in the community, and most live in

their own households. Seventy-one percent of all persons

over 65 own their own home (Woodward, 1986). Those who do

not live in their own homes have a variety of housing

arrangements available to them depending on their health and

economic status.

Living arrangements of older people has been classified

as living alone (complete independent living), living with

non-relatives, living with a spouse, living with other

relatives, and not living in a household (Shanas, 1962;

Wilson, 1977). A variety of factors impinge upon and









determine which of the five arrangements will be selected by

or for individual elderly persons. These factors include

marital status, sex, functional impairments, race, income,

health status (both mental and physical), and attitudes.

The vast majority, approximately 95 percent, of all aged

persons, live independently in the community, either by

themselves or, more often, with a spouse, family, or friends.

Butler and Lewis (1983) report that of every ten older

Americans, seven live in families. Approximately one fourth

live alone or with nonrelatives. This situation differs for

men and women. Women are three times more likely to live

alone or with nonrelatives.

The frequent statement that most older black people live

in extended families is only a myth. Studies have shown that

"50.2 percent of black persons over the age of 60 years lived

alone or with only one other person, relative or nonrelative,

while 16 percent were found to live entirely alone" (Butler

and Lewis, 1983:27). There is also evidence that 11 of every

100 older blacks have no living relatives, compared to 6 of

100 whites (Butler and Lewis, 1983). Data contrasting men

and women show that half of all black older men live with

their wives. But again, because of a longer life span, only

one fifth of black older women live with their husbands

(Butler and Lewis, 1983).










Housing Alternatives

In the United States, residences available to the

elderly are Adult Foster Homes, Adult Congregate Living

Facilities (ACLFs) or Congregate Housing, Senior Citizens

Lodge and Home Care, and Granny Flats. There are also

personal care boarding homes, commercial boarding homes,

congregate care homes, congregate care, life care or

continuous care, retirement villages, and shared living.

The old are anything but homogeneous. These people lead

vastly different lives depending upon their situation.

Living arrangements of men over 65 differ markedly from those

of women. Similarly, the living arrangements of people with

children differ from those of persons without children.

Grouping together all older people would therefore only

obscure these important differences. Differences in marital

status are responsible for many of the differences in the

living arrangements of men and women, black and white.

The most recent data on marital status of elderly women

reflect a most striking change in living arrangements of any

age or sex group over the past two decades: the decline in

older women who live with other relatives (from 19 to 10

percent between 1965 and 1981) and the commensurate rise in

the proportion living alone (from 31 to 40 percent during the

same period). The major contributory factor to this shift is

economics, giving older women more independence today than

they had two decades ago. More older women are now able to









afford independent residences and maintain their own

automobiles. In some cases this is due to the liberalization

of Social Security benefits and the introduction of Medicare

in 1965 (Hess, 1986).

With the concept of shared housing (not only intra- but

also intergender) becoming more popular, in the future we

might expect to see more widows and widowers who are not

married living together in the same household. In 1983 there

were about 120,000 households in which a nonmarried couple,

one of whom was 65 and over, lived together (U.S. Bureau of

the Census, 1983d).

State of Health

The state of health of the elderly plays a major role in

deciding their living arrangements. The greater the number

of chronic ailments that older persons have, the less the

likelihood of their living alone. This situation is

compounded if the impairments result from severe impairments

of vision or mobility. Increased frailty and incapacity can

necessitate that an older person not living with a spouse,

and who has grown children, change his or her living

arrangements. That is, he or she may move in with one of his

or her children. The physical condition of the very sick

older person forces him or her to be much more dependent upon

family members not only for physical care but for

companionship and social activities.










In the absence of children, an older person may move in

with a relative, or have a relative move in with him or her.

In situations such as these, they mutually decide who should

be head of the household.

Sometimes elderly dependent parents move from one

section of the country to another to share a child's home,

paying something towards the rent. If their health is fairly

good, some are able to help with babysitting while their

children go to work. Some are also able to help with

housework.

Visitation by Family and Friends

One important aspect of an older person's life is

receiving visits from relatives and friends; older people

therefore prefer to live near at least one child. This

allows them to see their children often. Visiting their

children or receiving visits from them contributes to the

life satisfaction of older persons. This is further enhanced

if there are grandchildren present. Some may see their

children as often as once per week while others receive

visits only on special holidays such as Christmas, Easter and

Thanksgiving. Family anniversaries may also merit visits

especially from those who live far away.

Most older people are long-time residents in the areas

in which they live and are able either to visit or receive

visits from neighbors. However, an older person may

sometimes find that he or she has outlived most of those who









once were visiting neighbors. Visits from relatives, other

than children, also play a major role especially for those

older persons who do not have children. Other people such as

clergymen, church visitation groups, and welfare workers may

form a part of the visiting group. A survey carried out

about three decades ago demonstrated that in general, persons

without living children appear to be the most isolated group

in the aged population (Shanas, 1962).

Today there is expected to be less isolation as we find

that elderly persons can choose the type of living

arrangement which best contributes to a reduction in

isolation and hence enhances their life satisfaction. The

myth of the isolated elderly no longer has strong support

(Aldous, 1987). The Older Americans Council plans various

activities, and provides meals-on-wheels delivered by

volunteers. These volunteers play a double role. As they

deliver meals they also use this time to visit. To reduce

loneliness experienced by some elderly persons, there is day

care designed especially for the elderly and there is low

cost congregate living which moves the older person from

living alone to living with others. Those who are more

affluent may move into retirement villages where activities

are designed to keep them from being lonely and bored.

Racial Constraints

Living arrangements may differ according to race. More

older blacks than whites do not live with their spouses.










This has been attributed to the greater economic pressures on

black families, including unemployment and public welfare

laws that encourage black men to leave home early in life.

The lower socioeconomic status of the majority of black

elderly persons also militates against them living in

expensive retirement facilities.

It has often been posited that black elderly persons

live in extended families. Thus, isolation has never been

seen to be a problem with black elderly people. Shifts have

been seen however, in the living arrangements of elderly

blacks. An examination of multigenerational households in

the U.S. population found that a major change had occurred

suggesting that elderly people who might have lived with

their kin have gradually shifted to living alone (Mindel,

1979). This is an indication that black elderly persons are

more similar to whites than previously supposed in that among

the black elderly there is almost as great a tendency for

them to live alone as there is among whites (Mindel, 1986).

Cantor et al. (1979) found that a larger number of black

elderly women were likely to report themselves as heads of

households than was the case among white families. They

contend that this sharing of limited resources suggests a

positively adaptive method of meeting the pressures of

poverty and unemployment within a functional family system.

Mindel (1986) observes that among black Americans there is a










greater likelihood that an elderly female will be a head of

household.

Older people want to continue to live in their own homes

as long as possible irrespective of their race and whether or

not they have children. The common belief that older people

in the United States are isolated either physically or

socially has not been proven. On the contrary Shanas (1962)

concluded from a survey that when older people had children

they generally lived close to at least one of them.

Furthermore, older people see their children often. Even

children who live at a distance apparently try to see their

parents on major holidays and other special occasions. While

marital status, health status and gender play a major role in

determining the living arrangements of older people today,

because of the available social supports, most older persons

can fit into one form or another of living arrangement and

avoid institutionalization.

Geographic Distribution

Older people, both black and white, live most frequently

in central parts of cities and in rural locations. The

residence patterns of older black persons show a somewhat

different configuration than that of older people as a whole.

Three-fifths still reside in the South, many in rural areas,

but because of the large numbers that moved to urban areas in

the black rural-to-urban migrations of the early 1900s, older

black persons are now also concentrated in central cities,










primarily in those areas with the worst housing. By 1970,

one of two older blacks lived in central city locations. In

1980 black elderly remained heavily concentrated (68 percent)

in the central core of older cities (Hess, 1986). Many are

trapped there under the dual influence of economic hardship

and a continuing racism that tends to preserve the suburban

areas for whites.

Standards of Housing

It has been estimated that up to 30 percent of older

persons in the U.S live in substandard housing largely as a

result of outright poverty or marginal income. Many of these

have become substandard as the costs of maintenance,

utilities, and property taxes have so skyrocketed that upkeep

and needed improvements have become impossible for many

elderly homeowners. Government subsidies for maintenance

have been a great help recently because most elderly people

live on fixed incomes. Those who do not live in their own

homes either live alone, with relatives or friends or in

retirement facilities. Some older people live in public

housing, "often seen by them as a highly desirable resource

in view of the wretched alternatives available. Many are so

poor that they cannot even afford public housing and some of

these are forced to reside in single room occupancy (SROs)

hotels embedded in a fierce environment peopled by petty

thieves, pimps, prostitutes, addicts, and hustlers"

(Stephens, 1976).









Income of the Elderly

Poverty, like substandard housing, is typically

associated with old age. People who are poor all their lives

can expect to become poorer in their old age and elderly

blacks are especially plagued by poverty. In fact, it is

reported that the rate of poverty among older blacks is twice

that of older whites. "In 1984 the median income for black

males over the age of 65 was $6,163 compared to $10,890 for

white males. For black females the 1984 median income was

$4,345, while for white females the figure was $6,309"

(Johnson, 1988:101). Blacks have often been employed in the

service industry and in seasonal jobs. In the competitive

sphere of job situations one could say that they are at the

bottom of the heap. Many blacks have few work skills, and

discriminatory hiring practices common throughout the society

render some virtually unemployable. Jobs generate only

sporadic and minimal income. Carp's (1972) study of the

occupational characteristics of the aged slum dweller show

that

retirement--usually from menial jobs that provided
no security, tenure, or fringe benefits--has not
been an event that occurred on a given day, but was
rather the culmination of increasingly frequent and
lengthy periods of time during which these
individuals were unable to obtain employment.
(Carp, 1972:57)

These observations fittingly describe many blacks. It has

been noted that some find more or less steady conventional

jobs in low-paying, low-skill services, working as waiters,









dishwashers and cleanup helpers. These are jobs with

abysmally low pay scales, little security, and poor working

conditions. All of these contribute to their dependency on

Social Security and Welfare. The economic status of elderly

persons dictates their living arrangements to a great degree.

It is also a determinant of caregiving and plays a major role

in health status, health beliefs and education.

Plan of Research

To reiterate, the purpose of the study is to examine the

level and type of caregiving of elderly persons in a black

community. It was assumed that by going into the community

and studying it through interviews and observations, other

questions and issues that affect black elderly people would

surface. The intention was to explore the use of formal and

informal networks in order to test whether friends, kin,

church, and neighbors provide a pivotal resource for

responding to the needs of elderly persons in the community.

In order to examine caregiving of black elderly persons,

this research concentrates on the age group 65 years and

older taking care in some instances to compare and contrast

the care-giving network as it affects the young-old, those 65

to 74 years of age; the old-old, those 75 to 84 years; and

the oldest-old, those who are 85 years and over. The

research methodology employed is based on the view that data

needed to understand caregiving at this stage of our









knowledge are best gathered through qualitative research.

Certain information can only be garnered from field

research.

Chapter Two addresses black families and black elderly

persons in the United States. An analysis of black families

is germane to the study of black elderly persons and a review

of previous research on black elderly persons is in turn

necessary for studying a group of black elderly persons in a

particular community. It is necessary to have as clear as

possible an understanding of this racial group before

attempting an assessment of its elderly subgroup. This

chapter also analyzes the demographic characteristics of

black families and black elderly persons. The aim is to

bring into focus changes concerning the diversity of black

family patterns and the theories that are used to study

today's black Americans. The major demographic areas

addressed are (1) family composition, (2) marriage and

divorce and (3) education, employment and income. Black

elderly persons are analyzed in terms of health problems

and kinship in addition to the general demographic

patterns.

Chapter Three presents a review of caregiving by formal

and informal support systems. The chapter begins with a

brief introduction which is followed by an overview of

caregivers and caregiving including the literature, the

formal support system, the informal support system,










impairments of elderly persons, activities of daily living

(ADLs), instrumental activities of daily living (IADLs),

support systems for elderly black persons, and caregiver

stress and burden. The chapter ends with an analysis of

caregiving and black elderly persons followed by a brief

summary.

Chapter Four contains a description of the methodology

used and the setting in which the field research took place.

Data were gathered from a convenience sample of 71 elderly

persons and/or their primary caregiver where this was

necessary.

The findings from the field research are presented in

descriptive form in Chapter Five supported by a quantitative

analysis of forty independent variables. A description of

the elderly people of Eatonville as well as their caregiving

networks is included. Family, impairments and caregiving are

addressed. Vignettes are utilized to demonstrate the various

ways in which the elderly persons of Eatonville access and

utilize formal and informal support systems either separately

or combined.

Chapter Six contains conclusions and implications. The

potential impact of this study lies in its assessment of how

factors relating to caregiving affect the well being of black

elderly persons. It is hoped that local, state, and national

programs designed for older persons will eventually shift an

emphasis from support for the institutionalized to support







28

for the elderly person living at home, paying special

attention to black elderly people. Such a shift will

influence the life satisfaction and wellbeing of older black

persons in positive ways.














CHAPTER TWO
BLACK FAMILIES--BLACK ELDERLY PERSONS


Of all social institutions, the family is perhaps the

most basic (Tischler et al., 1983). Sociologists view

institutions as systems of social norms and norms are

society's rules of conduct for its members (Leslie, 1979).

The family can be studied either as an institution or as a

social group. Leslie (1979:22) points out that

when the family is viewed as a social institution,
the norms governing family forms and functions are
emphasized. [However], when one focuses upon the
family as a social group, attention is directed
more toward its internal functioning than toward
its relationships with other aspects of the
society.

Definition of Family

It is difficult to find a definition of family general

enough to cover the family as it exists in all societies, but

a generally accepted typology of families includes the

concepts of nuclear family and extended family. A family has

traditionally been defined as a married couple or group of

adult kin who cooperate and divide labor along sex lines,

rear children, and share a common dwelling place. A variety

of family forms have emerged to challenge this definition.

Examples of these are single-parent families, cohabiting

families, blended families, families without children, and









gay and lesbian families (Strong and DeVault, 1989). Strong

and DeVault (1989) propose a contemporary definition which,

in order to include these diverse forms, would define the

family as one or more adults related by blood, marriage, or

affiliation who cooperate economically, share a common

dwelling place, and may rear children.

The classical definition of family, of which we now see

variations is that given by Peter Murdock (1965) in his book

Social Structure. Murdock's definition states that

the family is a social group characterized by
common residence, economic cooperation, and
reproduction, and consists of a male and female
adult and their offspring or adopted children.
(Murdock,1965:1).

Murdock used husband/wife and therefore implied legal

marriage. He later distinguished marriage and the family.

Murdock's definition really speaks about the structure of the

family, and implies the makeup of a family. He refers to a

nucleus of individuals. His nuclear family is approximately

the same as Levi Strauss's conjugal relationships. While

nuclear stresses the husband-wife relationship,, extended

family is used to imply parent-child relationship applying to

a type of family which usually comprises three generations,

that is, man, spouse, their children, their children's

spouses (especially sons), and their children living either

in the same household or very near to each other with some

cooperative domestic arrangement. Extended family is the

same as consanguine, implying blood relatives. The nuclear









family tends to be a small unit, whereas the extended family

is a larger unit. The nuclear family, because of its size,

is more applicable to living in modern societies and the

extended family to living in more traditional societies.

Authority structure differs in the different family systems.

The nuclear unit tends to be patriarchal, implying that

authority is vested in the male. It is, however, sometimes

matriarchal.

Functions of the family are central to life, culture,

and society. Functions of the family were long seen as

providing a source of intimate relationships, acting as a

unit of economic cooperation, producing and socializing

children, and assigning status and social roles to

individuals. It is contended, however, that while these

are the basic functions that families are "supposed" to

fulfill, families do not necessarily have to fulfill them

all. Strong and DeVault (1989) suggest that technology,

industrialization, mobility, and other factors are altering

the way the family performs its functions today. The

question as to whether every family performs these basic

functions leads to the debate over the universality of the

family. The United States with its numerous ethnic and

racial groups supplies various family forms which could be

studied cross-culturally. To this end, the present review of

black families in the United States addresses black people as

a sub-group of the society and discusses family forms of









blacks, that is, residence, forms of marriage, authority

structure, and functions of black families. The area of kin

relationship will also be addressed since kinship is germane

to any study of black families and black elderly persons in

particular.

Black Families

Knowledge of black families must form the basis for

studying any segment of black communities since the family is

intricately tied to the society. A diversity of black family

patterns exists in the United States and it is maintained

that different family forms prevail at different class and

income levels throughout the American society. This has led

to the conclusion that the black family is itself a fiction

(Glick, 1988). Hence, this study will analyze 'black

families' rather than 'the black family.'

Family forms of blacks can be analyzed in terms of

residence, forms of marriage, authority structure, functions

of black families and kin. In this analysis of black

families three major demographic areas are addressed. These

are family composition; marriage and divorce; and education,

employment, and income. The strengths of black families is

also addressed.

Studies of black families date as far back as the early

1900s and can be found in the works of W. E. DuBois (1969),

Franklyn Frazier (1932), Melville Herskovits (1930, 1941),

and Drake and Cayton (1962). Others such as John Dollard









(1937) conducted community studies in the South in the 1930s,

focusing on the prevailing caste system and its effect on

social life. Hylan Lewis (1955) carried out a community

study among blacks in a North Carolina town. Virginia Young

(1970) conducted research among southern black populations.

Molly Dougherty (1978) carried out research among black girls

and described how they developed into women in a rural black

community in North Central Florida. Very little research on

blacks was carried out in the 1940s and the 1950s.

Research among black populations and black families in

the United States has been influenced by the sociological

tradition and contributions of both Frazier (1932, 1939) and

Herskovits (1930, 1941). Frazier (1939) referred to the

instability of marital unions among "New World" blacks, as

well as the lack of social support for the man to operate

effectively in the male or father role. He emphasized a

structural explanation, to replace an explanation based on

African cultural survival in vogue then. He also formulated

some significant generalizations about the effects of slavery

upon the family life of American blacks. With respect to New

World blacks, he observed that black Americans were trying to

build a stable life after the almost total social

disorganization of slavery and in a society which continued

to be hostile and discriminatory. Frazier argued that the

effects of emancipation on black families resulted in









problems affecting today's black family. Frazier (1939:81-

85) wrote

mobility of the black population after emancipation
was bound to create disorder and produce
widespread demoralization. Promiscuity, and
confusion in marital relations would be evident
while marriage as a formal and legal relation was
not a part of the mores of the freedmen. The
severe hardship on Negro "families" after
emancipation left them without any means of
subsistence. Where families had developed a fair
degree of organization during slavery, the male
head assumed responsibility for their support.

Frazier noted that this severe hardship became a test of

the strength of family ties. Two general tendencies are

manifest in the fortunes of the Negro family dating the

period of its adjustment to the state of freedom. For those

families that had achieved a fair degree of organization

during slavery, transition was easy. Authority of the father

was firmly established in these families, and the woman in

the role of mother and wife fit into the pattern of a

patriarchal household. Roles were fairly clearcut, and the

father became the chief, if not the sole breadwinner thus

demonstrating that he had assumed the responsibilities of his

new status. Sometimes he acquired land of his own and

thereby further consolidated the common interests of the

family group (Frazier, 1939). The second tendency is that

the loose ties that held men and women together in
a nominal marriage relation during slavery broke
easily during the crisis of emancipation. When
this happened, the men cut themselves loose from
all family ties and followed the great body of
homeless men wandering about the country in search
of work and new experience. Sometimes women,









primarily those without children, did the same.
(Frazier, 1939:88)

Historically emancipation locked black families into two

groups, in which many today still find themselves. Most

studies would have us feel that the latter group is the most

dominant and some scholars' descriptions of black families

have implied that their members are shiftless and uneducated.

Herskovits (1930), in his study of New World black

families, noted that a close bond existed between mother and

child. He also noted the peripheral status of the man or

father, implying matrilocality and marginality. His

conclusion was that these patterns were vestiges of African

systems. Herskovits has been acclaimed as one of the first

scholars to recognize similarities in African cultural

patterns and those of African descendants living in the

United States, the West Indies, and Brazil. It is said that

one of his major contributions was a more realistic

conceptualization of family life in traditional African

societies, which are characterized by unity, stability, and

security (Dodson, 1988).

Negative assumptions have been made about blacks in

general and about black men in particular. The main ones are

that they do not want to work and are disinterested in their

children. Such pathological and dysfunctional views of black

families, associated with the work of authors such as Daniel

Patrick Moynihan (1965) in the "Moynihan Report," have

elicited responses in defense of black families. One such









response comes from the writer and sociologist William Ryan.

Ryan's (1976) work, Blaming the Victim, serves as an

excellent rebuke to all those who place all the blame for the

black person's ills on the black person himself. In

pondering the thought processes of victim-blaming, Ryan

analyzes a new ideology which he sees as very different from

the open prejudice and reactionary tactics of the old days.

Its adherents include what he calls "sympathetic social

scientists with social consciences in good working order and

liberal politicians with a genuine commitment to reform"

(Ryan, 1976:7). Continuing his chastisement of this group of

victim blamers, Ryan (1976:6-7) states that

they are very careful to dissociate themselves from
vulgar Calvinism or crude racism and indignantly
condemn any notions of innate wickedness or genetic
effect. The Negro is not born inferior they shout
apoplectically. Force of circumstance, they
explain in reasonable tones, has made him inferior.
They dismiss with self-righteous contempt any
claims that the poor man in America is plainly
unworthy or shiftless or enamored of idleness.
They say that he is caught in the cycle of poverty.
He is trained to be poor by his culture or family
life, endowed by his environment.

The culture of poverty theory has also been used to

analyze black families and became a part of the

infrastructure of black ills. Oscar Lewis (1966) carried out

studies in Puerto Rico and referred to unstable family forms,

mating patterns and poverty. It was Lewis who used the term

"Culture of Poverty" to imply that the poor "in time" come to

represent a certain sub-culture of poverty. This "culture of

poverty" syndrome has been assigned to black persons in the









United States because they are usually seen as having

unstable family forms and mating patterns and as being

necessarily poor. Lewis' "culture of poverty" theory as

applied to black people in the United States, has, however,

been rejected. Ryan (1976) draws our attention to "those who

would want us to believe the myth regarding the culture of

poverty, that it produces persons fated to be poor, in order

to blind us to the fault of a corporation dominated economy"

(Ryan, 1976:120). Ryan also addresses the myth that black

families produce young men incapable of achieving equality

which he observes is "designed to blind us to the pervasive

racism that informs and shapes and distorts every social

institution" (Ryan, 1976:120).

Attempts at demythologizing black families are to be

found in the works of several other researchers including

Joyce Ladner (1988), John McAdoo (1988), Harriet Pipes McAdoo

(1988), and Robert Staples (1971, 1981, 1985). Staples

(1985) blames the inability of black aspirations for a

traditional family life and roles on structural conditions.

These structural conditions are said to have the greatest

impact on the black male and force him to abdicate his role

as husband and father. This has had far reaching effects

resulting in what Staples sees as the most significant change

in black families during the last 30 years: the proliferative

growth of female-headed households. He notes that "when the

Moynihan report was first issued in 1965 more than three-










fourths of all black families with children were headed by a

husband and wife. In 1982, however, barely one-half of all

such families included parents of both sexes" (Staples,

1985:1006). This had severe consequences for black families

because of disparities in family income. Households headed

by black women had a median income of $7,458 in comparison

with the median income of $20,586 for black married couples

and $26,443 for white married couples (U.S. Bureau of the

Census, 1983).

An examination of the situation of black families 20

years after the publication of the Moynihan report forces

Staples to ask questions such as: "How is it that a group

that regards family life as its most important source of

satisfaction finds a majority of its women unmarried?," "Why

does a group with more traditional sexual values than its

white peers have a majority of its children born out-of-

wedlock?," and "How is it that a group that places such

importance on the traditional nuclear family finds a near

majority of its members living in single-parent households?"

(Staples, 1985:1006).

Staples sees the structural conditions of the black

population as being responsible for the problems experienced

by today's black families. "These conditions not only

denigrate the black male but reduce the quantity and quality

of black males and hence rob black females of satisfactory

potential mates" (Staples, 1985:1006). Studies have shown









that 46.6 percent of the 8.8 million black men of working age

were not in the labor force. Some were unemployed, some had

dropped out of the labor force, some were in prison and

almost 1 million were classified as "missing" because the

Census Bureau said it could not locate them (Staples, 1985).

The situation is further exacerbated by the number of

black males serving in the Armed Forces. Census figures

(1983) report that in 1982 a significant number (415,000) of

blacks were under arms. This figure represented 20 percent

of all United States military personnel. It is estimated

that 90 percent of these were male (Staples, 1985).

The job situation of black males in the civilian labor

force contributes to enlistment as a choice. Instead of

being a means to an end, the Armed Forces become an end in

themselves for a large number of black males. "This results

in a rate of re-enlistments for black males which is much

higher than their white counterparts" (Staples, 1985:1009).

Socio-Demographic Profile of Black Families

Black families include a variety of family types. The

majority are either families which are maintained by a

married couple or those which are maintained by one parent

and one or more of the parent's own young children. In 1985,

81 percent of black Families were of one or the other of

these types, and the corresponding proportion for all

families without regard for race was 91 percent (U.S. Bureau

of the Census, 1986). Families which were not of either of









these types consist of such groups of relatives as

grandparents and their grandchildren, brothers and sisters,

and other relatives. A large percentage of black families

have young children among their members. In 1985 this figure

was 57 percent. This is a reflection of the higher birth

rate of black women coupled with the shorter survival of

black marriages (Glick, 1988).

Single parent families are another common form of black

families. In 1985 these families represented 30 percent of

all black families while the corresponding proportion for all

families without regard for race was 11 percent (U.S. Bureau

of the Census, 1986). Factors such as the vast increase in

the divorce rate and a decline in mortality rate for young

mothers have resulted in four times as many young children

living with a divorced parent versus a widowed parent in 1985

as did so in 1960 (Glick, 1988). Glick (1988) also notes a

continual increase since the 1960s and up until the present

time, in the number of young adults who are living in the

parental home.

Education

Blacks are still more likely to attend racially

imbalanced schools representing 44 percent of black children

in the North and 20 percent in the South. They have less

education on the whole than their white counterparts, and the

education they receive may be inferior due to the fact that

the schools they attend lie mainly in poor school districts.









Only 8 percent of blacks compared to 18 percent of whites

have college degrees. However, blacks today have much better

prospects than their parents did. Blacks have made strong

gains in education. From 1968 to 1878, for example, the

proportion of black children in the South attending mostly

black schools dropped from 79 percent to 59 percent (Stevens,

1980). From 1970 to 1980 the proportion of black

undergraduates at American colleges jumped from 7 percent to

11 percent, while black enrollment in graduate and

professional schools increased from 4 percent to 6 percent

(Stevens, 1980).

These educational gains have led to better-paying jobs

for many blacks. For example, about 6 percent of the

nation's managers and administrators are black. Today blacks

hold about 10 percent of the positions in finance, real-

estate, and insurance. And between 1968 and 1980 the number

of blacks elected to public office in the 11 states of the

deep South increased from 156 to 1813 (Henslin and Light,

1983; Rowan, 1981).

Despite such gains, however, black persons remain

underrepresented in American politics; Wright (1979) notes

that less than 2 percent of elected officials are black.

Although black people today have better education and

increased opportunities, ethnic discrimination still

underlies their relative impoverishment. At all levels,

whether among factory workers, managers, or supervisors,










income gaps still separate blacks and whites, and the gap

always puts whites on top (Wright, 1979).

Economics

Although nearly one third (30.9 percent) of all black

families lived in poverty in 1984, nearly the same number

(29.4 percent) of black families had earnings above $25,000

(white median family income was $27,000 that year). Income

varies widely among black families by family composition.

While median income for all black families totaled $15,432 in

1984, it totaled $28,775 in married couple families with the

wife in the labor force, but just $8,648 for female headed

households (Malveaux, 1988). Whether black families

experience poverty, receive public assistance, or maintain

relatively high earnings, disparities between black and white

families at every income level are important (U.S. Department

of Commerce, 1985). It is important to emphasize the

diverse composition of black families, in that black families

range from single mothers who receive public assistance and

raise their children against all odds, to upwardly mobile,

dual-earner families with incomes above $50,000 per year

(Malveaux, 1988).

Marriage and Divorce

"Young adult black persons have a consistent pattern of

postponing marriage longer than persons of other races"

(Glick, 1988:119). Statistics show that there was a sharply

increasing delay of marriage between 1970 and 1985 in the









form of a rising percentage of persons in their twenties who

had never married (Glick, 1988). The phenomenon called a

"marriage squeeze" is held as one of the prime reasons for

this delay. The marriage squeeze as experienced today makes

it more difficult for women of marriageable age to find

husbands in their range. Back women are reported to be

especially affected by this phenomenon (Strong and DeVault,

1989).

Staples (1985) explains that the reason why a near

majority of black Americans, especially women, are not

married and living in traditional nuclear family units

is not a result of any devaluation of marriage qua
institution but rather a function of limited
chances to find individuals in a restricted and
small pool of potential partners who can
successfully fulfill the normatively prescribed
familial roles. (Staples, 1985:1005)

The divorce rate in black families is said to be the

highest of all racial groups in the United States of America.

One in every two black marriages is said to end in divorce.

Combined data from several national surveys taken between

1973 and 1980 indicate that 37.2 percent of black males and

42.2 percent of black females who have ever been married have

divorced. This is not surprising since a large percentage of

blacks fall in the lower socioeconomic group and because of

the strong negative correlation between socioeconomic status

and divorce rates. As income levels for blacks increase,

divorce rates also decrease (Raschke, 1987). It is reported

that in 1985 there were 25 percent as many black divorced









persons as black married persons in the United States.

Findings suggest that the proportion of divorced persons who

remarry is lower among blacks than whites at each interval

since divorce (U.S.Bureau of the Census, 1980; Glick, 1988).

Based on findings from an earlier study conducted in 1980,

Glick (1988) notes that remarriage is more likely to be

followed by redivorce among black women 35 to 44 years old

than among women of other races of the same age.

Both cultural and structural explanations have been used

to explain black family forms. However, neither cultural nor

structural explanations by themselves can adequately account

for existing black family forms; both are needed. For

example, cultural explanations require knowledge of the

African family system, and the American plantation system,

and its patterns of mating. It was in the plantation system

that the weakening of the male role began as well as the

attempt to de-emphasize any form of family unit. Economic

production was the prime objective of the American plantation

system, but it was not encouraged within the context of the

"family life." This led to unstable relations between

managers and workers and among workers. This instability

could contribute to the claim that black marriages are less

stable (Heiss, 1975). It was only after emancipation that

the ex-slaves attempted to introduce some stability into

their family units.









Living Arrangements of Children

Some of the sharpest differences between the family life

of blacks and other races can be found in the living

arrangements of young children. For example, of all children

under 18 in 1985, 15 percent were black but 35 percent of

those living with a lone mother were black. The most extreme

contrast is found among children living with a mother who had

never been married--two of every three (67 percent) of these

children in 1985 had a black mother. In fact, as many black

children were living with a never-married parent as with a

divorced or separated parent (26 percent and 24 percent,

respectively).

Nearly all of the racial differences that can be

demonstrated from data present a picture of much greater

family disorganization in the living arrangements of black

children than of other young children. Even though there was

about a one-third downturn between 1980 and 1985 in the

proportion of black children living with a separated or

widowed mother, there was a doubling of the proportion with a

never-married mother (from 13 percent to 25 percent).

The rapid growth in the number of young children
living with a never-married mother is closely
related to the sharp upturn in the proportion of
births occurring to unmarried mothers. Vital
statistics reveal that the proportion of births to
unmarried mothers rose from 35 percent in 1970 to
59 percent in 1984 for black births and from "only"
6 percent to 21 percent for all races. Although
the rate of increase for black births to unmarried
mothers was not as great as that for all races, the
level is still close to three times as high as that
for all races (59 percent versus 21 percent). As









recently as 1960, there were more young children
living with a widowed parent than with a divorced
parent, but now four times as many live with a
divorced parent as with a widowed parent. This
shift resulted from both a declining mortality rate
for young mothers and a vast increase in the
divorce rate. (Glick, 1988:114)

Glick observes that a continuing larger proportion of

black than other children under 18 live apart from either

parent. According to the 1980 census, these children

represented 4.5 percent of the children of all races and 11

percent of black children. A significant proportion of those

children who were living apart from their parents were

residing with relatives, and the rest were living with foster

parents or in institutions. Living with their grandparents

was the most frequent form of living arrangement for those

children who were living with relatives (about two-thirds).

It is hypothesized that in these circumstances, many of the

mothers being younger, better educated, and more employable

must have left their children in the care of older relatives

while they moved elsewhere to increase their opportunities to

earn a living (Glick, 1988).

Young Adults Leaving Home

The departure of young adults from their parental home

generally occurs during their late teens or their twenties

and is a critical period for all concerned. Glick and Lin

(1986) report that up until 1970 approximately 32 percent of

the black population 18 to 29 years old were still living in

their parental homes or had returned to live there. By 1970,










however, the trend had turned upward and has continued to

rise. In that year, the authors note that the figure had

risen to 40 percent, and by 1984 it stood at 46 percent, well

above the 36 percent for those of all races in 1984. This

recent phenomenon of late departure from (or return to) the

parental home has also been characteristic of young adults of

all races. Factors which are said to contribute to this

include relatively high rates of unemployment, divorce, and

unmarried parenthood, as well as to more young adults

delaying marriage while they attend tertiary institutions to

further their education (Glick and Lin, 1986).

Conceptualization of Black Families

Early research among black populations and black

families in the United States has been influenced by the

sociological tradition and contributions of both Frazier and

Herskovits. Earlier works such as those of Frazier have,

however, been criticized because of their cultural

ethnocentric approach. Dodson (1988) looks at contrasting

approaches to the study of black families and compares the

cultural ethnocentric approach to the cultural relativity

approach. She notes that the pathological and dysfunctional

view of black families has been primarily related to the

cultural ethnocentric approach associated with the work of E.

Franklin Frazier (1939) and Daniel P. Moynihan (1965).

Dodson (1988) sees the works of these scholars as having

culminated in the implementation of social policies










predicated on the assumption that the black family is

unstable, disorganized, and unable to provide its members

with the social and psychological support and development

needed to assimilate fully into American society. Dodson

observes that studies which concentrated on the dysfunctional

and disorganized aspects of black family life have deduced

that the typical black family is fatherless, on welfare,

thriftless, and overpopulated with illegitimate children.

Inevitably they have recommended economic reforms for

"saving" black families from their own pathology (Dodson,

1988).

Opposing the cultural ethnocentric approach are those

scholars who tend to focus on the strengths of black families

rather than their weaknesses, having in most instances traced

the origins of these cultural differences back to black

Americans' African cultural heritage. The cultural

relativity school begins with the assumption that black

American culture and family patterns possess a degree of

cultural integrity that is neither related to nor modeled on

white American norms (Dodson, 1988). Dodson sees the

cultural relativistic view as having been developed primarily

as a reaction to the deficit view. Proponents of this view

maintain that the black family is a functional entity.

Dodson observes that this conceptualization is designed to

challenge the theories and social policies emanating from the

ethnocentric approach. However, she is aware of the common









assumptions underlying the theoretical and empirical

arguments of the two schools. That is, that black and white

families are qualitatively different culturally. She notes,

however, that this assumption is not shared by all students

of black family life. Proponents of the cultural relativity

view include Andrew Billingsley (1968), Robert Hill (1972),

Wade Nobles (1974), and Virginia Young (1970). The consensus

among these scholars is that black Americans' cultural

orientation encourages family patterns that are instrumental

in combating the oppressive racial conditions of American

society. There is, however, a variation in their individual

assessment of the degree to which African culture influenced

the culture of black Americans (Dodson, 1988). In examining

the American black family, proponents of cultural relativism

in North America point out that slavery did not totally

destroy the traditional African base of black family

functioning (Dodson, 1988). Dodson cites the works of

Blassingame (1972), Nobles (1974), and Turnbull (1976).

Research has also found that black families are not

disorganized or dysfunctional. Young (1970) observed

patterns of high illegitimacy rates and frequent marital

dissolutions usually associated with disorganization.

However, these patterns were interpreted by the researcher as

natural to the emotional underpinnings of the family system

and thus, functional. The central position of the female in

the domestic organization is thought to be related to the









restrictions on black male participation in the economic and

political institutions of the wider society throughout the

Western Hemisphere (Dougherty, 1978; Scanzoni, 1971).

Historically, family theorists have argued that family

structure and achievement interact with one another (Parsons

and Bales, 1955). While that may have some validity for

certain ethnic groups in America, none of those groups share

the history and current social conditions of the black

population in the United States (Staples, 1985). According

to Staples (1985) "the peculiar history of black Americans,

combined with structural conditions inimical to family

formation and maintenance, have precipitated a crisis in the

black family." Staples' observations have been supported by

others (Coner-Edwards and Spurlock, 1988).

Kinship and the Extended Family

Strong kinship bonds is one of five characteristics

which have been isolated as being functional for the survival

of black families and is identified as one of the strengths

of black families (Hill, 1972). Nobles (1974, 1988) has

indicated that the black community is oriented primarily

toward extended families, in that most black family

structures involve a system of kinship ties. This idea has

been supported by Billingsley (1968), Hayes and Mendel

(1973), Hill (1972), and Stack (1974). Blacks are known to

have higher fertility rates and larger families than whites.










This renders them more likely to live in multigenerational

households.

At this point it may be useful to define the extended

family. The most famous definition is that given by George

Murdock (1965:2):

An extended family consists of two or more nuclear
families affiliated through an extension of the
parent-child relationship rather than of the
husband-wife relationship; that is, by joining the
nuclear family of a married adult to that of his
parents. It embraces, typically, an older man, his
wife or wives, his unmarried children, his married
sons, and the wives and children of the latter.
Three generations, including the nuclear families
of father and sons, live under a single roof or in
a cluster of adjacent dwellings.

The extended family system is assumed to provide support

for family members, either as assistance for protection or

for mobility. It is argued that the extended family in the

black community consists not only of conjugal and blood

relatives, but of nonrelatives as well. Additionally, the

prevalence of extended families, as compared with nuclear

families, is held as another cultural pattern which

distinguishes whites and blacks. Dodson (1988) argues,

however, that the extent to which such families are

characteristic of the black community has not been adequately

substantiated.

Numerous studies have shown the positive effects of

kinship networks among blacks, but there are others that have

found relatively few differences by race among elderly people

in participation with family and kin (Heiss, 1975). In









addition, some maintain that black people have fewer

relatives to call on in an emergency (Heiss, 1975). Kinship

patterns among blacks are much debated and kinship is linked

to the extended family. Cowgill (1972) in his earlier work

went to great lengths to show how the elderly in developing

countries were not as dependent on their governments as those

in developed countries because of kinship patterns. This

theory has been extended to apply to black elderly persons in

the United States. Some have charged that patterns of kin

relations sometimes produce frustration and unhappiness, but

Heiss (1975), addressing this charge states that there is

little evidence to support this. Heiss concludes that people

who live in extended households are not significantly less

satisfied than those who live in nuclear homes (Heiss, 1975).

Heiss observes that this holds for several different kinds of

multigenerational homes.

Harriette Pipes McAdoo (1988) in an empirical

examination of upward mobility and extended-family

interactions in black families, examined whether involvement

within the extended-family support network was a help or a

hindrance to upward mobility. Theories related to the value

of support networks as a coping strategy of poverty and not

of culture were directly addressed. The findings indicated

that the education and achievement of the individuals were

often impossible without the support of the extended family,

and that the reciprocal extended family-help patterns









transcended economic groups and continued to be practiced

even when families had moved from poverty to the middle-

income level. McAdoo concluded that the continuation of the

extended-family support system reflects continued cultural

patterns and is a factor in countering the vulnerability of

the black middle class. Both factors are operational within

all of the mobility patterns.

The kin support network because it involves
cultural patterns created and retained from earlier
times that are still functional and supportive of
black family life is as essential now as it was in
earlier generations. (McAdoo, 1988:166)

Hayes and Mendel (1973) demonstrated that the extended

family is a more prominent structure for black families and

that blacks differ from whites in intensity and extent of

family interaction. Based on their study of midwestern urban

families they concluded that, with the exception of parents,

blacks interact with more of their kin than do whites. Black

families also receive more help from kin and have a greater

number and more diversified types of relatives living with

them than do whites.

Dubey (1971) examined the relationship between self-

alienation and extended family. He concluded that subjects

with a high degree of powerlessness were significantly more

oriented toward the extended family. Dubey's study has been

credited with raising the question of whether the extended

family is used as a buffer between oppression of the dominant

society and the unmet needs of the family (Dodson, 1988).









Stack (1974) proposed that the extended family is, in

part, a strategy for meeting physical, emotional, and

economic needs of black families, and involves a reciprocal

network of sharing to counter the lack of economic resources.

Kinship and the extended family are said to play important

roles in the lives of black elderly persons.

Black Elderly Persons

The number of elderly Americans who are black continues

to increase at a faster rate than the other segments of the

black population. In 1980, elderly black persons age 65

years and over constituted almost 8 percent of the black

population, that is about 2.1 million. Moreover, 7.5 percent

of the elderly or 157,000, were 85 years and older. The

"cross-over" phenomenon experienced by blacks who manage to

survive to 75 years of age has been used to explain the

tendency for this group of black people to disproportionately

outnumber others 75 years and older (Cornely, 1970). Elderly

black people were the fastest growing segment of their

population group in the decade of the seventies, increasing

34 percent. During this period the increase for the total

black population was only 16 percent (Johnson, 1988).

Because black Americans have had limited access to

supportive social services, elderly black persons have relied

a great deal on the supportive resources of their families,

and families in turn have relied on elderly relatives (Dancy,

1977). Research has shown that the larger black extended









family is highly integrated, is not based on female

dominance, and provides important resources for the survival

and social mobility of its members (Mindel, 1986).

In recent years, considerable new work has been done

examining the nature of the black extended kin support system

and its ability to care for its members (Aschenbrenner, 1973;

Hill, 1971; Martin and Martin, 1978; Mindel, 1980; Stack,

1974; Staples, 1981). With respect to black elderly persons,

this support system often becomes crucial, considering that

in many cases formal governmental support systems are not

always sufficient. A common theme which runs through much of

the discussion of the black family is the important function

of the black family as a social and psychological refuge for

individual members (Mindel, 1986).

Elderly persons tend to be an important element in the

structure of black family systems. In fact Wylie (1971)

argued that the elderly are more apt to be included in the

black family structure than in white families. Cantor,

Rosenthal, and Wilker (1979) found that elderly black women

continued to carry out instrumental and effective familial

roles far beyond the period customary among whites. They

argue that elderly black women were more highly involved in a

mutual assistance system among and between family members.

It was mentioned earlier that elderly black persons

experienced what has been described as triple-jeopardy and

elderly black women quadruple-jeopardy because of their










position in the American social arrangement. Black elderly

persons experience great hardships because they are subject

to racist stereotypes, and the often impoverished quality of

their lives reflects this (Dancy, 1977). The socioeconomic

status and position of blacks within the United States must

be addressed in considering issues affecting the care of

elderly black Americans (Bennett, 1982; Johnson, 1988).

Johnson (1988) makes reference to the covert and overt

aspects of various forms of racism which have been

instrumental in determining both the status and position of

the black elderly. "The engineered human degradation and

oppression of racism have taken their toll on the current

population of black elderly, and will influence the well-

being and quality of life of all black Americans for the

foreseeable future" (Johnson, 1988). Any study of black

elderly persons in the United States must demonstrate an

understanding of the difference in demographic facts,

history, culture, and life style as against the majority

group.

Marital and Living Arrangements

Among black elderly persons, a lower percentage are

married both in the young-old, and in the old-old period than

are white elderly. This holds for both male and female

(Johnson, 1988). There is also statistical evidence that

substantially more black elderly are widowed and divorced

than are white elderly. The marital status of black elderly










persons in 1980 was as follows: 56.9 percent of the men were

married, 22.1 percent were widowed, 14.7 percent were

divorced or separated, and 6.5 percent were single, never

married; for the women 25.0 percent were married, 57.7

percent were widowed, 11.6 percent were divorced or

separated, and 5.6 percent were single, never married

(Johnson, 1988). Since women outlive men, they also tend to

be without a mate.

Many elderly black persons live alone. It has been

noted that this tendency is almost as great among elderly

black persons as it is among whites. Black elderly persons

often take other relatives into their homes. It has been

noted (Hill, 1972) that four times as many families headed by

black elderly couples take younger relatives into their

households than do white elderly couples. Hill also reports

that families headed by black elderly females take in the

highest proportion (48 percent) of children. Another

important observation is that "a higher proportion of white

than black female headed families had elderly members living

with them" (Hill, 1972:6).

Housing

Stokesberry (1985) argues that in the area of economic

issues, and other issues, there is not a great deal of

difference in the need for services for all elderly persons

in terms of quality, quantity, and accessibility. However,

being a minority member exacerbates the problem all elderly









have in reference to their need for appropriate, affordable,

and adequate housing. Black elderly persons like their white

counterparts experience housing problems. Those who do not

own their own home, must resort to renting (sometimes

subsidized by government) or living in elderly hotels (SROs).

Although there are Adult Congregate Living Facilities

(ACLF's), not too many black elderly persons reside in them.

The literature supports the claim that most black elderly

persons reside at home.

Health Status

"The health status of elderly black people is poorer

than that of elderly white people" (Aiken, 1982:179).

Elderly black persons demonstrate different configurations

regarding certain chronic diseases. A Report of the

Secretary's Task Force on Black and Minority Health reports a

higher incidence of hypertension among elderly black persons.

The incidence of diabetes is also reported to be higher in

elderly black persons, and the same is true for certain types

of cancers (U.S.Department of Health and Human Services,

1985). It is reported that major chronic diseases which are

aggravated by dietary excesses are said to be in excess

prevalence among minority groups. For example, hypertension

and diabetes are prevalent among black Americans

(U.S.Departmentof Health and Human Services, 1985). Dietary

intake is influenced by socioeconomic status. Nutrient

intakes are higher at higher levels of disposable income (in









the low to middle income range), with the exception of

carbohydrate intake, which decreases with decreasing income.

Black elderly persons continue to suffer from the lack

of adequate health care services. The majority receive

health care through Medicaid funding. It has been and

continues to be a problem for black elderly persons to find

physicians who will agree to accept the Medicaid

reimbursement. Neighborhoods and geographic location play a

major role in this situation (Stokesberry, 1985). The cost

of medical care and the availability and accessibility of

such care place difficulties in the paths of black elderly

persons. Studies have implicated structural, social, and

psychological factors in health utilization behavior.

In terms of availability and accessibility, the

conceptual framework generated by Andersen and Newman (1973)

and Aday and Andersen (1978) with regard to health services

finds application in, and contributes greatly to,

understanding these phenomena. Three groups of variables are

identified in this conceptual framework: (1) predisposing

factors which are social-structural variables (for example,

race, religion, ethnicity) as well as family attitudes and

health beliefs that may affect the recognition that health

services are needed; (2) enabling factors which include

individual characteristics or circumstances, such as

available family income and accessibility of service, that

might hinder or accelerate use of a health service; and









finally (3) need factors which include subjective perceptions

and judgments about the seriousness of symptoms, the level of

physical disability or psychological impairment, and an

individual's response to illness. With regard to black

elderly persons their educational level (a predisposing

factor) and their income and insurance coverage as well as

accessibility of health services (enabling factors) are

important predictors of their use of health services. This

model finds easy application to the availability,

accessibility, and use of formal services by elderly black

persons.

Economic Status

Black elderly persons have generally earned less than

their white counterparts throughout their lifespan. The

types of income that those over 65 have available to them are

significantly different for the black and the white

population. The three major sources of income for elderly

black persons, whether they were living alone or in a family

situation, were, in order, Social Security, earnings from

employment, and Supplemental Security Income (SSI). For the

white elderly who were living alone, the three sources of

income were Social Security, dividends, and pension incomes;

and for white elderly who were living in a family situation

the three main sources of income were Social Security,

dividends, and earnings from outside the home (Stokesberry,

1985).









Separating the men and the women, Stokesberry (1985)

points out that 39 percent of black women receive SSI in

addition to Social Security and income from continued

employment after age 60 or 65. Among the black males, 27

percent were receiving SSI, indicating that their Social

Security payments obviously were so low that they were also

entitled to the SSI. For white males, only 12 percent were

receiving SSI and only 11 percent of white female elderly

were receiving SSI.

At the end of the decade of the 1970s, approximately one

out of three black elderly persons lived below the poverty

level (Stokesberry, 1985). Drawing from the data of Hill

(1978), Stokesberry observes that "even with a dramatic

reduction in the proportion of black elderly persons living

in poverty during the seventies (50 to 36 percent), at the

end of that decade the numbers of black elderly persons below

the poverty level was still three times that of the white

elderly" (Stokesberry, 1985:32). The disparity in the

poverty level of black elderly persons continued to be an

area of concern in the 1980s. Johnson (1988) reports the

number of black elderly persons living below the poverty

level as being two times that of whites in the 1980s.

Johnson (1988) reports a decline from 39.1 percent in 1983 to

33 percent in 1986 representing a figure of well over 700,000

black elderly persons aged 65 and over. Although this shows

some improvement in the economic situation of black elderly









persons from the 1970s to the 1980s, such a disparate

situation is still an indictment on a country which is one of

the richest in the world.

Stokesberry (1985) refers to the existence of blacks

whose income from Social Security, SSI and private pensions

may not meet the basic needs for food, shelter, and health

care. This is compounded by the fact that the lack of

training and skills to continue employment after retirement,

if that is a financial necessity, or to re-enter the

workforce is a special problem for these persons

(Stokesberry, 1985).

Elderly black persons largely represent that pool of

elderly persons who, in the days when they had membership in

the labor force, were saddled with the lowest paying and

dirtiest jobs. Their numbers include a few retired school

teachers, retired owners of small businesses, or former

government employees, but these represent only a very small

proportion of today's elderly black persons. The majority

worked in manual labor, and domestic service jobs. These

jobs did not offer benefits and were not covered by Social

Security. As a result, many black elderly persons now

receive minimum Social Security which cannot cover everyday

living expenses. Black elderly persons are thus likely to

remain employed after retirement age due to inadequate or

nonexistent retirement income.










Although there does not seem to be a difference in the

proportion of elderly blacks and whites who re-enter the work-

force after they reach 65, elderly black males in this

situation have a much higher unemployment rate than do

elderly white males (Stokesberry, 1985). Of note, too, is

the fact that the unemployment level for black females is

lower than it is for white females.

The economic disparity in the black American community

can be seen at all levels and in all types of families.

Black family median income was 56 percent of white family

income in 1984. This difference in income was also found

among the elderly who have generally earned less throughout

their life span. In 1984 the median income for black males

over the age of 65 was $6,163 compared to $10,890 for white

males. For black females the 1984 median income was $4,345.

For white females the figure was $6,309 (Johnson, 1988).

Religion

In considering the unique aspects of the black cultural

experience it is imperative that one be attuned to the

religious experience of black elderly persons. Hill (1972)

lists strong religious orientation as one of the strengths of

black families, which function for their survival,

development, and stability.

A strong orientation toward religion and the black

church is a cultural attribute which holds a great deal of

importance in the lives of black elderly persons. Dancy









(1977) states that "the black elderly have needed a frame of

reference to enable them to cope with the oppressive forces

of racial discrimination, and for many this frame of

reference is religion." "Historically," he states,

religion and the black church have played a vital
role in the survival and advancement of blacks.
The black church is an independent institution
which blacks control in their communities. It is
the one black institution which has remained
relatively free from white authority. (Dancy,
1977: 22-24)

Black churches include such traditional black Protestant

denominations as the Baptists and Methodists, as well as

varied Pentecostal or fundamentalist religious groups.

In the black church there are points of uniqueness
(culturally and experientially) that differ from
the mainline churches of the dominant society. An
example is worship through celebration. The black
elderly have within the black church the freedom to
express themselves as the Spirit dictates. The
black church is a place of affirmation, rejoicing,
and recognition. Historically, these churches have
provided for the elderly a place where they can
feel like somebody and be somebody. The church's
role as the provider of opportunities for many poor
black elderly persons to gain an understanding of
the world beyond their city and state through
missionary groups and church related trips has been
observed. (Dancy, 1977:23)

Dancy sees the religious experience of the black elderly

especially those from the low-income group, as contributing

to the value they place on life.

In the face of life's many trials--ageism, racism,
the normal changes of sixty and more years, the
uprooting from the rural South to the urban North
or West--the black elderly have often found solace,
strength and assurance in the black church. In
society at large they have experienced rejection,
but in the church they have found acceptance and
freedom. The black church has provided them an









avenue of release-"that soon we'll be done with the
troubles of the world," as the spiritual puts it-
and an avenue of rejoicing and renewal. Self-
understanding is shaped by many factors. American
society has not helped to instill racial pride in
black people. Such pride and affirmation have had
to come from within, and from the supportive
encouragement of other black persons and of the
black church which refused to accept the idea that
black people were inferior. Through the church,
black elderly persons were reminded that they
possessed dignity and that such dignity would
endure in spite of all that men could do to them.
(Dancy, 1977:23)

Many black elderly persons would not have much to keep

them going if they did not have the black church. It is

important therefore, that anyone embarking on a study of

black elderly persons and black communities have an

understanding of the dynamics of the black church and the

influence that religion has on black elderly persons. The

church is described as a channel through which a large

segment of the black elderly can be reached, and the black

church continues to be a source of communication with the

outside world for many black people in the United States.

Historically, the black church has been a strong social

force among black elderly persons. Dancy (1977) observes

that "when vital social services were not available to its

parishioners, the black church provided the needed counsel,

the services, and the framework of meaning. The black church

has always been an organizing force" he notes and "a service

center for its members" (Dancy, 1977:24). A challenge facing

those who are interested in the problems of black elderly

persons in terms of social supports, as advocates, is to









change the societal system which fails to meet the clients'

needs. In this effort, the cooperation and support of black

pastors and congregations can be enlisted. By mobilizing in

this fashion, these persons and the church can move beyond

their daily piecemeal supportive efforts (Dancy, 1977).

Whatever the task, there is powerful potential for reform

when the black church is considered a part of the informal

network system as it affects black elderly persons. The role

of the church in an aging society is becoming more visible.

This does not only apply to the black church, but other

churches and synagogues are being called on to develop a wide

range of activities to enhance the spiritual, emotional, and

physical well-being of older persons (Sheehan, Wilson and

Marella, 1988). It is obvious then, that something which

black churches have been doing for their elderly persons for

a very long time is now being recognized and courted for the

rest of the elderly population.

Kinship Relations and Family Support

No analysis of black elderly persons would be effective

or complete without some observations about the kinship

system and the role it plays in the lives of black people.

There is a growing body of literature on black families

describing the components of the kinship system. Literature

on the kinship interaction among black families as well as

the system of mutual aid and support that persists and exists

within black families is also on the increase (Mindel, 1986).









Discussions of kinship in the United States usually cover

three areas, affectional attachments, interaction, and mutual

assistance (Mindel, 1986).

It appears from the research that for blacks the kinship

network serves its members most effectively as a functional

mutual aid system. Numerous studies have shown that black

relatives help each other with financial aid, child care,

advice, and other supports to a rather extensive degree

(Aschenbrenner, 1975; Hill, 1971; Martin and Martin, 1978;

Shimkin et al., 1978; Stack, 1974). Strong kinship bonds is

one of the attributes of black families. A sense of

cohesiveness is a strength of black families and elderly

persons are often the focal point of that cohesiveness.

(Dancy, 1977).

One consequence of discrimination is that it has
caused black people to depend on each other and to
distrust the dominant society which would not
accord them respect. The desire for dignity and
freedom from oppression helps account for the black
elderly person's reliance on the strong family
bond. Family members recognize and value black
elderly persons, because they have survived and
surmounted many obstacles which the dominant
culture has strewn in their path. In turn, the
family frequently provides needed emotional support
and understanding. (Dancy, 1977:20-22)

Summary

In this chapter black families have been examined in

terms of social, economic, and demographic factors. Various

theoretical approaches used to study black families in

America have been analyzed. The strengths and weaknesses of

black families have been discussed and a profile of black









elderly persons has been presented. Of importance is how

black elderly persons have coped considering their position

in the society. The role of the black church as it continues

to respond to the needs of its elderly members has been

examined. Caregiving as it relates to black elderly persons

continues to be dependent on the informal support system

which includes, family, church and kinship networks. It has

been shown that studying black families from the cultural

relativistic approach can have positive effects by dispelling

some of the myths long held about these families. It could

also reduce the tendency of stereotyping these families and

so prove effective in countering the cultural ethnocentric

school which has for years underpinned some of the wrongs

that have been meted out to black Americans by some

researchers. The caring nature that is inherent in black

families has enabled them over the years to take care of and

nurture their elderly relatives. This characteristic is also

responsible to some extent for the manner in which elderly

relatives of black families have also always supported the

younger members of their families.














CHAPTER THREE
CAREGIVING

A Review of the Literature

Although there may be no theory of caregiving for the

elderly, there is, within the literature, information on the

concept of caregiving and since this is such a central part

of this study it is important that we inform ourselves

regarding its meaning. In the literature there is no clear

cut or agreed upon general concept of caregiving. Although

there is a rapidly growing body of literature on caregiving

wherein reference is made repeatedly to the aspects of

caregiving tasks, the stress and burden of caregiving

(Cantor, 1983; Gubrium and Lynott, 1987), the economics

associated with caregiving (Arling and McAuley, 1983),

caregiver selection (Ikels, 1986), as well as the demands,

risks, and costs of caregiving, family responsibility and

caregiving (Gubrium, 1988; Soldo and Myllyluoma, 1983) the

difficulty still lies in finding any concise conception of

the term. Indeed what we have is all very much an intuitive

and common sense understanding of the meaning of caregiving,

and the above are examples of the common sense ordinary way

in which the term caregiving is used in the literature. The

concept of "caregiving" is used when older people need care









of any sort because they are chronically impaired and hence

unable to perform certain functions without assistance. This

care may be administered in the home or in an institution.

This study is concerned with care which is administered in

the home, and that is the conception of caregiving that is

used. That is, a consensual, intuitive, common sense meaning

of caregiving. But in order to go beyond what is in the

literature I define caregiving using the following questions:

First, is there a need for care? Is there impairment? Is

there helplessness? and is there a need for assistance? The

search for answers to these questions directs the researcher

into looking at programs such as Social Security, Medicare

and Medicaid and other such features (these constitute the

formal system), and family members and friends (these

constitute the informal system).

Why are findings on such things as Social Security,

hospitals, food stamps, family members, friends and

neighbors, important to such an investigation? The answer

lies in the fact that the concept can be subdivided into two

types of caregiving: formal and informal. Both systems

together make, up one caregiving network.

The term caregiving has been used in the gerontological

literature as an umbrella term to cover a wide variety of

support services for elderly persons. The concept will be

defined here in terms of its application and utility. A

caregiving equation could be defined as follows: Formal +









Informal Assistance = Caregiving. Why is there a need for

formal and informal assistance? There is a time in the lives

of many human beings when they are unable to do things for

themselves and unable to supply all the support they need to

manage effectively. For example a person who is impaired

mentally, physically, and/or economically needs assistance

from one or both systems. Hence, we can logically say that

caregiving is taking place if the needed assistance is

forthcoming and does not cause a strain for the care

receiver, or causes very little strain, while taking place.

The concept of Caregiving usually connotes a care equation

and caregiving can take place when the care receiver is in an

institutionalized or noninstitutionalized setting.

Caregivers and Caregiving

Many older people are able to cope by themselves, but a

large number get to the point where they need care. This

places them in the category of care receivers. Those who

administer the care are known as caregivers and the product

administered is known in the gerontological literature as

caregiving.

Older people not only have to cope with the physical

problems indigenous to their population, but they also have

to cope with stressful life events such as death of a spouse,

loss of financial benefits when they are no longer able to

work, and loneliness (Shivers and Fait, 1980). Shivers and

Fait (1980) also note that "if any generalization can be made









about the aging process, it is the increasing vulnerability

of the organism to environmental stress, disease, and

continuing loss of functional ability of organs and systems"

(Shivers and Fait, 1980:19).

In a survey conducted by the American Association of

Retired Persons, the major events causing the need for care

were found to include major illness, hospitalization, death

of a spouse, retirement, and being laid off or fired

(American Association of Retired Persons, 1986). This survey

also found that the kinds of help provided by caregivers

range from financial support and managing finances to

household chores, personal care, ambulation, transportation,

administration of medication, companionship, making or

receiving phone calls, and arranging outside help ((American

Association of Retired Persons, 1986). Caregiving, then,

refers to care provided to an elderly person with some degree

of physical, mental, or emotional impairment which limits

independence and necessitates ongoing assistance (Horowitz,

1985).

The organization of society today determines that people

receive support from agencies of government (the formal

system) or from family, kin, and neighbors (the informal

system). The elderly recipient of care may benefit from both

formal and informal support systems.

Care receivers are often plagued by various chronic

illnesses that limit their abilities to care for themselves.









Care receivers, on average, suffer from four medical problems

from among a list of over 20. These include high blood

pressure, arthritis, vision problems, heart problems,

depression, circulatory problems, hearing problems, memory

loss, sleep disorders, dizziness, respiratory problems,

diabetes, stroke, constipation, bone fracture (especially of

the femur), cancer, elimination problems, diarrhea,

drug/alcohol problems and Alzheimer's disease (American

Association of Retired Persons, 1986). The AARP study also

reports that the health conditions most frequently

experienced by older care receivers were high blood pressure,

arthritis, vision problems, heart problems, depression, and

circulation problems (American Association of Retired

Persons, 1986).

The Formal Support System

Government, through bureaucracies at local, state and

federal levels, is committed to providing financial support

in the form of Social Security to the elderly. Through

Medicare and Medicaid, government also provides a portion of

the payment for the health care for the elderly. In a series

of reports compiled by the Social Security Administration,

public social-welfare expenditures are defined as cash

benefits, services, and administrative costs of all programs

operating under public laws that are of direct benefit to

individuals and families. The programs included are those

for income maintenance (social insurance and public aid) and






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Missing
or
Unavailable









The Informal Support System

Caregiving needs to be assessed in the same way as any

other social organization. Once the formal segment has

carried out its role, everything that remains is expected to

be undertaken by the informal system.

Informal caregivers are usually spouses, children, and

relatives in that order. The process of caretaker selection

appears to follow rules that transcend cultural differences.

Certain demographic groups have a greater likelihood of being

care givers than others. Results of the survey conducted by

the American Association of Retired Persons (1986) indicated

that the probability or likelihood of being a care giver is

greater for females than it is for males, and the likelihood

of having caregiving responsibilities is greater for females

who are older, and widowed (American Association of Retired

Persons, 1986). This finds support in the caregiving

literature where many researchers note that filial caregiving

connotes daughters and that this has implications for the

role of women in our society.

Researchers have been able to detect the underlying

dynamic that leads to caretaker selection (Ikels, 1986). The

factors found to be involved in the selection of caretakers

fall under three headings: Demographic Imperatives,

Antecedent Events, and Situational Factors. Demographic

Imperatives listed the caretaker as being the only child, the

only child of preferred sex, and the only proximate child.









Antecedent Events incorporate those such as gradual

emergence, explained by the dependent child or children who

were still at home when widowhood occurred. These children

are said to be slated early on for the caretaking role and

gradually assume it. Situational Factors such as least

inconvenience and greatest motivation are also used in the

selection of a candidate for the role of caretaker (Ikels,

1986). All things being equal, in most cultures the child

with the least obligations and the greatest motivation will

undertake the role of caretaker.

Most caregivers provide several different supports

simultaneously. The average caregiver provides approximately

four supports to the person being cared for (American

Association of Retired Persons, 1986). This places heavy

burdens on them, since a large proportion also hold full time

jobs. The majority of employee caregivers care for aged

relatives who live in their own home, some near the caregiver

and some quite far away. Some caregivers share housing with

the older person, while some of the care receivers may live

in a nursing home near or far from the caregiver (American

Association of Retired Persons, 1986).

Some subgroups of the elderly population are known to

place more faith in the informal support system and hence

receive most of their support from this system. Black

elderly persons are among those who, for reasons that have









been given some support in the literature, place heavy

dependence on the informal support system.

Impairments of the Elderly

The process of aging begins with conception and

continues until death. Unless some catastrophic event causes

early death, most people tend to follow an aging cycle that

terminates at or about the beginning or the middle of the

seventh decade. Only a few people live into their nineties,

and a tiny proportion go on to be centenarians. According to

the 1980 Census there were 32,000 persons aged 100 or older

in the United States, two-thirds of whom were women. Many

factors contribute to longevity. This can be the result of

genetic foundation, nutrition, environment, physical

capacity, lack of stress, or a combination of these. Many of

those attaining long life can expect to be plagued by some

kind of impairment either mental or physical. Some elderly

experience minimum impairment while others suffer terribly.

To impair is generally defined as "to make worse, to

lessen in quality, quantity, value, excellence or strength;

to deteriorate" (New Webster Dictionary of the English

Language-Deluxe Encyclopedia Edition, 1984). Melloni's

Illustrated Medical Dictionary (1985:218), defines impairment

as "damage resulting from injury or disease," and mental

impairment as "intellectual defect as manifested by

psychologic tests and diminished effectiveness (social and

vocational)."









When considering impairments in the elderly one should

concentrate on those that cause the greatest handicaps, since

certain impairments of elderly persons are more devastating

than others. Hearing, visual, and mental impairment are of

particular concern and demand special emphasis. When we are

dealing with areas such as living arrangements for the

elderly, we are faced with an even greater problem; that of

functional impairment. Those who are functionally impaired

are those who have trouble in mobility or transportation,

personal care, basic housekeeping activities, and self-

management, i.e., taking medication, using the telephone

(Verbrugge, 1986).

"Hearing loss is more common than visual loss among

elderly persons, although both are found to increase with

age" (Butler and Lewis, 1983:108). Although most persons

past 60 years of age retain hearing sufficient for normal

living, the elderly individual is three times more likely to

display a significant loss of hearing than is a younger

person, and older males have greater hearing loss than do

older females (Shivers and Fait, 1980). Statistics from the

National Health and Nutrition Examination Survey (HANES I) of

1971 indicate that the ratio of hearing loss for persons less

than 17 years of age as opposed to that for persons of 65

years and over increases from 3.5 per 1,000 persons to 133

per 1,000. About 19 percent of individuals age 45 to 54 as

compared to 75 percent in the 70- to 79-year-old age group









report a hearing loss. It has also been reported that 23

percent of elderly persons 65 to 70 years of age and 40

percent of those age 75 and above reported that they had

hearing impairments that were somewhat handicapping (The

National Health and Nutrition Examination Survey, 1971).

Hearing is crucial to mental health in old age; hence

hearing loss has been known to contribute to depression among

the elderly. Butler and Lewis (1983:109) note that "hearing

impaired persons receive much less empathy than visually

impaired persons and are more subject to depression,

demoralization, and psychotic symptoms." It is estimated

that in the United States there are 5.5 million elderly

persons (over the age of 65) with hearing defects (Butler and

Lewis, 1983).

Visual Impairment

Visual impairment presents its own problems for the

elderly. Nearly half of the legally blind population in the

United States is 65 years of age or older (Butler and Lewis,

1983). Macular degeneration, cataracts, glaucoma, and

diabetic retinopathy are the four most common causes of

visual impairment in the older age group (Butler and Lewis,

1983). Visual impairment can be devastating in terms of both

psychological isolation and physical immobilization. Visual

impairment can result in accidents in old age. By affecting

driving, the outcome can be loss of one's drivers license,

thus increasing dependency on others for transportation.









Visual impairment can also be responsible for accidents in

the home such as physical injury and the misreading of labels

on medications and on household products. All of this

impedes the visually impaired person from living alone.

Mental Impairment

Chronic conditions among elderly persons include those

of a psychopathological nature. The elderly are more likely

than younger persons to develop mental manifestations of

their physical problems. According to Pfeiffer (1977),

approximately 15 percent of the elderly population in the

United States suffer from significant, substantial, or at

least moderate psychopathological conditions. It is also

estimated that between 70 and 80 percent of elderly nursing

home patients suffer from moderately severe mental disorders

(Whanger, 1973). Kart (1985) reports that organic brain

syndromes, depressive disorders, schizophrenia, and alcohol

disorders are listed among the specified diagnoses accounting

for the highest rates of patient-care episodes in outpatient

psychiatric services for old people in the United States in

1971. He cautions however, that for many reasons these

figures may not be as authentic as we could be led to

believe. Kart (1985) cites several factors that are

conceptual and methodological in nature which contribute to

this probable incorrect documentation. He notes that

the epidemiology of psychopathological conditions
is beset by conceptual and methodological problems.
Diagnosing schizophrenia or depression is often
difficult even under careful conditions of









assessment. Diagnoses are not made under strict
experimental conditions. There is a substantial
degree of subjectivity involved, complicated by the
fact that different doctors use different
definitions and criteria and vary widely in their
competence and in their understanding of aging
processes. (Kart, 1985:182)

Changes in the environment have also been said to be a causal

factor in the early mental change shown by elderly persons

(Libow, 1973). Research shows that many cognitive problems

in old people may result from adverse drug reactions (Lipton

and Lee, 1978). Iatrogenic brain disorders are not uncommon.

Doctors unwittingly produce reversible and often unrecognized

irreversible brain disorders. Tranquilizers and hypnotics

are said to be the most likely causes of such conditions, but

steroids used for arthritis can cause organic brain disorders

as well as hypomania or depression or both (Butler and Lewis,

1983). Despite the difficulties involved in determining the

degree and extent to which psychopathological conditions are

distributed among the elderly, there is no doubt that some

elderly people are mentally impaired, hence requiring care

that is usually very demanding on the caregiver.

The mental health evaluation in its simplest sense is a

method of looking at the problems of older people, arriving

at decisions as to what is wrong, and concluding what can be

done to try to alleviate or eliminate these problems.

Evaluators use historical data from the person's past;

current medical, psychiatric, and social examinations; and

their own personal interactions with the individual to get a










many sided and, one hopes, coherent picture of what is

happening (Butler and Lewis, 1983). Knowledge of the racial,

cultural, and ethnic backgrounds of these elderly persons

during the process of evaluation is germane to the evaluation

process.

Decisions made on the basis of the mental health

evaluation should be aimed at the well-being of the older

person, not only via medical and professional treatment, but

through social supports. Knowledge of the resources

available for treatment purposes should be uppermost in the

mind of the therapist; also it is important to know of the

older person's own emotional and physical capabilities, the

assets in his or her family and social structure, and the

kind of services and support available in the community

(Butler and Lewis, 1983:165). Treatment goals should be

reasonable and reachable and when decisions are made not only

must the margin of error be small and aimed at the well-being

of the elderly person, but care should be taken that

presentation of the decision should be in language which can

be understood by the older person's family and friends as

well as by the older person (Butler and Lewis, 1983). This

will provide them with a basis for assessing the mental

health care offered them and will know what to expect and how

to best participate actively in evaluation and treatment

(Butler and Lewis, 1983).









Depression appears to be the most common functional

psychiatric disorder in the later years. Depression can vary

in duration and degree; it may be triggered by loss of a

loved one or by the onset of a physical disease (Impallomeni

and Antonini, 1980; Kart, 1985). Depression often results

from adjustment reactions. It can be triggered by fear. The

fears of elderly persons are many and justified. Elderly

persons fear being alone, they fear being attacked, and they

fear the loss of loved ones. Kart (1985) observes that the

complexity of their emotionality can result in increased

blood pressure (increased heart rate) stemming from their

physical problems and these in turn can result in depression.

Today's elderly person grew up in the 1920s, a period when

people were termed mad, crazy, and so on if they acted even

slightly strange; hence their fears are justified. A

depressed individual may show any combination of

psychological and physiological manifestations. Diagnosis is

difficult and treatment is problematic. Drug therapies are

popular for the elderly since they are viewed by many

professionals as poor candidates for the psychotherapies

(Kart, 1985:183).

Suicidal thoughts often accompany depression. Suicide

rates are very high among the elderly. According to the U.S.

Public Health Service, in 1975 these were between 43 percent

and 62 percent higher than they were for the total

population. The elderly accounted for 16.3 percent of all









the suicides in the United States in 1975 (U.S.Department of

Health, Education, and Welfare, 1977). An examination of

suicide rates by sex and race for 1979 revealed that aged

white males show the highest suicide rate of any group, 39.2

per 100,000 population. Their rate is three times that of

aged black males (12.9), more than five times that of aged

white females (7.3 per 100,000 population), and about

sixteen times that of aged black females (2.5 per 100,000

population) (U.S. Bureau of the Census, 1982-83). Elderly

females in the United States have among the lowest suicide

rates in the world.

Paranoia and hypochondriasis are two additional

functional disorders common to elderly persons. Paranoia is

a delusional state, usually persecutory in nature. It often

involves attributing motivations to other people that they

simply do not have (Kart, 1985:184). Paranoia is reported to

be more common in individuals who suffer from sensory defects

such as hearing loss (Eisdorfer, 1960; Houston and Royse,

1954). Some paranoia may result from changes in life

situation. Paranoid reactions of the elderly person are

usually directed at the spouse or adult children or persons

working in the home (home help). There is a lot of

misinterpretation and misunderstanding in such situations.

Paranoia could contribute to the degree of stress which

caregivers and others experience. The older person usually

accuses others (Pfeiffer, 1977), and isolation can result by









virtue of their behavior, this in turn can lead to

depression.

Hypochondriasis is an overconcern for one's health,

usually accompanied by delusions about physical dysfunction

and/or disease. The disorder presents problems in treatment

since hypochondriacs are not predisposed to psychological

explanations of their condition. Telling the patient that

nothing is really wrong is rarely effective (Kart, 1985).

Elderly people and their relatives fear Alzheimer's disease.

They also fear cancer, especially cancer of the colon, and so

they use laxatives to prevent constipation. Butler and Lewis

(1983:298) note that bowel complaints, especially

constipation, in both mental disorders (for example,

depression) and physical conditions, are frequent and provoke

anxiety in older people.

The distinction is made between organic brain syndromes

(OBS) and organic mental disorders (OMD) (American

Psychiatric Association, 1980). Organic brain syndrome

refers to a group of psychological or behavioral signs and

symptoms without reference to etiology. Organic mental

disorder designates a particular OBS in which the etiology is

known or presumed (American Psychiatric Association, 1980).

OBS can be grouped into six categories, the most common of

which are delirium, dementia, and intoxication and

withdrawal. It is believed that as many as half of those

elderly persons with mental disorders have OBS (Redick et









al., 1973); the prevalence rate of OBS appears to increase

with age (Redick et al., 1973), although onset usually occurs

in the seventh to ninth decades and is more common in women

than in men (Fann et al., 1976).

Kart (1985) observes that primary degenerative dementia

of the Alzheimer type may be the single most common OBS.

According to the DSM-111, between 2 and 4 percent of the

entire population over the age of 65 may have this dementia.

Alzheimer's disease has an "insidious onset and gradually

progressive course" (American Psychiatric Association, 1980).

"It brings a multifaceted loss of intellectual abilities,

including memory, judgement, and abstract thought, as well as

changes in personality and behavior. The clinical picture may

be clouded by the presence of depression, delusions, or (more

rarely) delirium" (Kart, 1985:184). Some conditions may

manifest themselves as something else, leading to

misdiagnosis, for example, senility. There are times when

there is misdiagnosis of this condition and some use the term

pseudosenility to refer to such conditions (Libow, 1973).

Causes of pseudosenility, Libow notes, include drug reactions

(and the elderly are usually taking more than four types of

drugs at any single time), malnutrition (another problem of

older people), and fever. When these conditions are treated,

the senility often vanishes (Libow, 1973).

Older persons need a lot of support to help them

overcome the feelings of worthlessness and depression that




Full Text
OLD AGE AND CAREGIVING IN A BLACK COMMUNITY
By
SYLVIA CICILY CLAIRE LAWSON
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA UNIVÃœR-!*Y OF FLORIDA LIEMrjES
1990

Copyright 1990
by
Sylvia Cicily Claire Lawson

In Memory Of My Parents
Eunice E. Earle
(1899 - 1983)
Stanford A. Earle
(1884 - 1959)
and My Sister
Rowena E. Earle Mitchell
(1920 - 1980)

ACKNOWLEDGEMENTS
I would like to express my appreciation to the many
persons who provided me with their help, time, and moral
support in the production of this dissertation. These
persons include friends, family members, faculty members at
the University of Florida, and the government and people of
the Town of Eatonville, Florida.
Special thanks are extended to my chairperson, Dr. Lee
Crandall, whose patience and support were above and beyond
the call of duty. Without his guidance, critical comments,
and constant encouragement this dissertation would have taken
much longer to complete.
I am also very grateful to all the other members of my
committee. Dr. Akers has been a special tutor, mentor and
friend who has encouraged me throughout my graduate career.
His critical comments and helpful suggestions ensured that
the dissertation was satisfactorily completed. Dr. Vera has
been a special friend, teacher and mentor throughout my
graduate career. Dr. Paul Duncan steered me on the original
path to Medical Sociology. Dr. Kelso has given me support
and many ideas throughout my graduate career, and Dr. Gubrium
sowed the seeds of caregiving for the elderly. I owe a
iv

special debt of gratitude to Dr. Faye Gary Harris for her
encouragement and for willingly stepping in at the last
minute as a substitute committee member. Thanks also to Drs.
Felix Berardo and Joseph Vandiver for their support and
encouragement, and to Dr. Michael Radelet for supervising the
pilot study and encouraging me to proceed with the research
project.
Collecting the data for this dissertation would not have
been possible without the assistance of the people of the
Town of Eatonville, who, without reservation, opened their
doors and their hearts to me. To them all I say thank you.
Some support for this research was provided by the
Office of Affirmative Action, University of Florida. I am
especially grateful to Dr. Jacqueline Hart for her assistance
and encouragement.
Thanks to the American Sociological Association for
providing me with a Fellowship, and to the University of
Florida for providing me with a Fellowship. Several other
persons at the University of Florida including Dr. Madeline
Lockhart, Dean of the graduate school, and Dr. Art Sandeen,
Vice President for Student Affairs, have been very supportive
and encouraging.
Thanks to Ms. Connie Sadler for her assistance in
transcribing the taped interviews and to Ms. Nadine Gillis
for the final product. To my dear friend Barbara Cohen I
will always be grateful for her love, caring, and support.
v

Special thanks to Revd. Dr. Gary Crawford and my church
family at the Westside Baptist Church for their love and
caring over the years. I could not have survived without
them.
The support and encouragement of my close-knit family
sustained me daily. I am grateful for the support of my
sisters and brothers-in-law, Mary and Vernal Dyce, Agnes and
Augustus Wright, and Monica and Clive McKenzie; my brothers
and sisters-in-law, Joseph and Pearl Earle and Jonathan and
Yvonne Earle; and my brothers John and James Earle. Special
thanks to my brother Jonathan who was always there for me
with his daily words of encouragement and for all his
assistance. Thanks also to my cousin Iretta for her support
and encouragement.
My two children Deirdre and Peter took on the
responsibility of parenting their mother during the long
arduous years of graduate school. I can only hope that they
will be proud of and benefit from my accomplishments.
vi

TABLE OF CONTENTS
Eac[£.
ACKNOWLEDGEMENTS iv
LIST OF TABLES xi
LIST OF FIGURES xii
ABSTRACT xiii
CHAPTERS
ONE INTRODUCTION 1
America's Elderly: An Overview 5
Marital Status 11
Health Status 12
Living Arrangements 15
Housing Alternatives 17
State of Health 18
Visitation by Family and Friends 19
Racial Constraints 20
Geographic Distribution 22
Standards of Housing 23
Income of the Elderly 24
Plan of Research 25
TWO BLACK FAMILIES—BLACK ELDERLY PERSONS 29
Definition of Family 29
Black Families 32
Socio-Demographic Profile of Black Families... 40
Education 40
Economics 42
Marriage and Divorce 42
Living Arrangements of Children 45
Young Adults Leaving Home 4 6
Conceptualization of Black Families 47
Kinship and the Extended Family 50
Black Elderly Persons 54
Marital and Living Arrangements 56
Housing 57
vii

Health Status 58
Economic Status 60
Religion 63
Kinship Relations and Family Support 66
Summary 67
THREE CAREGIVING 69
A Review of the Literature 69
Caregivers and Caregiving 71
The Formal Support System 73
The Informal Support System 75
Impairments of the Elderly 77
Visual Impairment 79
Mental Impairment 80
Activities of Daily Living 88
Instrumental Activities of Daily Living 89
Support Systems for Elderly Black Persons 90
Caregiver Stress and Burden 93
Caregiver Stress 93
Felt Burden 94
Caregiving and the Black Elderly 96
Summary 99
FOUR METHODOLOGY AND RESEARCH SETTING 100
Methodology 100
The Research Setting 105
Demographic Profile 109
Education Ill
Economics 112
Politics 115
Housing 115
Religion 115
Recreation 116
Caregiving in Eatonville 119
Sample for Interviews and Quantitative
Analysis 120
Measurement of Variables 123
Operationalizing the Major Variables 124
Age of Respondent 124
Gender of Respondent 124
Marital Status 124
Residential Status 125
Living Arrangements 125
Disability 125
Health Status 125
Number of ADL Tasks 126
Number of IADL Tasks 127
Socio-Economic Status 127
viii

Family 129
Care Receiver 129
Caregiver 12 9
Formal Support 12 9
Informal Support 132
Agency Awareness 133
Indication for the Need for More Help 134
Summary 134
FIVE FINDINGS AND DISCUSSIONS 136
Vignette #1 139
Vignette #2 145
Vignette #3 147
Vignette #4 154
Vignette #5 156
Vignette #6 163
Quantitative Descriptive Analysis 170
Family. 173
Children, grandchildren and siblings 173
Migration 17 6
Occupation and work 178
Income source 180
Marital and living arrangements 183
Home and land ownership 183
Household composition 186
Impairments 191
Activities of Daily Living-ADLs 191
Instrumental Activities of Daily
Living (IADLs) 193
Caregiving 196
Cross Tabulations of Quantitative Data 198
Need help by caregiver 201
Formal support by informal support 202
Agency awareness by formal support 203
More help needed by age 204
More help needed by sex 204
More help needed by disabled status 204
More help needed by formal support 209
More help needed by number of health
problems 210
More help needed by informal support 214
More help needed by other agency
awareness 217
Discussion 218
Summary 220
ix

SIX
CONCLUSIONS AND IMPLICATIONS
221
Implications for Future Research 222
Policy Implications 223
APPENDICES
A CODING 237
B SURVEY OF CAREGIVING RESPONSIBILITIES 239
C INFORMATION SHEET 247
D CHARACTERISTICS OF EATONVILLE'S ELDERLY
ACCORDING TO AGE COHORT 249
E POSITION OF ORANGE COUNTY IN THE STATE
OF FLORIDA 250
F POSITION OF THE TOWN OF EATONVILLE 251
REFERENCES 252
BIOGRAPHICAL SKETCH 269
x

LIST OF TABLES
Table Ease.
4-1 Population Figures—Eatonville —1980 110
4-2 Age Distribution—Eatonville--1980 110
4-3 Number of Households—Eatonville —1980 110
4-4 Average Number of Persons per Household—1980. Ill
5-1 Characteristics of Eatonville's Black
Elderly Sample 171
5-2 Summary Table of Elderly Sample by Offspring
and Siblings 174
5-3 Current and/or Previous Occupation 179
5-4 Summary Table of Marital, Residence and
Household Status 184
5-5 Summary Table of Activities of Daily Living... 193
5-6 Summary Table of Instrumental Activities of
Daily Living 195
5-7 Summary Table of Caregiving Characteristics
of Eatonville's Elderly Sample 197
5-8 Means, Standard Deviations and Other Values
of Major Variables 199
5-9 Results of Tests of Significance and Measures
of Association 200
5-10 Degree of Help Needed Based on the Number
of Health Problems 213
5-11 The Need for More Help Based on Type of
Informal Support Received 215
5-12 The Need for More Help Based on Type of
Community Support Received 216
xi

LIST OF FIGURES
Figure Page
4-1 Schematic Representation of the Place
of the town of Eatonville in the East
Orlando Community 118
5-1 Diagram showing the combinations of level of
dependence and type of support described in
each of the six vignettes of elderly persons
in the community 169
xii

Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
OLD AGE AND CAREGIVING IN A BLACK COMMUNITY
By
Sylvia Cicily Claire Lawson
August, 1990
Chairman: Lee A. Crandall
Cochairman: Jaber F. Gubrium
Major Department: Sociology
Currently existing formal and informal support systems
necessary for providing a better quality of life for
noninstitutionalized elderly persons, especially those who are
poor and Black, may be inadequate. This research employs a
conceptual framework and methodology designed to examine
knowledgeability, accessibility, and use of services among
noninstitutionalized elderly Black persons. The social and
cultural situations of Black elderly persons are examined to
assess whether these elements determine and or contribute to
their participation in, and knowledge about, available formal
sources of assistance for instrumental activities of daily
living (IADLs). The analytical model differentiates elderly
persons who are users from non users of formal services and
assesses their knowledgeability regarding formal and informal
xiii

services which are in place to assist them with various IADL
functions.
Information was gathered, over a period of approximately
twelve months, on a convenience sample of 71 elderly persons in
an all black community in central Florida, using in-depth
interviews and participant observation. This approach provides
process data rather than the typical snapshot supplied through
one-shot survey interviews. The nature of the design of the
study allowed for the cross-checking and rechecking of what
people say and do, increasing the reliability and accuracy of
the data.
The data gathered by this research do not support
assumptions about kinship patterns of informal caregiving that
place great emphasis on the role of the black extended family.
v
A large proportion of the elderly studied were living alone.
\
The findings suggest that black elderly persons have limited
awareness of the various services available through government
agencies to assist them with their IADL functions. They
instead utilize informal agency sources of help or do without
needed services. The informal system of caregiving in this
community also appears to fall short of providing the
assistance needed by black elderly persons.
xiv

CHAPTER ONE
INTRODUCTION
Caregiving in its simplest form refers to care provided
to someone who, because of physical or other limitations, is
unable to perform certain functions unassisted. The concept
of caregiving to the elderly is well defined by Horowitz
(1985), as care provided to persons over the age of 65 with
some degree of physical, mental, or emotional impairment
which limits independence and necessitates ongoing
assistance. This is the concept of caregiving used in the
present research.
Insufficient caregiving for functionally disabled
elderly persons in the community has become a serious social
problem in American society. The responsibility of caring
for persons 65 years of age and over, which has been for
centuries primarily the responsibility of the family, one
segment of the informal support system, has now become a
joint venture between the state (the formal system) and the
family. The informal support system consists of all unpaid
help provided by family, friends, neighbors, or others who
are not part of a group formally organized to provide long¬
term care assistance (Branch and Jette, 1983). Formal
support on the other hand, refers to organized care provided
1

2
by government or voluntary organizations or agencies that
exist to provide long-term care services to the
noninstitutionalized impaired elderly (Branch and Jette,
1983). Once responsibility shifts to or involves the state,
there are social as well as moral obligations to be
addressed. The question becomes: are those who are in need
receiving the care needed to lead a reasonably satisfactory
level of daily living? Where the formal system of caregiving
falls short, the burden shifts to the informal system to give
needed support. Where the informal system falls short,
governmental assistance is needed.
This research focuses on the informal system of
caregiving to elderly black persons in need. The literature
on black families has continued to expound on the primary
role played by these families in taking care of their elderly
relatives in the extended family setting. The general
consensus is that the informal system is especially strong in
the black community. The question is: to what extent is this
image of elderly care in the black community accurate? That
is: are black families still playing the role of caregivers
to their elderly relatives in these final decades of the
twentieth century? In spite of the consensus in the
literature, there has been very little empirical research on
the role of the extended family and other informal caregiving
for black elderly persons. Although the gerontological
literature is replete with studies concerned with caregiving

3
for the elderly, there is very little research on caregiving
for black elderly persons. This research takes a careful, in-
depth, qualitative approach to locating and describing the
state of care, informal and formal, provided for elderly
persons in one black community. To the knowledge of the
researcher this is the first study to do so. The purpose is
to contribute to our knowledge of how needy elderly persons
are cared for in the black community.
This study, then, is an attempt to help fill some of the
gaps in research on elderly black persons. The problem is
mainly one of supports for this population of persons. Black
elderly persons in need of assistance are more likely than
white elderly persons to be in residence in the community
than in institutions. The general question that needs to be
answered is: what are the systems in the community that do or
do not provide care for black elderly persons who are in
need? The systems that are available for providing care to
elderly black people fall into two distinct but interrelated
categories of the formal and the informal caregiving systems.
The major part of the study was conducted through visits,
observations and interviews concentrated on the informal
system mainly during the year the researcher spent in
residence in Eatonville, historically, an all black
community in Florida. Data were also gathered on the formal
system through interviews with government officials,
published data, and record archives.

4
As noted, the central reason for embarking on a study
such as this is to see to what extent black family
traditions, and community traditions have an impact on
caregiving to elderly persons. Is the traditional view of
the importance of the extended black family myth or reality?
It is possible to obtain answers to this question in a
variety of ways, but the researcher opted to conduct the
study in Eatonville for several reasons. It was felt that a
predominantly black community would present a more
homogeneous group of elderly persons. Also, it was believed
that black traditions and social support systems would be
most viable and visible in a community which had a long¬
standing identity as an autonomous community rather than
being just a semblage of neighborhoods. Eatonville was
selected because it closely fit the model of a community
which was nearly all black with some historical identity as a
separate community of black citizens.
Answers to the above questions have implications for
policy makers. A study such as this should also have
implications for the discipline of sociology, especially to
the fields of social gerontology and medical sociology, since
black elderly persons and their need for health and other
care as a group represents a source of potential research
interest and constitutes a segment that has received very
little study. However, the focus is primarily applied and
descriptive social research addressing the physical, social,

5
mental, and financial welfare of noninstitutionalized black
elderly persons, (aged 65 years and over). There is little
theoretical development in the literature on which to build,
and neither testing nor construction of theory is a goal of
this research. Rather, the goal of this research is to
provide a description of the informal and formal care given
to black elderly persons based on their perceptions and
descriptions and on the researcher's own observations. The
notion of caregiving having been introduced, an overview of
the elderly in America will be presented.
America's Elderly: An Overview
There are today approximately twenty-seven million
persons aged 65 and over in the United States, comprising 12
percent of our population (U.S. Bureau of the Census, 1984).
This translates into approximately one in nine Americans who
are aged 65 years and over. Older persons today are
categorized as falling into three groups: the young-old, 65
to 74; the old-old, 75 to 84; and the oldest-old who are
those aged 85 years and over. Demographic shifts are evident
due to the rapid graying of America in the decades of the
1970s and the 1980s as well as projections for the 1990s and
well into the twenty-first century. The trend is toward a
progressively older society. By the year 2030, when the core
of the baby boom generation reaches retirement age, the
projection is that over one in five Americans will be aged 65
or older (U.S. Bureau of the Census, 1984). It is also

6
estimated by the Census Bureau that the very old, those 85
and older, will increase from 2.7 million today to 8.6
million in 2030 and 16 million in 2050. These shifts have
forced the polity into the realization that there is need for
the creation of more support systems to care for these
elderly persons.
The proportion of people who are elderly varies by race,
ethnicity, and sex. People aged 65 and over make up 12
percent of all whites, 8 percent of blacks, 6 percent of
Asians, and 5 percent each of the Hispanic and American
Indian populations (Hess, 1986). Despite the goal of the
1965 Older Americans Act to enable the aged to maintain
independence and to improve the quality of their lives, the
practice of institutionalizing functionally impaired older
people continues unabated (Olson, 1982). The problem is not
so much with current numbers of persons institutionalized,
but with the rate of institutionalization. This is, a 2
percent rate of institutionalization in 1910 amounted to
80,000 persons, whereas the 1980 rate (at 5.0 percent
institutionalized) translates to over one million elderly
persons living in institutions, a better than tenfold
increase (Olson, 1982). If the rate of institutionalization
continues to increase as the population ages, then by the
early twenty-first century the numbers of persons in such
care will grow still further. Despite increases in the rate
of institutionalization, there still remains a large

7
percentage of elderly persons (95 percent to 98 percent) who
are not institutionalized at any given time. Blacks make up
11.69 percent of the United States (US) population. That is
26,488,218 persons (U.S. Bureau of the Census 1980). Of the
population of black persons in the United States,
approximately 2.2 million are over the age of 65 years.
Elderly black people have many problems that elderly white
people do not have. This situation is referred to by some as
double and triple jeopardy (Jackson, Kolody, and Wood, 1982;
Kart, 1985). That is, they have the problem not only of
being elderly, but complicating this are the features of
being black and, for the majority, of being poor. Black
females have quadruple jeopardy, that is, of being old,
black, poor, and female.
Because of the uniqueness of their situation, blacks
should be studied separately as a subgroup of the elderly
population who have special needs and who need special
attention from researchers. As early as 1968, Billingsley
pointed out that, even though the black family system is one
institution in a complex of various American institutions,
the black family cannot be totally understood or interpreted
from a general (white) analytical framework. The limits of
using a general analytical framework have been evidenced
through various studies. Areas such as poverty and kinship
patterns are very important in any study relating to black

8
families. The same does not hold for the general U.S.
population.
Poverty is suffered by large numbers of elderly black
people today; in 1981, 39 percent of elderly blacks lived
below the poverty level (U.S. Bureau of the Census, 1981).
The systematic racial discrimination tolerated in the United
States during the early decades of this century resulted in a
lack of education for this cohort of individuals leading to
lack of professional qualifications for the majority and
hence the impossibility of procuring high-paying jobs. This
led to marginal occupations and dependence on social services
agencies throughout the life of many blacks, and gave them
little access to private pensions. In the case of black
elderly people, this helps to explain the fact that few of
them are found in retirement villages, retirement
condominiums or such. Institutionalized racism exacerbates
the economic situation. Most blacks still feel uncomfortable
in white dominated communities.
Kinship patterns among blacks also contribute to the
preference that blacks have for remaining at home to the end
of their days. It has been claimed and it is generally
acknowledged that the black kinship network is more extensive
and cohesive than kinship bonds among the white population
(Staples, 1981). Research shows that for blacks the kinship
network serves its members most effectively as a functional
mutual aid system (Mindel, 1986) . Numerous studies have

9
shown the positive effects of kinship networks among blacks,
but there are others that have found relatively few
differences by race among elderly people in participation
with family and kin (Heiss, 1975).
Most black elderly people have experienced extended
family arrangements. The offspring of black elderly persons
have traditionally felt responsible for their care and
welfare, whether they be parents, grandparents, or other
blood relatives. Even close family friends are ofttimes
afforded the same treatment as family in black communities;
sometimes such persons are termed "fictive kin.”
Blacks have always been known to be religious. Churches
and friendly societies all cater to elderly black persons,
filling the gaps left void by government. Out of these
informal institutions have sprung such organizations as
Dorcas Societies and similar groups which have taken care of
clothing the poor. Black elderly women especially, while
benefiting from these organizations, also contribute a great
deal to them in terms of service. They voluntarily do sewing
and craft as means of helping each other.
The survival pattern for whites has always been better
than that of non-whites. However, the difference in life
expectancy at birth for whites which was 15.9 years higher in
1900-1902 than it was for blacks had, by 1982, decreased to a
4.9 year difference for females, and a 6.6 year difference
for males (U.S. Department of Health and Human Sciences,

10
National Center for Health Statistics, Monthly Vital
Statistics Report, 1983) . In 1983 life expectancy at birth
for white males and white females in America was 72 years and
79 years respectively, while for black males and black
females it was 65 years and 74 years, respectively (U.S.
Department of Health and Human Services: Report of the
Secretary's Task Force on Black and Minority Health, 1985).
The lower life expectancy of blacks has been attributed to
their generally lower socio-economic status in the United
States (Butler and Lewis, 1983).
It has, however, been found that reversal occurs at a
certain age. At that age which has been termed the
"crossover point," blacks begin to show a greater survival
rate than whites (Comely, 1970; Heiss, 1975; U.S. Dept, of
Health and Human Services, 1985). In 1976 the crossover was
found to occur at age 65 for men and 72 for women. This
"crossover" was first reported in 1968 (Heiss, 1975), but the
explanation for it was unclear and it was attributed to the
"survival of the strongest." This is still used to explain
this phenomenon (Mantón, 1982; Markides, 1983). Although
blacks comprise about 11.69 percent of the total population
in the United States, black people make up only 8 percent of
the older age group. Black older women outlive black older
men. The .ratio of black women per 100 black men increased
from 115 in 1960 to 131 in 1970 and black females make up

11
56.7 percent of the total black aged population (Butler and
Lewis, 1983).
Marital Status
The majority of men over 65 years in the United states,
even those aged 75 and older, are married (79.8 percent in
1983), and living with their wife. In contrast, the majority
of women over 65 are not currently married (U.S.Bureau of the
Census, 1984a). Several factors contribute to the
probability that an older man will have a wife with whom he
will be living. One well known factor is that men typically
marry women who are younger than themselves while society
still discourages women from marrying men who are younger
than they are. This difference is exacerbated by the lower
life expectancy of males. Another factor is that the
remarriage rates of older men are higher compared to women
(U.S. Department of Health and Human Services Survey
1983b:7). In 1980, among nonmarried persons aged 65 and
over, men remarried at nine times the rate of women. The
result of this situation is that most older women are widows.
There are at least three times as many widows as widowers to
be found in the U.S. (Hess, 1986).
Among black elderly persons whether male or female, a
lower percentage are married both in the young-old period and
in the old-old period when compared to white elderly persons.
Substantially more black elderly persons are widowed and
divorced than are white elderly persons (Mindel, 1986). For

12
black women, aged 75 years and over, 78 percent are reported
as widowed in 1983 (U.S.Bureau of the Census, 1984). The
shorter life expectancy of black men is an important
contributory factor, leaving a black woman widowed much
earlier than a white woman.
Health Status
As people get older their resistance to new diseases
declines. Verbrugge (1986) states that chronic diseases
developed earlier in life tend to deteriorate, and although
acute conditions are less frequent in older persons, the
recovery period for them is longer. "Health status refers to
measures of illness, injury, and symptoms, including people's
own evaluations of their health, interview reports of health
problems, and data from medical examinations" (Verbrugge,
1986:182). Closely associated with, or linked to, health
status is "health behaviors." It is common knowledge among
health care professionals that health behaviors impact very
strongly on health status. "Health behaviors refer to all
curative and preventive actions, relating to short-term
disability ('restricted activity'), long-term disability
('functional limitations'), use of health services, and use
of medications" (Verbrugge, 1986:182). Culture plays a major
role in any analysis of health behaviors in that "cultural
patterns and typical ways of life give substance to the
manner in which illness is perceived, expressed, and reacted
to" (Mechanic, 1978:55).

13
There are some health problems which are common
companions to old age. These are heart disease, cancer,
cerebrovascular disease and hypertension. Heart disease has
been identified as the principal cause of death among the
elderly and accounts for a great deal of morbidity,
disablement, and inactivity in older people (Kart, 1985).
The incidence of cancer increases with age; hence, older
people should be encouraged to have periodic preventive
medical examinations. Cerebrovascular disease which
manifests itself as a stroke is the result of impaired brain
tissue. Cerebral thrombosis is a main cause of stroke in the
elderly. Kart (1985) notes that as many as one in four older
people have hypertension, or high blood pressure. Other
prevalent elderly-related health problems, which are
bothersome though less life-threatening, are arthritis,
digestive disorders, foot and skin problems, and chronic
respiratory symptoms (Verbrugge, 1986). Other health
problems associated with aging are the decline of sensory
(vision, hearing, balance) and mental faculties and the
weakening of bones and muscles. A popular manifestation of
bone weakening is osteoporosis especially in elderly females.
Elderly black persons demonstrate different
configurations regarding certain chronic diseases. There is
a higher incidence of hypertension among elderly black
persons. The incidence of diabetes is also reported to be
higher in elderly black persons. The same is true for

14
certain types of cancers (lung, esophagus, prostate, stomach,
cervix, uterus, multiple myeloma, pancreas and larynx). In
fact, it is reported that blacks have the highest overall age-
adjusted cancer rates (for both incidence and mortality) of
any U. S. population group (Report of the Secretary's Task
Force on Black and Minority Health,1986a. 1986b).
Health data confirm that older men are more seriously
ill than older women, but the data also indicate that older
women are more frequently ill than men. "Data on subjective
perceptions of health status, acute and chronic conditions,
and disability for acute and chronic conditions support this
conclusion" (Verbrugge, 1986:185).
When the health problems of elderly persons are analyzed
according to gender, older women are found to have more acute
and more chronic conditions; they are bothered more by their
chronic conditions, but these diseases are seldom life-
threatening. Older men have higher rates of life-threatening
conditions, which lead to employment restrictions and earlier
death. Attitudes and behavior toward illness may be very
important in explaining sex differentials in short-term
disability, limitations and death among older people
(Verbrugge, 1986) .
The overall level of health of America's aged has not
changed greatly since 1970: "while there are proportionately
more chronically ill very old people, the younger aged are
reported to be in better health than in the past" (Hess,

15
1986:17). Nine-tenths of the elderly describe their health
as fair or better compared with other people their age
(U.S.Bureau of the Census, 1983), and over half report no
limits on any major activity because of health
considerations. By age 85 years and over these figures
shift, with half reporting themselves unable to carry out a
major activity because of poor health. In 1980, as in 1965,
four of five older people reported having at least one
chronic condition, although in most cases this did not
interfere with major activities (Hess, 1986).
Health status plays a major role in caregiving for
elderly persons. It is a key determinant in their living
arrangements.
Living Arrangements
The 95 to 98 percent of America's older people who are
not institutionalized live in the community, and most live in
their own households. Seventy-one percent of all persons
over 65 own their own home (Woodward, 1986). Those who do
not live in their own homes have a variety of housing
arrangements available to them depending on their health and
economic status.
Living arrangements of older people has been classified
as living alone (complete independent living), living with
non-relatives, living with a spouse, living with other
relatives, and not living in a household (Shanas, 1962;
Wilson, 1977). A variety of factors impinge upon and

16
determine which of the five arrangements will be selected by
or for individual elderly persons. These factors include
marital status, sex, functional impairments, race, income,
health status (both mental and physical), and attitudes.
The vast majority, approximately 95 percent, of all aged
persons, live independently in the community, either by
themselves or, more often, with a spouse, family, or friends.
Butler and Lewis (1983) report that of every ten older
Americans, seven live in families. Approximately one fourth
live alone or with nonrelatives. This situation differs for
men and women. Women are three times more likely to live
alone or with nonrelatives.
The frequent statement that most older black people live
in extended families is only a myth. Studies have shown that
"50.2 percent of black persons over the age of 60 years lived
alone or with only one other person, relative or nonrelative,
while 16 percent were found to live entirely alone" (Butler
and Lewis, 1983:27). There is also evidence that 11 of every
100 older blacks have no living relatives, compared to 6 of
100 whites (Butler and Lewis, 1983). Data contrasting men
and women show that half of all black older men live with
their wives. But again, because of a longer life span, only
one fifth of black older women live with their husbands
(Butler and Lewis, 1983).

17
Housing Alternatives
In the United States, residences available to the
elderly are Adult Foster Homes, Adult Congregate Living
Facilities (ACLFs) or Congregate Housing, Senior Citizens
Lodge and Home Care, and Granny Flats. There are also
personal care boarding homes, commercial boarding homes,
congregate care homes, congregate care, life care or
continuous care, retirement villages, and shared living.
The old are anything but homogeneous. These people lead
vastly different lives depending upon their situation.
Living arrangements of men over 65 differ markedly from those
of women. Similarly, the living arrangements of people with
children differ from those of persons without children.
Grouping together all older people would therefore only
obscure these important differences. Differences in marital
status are responsible for many of the differences in the
living arrangements of men and women, black and white.
The most recent data on marital status of elderly women
reflect a most striking change in living arrangements of any
age or sex group over the past two decades: the decline in
older women who live with other relatives (from 19 to 10
percent between 1965 and 1981) and the commensurate rise in
the proportion living alone (from 31 to 40 percent during the
same period). The major contributory factor to this shift is
economics, giving older women more independence today than
they had two decades ago. More older women are now able to

18
afford independent residences and maintain their own
automobiles. In some cases this is due to the liberalization
of Social Security benefits and the introduction of Medicare
in 1965 (Hess, 1986) .
With the concept of shared housing (not only intra- but
also intergender) becoming more popular, in the future we
might expect to see more widows and widowers who are not
married living together in the same household. In 1983 there
were about 120,000 households in which a nonmarried couple,
one of whom was 65 and over, lived together (U.S. Bureau of
the Census, 1983d).
State of Health
The state of health of the elderly plays a major role in
deciding their living arrangements. The greater the number
of chronic ailments that older persons have, the less the
likelihood of their living alone. This situation is
compounded if the impairments result from severe impairments
of vision or mobility. Increased frailty and incapacity can
necessitate that an older person not living with a spouse,
and who has grown children, change his or her living
arrangements. That is, he or she may move in with one of his
or her children. The physical condition of the very sick
older person forces him or her to be much more dependent upon
family members not only for physical care but for
companionship and social activities.

19
In the absence of children, an older person may move in
with a relative, or have a relative move in with him or her.
In situations such as these, they mutually decide who should
be head of the household.
Sometimes elderly dependent parents move from one
section of the country to another to share a child's home,
paying something towards the rent. If their health is fairly
good, some are able to help with babysitting while their
children go to work. Some are also able to help with
housework.
Visitation by Family and Friends
One important aspect of an older person's life is
receiving visits from relatives and friends; older people
therefore prefer to live near at least one child. This
allows them to see their children often. Visiting their
children or receiving visits from them contributes to the
life satisfaction of older persons. This is further enhanced
if there are grandchildren present. Some may see their
children as often as once per week while others receive
visits only on special holidays such as Christmas, Easter and
Thanksgiving. Family anniversaries may also merit visits
especially from those who live far away.
Most older people are long-time residents in the areas
in which they live and are able either to visit or receive
visits from neighbors. However, an older person may
sometimes find that he or she has outlived most of those who

20
once were visiting neighbors. Visits from relatives, other
than children, also play a major role especially for those
older persons who do not have children. Other people such as
clergymen, church visitation groups, and welfare workers may
form a part of the visiting group. A survey carried out
about three decades ago demonstrated that in general, persons
without living children appear to be the most isolated group
in the aged population (Shanas, 1962).
Today there is expected to be less isolation as we find
that elderly persons can choose the type of living
arrangement which best contributes to a reduction in
isolation and hence enhances their life satisfaction. The
myth of the isolated elderly no longer has strong support
(Aldous, 1987). The Older Americans Council plans various
activities, and provides meals-on-wheels delivered by
volunteers. These volunteers play a double role. As they
deliver meals they also use this time to visit. To reduce
loneliness experienced by some elderly persons, there is day
care designed especially for the elderly and there is low
cost congregate living which moves the older person from
living alone to living with others. Those who are more
affluent may move into retirement villages where activities
are designed to keep them from being lonely and bored.
Racial-Constraints
Living arrangements may differ according to race. More
older blacks than whites do not live with their spouses.

21
This has been attributed to the greater economic pressures on
black families, including unemployment and public welfare
laws that encourage black men to leave home early in life.
The lower socioeconomic status of the majority of black
elderly persons also militates against them living in
expensive retirement facilities.
It has often been posited that black elderly persons
live in extended families. Thus, isolation has never been
seen to be a problem with black elderly people. Shifts have
been seen however, in the living arrangements of elderly
blacks. An examination of multigenerational households in
the U.S. population found that a major change had occurred
suggesting that elderly people who might have lived with
their kin have gradually shifted to living alone (Mindel,
1979). This is an indication that black elderly persons are
more similar to whites than previously supposed in that among
the black elderly there is almost as great a tendency for
them to live alone as there is among whites (Mindel, 1986).
Cantor et al. (1979) found that a larger number of black
elderly women were likely to report themselves as heads of
households than was the case among white families. They
contend that this sharing of limited resources suggests a
positively adaptive method of meeting the pressures of
poverty and unemployment within a functional family system.
Mindel (1986) observes that among black Americans there is a

22
greater likelihood that an elderly female will be a head of
household.
Older people want to continue to live in their own homes
as long as possible irrespective of their race and whether or
not they have children. The common belief that older people
in the United States are isolated either physically or
socially has not been proven. On the contrary Shanas (1962)
concluded from a survey that when older people had children
they generally lived close to at least one of them.
Furthermore, older people see their children often. Even
children who live at a distance apparently try to see their
parents on major holidays and other special occasions. While
marital status, health status and gender play a major role in
determining the living arrangements of older people today,
because of the available social supports, most older persons
can fit into one form or another of living arrangement and
avoid institutionalization.
Geographic Distribution
Older people, both black and white, live most frequently
in central parts of cities and in rural locations. The
residence patterns of older black persons show a somewhat
different configuration than that of older people as a whole.
Three-fifths still reside in the South, many in rural areas,
but because of the large numbers that moved to urban areas in
the black rural-to-urban migrations of the early 1900s, older
black persons are now also concentrated in central cities,

23
primarily in those areas with the worst housing. By 1970,
one of two older blacks lived in central city locations. In
1980 black elderly remained heavily concentrated (68 percent)
in the central core of older cities (Hess, 1986). Many are
trapped there under the dual influence of economic hardship
and a continuing racism that tends to preserve the suburban
areas for whites.
Standards of Housing
It has been estimated that up to 30 percent of older
persons in the U.S live in substandard housing largely as a
result of outright poverty or marginal income. Many of these
have become substandard as the costs of maintenance,
utilities, and property taxes have so skyrocketed that upkeep
and needed improvements have become impossible for many
elderly homeowners. Government subsidies for maintenance
have been a great help recently because most elderly people
live on fixed incomes. Those who do not live in their own
homes either live alone, with relatives or friends or in
retirement facilities. Some older people live in public
housing, "often seen by them as a highly desirable resource
in view of the wretched alternatives available. Many are so
poor that they cannot even afford public housing and some of
these are forced to reside in single room occupancy (SROs)
hotels embedded in a fierce environment peopled by petty
thieves, pimps, prostitutes, addicts, and hustlers"
(Stephens, 1976).

24
Income of the Elderly
Poverty, like substandard housing, is typically
associated with old age. People who are poor all their lives
can expect to become poorer in their old age and elderly
blacks are especially plagued by poverty. In fact, it is
reported that the rate of poverty among older blacks is twice
that of older whites. "In 1984 the median income for black
males over the age of 65 was $6,163 compared to $10,890 for
white males. For black females the 1984 median income was
$4,345, while for white females the figure was $6,309"
(Johnson, 1988:101). Blacks have often been employed in the
service industry and in seasonal jobs. In the competitive
sphere of job situations one could say that they are at the
bottom of the heap. Many blacks have few work skills, and
discriminatory hiring practices common throughout the society
render some virtually unemployable. Jobs generate only
sporadic and minimal income. Carp's (1972) study of the
occupational characteristics of the aged slum dweller show
that
retirement—usually from menial jobs that provided
no security, tenure, or fringe benefits—has not
been an event that occurred on a given day, but was
rather the culmination of increasingly frequent and
lengthy periods of time during which these
individuals were unable to obtain employment.
(Carp, 1972:57)
These observations fittingly describe many blacks. It has
been noted that some find more or less steady conventional
jobs in low-paying, low-skill services, working as waiters,

25
dishwashers and cleanup helpers. These are jobs with
abysmally low pay scales, little security, and poor working
conditions. All of these contribute to their dependency on
Social Security and Welfare. The economic status of elderly
persons dictates their living arrangements to a great degree.
It is also a determinant of caregiving and plays a major role
in health status, health beliefs and education.
Plan of Research
To reiterate, the purpose of the study is to examine the
level and type of caregiving of elderly persons in a black
community. It was assumed that by going into the community
and studying it through interviews and observations, other
questions and issues that affect black elderly people would
surface. The intention was to explore the use of formal and
informal networks in order to test whether friends, kin,
church, and neighbors provide a pivotal resource for
responding to the needs of elderly persons in the community.
In order to examine caregiving of black elderly persons,
this research concentrates on the age group 65 years and
older taking care in some instances to compare and contrast
the care-giving network as it affects the young-old, those 65
to 74 years of age; the old-old, those 75 to 84 years; and
the oldest-old, those who are 85 years and over. The
research methodology employed is based on the view that data
needed to understand caregiving at this stage of our

26
knowledge are best gathered through qualitative research.
Certain information can only be garnered from field
research.
Chapter Two addresses black families and black elderly
persons in the United States. An analysis of black families
is germane to the study of black elderly persons and a review
of previous research on black elderly persons is in turn
necessary for studying a group of black elderly persons in a
particular community. It is necessary to have as clear as
possible an understanding of this racial group before
attempting an assessment of its elderly subgroup. This
chapter also analyzes the demographic characteristics of
black families and black elderly persons. The aim is to
bring into focus changes concerning the diversity of black
family patterns and the theories that are used to study
today's black Americans. The major demographic areas
addressed are (1) family composition, (2) marriage and
divorce and (3) education, employment and income. Black
elderly persons are analyzed in terms of health problems
and kinship in addition to the general demographic
patterns.
Chapter Three presents a review of caregiving by formal
and informal support systems. The chapter begins with a
brief introduction which is followed by an overview of
caregivers and caregiving including the literature, the
formal support system, the informal support system,

27
impairments of elderly persons, activities of daily living
(ADLs), instrumental activities of daily living (IADLs),
support systems for elderly black, persons, and caregiver
stress and burden. The chapter ends with an analysis of
caregiving and black elderly persons followed by a brief
summary.
Chapter Four contains a description of the methodology
used and the setting in which the field research took place.
Data were gathered from a convenience sample of 71 elderly
persons and/or their primary caregiver where this was
necessary.
The findings from the field research are presented in
descriptive form in Chapter Five supported by a quantitative
analysis of forty independent variables. A description of
the elderly people of Eatonville as well as their caregiving
networks is included. Family, impairments and caregiving are
addressed. Vignettes are utilized to demonstrate the various
ways in which the elderly persons of Eatonville access and
utilize formal and informal support systems either separately
or combined.
Chapter Six contains conclusions and implications. The
potential impact of this study lies in its assessment of how
factors relating to caregiving affect the well being of black
elderly persons. It is hoped that local, state, and national
programs designed for older persons will eventually shift an
emphasis from support for the institutionalized to support

28
for the elderly person living at home, paying special
attention to black elderly people. Such a shift will
influence the life satisfaction and wellbeing of older black
persons in positive ways.

CHAPTER TWO
BLACK FAMILIES—BLACK ELDERLY PERSONS
Of all social institutions, the family is perhaps the
most basic (Tischler et al., 1983). Sociologists view
institutions as systems of social norms and norms are
society's rules of conduct for its members (Leslie, 1979).
The family can be studied either as an institution or as a
social group. Leslie (1979:22) points out that
when the family is viewed as a social institution,
the norms governing family forms and functions are
emphasized. [However], when one focuses upon the
family as a social group, attention is directed
more toward its internal functioning than toward
its relationships with other aspects of the
society.
Definition of Family
It is difficult to find a definition of family general
enough to cover the family as it exists in all societies, but
a generally accepted typology of families includes the
concepts of nuclear family and extended family. A family has
traditionally been defined as a married couple or group of
adult kin who cooperate and divide labor along sex lines,
rear children, and share a common dwelling place. A variety
of family forms have emerged to challenge this definition.
Examples of these are single-parent families, cohabiting
families, blended families, families without children, and
29

30
gay and lesbian families (Strong and DeVault, 1989). Strong
and DeVault (1989) propose a contemporary definition which,
in order to include these diverse forms, would define the
family as one or more adults related by blood, marriage, or
affiliation who cooperate economically, share a common
dwelling place, and may rear children.
The classical definition of family, of which we now see
variations is that given by Peter Murdock (1965) in his book
Social Structure. Murdock's definition states that
the family is a social group characterized by
common residence, economic cooperation, and
reproduction, and consists of a male and female
adult and their offsprings or adopted children.
(Murdock, 1965:1) .
Murdock used husband/wife and therefore implied legal
marriage. He later distinguished marriage and the family.
Murdock's definition really speaks about the structure of the
family, and implies the makeup of a family. He refers to a
nucleus of individuals. His nuclear family is approximately
the same as Levi Strauss's conjugal relationships. While
nuclear stresses the husband-wife relationship, extended
family is used to imply parent-child relationship applying to
a type of family which usually comprises three generations,
that is, man, spouse, their children, their children's
spouses (especially sons), and their children living either
in the same household or very near to each other with some
cooperative domestic arrangement. Extended family is the
same as consanguine, implying blood relatives. The nuclear

31
family tends to be a small unit, whereas the extended family
is a larger unit. The nuclear family, because of its size,
is more applicable to living in modern societies and the
extended family to living in more traditional societies.
Authority structure differs in the different family systems.
The nuclear unit tends to be patriarchal, implying that
authority is vested in the male. It is, however, sometimes
matriarchal.
Functions of the family are central to life, culture,
and society. Functions of the family were long seen as
providing a source of intimate relationships, acting as a
unit of economic cooperation, producing and socializing
children, and assigning status and social roles to
individuals. It is contended, however, that while these
are the basic functions that families are "supposed" to
fulfill, families do not necessarily have to fulfill them
all. Strong and DeVault (1989) suggest that technology,
industrialization, mobility, and other factors are altering
the way the family performs its functions today. The
question as to whether every family performs these basic
functions leads to the debate over the universality of the
family. The United States with its numerous ethnic and
racial groups supplies various family forms which could be
studied cross-culturally. To this end, the present review of
black families in the United States addresses black people as
a sub-group of the society and discusses family forms of

32
blacks, that is, residence, forms of marriage, authority
structure, and functions of black families. The area of kin
relationship will also be addressed since kinship is germane
to any study of black families and black elderly persons in
particular.
Black Families
Knowledge of black families must form the basis for
studying any segment of black communities since the family is
intricately tied to the society. A diversity of black family
patterns exists in the United States and it is maintained
that different family forms prevail at different class and
income levels throughout the American society. This has led
to the conclusion that the black family is itself a fiction
(Glick, 1988). Hence, this study will analyze 'black
families' rather than 'the black family.'
Family forms of blacks can be analyzed in terms of
residence, forms of marriage, authority structure, functions
of black families and kin. In this analysis of black
families three major demographic areas are addressed. These
are family composition; marriage and divorce; and education,
employment, and income. The strengths of black families is
also addressed.
Studies of black families date as far back as the early
1900s and can be found in the works of W. E. DuBois (1969),
Franklyn Frazier (1932), Melville Herskovits (1930, 1941),
and Drake and Cayton (1962). Others such as John Dollard

33
(1937) conducted community studies in the South in the 1930s,
focusing on the prevailing caste system and its effect on
social life. Hylan Lewis (1955) carried out a community
study among blacks in a North Carolina town. Virginia Young
(1970) conducted research among southern black populations.
Molly Dougherty (1978) carried out research among black girls
and described how they developed into women in a rural black
community in North Central Florida. Very little research on
blacks was carried out in the 1940s and the 1950s.
Research among black populations and black families in
the United States has been influenced by the sociological
tradition and contributions of both Frazier (1932, 1939) and
Herskovits (1930, 1941). Frazier (1939) referred to the
instability of marital unions among "New World" blacks, as
well as the lack of social support for the man to operate
effectively in the male or father role. He emphasized a
structural explanation, to replace an explanation based on
African cultural survival in vogue then. He also formulated
some significant generalizations about the effects of slavery
upon the family life of American blacks. With respect to New
World blacks, he observed that black Americans were trying to
build a stable life after the almost total social
disorganization of slavery and in a society which continued
to be hostile and discriminatory. Frazier argued that the
effects of emancipation on black families resulted in

34
problems affecting today's black family. Frazier (1939:81-
85) wrote
mobility of the black population after emancipation
was bound to create disorder and produce
widespread demoralization. Promiscuity, and
confusion in marital relations would be evident
while marriage as a formal and legal relation was
not a part of the mores of the freedmen. The
severe hardship on Negro "families" after
emancipation left them without any means of
subsistence. Where families had developed a fair
degree of organization during slavery, the male
head assumed responsibility for their support.
Frazier noted that this severe hardship became a test of
the strength of family ties. Two general tendencies are
manifest in the fortunes of the Negro family dating the
period of its adjustment to the state of freedom. For those
families that had achieved a fair degree of organization
during slavery, transition was easy. Authority of the father
was firmly established in these families, and the woman in
the role of mother and wife fit into the pattern of a
patriarchal household. Roles were fairly clearcut, and the
father became the chief, if not the sole breadwinner thus
demonstrating that he had assumed the respKsibilities of his
new status. Sometimes he acquired land of his own and
thereby further consolidated the common interests of the
family group (Frazier, 1939). The second tendency is that
the loose ties that held men and women together in
a nominal marriage relation during slavery broke
easily during the crisis of emancipation. When
this happened, the men cut themselves loose from
all family ties and followed the great body of
homeless men wandering about the country in search
of work and new experience. Sometimes women,

35
primarily those without children, did the same.
(Frazier, 1939:88)
Historically emancipation locked black families into two
groups, in which many today still find themselves. Most
studies would have us feel that the latter group is the most
dominant and some scholars' descriptions of black families
have implied that their members are shiftless and uneducated.
Herskovits (1930), in his study of New World black
families, noted that a close bond existed between mother and
child. He also noted the peripheral status of the man or
father, implying matrilocality and marginality. His
conclusion was that these patterns were vestiges of African
systems. Herskovits has been acclaimed as one of the first
scholars to recognize similarities in African cultural
patterns and those of African descendants living in the
United States, the West Indies, and Brazil. It is said that
one of his major contributions was a more realistic
conceptualization of family life in traditional African
societies, which are characterized by unity, stability, and
security (Dodson, 1988) .
Negative assumptions have been made about blacks in
general and about black men in particular. The main ones are
that they do not want to work and are disinterested in their
children. Such pathological and dysfunctional views of black
families, associated with the work of authors such as Daniel
Patrick Moynihan (1965) in the "Moynihan Report," have
elicited responses in defense of black families. One such

36
response comes from the writer and sociologist William Ryan.
Ryan's (1976) work, Blaming the Victim, serves as an
excellent rebuke to all those who place all the blame for the
black person's ills on the black person himself. In
pondering the thought processes of victim-blaming, Ryan
analyzes a new ideology which he sees as very different from
the open prejudice and reactionary tactics of the old days.
Its adherents include what he calls "sympathetic social
scientists with social consciences in good working order and
liberal politicians with a genuine commitment to reform"
(Ryan, 1976:7). Continuing his chastisement of this group of
victim blamers, Ryan (1976:6-7) states that
they are very careful to dissociate themselves from
vulgar Calvinism or crude racism and indignantly
condemn any notions of innate wickedness or genetic
effect. The Negro is not born inferior they shout
apoplectically. Force of circumstance, they
explain in reasonable tones, has made him inferior.
They dismiss with self-righteous contempt any
claims that the poor man in America is plainly
unworthy or shiftless or enamored of idleness.
They say that he is caught in the cycle of poverty.
He is trained to be poor by his culture or family
life, endowed by his environment.
The culture of poverty theory has also been used to
analyze black families and became a part of the
infrastructure of black ills. Oscar Lewis (1966) carried out
studies in Puerto Rico and referred to unstable family forms,
mating patterns and poverty. It was Lewis who used the term
"Culture of Poverty" to imply that the poor "in time" come to
represent a certain sub-culture of poverty. This "culture of
poverty" syndrome has been assigned to black persons in the

37
United States because they are usually seen as having
unstable family forms and mating patterns and as being
necessarily poor. Lewis' "culture of poverty" theory as
applied to black people in the United States, has, however,
been rejected. Ryan (1976) draws our attention to "those who
would want us to believe the myth regarding the culture of
poverty, that it produces persons fated to be poor, in order
to blind us to the fault of a corporation dominated economy"
(Ryan, 1976:120). Ryan also addresses the myth that black
families produce young men incapable of achieving equality
which he observes is "designed to blind us to the pervasive
racism that informs and shapes and distorts every social
institution" (Ryan, 1976:120).
Attempts at demythologizing black families are to be
found in the works of several other researchers including
Joyce Ladner (1988), John McAdoo (1988), Harriet Pipes McAdoo
(1988), and Robert Staples (1971, 1981, 1985). Staples
(1985) blames the inability of black aspirations for a
traditional family life and roles on structural conditions.
These structural conditions are said to have the greatest
impact on the black male and force him to abdicate his role
as husband and father. This has had far reaching effects
resulting in what Staples sees as the most significant change
in black families during the last 30 years: the proliferative
growth of female-headed households. He notes that "when the
Moynihan report was first issued in 1965 more than three-

38
fourths of all black families with children were headed by a
husband and wife. In 1982, however, barely one-half of all
such families included parents of both sexes" (Staples,
1985:1006). This had severe consequences for black families
because of disparities in family income. Households headed
by black women had a median income of $7,458 in comparison
with the median income of $20,586 for black married couples
and $26,443 for white married couples (U.S. Bureau of the
Census, 1983) .
An examination of the situation of black families 20
years after the publication of the Moynihan report forces
Staples to ask questions such as: "How is it that a group
that regards family life as its most important source of
satisfaction finds a majority of its women unmarried?," "Why
does a group with more traditional sexual values than its
white peers have a majority of its children born out-of-
wedlock?, " and "How is it that a group that places such
importance on the traditional nuclear family finds a near
majority of its members living in single-parent households?"
(Staples, 1985:1006).
Staples sees the structural conditions of the black
population as being responsible for the problems experienced
by today's black families. "These conditions not only
denigrate the black male but reduce the quantity and quality
of black males and hence rob black females of satisfactory
potential mates" (Staples, 1985:1006). Studies have shown

39
that 46.6 percent of the 8.8 million black men of working age
were not in the labor force. Some were unemployed, some had
dropped out of the labor force, some were in prison and
almost 1 million were classified as "missing" because the
Census Bureau said it could not locate them (Staples, 1985).
The situation is further exacerbated by the number of
black males serving in the Armed Forces. Census figures
(1983) report that in 1982 a significant number (415,000) of
blacks were under arms. This figure represented 20 percent
of all United States military personnel. It is estimated
that 90 percent of these were male (Staples, 1985) .
The job situation of black males in the civilian labor
force contributes to enlistment as a choice. Instead of
being a means to an end, the Armed Forces become an end in
themselves for a large number of black males. "This results
in a rate of re-enlistments for black males which is much
higher than their white counterparts" (Staples, 1985:1009).
Socio-Demographic Profile of Black Families
Black families include a variety of family types. The
majority are either families which are maintained by a
married couple or those which are maintained by one parent
and one or more of the parent's own young children. In 1985,
81 percent of black Families were of one or the other of
these types, and the corresponding proportion for all
families without regard for race was 91 percent (U.S. Bureau
of the Census, 1986). Families which were not of either of

40
these types consist of such groups of relatives as
grandparents and their grandchildren, brothers and sisters,
and other relatives. A large percentage of black families
have young children among their members. In 1985 this figure
was 57 percent. This is a reflection of the higher birth
rate of black women coupled with the shorter survival of
black marriages (Glick, 1988) .
Single parent families are another common form of black
families. In 1985 these families represented 30 percent of
all black families while the corresponding proportion for all
families without regard for race was 11 percent (U.S. Bureau
of the Census, 1986). Factors such as the vast increase in
the divorce rate and a decline in mortality rate for young
mothers have resulted in four times as many young children
living with a divorced parent versus a widowed parent in 1985
as did so in 1960 (Glick, 1988). Glick (1988) also notes a
continual increase since the 1960s and up until the present
time, in the number of young adults who are living in the
parental home.
Education
Blacks are still more likely to attend racially
imbalanced schools representing 44 percent of black children
in the North and 20 percent in the South. They have less
education on the whole than their white counterparts, and the
education they receive may be inferior due to the fact that
the schools they attend lie mainly in poor school districts.

41
Only 8 percent of blacks compared to 18 percent of whites
have college degrees. However, blacks today have much better
prospects than their parents did. Blacks have made strong
gains in education. From 1968 to 1878, for example, the
proportion of black children in the South attending mostly
black schools dropped from 79 percent to 59 percent (Stevens,
1980). From 1970 to 1980 the proportion of black
undergraduates at American colleges jumped from 7 percent to
11 percent, while black enrollment in graduate and
professional schools increased from 4 percent to 6 percent
(Stevens, 1980).
These educational gains have led to better-paying jobs
for many blacks. For example, about 6 percent of the
nation's managers and administrators are black. Today blacks
hold about 10 percent of the positions in finance, real-
estate, and insurance. And between 1968 and 1980 the number
of blacks elected to public office in the 11 states of the
deep South increased from 156 to 1813 (Henslin and Light,
1983; Rowan, 1981).
Despite such gains, however, black persons remain
underrepresented in American politics; Wright (1979) notes
that less than 2 percent of elected officials are black.
Although black people today have better education and
increased opportunities, ethnic discrimination still
underlies their relative impoverishment. At all levels,
whether among factory workers, managers, or supervisors,

42
income gaps still separate blacks and whites, and the gap
always puts whites on top (Wright, 1979).
Economics
Although nearly one third (30.9 percent) of all black
families lived in poverty in 1984, nearly the same number
(29.4 percent) of black families had earnings above $25,000
(white median family income was $27,000 that year). Income
varies widely among black families by family composition.
While median income for all black families totaled $15,432 in
1984, it totaled $28,775 in married couple families with the
wife in the labor force, but just $8,648 for female headed
households (Malveaux, 1988). Whether black families
experience poverty, receive public assistance, or maintain
relatively high earnings, disparities between black and white
families at every income level are important (U.S. Department
of Commerce, 1985). It is important to emphasize the
diverse composition of black families, in that black families
range from single mothers who receive public assistance and
raise their children against all odds, to upwardly mobile,
dual-earner families with incomes above $50,000 per year
(Malveaux, 1988).
Marriage and Divorce
"Young adult black persons have a consistent pattern of
postponing marriage longer than persons of other races"
(Glick, 1988:119). Statistics show that there was a sharply
increasing delay of marriage between 1970 and 1985 in the

43
form of a rising percentage of persons in their twenties who
had never married (Glick, 1988). The phenomenon called a
"marriage squeeze" is held as one of the prime reasons for
this delay. The marriage squeeze as experienced today makes
it more difficult for women of marriageable age to find
husbands in their range. Back women are reported to be
especially affected by this phenomenon (Strong and DeVault,
1989) .
Staples (1985) explains that the reason why a near
majority of black Americans, especially women, are not
married and living in traditional nuclear family units
is not a result of any devaluation of marriage qua
institution but rather a function of limited
chances to find individuals in a restricted and
small pool of potential partners who can
successfully fulfill the normatively prescribed
familial roles. (Staples, 1985:1005)
The divorce rate in black families is said to be the
highest of all racial groups in the United States of America.
One in every two black marriages is said to end in divorce.
Combined data from several national surveys taken between
1973 and 1980 indicate that 37.2 percent of black males and
42.2 percent of black females who have ever been married have
divorced. This is not surprising since a large percentage of
blacks fall in the lower socioeconomic group and because of
the strong negative correlation between socioeconomic status
and divorce rates. As income levels for blacks increase,
divorce rates also decrease (Raschke, 1987). It is reported
that in 1985 there were 25 percent as many black divorced

44
persons as black married persons in the United States.
Findings suggest that the proportion of divorced persons who
remarry is lower among blacks than whites at each interval
since divorce (U.S.Bureau of the Census, 1980; Glick, 1988).
Based on findings from an earlier study conducted in 1980,
Glick (1988) notes that remarriage is more likely to be
followed by redivorce among black women 35 to 44 years old
than among women of other races of the same age.
Both cultural and structural explanations have been used
to explain black family forms. However, neither cultural nor
structural explanations by themselves can adequately account
for existing black family forms; both are needed. For
example, cultural explanations require knowledge of the
African family system, and the American plantation system,
and its patterns of mating. It was in the plantation system
that the weakening of the male role began as well as the
attempt to de-emphasize any form of family unit. Economic
production was the prime objective of the American plantation
system, but it was not encouraged within the context of the
"family life." This led to unstable relations between
managers and workers and among workers. This instability
could contribute to the claim that black marriages are less
stable (Heiss, 1975). It was only after emancipation that
the ex-slaves attempted to introduce some stability into
their family units.

45
Living Arrangements of Children
Some of the sharpest differences between the family life
of blacks and other races can be found in the living
arrangements of young children. For example, of all children
under 18 in 1985, 15 percent were black but 35 percent of
those living with a lone mother were black. The most extreme
contrast is found among children living with a mother who had
never been married—two of every three (67 percent) of these
children in 1985 had a black mother. In fact, as many black
children were living with a never-married parent as with a
divorced or separated parent (26 percent and 24 percent,
respectively).
Nearly all of the racial differences that can be
demonstrated from data present a picture of much greater
family disorganization in the living arrangements of black
children than of other young children. Even though there was
about a one-third downturn between 1980 and 1985 in the
proportion of black children living with a separated or
widowed mother, there was a doubling of the proportion with a
never-married mother (from 13 percent to 25 percent).
The rapid growth in the number of young children
living with a never-married mother is closely
related to the sharp upturn in the proportion of
births occurring to unmarried mothers. Vital
statistics reveal that the proportion of births to
unmarried mothers rose from 35 percent in 1970 to
59 percent in 1984 for black births and from "only"
6 percent to 21 percent for all races. Although
the rate of increase for black births to unmarried
mothers was not as great as that for all races, the
level is still close to three times as high as that
for all races (59 percent versus 21 percent). As

46
recently as 1960, there were more young children
living with a widowed parent than with a divorced
parent, but now four times as many live with a
divorced parent as with a widowed parent. This
shift resulted from both a declining mortality rate
for young mothers and a vast increase in the
divorce rate. (Glick, 1988:114)
Glick observes that a continuing larger proportion of
black than other children under 18 live apart from either
parent. According to the 1980 census, these children
represented 4.5 percent of the children of all races and 11
percent of black children. A significant proportion of those
children who were living apart from their parents were
residing with relatives, and the rest were living with foster
parents or in institutions. Living with their grandparents
was the most frequent form of living arrangement for those
children who were living with relatives (about two-thirds).
It is hypothesized that in these circumstances, many of the
mothers being younger, better educated, and more employable
must have left their children in the care of older relatives
while they moved elsewhere to increase their opportunities to
earn a living (Glick, 1988).
Young Adults Leaving Home
The departure of young adults from their parental home
generally occurs during their late teens or their twenties
and is a critical period for all concerned. Glick and Lin
(1986) report that up until 1970 approximately 32 percent of
the black population 18 to 29 years old were still living in
their parental homes or had returned to live there. By 1970,

47
however, the trend had turned upward and has continued to
rise. In that year, the authors note that the figure had
risen to 40 percent, and by 1984 it stood at 46 percent, well
above the 36 percent for those of all races in 1984. This
recent phenomenon of late departure from (or return to) the
parental home has also been characteristic of young adults of
all races. Factors which are said to contribute to this
include relatively high rates of unemployment, divorce, and
unmarried parenthood, as well as to more young adults
delaying marriage while they attend tertiary institutions to
further their education (Glick and Lin, 1986).
Conceptualization of Black Families
Early research among black populations and black
families in the United States has been influenced by the
sociological tradition and contributions of both Frazier and
Herskovits. Earlier works such as those of Frazier have,
however, been criticized because of their cultural
ethnocentric approach. Dodson (1988) looks at contrasting
approaches to the study of black families and compares the
cultural ethnocentric approach to the cultural relativity
approach. She notes that the pathological and dysfunctional
view of black families has been primarily related to the
cultural ethnocentric approach associated with the work of E.
Franklin Frazier (1939) and Daniel P. Moynihan (1965).
Dodson (1988) sees the works of these scholars as having
culminated in the implementation of social policies

48
predicated on the assumption that the black family is
unstable, disorganized, and unable to provide its members
with the social and psychological support and development
needed to assimilate fully into American society. Dodson
observes that studies which concentrated on the dysfunctional
and disorganized aspects of black family life have deduced
that the typical black family is fatherless, on welfare,
thriftless, and overpopulated with illegitimate children.
Inevitably they have recommended economic reforms for
"saving" black families from their own pathology (Dodson,
1988).
Opposing the cultural ethnocentric approach are those
scholars who tend to focus on the strengths of black families
rather than their weaknesses, having in most instances traced
the origins of these cultural differences back to black
Americans' African cultural heritage. The cultural
relativity school begins with the assumption that black
American culture and family patterns possess a degree of
cultural integrity that is neither related to nor modeled on
white American norms (Dodson, 1988). Dodson sees the
cultural relativistic view as having been developed primarily
as a reaction to the deficit view. Proponents of this view
maintain that the black family is a functional entity.
Dodson observes that this conceptualization is designed to
challenge the theories and social policies emanating from the
ethnocentric approach. However, she is aware of the common

49
assumptions underlying the theoretical and empirical
arguments of the two schools. That is, that black and white
families are qualitatively different culturally. She notes,
however, that this assumption is not shared by all students
of black family life. Proponents of the cultural relativity
view include Andrew Billingsley (1968), Robert Hill (1972),
Wade Nobles (1974), and Virginia Young (1970). The consensus
among these scholars is that black Americans' cultural
orientation encourages family patterns that are instrumental
in combating the oppressive racial conditions of American
society. There is, however, a variation in their individual
assessment of the degree to which African culture influenced
the culture of black Americans (Dodson, 1988) . In examining
the American black family, proponents of cultural relativism
in North America point out that slavery did not totally
destroy the traditional African base of black family
functioning (Dodson, 1988). Dodson cites the works of
Blassingame (1972), Nobles (1974), and Turnbull (1976).
Research has also found that black families are not
disorganized or dysfunctional. Young (1970) observed
patterns of high illegitimacy rates and frequent marital
dissolutions usually associated with disorganization.
However, these patterns were interpreted by the researcher as
natural to the emotional underpinnings of the family system
and thus, functional. The central position of the female in
the domestic organization is thought to be related to the

50
restrictions on black male participation in the economic and
political institutions of the wider society throughout the
Western Hemisphere (Dougherty, 1978; Scanzoni, 1971) .
Historically, family theorists have argued that family
structure and achievement interact with one another (Parsons
and Bales, 1955). While that may have some validity for
certain ethnic groups in America, none of those groups share
the history and current social conditions of the black
population in the United States (Staples, 1985). According
to Staples (1985) "the peculiar history of black Americans,
combined with structural conditions inimical to family
formation and maintenance, have precipitated a crisis in the
black family." Staples' observations have been supported by
others (Coner-Edwards and Spurlock, 1988) .
Kinship and the Extended Family
Strong kinship bonds is one of five characteristics
which have been isolated as being functional for the survival
of black families and is identified as one of the strengths
of black families (Hill, 1972). Nobles (1974, 1988) has
indicated that the black community is oriented primarily
toward extended families, in that most black family
structures involve a system of kinship ties. This idea has
been supported by Billingsley (1968), Hayes and Mendel
(1973), Hill (1972), and Stack (1974). Blacks are known to
have higher fertility rates and larger families than whites.

51
This renders them more likely to live in multigenerational
households.
At this point it may be useful to define the extended
family. The most famous definition is that given by George
Murdock (1965:2):
An extended family consists of two or more nuclear
families affiliated through an extension of the
parent-child relationship rather than of the
husband-wife relationship; that is, by joining the
nuclear family of a married adult to that of his
parents. It embraces, typically, an older man, his
wife or wives, his unmarried children, his married
sons, and the wives and children of the latter.
Three generations, including the nuclear families
of father and sons, live under a single roof or in
a cluster of adjacent dwellings.
The extended family system is assumed to provide support
for family members, either as assistance for protection or
for mobility. It is argued that the extended family in the
black community consists not only of conjugal and blood
relatives, but of nonrelatives as well. Additionally, the
prevalence of extended families, as compared with nuclear
families, is held as another cultural pattern which
distinguishes whites and blacks. Dodson (1988) argues,
however, that the extent to which such families are
characteristic of the black community has not been adequately
substantiated.
Numerous studies have shown the positive effects of
kinship networks among blacks, but there are others that have
found relatively few differences by race among elderly people
in participation with family and kin (Heiss, 1975). In

52
addition, some maintain that black people have fewer
relatives to call on in an emergency (Heiss, 1975) . Kinship
patterns among blacks are much debated and kinship is linked
to the extended family. Cowgill (1972) in his earlier work
went to great lengths to show how the elderly in developing
countries were not as dependent on their governments as those
in developed countries because of kinship patterns. This
theory has been extended to apply to black elderly persons in
the United States. Some have charged that patterns of kin
relations sometimes produce frustration and unhappiness, but
Heiss (1975), addressing this charge states that there is
little evidence to support this. Heiss concludes that people
who live in extended households are not significantly less
satisfied than those who live in nuclear homes (Heiss, 1975).
Heiss observes that this holds for several different kinds of
multigenerational homes.
Harriette Pipes McAdoo (1988) in an empirical
examination of upward mobility and extended-family
interactions in black families, examined whether involvement
within the extended-family support network was a help or a
hindrance to upward mobility. Theories related to the value
of support networks as a coping strategy of poverty and not
of culture were directly addressed. The findings indicated
that the education and achievement of the individuals were
often impossible without the support of the extended family,
and that the reciprocal extended family-help patterns

53
transcended economic groups and continued to be practiced
even when families had moved from poverty to the middle-
income level. McAdoo concluded that the continuation of the
extended-family support system reflects continued cultural
patterns and is a factor in countering the vulnerability of
the black middle class. Both factors are operational within
all of the mobility patterns.
The kin support network because it involves
cultural patterns created and retained from earlier
times that are still functional and supportive of
black family life is as essential now as it was in
earlier generations. (McAdoo, 1988:166)
Hayes and Mendel (1973) demonstrated that the extended
family is a more prominent structure for black families and
that blacks differ from whites in intensity and extent of
family interaction. Based on their study of midwestern urban
families they concluded that, with the exception of parents,
blacks interact with more of their kin than do whites. Black
families also receive more help from kin and have a greater
number and more diversified types of relatives living with
them than do whites.
Dubey (1971) examined the relationship between self¬
alienation and extended family. He concluded that subjects
with a high degree of powerlessness were significantly more
oriented toward the extended family. Dubey's study has been
credited with raising the question of whether the extended
family is used as a buffer between oppression of the dominant
society and the unmet needs of the family (Dodson, 1988) .

54
Stack (1974) proposed that the extended family is, in
part, a strategy for meeting physical, emotional, and
economic needs of black families, and involves a reciprocal
network of sharing to counter the lack of economic resources.
Kinship and the extended family are said to play important
roles in the lives of black elderly persons.
Black Elderly Persons
The number of elderly Americans who are black continues
to increase at a faster rate than the other segments of the
black population. In 1980, elderly black persons age 65
years and over constituted almost 8 percent of the black
population, that is about 2.1 million. Moreover, 7.5 percent
of the elderly or 157,000, were 85 years and older. The
"cross-over" phenomenon experienced by blacks who manage to
survive to 75 years of age has been used to explain the
tendency for this group of black people to disproportionately
outnumber others 75 years and older (Comely, 1970) . Elderly
black people were the fastest growing segment of their
population group in the decade of the seventies, increasing
34 percent. During this period the increase for the total
black population was only 16 percent (Johnson, 1988).
Because black Americans have had limited access to
supportive social services, elderly black persons have relied
a great deal on the supportive resources of their families,
and families in turn have relied on elderly relatives (Dancy,
1977). Research has shown that the larger black extended

55
family is highly integrated, is not based on female
dominance, and provides important resources for the survival
and social mobility of its members (Mindel, 1986).
In recent years, considerable new work has been done
examining the nature of the black extended kin support system
and its ability to care for its members (Aschenbrenner, 1973;
Hill, 1971; Martin and Martin, 1978; Mindel, 1980; Stack,
1974; Staples, 1981). With respect to black elderly persons,
this support system often becomes crucial, considering that
in many cases formal governmental support systems are not
always sufficient. A common theme which runs through much of
the discussion of the black family is the important function
of the black family as a social and psychological refuge for
individual members (Mindel, 1986) .
Elderly persons tend to be an important element in the
structure of black family systems. In fact Wylie (1971)
argued that the elderly are more apt to be included in the
black family structure than in white families. Cantor,
Rosenthal, and Wilker (1979) found that elderly black women
continued to carry out instrumental and effective familial
roles far beyond the period customary among whites. They
argue that elderly black women were more highly involved in a
mutual assistance system among and between family members.
It was mentioned earlier that elderly black persons
experienced what has been described as triple-jeopardy and
elderly black women quadruple-jeopardy because of their

56
position in the American social arrangement. Black elderly
persons experience great hardships because they are subject
to racist stereotypes, and the often impoverished quality of
their lives reflects this (Dancy, 1977). The socioeconomic
status and position of blacks within the United States must
be addressed in considering issues affecting the care of
elderly black Americans (Bennett, 1982; Johnson, 1988).
Johnson (1988) makes reference to the covert and overt
aspects of various forms of racism which have been
instrumental in determining both the status and position of
the black elderly. "The engineered human degradation and
oppression of racism have taken their toll on the current
population of black elderly, and will influence the well¬
being and quality of life of all black Americans for the
foreseeable future" (Johnson, 1988) . Any study of black
elderly persons in the United States must demonstrate an
understanding of the difference in demographic facts,
history, culture, and life style as against the majority
group.
Marital and Living Arrangements
Among black elderly persons, a lower percentage are
married both in the young-old, and in the old-old period than
are white elderly. This holds for both male and female
(Johnson, 1988). There is also statistical evidence that
substantially more black elderly are widowed and divorced
than are white elderly. The marital status of black elderly

57
persons in 1980 was as follows: 56.9 percent of the men were
married, 22.1 percent were widowed, 14.7 percent were
divorced or separated, and 6.5 percent were single, never
married; for the women 25.0 percent were married, 57.7
percent were widowed, 11.6 percent were divorced or
separated, and 5.6 percent were single, never married
(Johnson, 1988). Since women outlive men, they also tend to
be without a mate.
Many elderly black persons live alone. It has been
noted that this tendency is almost as great among elderly
black persons as it is among whites. Black elderly persons
often take other relatives into their homes. It has been
noted (Hill, 1972) that four times as many families headed by
black elderly couples take younger relatives into their
households than do white elderly couples. Hill also reports
that families headed by black elderly females take in the
highest proportion (48 percent) of children. Another
important observation is that "a higher proportion of white
than black female headed families had elderly members living
with them" (Hill, 1972:6).
Housing
Stokesberry (1985) argues that in the area of economic
issues, and other issues, there is not a great deal of
difference in the need for services for all elderly persons
in terms of quality, quantity, and accessibility. However,
being a minority member exacerbates the problem all elderly

58
have in reference to their need for appropriate, affordable,
and adequate housing. Black elderly persons like their white
counterparts experience housing problems. Those who do not
own their own home, must resort to renting (sometimes
subsidized by government) or living in elderly hotels (SROs).
Although there are Adult Congregate Living Facilities
(ACLF's), not too many black elderly persons reside in them.
The literature supports the claim that most black elderly
persons reside at home.
Health Status
"The health status of elderly black people is poorer
than that of elderly white people" (Aiken, 1982:179).
Elderly black persons demonstrate different configurations
regarding certain chronic diseases. A Report of the
Secretary's Task Force on Black and Minority Health reports a
higher incidence of hypertension among elderly black persons.
The incidence of diabetes is also reported to be higher in
elderly black persons, and the same is true for certain types
of cancers (U.S.Department of Health and Human Services,
1985). It is reported that major chronic diseases which are
aggravated by dietary excesses are said to be in excess
prevalence among minority groups. For example, hypertension
and diabetes are prevalent among black Americans
(U.S.Departmentof Health and Human Services, 1985). Dietary
intake is influenced by socioeconomic status. Nutrient
intakes are higher at higher levels of disposable income (in

59
the low to middle income range), with the exception of
carbohydrate intake, which decreases with decreasing income.
Black elderly persons continue to suffer from the lack
of adequate health care services. The majority receive
health care through Medicaid funding. It has been and
continues to be a problem for black elderly persons to find
physicians who will agree to accept the Medicaid
reimbursement. Neighborhoods and geographic location play a
major role in this situation (Stokesberry, 1985). The cost
of medical care and the availability and accessibility of
such care place difficulties in the paths of black elderly
persons. Studies have implicated structural, social, and
psychological factors in health utilization behavior.
In terms of availability and accessibility, the
conceptual framework generated by Andersen and Newman (1973)
and Aday and Andersen (1978) with regard to health services
finds application in, and contributes greatly to,
understanding these phenomena. Three groups of variables are
identified in this conceptual framework: (1) predisposing
factors which are social-structural variables (for example,
race, religion, ethnicity) as well as family attitudes and
health beliefs that may affect the recognition that health
services are needed; (2) enabling factors which include
individual characteristics or circumstances, such as
available family income and accessibility of service, that
might hinder or accelerate use of a health service; and

60
finally (3) need factors which include subjective perceptions
and judgments about the seriousness of symptoms, the level of
physical disability or psychological impairment, and an
individual's response to illness. With regard to black
elderly persons their educational level (a predisposing
factor) and their income and insurance coverage as well as
accessibility of health services (enabling factors) are
important predictors of their use of health services. This
model finds easy application to the availability,
accessibility, and use of formal services by elderly black
persons.
Economic Status
Black elderly persons have generally earned less than
their white counterparts throughout their lifespan. The
types of income that those over 65 have available to them are
significantly different for the black and the white
population. The three major sources of income for elderly
black persons, whether they were living alone or in a family
situation, were, in order, Social Security, earnings from
employment, and Supplemental Security Income (SSI). For the
white elderly who were living alone, the three sources of
income were Social Security, dividends, and pension incomes;
and for white elderly who were living in a family situation
the three main sources of income were Social Security,
dividends, and earnings from outside the home (Stokesberry,
1985).

61
Separating the men and the women, Stokesberry (1985)
points out that 39 percent of black women receive SSI in
addition to Social Security and income from continued
employment after age 60 or 65. Among the black males, 27
percent were receiving SSI, indicating that their Social
Security payments obviously were so low that they were also
entitled to the SSI. For white males, only 12 percent were
receiving SSI and only 11 percent of white female elderly
were receiving SSI.
At the end of the decade of the 1970s, approximately one
out of three black elderly persons lived below the poverty
level (Stokesberry, 1985). Drawing from the data of Hill
(1978), Stokesberry observes that "even with a dramatic
reduction in the proportion of black elderly persons living
in poverty during the seventies (50 to 36 percent), at the
end of that decade the numbers of black elderly persons below
the poverty level was still three times that of the white
elderly" (Stokesberry, 1985:32). The disparity in the
poverty level of black elderly persons continued to be an
area of concern in the 1980s. Johnson (1988) reports the
number of black elderly persons living below the poverty
level as being two times that of whites in the 1980s.
Johnson (1988) reports a decline from 39.1 percent in 1983 to
33 percent in 1986 representing a figure of well over 700,000
black elderly persons aged 65 and over. Although this shows
some improvement in the economic situation of black elderly

62
persons from the 1970s to the 1980s, such a disparate
situation is still an indictment on a country which is one of
the richest in the world.
Stokesberry (1985) refers to the existence of blacks
whose income from Social Security, SSI and private pensions
may not meet the basic needs for food, shelter, and health
care. This is compounded by the fact that the lack of
training and skills to continue employment after retirement,
if that is a financial necessity, or to re-enter the
workforce is a special problem for these persons
(Stokesberry, 1985).
Elderly black persons largely represent that pool of
elderly persons who, in the days when they had membership in
the labor force, were saddled with the lowest paying and
dirtiest jobs. Their numbers include a few retired school
teachers, retired owners of small businesses, or former
government employees, but these represent only a very small
proportion of today's elderly black persons. The majority
worked in manual labor, and domestic service jobs. These
jobs did not offer benefits and were not covered by Social
Security. As a result, many black elderly persons now
receive minimum Social Security which cannot cover everyday
living expenses. Black elderly persons are thus likely to
remain employed after retirement age due to inadequate or
nonexistent retirement income.

63
Although there does not seem to be a difference in the
proportion of elderly blacks and whites who re-enter the work¬
force after they reach 65, elderly black males in this
situation have a much higher unemployment rate than do
elderly white males (Stokesberry, 1985). Of note, too, is
the fact that the unemployment level for black females is
lower than it is for white females.
The economic disparity in the black American community
can be seen at all levels and in all types of families.
Black family median income was 56 percent of white family
income in 1984. This difference in income was also found
among the elderly who have generally earned less throughout
their life span. In 1984 the median income for black males
over the age of 65 was $6,163 compared to $10,890 for white
males. For black females the 1984 median income was $4,345.
For white females the figure was $6,309 (Johnson, 1988) .
Religion
In considering the unique aspects of the black cultural
experience it is imperative that one be attuned to the
religious experience of black elderly persons. Hill (1972)
lists strong religious orientation as one of the strengths of
black families, which function for their survival,
development, and stability.
A strong orientation toward religion and the black
church is a cultural attribute which holds a great deal of
importance in the lives of black elderly persons. Dancy

64
(1977) states that "the black elderly have needed a frame of
reference to enable them to cope with the oppressive forces
of racial discrimination, and for many this frame of
reference is religion." "Historically," he states,
religion and the black church have played a vital
role in the survival and advancement of blacks.
The black church is an independent institution
which blacks control in their communities. It is
the one black institution which has remained
relatively free from white authority. (Dancy,
1977: 22-24)
Black churches include such traditional black Protestant
denominations as the Baptists and Methodists, as well as
varied Pentecostal or fundamentalist religious groups.
In the black church there are points of uniqueness
(culturally and experientially) that differ from
the mainline churches of the dominant society. An
example is worship through celebration. The black
elderly have within the black church the freedom to
express themselves as the Spirit dictates. The
black church is a place of affirmation, rejoicing,
and recognition. Historically, these churches have
provided for the elderly a place where they can
feel like somebody and be somebody. The church's
role as the provider of opportunities for many poor
black elderly persons to gain an understanding of
the world beyond their city and state through
missionary groups and church related trips has been
observed. (Dancy, 1977:23)
Dancy sees the religious experience of the black elderly
especially those from the low-income group, as contributing
to the value they place on life.
In the face of life's many trials—ageism, racism,
the normal changes of sixty and more years, the
uprooting from the rural South to the urban North
or West—the black elderly have often found solace,
strength and assurance in the black church. In
society at large they have experienced rejection,
but in the church they have found acceptance and
freedom. The black church has provided them an

65
avenue of release-"that soon we'll be done with the
troubles of the world," as the spiritual puts it-
and an avenue of rejoicing and renewal. Self¬
understanding is shaped by many factors. American
society has not helped to instill racial pride in
black people. Such pride and affirmation have had
to come from within, and from the supportive
encouragement of other black persons and of the
black church which refused to accept the idea that
black people were inferior. Through the church,
black elderly persons were reminded that they
possessed dignity and that such dignity would
endure in spite of all that men could do to them.
(Dancy, 1977:23)
Many black elderly persons would not have much to keep
them going if they did not have the black church. It is
important therefore, that anyone embarking on a study of
black elderly persons and black communities have an
understanding of the dynamics of the black church and the
influence that religion has on black elderly persons. The
church is described as a channel through which a large
segment of the black elderly can be reached, and the black
church continues to be a source of communication with the
outside world for many black people in the United States.
Historically, the black church has been a strong social
force among black elderly persons. Dancy (1977) observes
that "when vital social services were not available to its
parishioners, the black church provided the needed counsel,
the services, and the framework of meaning. The black church
has always been an organizing force" he notes and "a service
center for its members" (Dancy, 1977:24). A challenge facing
those who are interested in the problems of black elderly
persons in terms of social supports, as advocates, is to

66
change the societal system which fails to meet the clients'
needs. In this effort, the cooperation and support of black
pastors and congregations can be enlisted. By mobilizing in
this fashion, these persons and the church can move beyond
their daily piecemeal supportive efforts (Dancy, 1977).
Whatever the task, there is powerful potential for reform
when the black church is considered a part of the informal
network system as it affects black elderly persons. The role
of the church in an aging society is becoming more visible.
This does not only apply to the black church, but other
churches and synagogues are being called on to develop a wide
range of activities to enhance the spiritual, emotional, and
physical well-being of older persons (Sheehan, Wilson and
Marella, 1988). It is obvious then, that something which
black churches have been doing for their elderly persons for
a very long time is now being recognized and courted for the
rest of the elderly population.
Kinship Relations and Family Support
No analysis of black elderly persons would be effective
or complete without some observations about the kinship
system and the role it plays in the lives of black people.
There is a growing body of literature on black families
describing the components of the kinship system. Literature
on the kinship interaction among black families as well as
the system of mutual aid and support that persists and exists
within black families is also on the increase (Mindel, 1986).

67
Discussions of kinship in the United States usually cover
three areas, affectional attachments, interaction, and mutual
assistance (Mindel, 1986).
It appears from the research that for blacks the kinship
network serves its members most effectively as a functional
mutual aid system. Numerous studies have shown that black
relatives help each other with financial aid, child care,
advice, and other supports to a rather extensive degree
(Aschenbrenner, 1975; Hill, 1971; Martin and Martin, 1978;
Shimkin et al., 1978; Stack, 1974). Strong kinship bonds is
one of the attributes of black families. A sense of
cohesiveness is a strength of black families and elderly
persons are often the focal point of that cohesiveness.
(Dancy, 1977) .
One consequence of discrimination is that it has
caused black people to depend on each other and to
distrust the dominant society which would not
accord them respect. The desire for dignity and
freedom from oppression helps account for the black
elderly person's reliance on the strong family
bond. Family members recognize and value black
elderly persons, because they have survived and
surmounted many obstacles which the dominant
culture has strewn in their path. In turn, the
family frequently provides needed emotional support
and understanding. (Dancy, 1977:20-22)
Summary
In this chapter black families have been examined in
terms of social, economic, and demographic factors. Various
theoretical approaches used to study black families in
America have been analyzed. The strengths and weaknesses of
black families have been discussed and a profile of black

68
elderly persons has been presented. Of importance is how
black elderly persons have coped considering their position
in the society. The role of the black church as it continues
to respond to the needs of its elderly members has been
examined. Caregiving as it relates to black elderly persons
continues to be dependent on the informal support system
which includes, family, church and kinship networks. It has
been shown that studying black families from the cultural
relativistic approach can have positive effects by dispelling
some of the myths long held about these families. It could
also reduce the tendency of stereotyping these families and
so prove effective in countering the cultural ethnocentric
school which has for years underpinned some of the wrongs
that have been meted out to black Americans by some
researchers. The caring nature that is inherent in black
families has enabled them over the years to take care of and
nurture their elderly relatives. This characteristic is also
responsible to some extent for the manner in which elderly
relatives of black families have also always supported the
younger members of their families.

CHAPTER THREE
CAREGIVING
A Review of the Literature
Although there may be no theory of caregiving for the
elderly, there is, within the literature, information on the
concept of caregiving and since this is such a central part
of this study it is important that we inform ourselves
regarding its meaning. In the literature there is no clear
cut or agreed upon general concept of caregiving. Although
there is a rapidly growing body of literature on caregiving
wherein reference is made repeatedly to the aspects of
caregiving tasks, the stress and burden of caregiving
(Cantor, 1983; Gubrium and Lynott, 1987), the economics
associated with caregiving (Arling and McAuley, 1983),
caregiver selection (Ikels, 1986), as well as the demands,
risks, and costs of caregiving, family responsibility and
caregiving (Gubrium, 1988; Soldo and Myllyluoma, 1983) the
difficulty still lies in finding any concise conception of
the term. Indeed what we have is all very much an intuitive
and common sense understanding of the meaning of caregiving,
and the above are examples of the common sense ordinary way
in which the term caregiving is used in the literature. The
concept of "caregiving" is used when older people need care
69

70
of any sort because they are chronically impaired and hence
unable to perform certain functions without assistance. This
care may be administered in the home or in an institution.
This study is concerned with care which is administered in
the home, and that is the conception of caregiving that is
used. That is, a consensual, intuitive, common sense meaning
of caregiving. But in order to go beyond what is in the
literature I define caregiving using the following questions:
First, is there a need for carp? Is there impairment? Is
â–  /
there helplessness? and is there a need for assistance? The
search for answers to these questions directs the researcher
into looking at programs such as Social Security, Medicare
and Medicaid and other such features (these constitute the
formal system), and family members and friends (these
constitute the informal system).
Why are findings on such things as Social Security,
hospitals, food stamps, family members, friends and
neighbors, important to such an investigation? The answer
lies in the fact that the concept can be subdivided into two
types of caregiving: formal and informal. Both systems
together make, up one caregiving network.
The term caregiving has been used in the gerontological
literature as an umbrella term to cover a wide variety of
support services for elderly persons. The concept will be
defined here in terms of its application and utility. A
caregiving equation could be defined as follows: Formal +

71
Informal Assistance = Caregiving. Why is there a need for
formal and informal assistance? There is a time in the lives
of many human beings when they are unable to do things for
themselves and unable to supply all the support they need to
manage effectively. For example a person who is impaired
mentally, physically, and/or economically needs assistance
from one or both systems. Hence, we can logically say that
caregiving is taking place if the needed assistance is
forthcoming and does not cause a strain for the care
receiver, or causes very little strain, while taking place.
The concept of Caregiving usually connotes a care equation
and caregiving can take place when the care receiver is in an
institutionalized or noninstitutionalized setting.
Caregivers and Caregiving
Many older people are able to cope by themselves, but a
large number get to the point where they need care. This
places them in the category of care receivers. Those who
administer the care are known as caregivers and the product
administered is known in the gerontological literature as
caregiving.
Older people not only have to cope with the physical
problems indigenous to their population, but they also have
to cope with stressful life events such as death of a spouse,
loss of financial benefits when they are no longer able to
work, and loneliness (Shivers and Fait, 1980). Shivers and
Fait (1980) also note that "if any generalization can be made

72
about the aging process, it is the increasing vulnerability
of the organism to environmental stress, disease, and
continuing loss of functional ability of organs and systems"
(Shivers and Fait, 1980:19).
In a survey conducted by the American Association of
Retired Persons, the major events causing the need for care
were found to include major illness, hospitalization, death
of a spouse, retirement, and being laid off or fired
(American Association of Retired Persons, 1986). This survey
also found that the kinds of help provided by caregivers
range from financial support and managing finances to
household chores, personal care, ambulation, transportation,
administration of medication, companionship, making or
receiving phone calls, and arranging outside help ( (American
Association of Retired Persons, 1986) . Caregiving, then,
refers to care provided to an elderly person with some degree
of physical, mental, or emotional impairment which limits
independence and necessitates ongoing assistance (Horowitz,
1985).
The organization of society today determines that people
receive support from agencies of government (the formal
system) or from family, kin, and neighbors (the informal
system). The elderly recipient of care may benefit from both
formal and informal support systems.
Care receivers are often plagued by various chronic
illnesses that limit their abilities to care for themselves.

73
Care receivers, on average, suffer from four medical problems
from among a list of over 20. These include high blood
pressure, arthritis, vision problems, heart problems,
depression, circulatory problems, hearing problems, memory
loss, sleep disorders, dizziness, respiratory problems,
diabetes, stroke, constipation, bone fracture (especially of
the femur), cancer, elimination problems, diarrhea,
drug/alcohol problems and Alzheimer's disease (American
Association of Retired Persons, 1986). The AARP study also
reports that the health conditions most frequently
experienced by older care receivers were high blood pressure,
arthritis, vision problems, heart problems, depression, and
circulation problems (American Association of Retired
Persons, 1986).
The Formal Support SyaLem
Government, through bureaucracies at local, state and
federal levels, is committed to providing financial support
in the form of Social Security to the elderly. Through
Medicare and Medicaid, government also provides a portion of
the payment for the health care for the elderly. In a series
of reports compiled by the Social Security Administration,
public social-welfare expenditures are defined as cash
benefits, services, and administrative costs of all programs
operating under public laws that are of direct benefit to
individuals and families. The programs included are those
for income maintenance (social insurance and public aid) and

Page
Missing
or
Unavailable

75
The Informal Support System
Caregiving needs to be assessed in the same way as any
other social organization. Once the formal segment has
carried out its role, everything that remains is expected to
be undertaken by the informal system.
Informal caregivers are usually spouses, children, and
relatives in that order. The process of caretaker selection
appears to follow rules that transcend cultural differences.
Certain demographic groups have a greater likelihood of being
care givers than others. Results of the survey conducted by
the American Association of Retired Persons (1986) indicated
that the probability or likelihood of being a care giver is
greater for females than it is for males, and the likelihood
of having caregiving responsibilities is greater for females
who are older, and widowed (American Association of Retired
Persons, 1986). This finds support in the caregiving
literature where many researchers note that filial caregiving
connotes daughters and that this has implications for the
role of women in our society.
Researchers have been able to detect the underlying
dynamic that leads to caretaker selection (Ikels, 1986). The
factors found to be involved in the selection of caretakers
fall under three headings: Demographic Imperatives,
Antecedent Events, and Situational Factors. Demographic
Imperatives listed the caretaker as being the only child, the
only child of preferred sex, and the only proximate child.

76
Antecedent Events incorporate those such as gradual
emergence, explained by the dependent child or children who
were still at home when widowhood occurred. These children
are said to be slated early on for the caretaking role and
gradually assume it. Situational Factors such as least
inconvenience and greatest motivation are also used in the
selection of a candidate for the role of caretaker (Ikels,
1986). All things being equal, in most cultures the child
with the least obligations and the greatest motivation will
undertake the role of caretaker.
Most caregivers provide several different supports
simultaneously. The average caregiver provides approximately
four supports to the person being cared for (American
Association of Retired Persons, 1986) . This places heavy
burdens on them, since a large proportion also hold full time
jobs. The majority of employee caregivers care for aged
relatives who live in their own home, some near the caregiver
and some quite far away. Some caregivers share housing with
the older person, while some of the care receivers may live
in a nursing home near or far from the caregiver (American
Association of Retired Persons, 1986) .
Some subgroups of the elderly population are known to
place more faith in the informal support system and hence
receive most of their support from this system. Black
elderly persons are among those who, for reasons that have

77
been given some support in the literature, place heavy
dependence on the informal support system.
Impairments of the Elderly
The process of aging begins with conception and
continues until death. Unless some catastrophic event causes
early death, most people tend to follow an aging cycle that
terminates at or about the beginning or the middle of the
seventh decade. Only a few people live into their nineties,
and a tiny proportion go on to be centenarians. According to
the 1980 Census there were 32,000 persons aged 100 or older
in the United States, two-thirds of whom were women. Many
factors contribute to longevity. This can be the result of
genetic foundation, nutrition, environment, physical
capacity, lack of stress, or a combination of these. Many of
those attaining long life can expect to be plagued by some
kind of impairment either mental or physical. Some elderly
experience minimum impairment while others suffer terribly.
To impair is generally defined as "to make worse, to
lessen in quality, quantity, value, excellence or strength;
to deteriorate" (New Webster Dictionary of the English
Language-Deluxe Encyclopedia Edition, 1984). Melloni's
Illustrated Medical Dictionary (1985:218), defines impairment
as "damage resulting from injury or disease," and mental
impairment as "intellectual defect as manifested by
psychologic tests and diminished effectiveness (social and
vocational)."

78
When considering impairments in the elderly one should
concentrate on those that cause the greatest handicaps, since
certain impairments of elderly persons are more devastating
than others. Hearing, visual, and mental impairment are of
particular concern and demand special emphasis. When we are
dealing with areas such as living arrangements for the
elderly, we are faced with an even greater problem; that of
functional impairment. Those who are functionally impaired
are those who have trouble in mobility or transportation,
personal care, basic housekeeping activities, and self¬
management, i.e., taking medication, using the telephone
(Verbrugge, 1986).
"Hearing loss is more common than visual loss among
elderly persons, although both are found to increase with
age" (Butler and Lewis, 1983:108). Although most persons
past 60 years of age retain hearing sufficient for normal
living, the elderly individual is three times more likely to
display a significant loss of hearing than is a younger
person, and older males have greater hearing loss than do
older females (Shivers and Fait, 1980). Statistics from the
National Health and Nutrition Examination Survey (HANES I) of
1971 indicate that the ratio of hearing loss for persons less
than 17 years of age as opposed to that for persons of 65
years and over increases from 3.5 per 1,000 persons to 133
per 1,000. About 19 percent of individuals age 45 to 54 as
compared to 75 percent in the 70- to 79-year-old age group

79
report a hearing loss. It has also been reported that 23
percent of elderly persons 65 to 70 years of age and 40
percent of those age 75 and above reported that they had
hearing impairments that were somewhat handicapping (The
National Health and Nutrition Examination Survey, 1971).
Hearing is crucial to mental health in old age; hence
hearing loss has been known to contribute to depression among
the elderly. Butler and Lewis (1983:109) note that "hearing
impaired persons receive much less empathy than visually
impaired persons and are more subject to depression,
demoralization, and psychotic symptoms." It is estimated
that in the United States there are 5.5 million elderly
persons (over the age of 65) with hearing defects (Butler and
Lewis, 1983) .
Visual Impairment
Visual impairment presents its own problems for the
elderly. Nearly half of the legally blind population in the
United States is 65 years of age or older (Butler and Lewis,
1983). Macular degeneration, cataracts, glaucoma, and
diabetic retinopathy are the four most common causes of
visual impairment in the older age group (Butler and Lewis,
1983). Visual impairment can be devastating in terms of both
psychological isolation and physical immobilization. Visual
impairment can result in accidents in old age. By affecting
driving, the outcome can be loss of one's drivers license,
thus increasing dependency on others for transportation.

80
Visual impairment can also be responsible for accidents in
the home such as physical injury and the misreading of labels
on medications and on household products. All of this
impedes the visually impaired person from living alone.
Mental Impairment
Chronic conditions among elderly persons include those
of a psychopathological nature. The elderly are more likely
than younger persons to develop mental manifestations of
their physical problems. According to Pfeiffer (1977),
approximately 15 percent of the elderly population in the
United States suffer from significant, substantial, or at
least moderate psychopathological conditions. It is also
estimated that between 70 and 80 percent of elderly nursing
home patients suffer from moderately severe mental disorders
(Whanger, 1973). Kart (1985) reports that organic brain
syndromes, depressive disorders, schizophrenia, and alcohol
disorders are listed among the specified diagnoses accounting
for the highest rates of patient-care episodes in outpatient
psychiatric services for old people in the United States in
1971. He cautions however, that for many reasons these
figures may not be as authentic as we could be led to
believe. Kart (1985) cites several factors that are
conceptual and methodological in nature which contribute to
this probable incorrect documentation. He notes that
the epidemiology of psychopathological conditions
is beset by conceptual and methodological problems.
Diagnosing schizophrenia or depression is often
difficult even under careful conditions of

81
assessment. Diagnoses are not made under strict
experimental conditions. There is a substantial
degree of subjectivity involved, complicated by the
fact that different doctors use different
definitions and criteria and vary widely in their
competence and in their understanding of aging
processes. (Kart, 1985:182)
Changes in the environment have also been said to be a causal
factor in the early mental change shown by elderly persons
(Libow, 1973). Research shows that many cognitive problems
in old people may result from adverse drug reactions (Lipton
and Lee, 1978). Iatrogenic brain disorders are not uncommon.
Doctors unwittingly produce reversible and often unrecognized
irreversible brain disorders. Tranquilizers and hypnotics
are said to be the most likely causes of such conditions, but
steroids used for arthritis can cause organic brain disorders
as well as hypomania or depression or both (Butler and Lewis,
1983). Despite the difficulties involved in determining the
degree and extent to which psychopathological conditions are
distributed among the elderly, there is no doubt that some
elderly people are mentally impaired, hence requiring care
that is usually very demanding on the caregiver.
The mental health evaluation in its simplest sense is a
method of looking at the problems of older people, arriving
at decisions as to what is wrong, and concluding what can be
done to try to alleviate or eliminate these problems.
Evaluators use historical data from the person's past;
current medical, psychiatric, and social examinations; and
their own personal interactions with the individual to get a

82
many sided and, one hopes, coherent picture of what is
happening (Butler and Lewis, 1983) . Knowledge of the racial,
cultural, and ethnic backgrounds of these elderly persons
during the process of evaluation is germane to the evaluation
process.
Decisions made on the basis of the mental health
evaluation should be aimed at the well-being of the older
person, not only via medical and professional treatment, but
through social supports. Knowledge of the resources
available for treatment purposes should be uppermost in the
mind of the therapist; also it is important to know of the
older person's own emotional and physical capabilities, the
assets in his or her family and social structure, and the
kind of services and support available in the community
(Butler and Lewis, 1983:165). Treatment goals should be
reasonable and reachable and when decisions are made not only
must the margin of error be small and aimed at the well-being
of the elderly person, but care should be taken that
presentation of the decision should be in language which can
be understood by the older person's family and friends as
well as by the older person (Butler and Lewis, 1983). This
will provide them with a basis for assessing the mental
health care offered them and will know what to expect and how
to best participate actively in evaluation and treatment
(Butler and Lewis, 1983).

83
Depression appears to be the most common functional
psychiatric disorder in the later years. Depression can vary
in duration and degree; it may be triggered by loss of a
loved one or by the onset of a physical disease (Impallomeni
and Antonini, 1980; Kart, 1985). Depression often results
from adjustment reactions. It can be triggered by fear. The
fears of elderly persons are many and justified. Elderly
persons fear being alone, they fear being attacked, and they
fear the loss of loved ones. Kart (1985) observes that the
complexity of their emotionality can result in increased
blood pressure (increased heart rate) stemming from their
physical problems and these in turn can result in depression.
Today's elderly person grew up in the 1920s, a period when
people were termed mad, crazy, and so on if they acted even
slightly strange; hence their fears are justified. A
depressed individual may show any combination of
psychological and physiological manifestations. Diagnosis is
difficult and treatment is problematic. Drug therapies are
popular for the elderly since they are viewed by many
professionals as poor candidates for the psychotherapies
(Kart, 1985:183) .
Suicidal thoughts often accompany depression. Suicide
rates are very high among the elderly. According to the U.S.
Public Health Service, in 1975 these were between 43 percent
and 62 percent higher than they were for the total
population. The elderly accounted for 16.3 percent of all

84
the suicides in the United States in 1975 (U.S.Department of
Health, Education, and Welfare, 1977) . An examination of
suicide rates by sex and race for 1979 revealed that aged
white males show the highest suicide rate of any group, 39.2
per 100,000 population. Their rate is three times that of
aged black males (12.9), more than five times that of aged
white females (7.3 per 100,000 population), and about
sixteen times that of aged black females (2.5 per 100,000
population) (U.S. Bureau of the Census, 1982-83). Elderly
females in the United States have among the lowest suicide
rates in the world.
Paranoia and hypochondriasis are two additional
functional disorders common to elderly persons. Paranoia is
a delusional state, usually persecutory in nature. It often
involves attributing motivations to other people that they
simply do not have (Kart, 1985:184). Paranoia is reported to
be more common in individuals who suffer from sensory defects
such as hearing loss (Eisdorfer, 1960; Houston and Royse,
1954). Some paranoia may result from changes in life
situation. Paranoid reactions of the elderly person are
usually directed at the spouse or adult children or persons
working in the home (home help). There is a lot of
misinterpretation and misunderstanding in such situations.
Paranoia could contribute to the degree of stress which
caregivers and others experience. The older person usually
accuses others (Pfeiffer, 1977), and isolation can result by

85
virtue of their behavior, this in turn can lead to
depression.
Hypochondriasis is an overconcern for one's health,
usually accompanied by delusions about physical dysfunction
and/or disease. The disorder presents problems in treatment
since hypochondriacs are not predisposed to psychological
explanations of their condition. Telling the patient that
nothing is really wrong is rarely effective (Kart, 1985).
Elderly people and their relatives fear Alzheimer's disease.
They also fear cancer, especially cancer of the colon, and so
they use laxatives to prevent constipation. Butler and Lewis
(1983:298) note that bowel complaints, especially
constipation, in both mental disorders (for example,
depression) and physical conditions, are frequent and provoke
anxiety in older people.
The distinction is made between organic brain syndromes
(OBS) and organic mental disorders (OMD) (American
Psychiatric Association, 1980). Organic brain syndrome
refers to a group of psychological or behavioral signs and
symptoms without reference to etiology. Organic mental
disorder designates a particular OBS in which the etiology is
known or presumed (American Psychiatric Association, 1980).
OBS can be grouped into six categories, the most common of
which are delirium, dementia, and intoxication and
withdrawal. It is believed that as many as half of those
elderly persons with mental disorders have OBS (Redick et

86
al., 1973); the prevalence rate of OBS appears to increase
with age (Redick et al., 1973), although onset usually occurs
in the seventh to ninth decades and is more common in women
than in men (Fann et al., 1976).
Kart (1985) observes that primary degenerative dementia
of the Alzheimer type may be the single most common OBS.
According to the DSM-111, between 2 and 4 percent of the
entire population over the age of 65 may have this dementia.
Alzheimer's disease has an "insidious onset and gradually
progressive course" (American Psychiatric Association, 1980).
"It brings a multifaceted loss of intellectual abilities,
including memory, judgement, and abstract thought, as well as
changes in personality and behavior. The clinical picture may
be clouded by the presence of depression, delusions, or (more
rarely) delirium" (Kart, 1985:184). Some conditions may
manifest themselves as something else, leading to
misdiagnosis, for example, senility. There are times when
there is misdiagnosis of this condition and some use the term
pseudosenility to refer to such conditions (Libow, 1973).
Causes of pseudosenility, Libow notes, include drug reactions
(and the elderly are usually taking more than four types of
drugs at any single time), malnutrition (another problem of
older people), and fever. When these conditions are treated,
the senility often vanishes (Libow, 1973) .
Older persons need a lot of support to help them
overcome the feelings of worthlessness and depression that

87
often assail them. Opportunities to encourage them must be
grasped by all those responsible including social workers,
family, relatives and friends. Emphasis must be placed on
the positive values of their greater understanding of life,
experience, and wisdom. Too often those around them tend to
ignore, deny or denigrate these values. The older person
given this kind of support, "can be helped to withstand the
onslaught of his or her various incapacities, build up self¬
esteem, accept more easily the change in his or her status,
and see him- or herself as being a worthwhile person despite
incapacities" (Field, 1972:169). The importance of the
supportive role cannot be overemphasized. The mental health
of the older person can be ameliorated, and some problems can
be diminished if there is adequate support. There are times
when nothing can be done regarding the disease, but anxieties
can be reduced or removed. Those close to the older person
also need support, especially if they are the primary
caregivers. The stress burden can be relieved in most cases
if others are supportive in crisis situations.
The problems associated with audio, visual, and mental
impairments of older people will always be with us and most
times will be cause for anxiety for both the older person and
his or her loved ones. Irrespective of the situation there
are different supportive roles to be played by the formal and
the informal network. If these roles are played with
consideration and empathy many of the problems, especially

88
those stemming from anxiety, can be minimized and older
persons can be helped to live out their last days with
dignity, self-respect, and a sense of self-worth. It is
imperative that mentally impaired elderly persons not live on
their own, since there is the likelihood of them harming
themselves. Drug compliance is particularly unreliable in
these persons and there is also an higher than average risk
of self-poisoning (Impallomeni and Antonini, 1980).
Activities of Daily Living
Some measures of impairment focus on the older persons
functional capacity to perform certain tasks. Functionally
impaired persons are those who are unable to perform the
tasks or activities of daily living (ADL) without the
assistance of other persons. Functional impairments result
from chronic diseases such as arthritis and others that
restrict the elderly and cause physical limitations. The
activities of daily living usually evaluated by researchers
include bathing and dressing, combing one's hair, making
one's bed and being able to perform simple domestic chores
like preparing a meal, feeding oneself, toileting and
transferring (from bed to chair or commode and vice versa, or
from one part of the house to another (American Association
of Retired Persons, 1986). Older persons, who are not
institutionalized, and who fall into the category of ADL-
limited, usually qualify for programs such as Community
Care for the Elderly (CCE). In some states this program is

89
state-funded. Functionally impaired elderly usually depend
on family, friends, or agencies for their primary and/or
secondary support.
Impairments not only restrict the elderly physically,
but can and do result in other problems for them. For
example, failure or noncompliance in the taking of
medications, is a major factor in determining response to any
therapeutic regimen requiring self-administration. Impaired
hearing or sight can often result in errors in the intake of
drugs. To complicate this further a large proportion of
elderly persons especially minority elderly persons are
unable to read, which leads to further confusion.
Instrumental Activities of Daily./Living
Both black and white older people are said to be much
more likely to utilize informal rather than formal agency
sources of help for the main instrumental activities of daily
living (IADLs). But the black aged are generally much less
likely to know of various sources of assistance irrespective
of whether they are presently in need of services or were to
develop a future need (Trevino-Richard and Krain, 1987). The
main IADLs assessed are (1) the need for help with yardwork;
(2) the need for help getting to places farther than walking
distance; (3) the ability to prepare one's own meals; (4) the
ability to manage one's own finances, and the ability to
administer one's own medications.

90
Impairments in whatever form, auditory, visual,
functional, or mental, usually severely handicap older
persons not only physically but socially. The degree and
type of impairment determines how, where, or with whom
elderly persons live. Depression and other diagnosable
mental states can be the result of certain physical
impairments which produce isolation and loneliness. The
nature and extent of an older person's impairment also
determines that person's ability to perform the activities of
daily living, and is instrumental to the accomplishment of
their daily living tasks.
Support Systems for Elderly Black Persons
A topical issue today is the use of and knowledgeability
about formal and informal sources of assistance by older
black persons for a variety of health and social needs that
many of them experience. Generally, most of the formal
services available to older adults are provided through the
Area Agencies on Aging (AAoA) as mandated by the Older
Americans Act of 1965. The purpose of the Act was to make a
comprehensive and coordinated range of social services
available to older persons through the partnership of older
citizens, community agencies, and state and local governments
(Kutza, 1981). The Act, amended in 1967, 1969, 1973, 1975,
and 1978, authorizes funds for four activities. The first
and probably the most important is "for the establishment of
state and substate agencies, which are to plan and coordinate

91
services to the elderly within a geographical area" (Title
111). 'Services' are very broadly defined to include health,
continuing education, welfare, recreation, homemaker
services, counseling and referral, transportation, housing,
supportive services, as well as nutrition services and
multipurpose senior centers (Kutza, 1981).
It is important that these agencies understand the
patterns of need among persons of different race or ethnic
backgrounds as well as the general level of knowledge of
these persons concerning the sources that are available to
them. Accordingly, critical issues in aging network research
include measuring how much assistance is provided by the
formal and informal network to those in need of help,
determining whether there is a need to supplement the
informal network, and assessing whether those in need of help
are aware of the programs available to assist them (Trevino-
Richard and Krain, 1987). The research findings of Richard
and Krain suggest that differences between black and white
aged are minimal in regard to the general needs for services
and the numbers that gain access to agency services. Dancy,
(1977) however, observes that
Elderly blacks have learned, over a lifetime of
bitter experience, that they should not expect a
high level of service from public agencies. As a
result they have developed certain styles of coping
with the dominant society and its agencies, styles
which have enabled them to survive and even deal
realistically with indifferent agencies. However,
they create a barrier which the concerned
practitioner will need to break down in order to

92
serve the elderly black client effectively.
(Dancy, 1977:30)
Black people have tended to be underinformed regarding
services available from the formal system and hence have
depended on the informal system for support. This may be
more by design than by accident and what Dancy (1977)
attributes to "the consequence of a painful history of
inequality, rejection, and ejection" (Dancy, 1977:30). Dancy
notes that in the past, blacks could be put out of a public
agency for asking too many questions about their rights.
Blacks have constantly been accused of depressing the
social system and especially of exploiting the welfare
system. Black elderly persons seem to have accepted their
situation and are unwilling, more than unable, to appeal to
the formal system for fear of being rebuffed. This coupled
with the conspiracy to keep them uninformed about the
services or benefits to which they are entitled has forced
them into greater dependence on the informal support system.
Their geographic location (most reside in the rural areas and
in Southern States where formal services may be less
adequately funded) also contribute to this behavior.
There is evidence that the availability of formal
support services in rural areas is significantly lower.
Nelson (1980) notes that the availability of day care,
homemaker, and foster care services, as well as the number of
acute care hospital beds is substantially less in rural
settings.

93
Dancy (1977) observes that few meaningful and needed
services are located in the communities in which black
elderly people live and too frequently they must travel
considerable distances to obtain a particular service.
Availability of transportation may be a determinant in
whether they make these trips or not.
Elderly black persons have designed their own coping
mechanism for dealing with the low service delivery
expectation. Strategies include appearing to agree with
practitioners and other authorities when in fact they do not
understand and avoiding the system. Closely related to
avoidance is withdrawal (either physically or
psychologically) from hostile and demeaning encounters or
situations which are not sensitive or supportive to them
(Dancy, 1977) . Dancy notes that the cost of such behavior is
the loss of benefits and services to which they are entitled.
He, however, sees a payoff in this behavior since the
technique has strengthened blacks who assumed greater
independence and pride by relying on their own resources
(Dancy, 1977).
Caregiver Stress and Burden
Caregiver Stress
Caregiver stress is one of the pathologies of
caregiving. This applies to both the caregiver with an
outside job and the one at home. For the working caregiver,
there may be interference with his or her work

94
responsibilities. Some may lose time from work because of
the crises that may occur. Many may lose sleep or suffer
extreme tiredness and anxiety, especially if their economic
situation militates against them being able to afford home
help where the care receiver is terribly impaired (American
Association of Retired Persons, 1986) . They, therefore,
suffer emotional and mental strain.
The formal support system can help to alleviate
situations such as these by providing counseling services for
these persons, as well as respite care for those for whom
they care. The caregiver should be able to call upon other
members of the family for help. In the absence of other
family members or relatives, neighbors may be able to provide
assistance. Government should provide support systems that
will complement the caregiver. It has been found (Quadagno
et al., 1987) that the provision of formal services can
relieve the stress of daily caregiving but has little to
offer regarding relieving the subjective feelings of burden
felt by caregivers constrained by the caregiving role.
Felt Burden
Caregiver burden is especially significant when the care
receiver is mentally impaired in some way. Caring for
someone who is stricken with Alzheimer's disease is one
example of this situation. Gubrium and Lynott (1987)
considered three components of the Alzheimer's disease care
equation. One component relates to felt burden and is the

95
caregiver's response to caring for the impaired elderly
person, which is usually conceived as the strain resulting
from the stresses of the burden of care. Felt burden is
assessed by distinguishing the impairment's impact on the
quality of the caregiver's daily life from its impact on the
caregiver's emotions (Gubrium and Lynott, 1987). To this
effect, certain questions are posed to the caregiver
necessitating responses leading to a determination of whether
caregiving responsibilities resulted in sleep difficulties
for the caregiver or led to the caregiver's social isolation.
In determining this the authors suggest that "a common item
tapping the impact of the care receiver's impairment on the
caregiver's emotional life would be the degree to which the
impairment and caregiving experience was depressing for the
caregiver" (Gubrium and Lynott, 1987:274).
Several researchers have developed and administered
measures of felt burden (Zarit et al., 1980; Robinson, 1983;
Poulshock and Deimling, 1984) . For Poulshock and Deimling
(1984), burden is broadly identified with the emotional costs
of embarrassment and overload, disruption of the daily
routine, and financial and health deterioration. Their
method of assessing burden was to have caregivers evaluate
the burden they felt in response to four separate indicators
of impairment. With regard to the patient's ADL impairment,
caregivers were required to rate related caregiving tasks
according to whether these tasks were tiring, difficult, or

96
upsetting. Poulshock and Deimling (1984:238) conclude that
the concept of burden should be used to refer to the
subjective perceptions of caregivers related to the degree of
problems experienced in relation to elders' specific
impairments.
Caregiving and the Black Elderly
Caregiving as it affects black elderly persons is just
as problematic as it is for the rest of the elderly
population. Black elderly persons, however, have to cope
with special caregiving problems. Most black elderly persons
are at home and it is reported that even at the oldest-old
age level, 85 years and over, only 12 percent of elderly
black persons live in institutions (Johnson, 1988). It is
also observed that the lower income levels in the black
American middle-class (as compared to the majority group),
the continued escalation of the cost of living, mobility of
family members and significant others, fixed income
dependence, and other economic factors will make it
increasingly difficult for middle-class black Americans to
take care of their own (Johnson, 1988) .
It is important that care giving and care receiving be
studied in terms of the situational factors impacting on
blacks throughout their lives. Inadequate health care,
insufficient food, poor housing, and no luxuries are a
continuation of a lifelong condition.

97
The stress and burden of caregiving and care receiving
fall heavily upon black elderly persons. They not only are
care receivers but in many instances are themselves
caregivers. When they are in the role of caregivers, it is
not usually a spouse, but other family members such as
grandchildren and other relatives who are the major care
receivers. The care receivers could also be neighbors or
friends. This is especially evident when the black elderly
person is female. Elderly black women have been found to
have a larger social network than their white counterparts
(Mindel, 1986). It has also been found that for blacks the
formal support system provided substantially more basic
maintenance services than it did for whites. These services
included financial aid, food, and living quarters. The
informal support system tended to provide home and personal
care services which included checking, supervision, meals,
nursing care, and homemaker services. In addition to the
division of labor between the formal and informal support
systems, it was found that the differences between black and
white elderly persons, once the effects of social class were
removed, were not especially great (Mindel, 1986).
Research findings concerning the support system of black
elderly persons show that to a somewhat greater degree the
informal family and kinship group of black elderly persons
provides and sees to it that the elderly are helped. In
addition, it has been observed (Hill, 1972; Mindel, 1986)

98
that many black elderly persons, are a main source of support
for younger members within their families. In this sense,
the support system is a system of mutual exchange of aid. It
is important to recognize the reciprocal nature of the
exchange system within black families since examinations that
include only the one-way delivery of aid to black elderly
persons may mask the true nature of the support system by not
reflecting the support the elderly give to other family
members (Mindel, 1986) .
A family's strengths lie in those characteristics that
enable it to respond to the particular needs of household
members and to the demands society places upon the family.
The empirically based analysis of McAdoo (1978) suggests that
the primary criterion of black family strength, whether
caring for the elderly or raising children, is the kinship
network. This network does not always have positive effects
on the black elderly since the value placed on the family by
older blacks makes them vulnerable to exploitation and abuse.
Elderly black people have problems accessing the formal
network, hence their heavy reliance on the informal network.
This is due to illiteracy and ignorance in many cases, but
there is also suspicion of government agencies based on past
experiences with institutional racism resulting in their
being denied equal access to the services and material
resources needed to function satisfactorily. Although black
elderly people are known to be a resilient group with sturdy

99
coping strategies, Stokesberry (1985) sees the need for the
development of a network of benefit advocate programs to
assist low income black elderly in obtaining benefits and
services to which they are entitled.
Summary
In this chapter, the caregiving function has been
discussed. Formal support, informal support, hearing,
visual, and mental impairments, functional impairment, and
stress/burden have been identified as germane to the
caregiving function. Caregiving and the black experience
have been given special attention since the degree of
caregiver strain has been linked to demographic factors such
as race and socioeconomic position (Cantor, 1983). It is not
clear whether there is, to some extent, an interrelationship
between all the caregiving components. The next chapter will
address the methodology utilized to study caregiving of black
elderly persons in the town of Eatonville, Florida. The aim
is to determine where, how, and with whom elderly persons in
that community live, and who takes care of them.

CHAPTER FOUR
METHODOLOGY AND RESEARCH SETTING
Methodology
This study focuses on black elderly persons living in
the "all-black" community of Eatonville, in Orange County,
Central Florida. The research is primarily field-based. The
data were gathered from in-depth interviews and participant
observation. The method of study is intended to be what
Eckert (1983) has described as a
systematic and holistic process of discovery which,
at its best, should be ecologically sensitive,
considering the older individual in his or her
primary groups, functional locale, and community.
(Eckert, 1983:470)
Eckert (1983) notes that this approach provides process
data rather than the typical snapshot supplied through one-
shot mail surveys or interviews. The nature of the design of
the study allows cross-checking and rechecking what people
say and do, thus increasing the reliability and accuracy of
the data. In the interview, people may state that they
perform certain roles. Participant observation may support
or refute this information. This use of multiple methods and
strategies serves to alleviate the weaknesses inherent in any
single design. The investigator is sensitized to the
perceptions and feelings of the population being studied,
100

101
thus reducing the likelihood of making erroneous assumptions
and conclusions about the group, as may occur when adopting
an "etic perspective" a priori.
The term etic perspective applies to the
conceptualization of a community from the point of view of
the "outsider." Eckert (1983) contends that outsiders
(typically researchers, planners, or service providers)
define community on the basis of some set of conceptual
divisions dictated by political, social, or scientific
objectives. Such definitions of community, he asserts,
tend to be couched in the language of objectivity
and precision, divorced from the culturally
specific meanings and implications present in any
naturally occurring situation. Insiders'
definitions of community, on the other hand, are
based on the set of perceptions and models
residents themselves hold. This demonstrates that
the differences between insiders' and outsiders'
perceptions can be quite distinct. (Eckert,
1983:471)
In this study both perceptions are taken into account.
Although it is not a true community study, it, however,
requires the same treatment as one would for a community
study.
The research method that is utilized in this study is
not new. It is very similar to what anthropologists refer to
as ethnography. Several researchers have transposed
ethnographic research techniques to the study of American
towns and communities. One of the pioneers in this method of
research was W. Lloyd Warner (1963) in his study of a New
England city, Yankee City. Begun in 1930, Warner's ambitious

102
and extensive study produced several volumes of rich data on
the industrial and social structure of a major U.S. city.
Warner's research had far reaching influence by stimulating
holistic studies of communities within the United States
(Whyte, 1943; Gans, 1962) and abroad (Arensberg, 1964;
Arensberg and Kimball, 1940) .
A study of community life in the state of New York,
Small Town in Mass Society by Vidich and Bensman (1958),
utilized anthropological techniques to understand a small
town in a regional and national context. The study views the
community as a limited and finite universe in which one can
examine in detail some major issues of modern American
society. The community is viewed as a stage on which major
issues and problems typical of the society are played out
(Vidich and Bensman, 1958).
Other researchers have opted to study clearly demarcated
communities within larger urban contexts. "They build on
ideas developed by 'Chicago School' sociologists who depicted
the 'city' as consisting of 'natural areas' or subareas
(slums, ethnic and residential neighborhoods) in dynamic
relationship and with more or less unique values and
behaviors attached to them" (Eckert, 1983:456). Ware's
(1935) study of Greenwich Village, Whyte's (1943) ethnography
of an Italian slum, and Gans'(1962, 1967) studies of both
urban and suburban enclaves are examples of this method.

103
The methods employed in this research are derived from
participant-observation developed from anthropologists to
study relatively small, isolated, and homogeneous peasant
communities (Eckert, 1983). The community studied here
satisfies most of the requirements for such a study. The
population does not exceed 3,000, it is racially homogeneous,
though not too isolated, and not a peasant community. There
is extended residence in the community. As described by
Eckert (1983), and in keeping with this method, there have
been meticulous observations (census taking, map making,
minute behavioral descriptions), casual and serendipitous
observations, informal and formal intensive interviewing, and
first hand participation in as many life events as possible.
It is typical of the researcher in most cases to enter the
field alone and not as a member of a research team. This was
done in the present study.
The method of research discussed above has had some
influence on the study of old age. Numerous ethnographic
accounts of the daily life of older persons have emerged in
the past two decades focusing on persons living in urban
hotels (Eckert, 1980; Stephens, 1976; Siegal, 1978; Teski,
1979), retirement communities (Jacobs, 1974; Johnson, 1971),
senior centers (Hazan, 1980; Myerhoff, 1978), adult
congregate living facilities (Bear, 1988; Benedict,1976;
Carp, 1976; Tibbitts, 1976), apartments (Hochschild, 1973),
senior high rises (Jacobs, 1975; Ross, 1977), and nursing

104
homes (Gubrium, 1975; Kayser-Jones, 1981). The studies
mentioned above attempt to describe life holistically within
bounded microenvironments and/or local neighborhoods in that
they assess how older persons experience their life on the
ground, that is, how older persons who having been used to a
different way of life, adjust and adapt to the social and
physical environments in which they find themselves (Eckert,
1983) .
The methods of participant observation to studies of
what is termed "life in well defined and bounded social
niches" (Eckert, 1983:457), although being extremely well
suited to answering the problems posed, display certain
serious shortcomings. One serious shortcoming which has
been noted in some of these studies concerns the
representativeness and generalizability of findings to other
settings (Eckert, 1983). To demonstrate this Eckert notes
that
studies which focus on one senior citizen center,
one hotel or one apartment building may produce
rich insights, yet are severely limited in what
they can tell us about life beyond those settings.
Hence, in cases where no sound sampling strategy
was employed regarding who was interviewed within
the setting, even description of the setting itself
must be questioned. Further limitations involve
the lack of connection between life within a
selected type of living environment and the larger
contexts of city and state politics, social
organization, economics and history. (Eckert,
1983:457)
To the extent that the study such as the one which has
been undertaken in this research, addresses issues difficult

105
to study in bounded environments the contribution to
gerontological research will increase (Eckert, 1983).
The Research Setting
The town of Eatonville in Orange County in Central
Florida was the setting for the research. The field research
was carried out from January to December 1989. The idea of
conducting field research in such a setting evolved out of an
interest in the living arrangements of those black elderly
persons who were not institutionalized. Such a study it was
thought would afford the researcher an opportunity to observe
black families and kinship patterns.
The Town of Eatonville was settled as early as 1880 by
small groups of blacks who had drifted into the area from
further north as well as from the black portion of the soon
to be incorporated Town of Fort Maitland. On August 18,
1887, 27 registered voters met in the public hall of the Town
of Eatonville in Orange County, Florida, to vote on the
question as to whether or not to incorporate their community.
They were all residents of the area within the proposed
Town's boundaries. Their meeting was historically
significant because all 27 were blacks and the municipality
which they unanimously voted to incorporate that day became
the first incorporated all-black community in the United
States (Town of Eatonville, FL). This all-black community
was an outgrowth of the white municipality of Maitland which
had been incorporated three years earlier in 1884. It

106
appears that the all white community of Maitland found the
blacks and the area they inhabited to be somewhat "unsightly"
and wanted them to move to another area. It was at this time
that one Josiah Eaton, who had helped establish Maitland,
offered to sell the blacks a rather large parcel of land one
mile to the west of Maitland. The land was bought by Joseph
Clarke, who would be the first mayor of Eatonville. Clarke
in turn sold the land within the bounds of Eatonville (named
after Josiah Eaton) to any blacks who wished to settle there.
The population of Eatonville continued to increase throughout
the late 1800s and early 1900s. Today, Eatonville is a city
of almost 2,800 people, bounded on the north and east by
Maitland and on the south by the city of Winter Park. It is
situated such that its main street provides the connecting
link between U.S. Highway 17 and U.S. 441. The city has
grown to the north and south of this main street.
Eatonville is approximately 6 miles east of Orlando.
The town is administered by a mayor with a small staff
of 28 persons. The mayor works part-time while the rest of
the staff are employed on a full-time basis. The
administration is carried out at the Town Hall, which is the
only government administrative building in the town. The
City Council consists of six elected officials the mayor,
vice-mayor, and four councilors.
The elderly citizens of Eatonville enjoy several unique
facilities provided by both the municipality and the county.

107
The reason for selecting Eatonville for a study of black
elderly people, is its uniqueness in being an all-black
community, administered by blacks, and the only one of its
kind in the state of Florida. It was hypothesized that this
would afford a certain homogeneity and a regulated
environment. In such an environment one would expect to find
less objection to senior citizens because of their race,
whether it be to residential proximity or to demands on the
system. Similarly, it was hypothesized that socio-cultural
constraints would be less likely to exist due to the racial
composition of the town, and hence would not impinge on
supports for the elderly. Absence of zoning limitations
means that there would always be opportunities for making
elderly housing available and not subject to zoning
curtailment. One would expect to find victimization either
nonexistent or lessened; hence, there would be no need to
consider ways of devictimizing the elderly of this community.
Being black, although from another culture, the author
did not have to embark on an anthropological study of black
culture. The people of the West Indies, from which the
author comes, share a common heritage with black Americans,
being in large part descendants of Africans who were brought
to the New World as slaves.
Preparation for the research involved the gathering of
demographic data and making numerous telephone calls both to
the County Administration and that of the town. Introductory

108
telephone calls were made and letters of introduction were
sent to the mayor and administrators of the town. Information
was also gained from several persons who were known to have
knowledge about the town.
Visits to neighboring nursing homes revealed that most
of Eatonville's elderly were living at home. Two nursing
homes were visited, both located in Winter Park. The first
one, DePugh, is about 10 minutes' drive from Eatonville. Its
residents are mainly black and it has a 40-bed capacity.
Thirty-seven of these beds were occupied on the day the
researcher visited but only one occupant was from Eatonville.
The second nursing home, Parklake, is situated on the border
between Eatonville and Winter Park. Of its 170 residents
only 14 were black, and of this number, only one was from
Eatonville. Winter Park is a predominantly white middle to
upper-middle class town. A third institution visited was the
only Adult Congregate Living Facility (ACLF) in Eatonville.
This facility is privately owned by a local couple. The
husband acts as Director and the wife as Resident Manager.
The facility has 24 beds, but only 3 are designated for
senior citizens' occupancy. Referrals are from the Health
and Rehabilitative Service's (HRS) office in Orlando. Senior
citizens from this facility participate in the daily
activities of the Senior Citizens Class at the Wymore
Education Center which is basically a county Nutrition site.
On the day that the center was visited, only one of the

109
allocated senior citizens' beds was occupied. The occupant
was a lady just over 65 years old and very active. This lady
was born in Eatonville but had left for several years,
returning about 10 years ago.
Demographic Profile
Demographic information is germane to any study of this
kind and is of exceptional import for comparative purposes.
The demographic profile of a community includes the
population, and the educational, occupational, and economic
features of the area.
The Town of Eatonville lies in Orange County,
approximately 6 miles East of Orlando a major tourist center
with major medical, educational, and county facilities. It
extends over approximately 2 square miles, after annexation.
The population of Eatonville in 1980 was 2,185 (Table 4.1).
This increased to 2,576 in 1985 and by 1988 had grown to an
estimated 2,668 (1989 Florida Statistical Abstract). Of
Eatonville's 1980 population only 48 were nonblack. Of this
number, 30 were white, 16 were of Spanish origin (11 Mexican
and 5 others not Cuban or Puerto Rican), one was Japanese and
one Hawaiian (Table 4.2).
Males make up 47.2 percent of Eatonville's population,
females the remaining 52.8 percent (Table 4.1). There are
661 households (Table 4.3) averaging 3.36 persons per
household. This is considered fairly high for the State of

110
Table
4-1: Population Figures—
Eatonville--1980
Total
Males
Females
Black
White
Spanish
Other
Origin
2185
1032
1153
2137
30
16 *
2 * *
%
47.2
52.8
97.8
1.4
0.73
0.09
* Not
Cuban or Puerto Rican
★ *
Japanese
= 1, Hawaiian = 1
Source
: Bureau
of Economic and
Business
Research,
College
of Business Administration, University of Florida,
Gainesville, Florida, 1986.
Table 4-2: Age Distribution—Eatonville—1980
<5 years
5-17
18-64
65 +
Total
All races
218
609
1198
160
2185
Percentage
9.98
27.88
54.83
7.32
101
Blacks
216
603
1170
159
2137
%
9.89
27.60
54.74
7.28
97.80
Whites
1
3
26
0
30
%
0.05
0.14
1.19
0.00
1.38
Source: Bureau of Economic and Business Research, College
of Business Administration, University of Florida,
Gainesville, Florida, 1986.
Table 4-3: Number of Households—Eatonville—1980
Black
634
White
15
Spanish
7
Other
5
Total
661
Source:
Bureau of Economic and Business Research, College
of Business Administration, University of Florida
Gainesville, Florida, 1986

ii:
1-
O
11
ida, since the state
and count;/
averages were 2.
55 and
2.
respectively (Tab-e
4.4) .
in 1960, 62 percent
of Eatcnvi
lie's population
(1358}
were
aged IE years of age
and over,
and 7.3 percent
o
\Q
r-l
fell ¿i» the age group 65 years and over (Table 4.2) , All
persons in the 65 and over age group except one are black
(Bureau of Economic and Business Research, 1986).
Tan
.Average Humber of Perscr.s per Household — I960
State ol
irsr.ce Count-
Eatonviiie
source:
Bureau of Economic ana Business Research, College
of Business Administration, University of Florida,
Gainesville, Florida, 1936.
Educa: . on
The majority
of che
r.ot beer, educated
beyond
therefore work in
areas .
construction, and
traae.
professionals and
para-p:
ana cides teaching
in sc:
adult resicents of Eatonville have
the elementary level. They
uc'n as custodiáis, contracting.
About 15 percent to 20 percent are
ofessior.ais for eniEp±e, teachers
ools •Eatenville's Economic
:e rview,
Special's
1986)

112
College of Business Administration, University of Florida,
1986) .
Economics
In 1985, the average per capita income for the people of
the town was $7,036 compared to $11,315 for Orange County and
$11,271 for the State of Florida (Bureau of Economic and
Business Research, College of Business Administration,
University of Florida, 1986). Although, the job market has
been improved through development ventures, especially for
school leavers, most of the labor force of Eatonville works
outside of the town making it a dormitory town for the large
tourist centers nearby. About 10 years ago decision makers
in Eatonville decided to become part of the economic world to
prepare for the economic boom, based on neighboring towns
such as Orlando and Altamonte Springs. In order to effect
this, the town applied for and received a $4.1 million grant
to install infrastructure: pave all the streets, put in sewer
lines, build a water plant, and put in sidewalks. Eatonville
is the only town in Orange County that is completely paved
and watered, and this has led to several companies moving
into the town. The city could no longer depend on
residential property taxes for support, because the average
household assessment was less than $25,000. With Florida's
$25,000 homestead exemption, enacted in 1980 (Statutes Number
196), the city government received little or no money from
property tax. The city therefore saw the need to concentrate

113
efforts on developing a commercial district in Eatonville.
Two years after effecting this they had more than doubled
their tax revenue by attracting commerce and industry into
the town. The increase in industry and commerce has meant
more jobs and more people working in the town itself. This
has also meant more money through taxes for the municipality.
Having examined the demographic profile, the remainder
of this section will be directed to other features of the
community including politics, housing, religion, and
recreation. Extreme care has been taken to plan the city,
since it is surrounded on three sides by other towns and
hence much more annexation is not envisaged because very
little land is available. A tour of the small town reveals
beautifully kept houses and yards, spin-offs of the grant
received earlier by the town. Large stores and shops are
conspicuously absent, but the close proximity of larger towns
takes care of this aspect of the needs of the residents: They
do not have to go extremely long distances to shop.
Businesses owned and operated by citizens of Eatonville
include the Tiger Gas Station, Vereen's Cabinet Shop, and
Eatonville Diversified Corporation which includes a funeral
home and commercial building. There are also Sims' Plant
Nursery, Johnson's Lawn Mower Repair Shop, and Ellis' Welding
and Metal. There is a Town Hall which is the administrative
center for the municipality. There are no hotels, and only a
single motel in the town. There are two night clubs, Mr. B's

114
and the Rainbow Bar, Grill and Entertainment Complex which is
one of the landmarks of the town (Otey, 1989). Mr. B's is
very formal with a rigid dress code. It is described as
being "as fine as any night club in Central Florida" (Otey,
1989:35-6). "Mr. B's is also a classic entertainment spot
for special parties, weddings, club meetings, conventions,
and reunions" (Otey, 1989:36). The Rainbow club is more like
a bar where some of the men of the town spend most of their
day. Another meeting place is Duncan's coffee shop where the
older men meet for coffee and social interaction. The town
boasts a beautiful community center: the Denton Johnson
Community Center, which acts as a central venue for clinics
and food distribution among other functions. There is a
single restaurant and there are two small grocery shops.
There is a kindergarten and day nursery, one large elementary
school and one high school which is also a vocational center.
The high school and vocational center make up the Wymore
Education Career Center. There is a large auditorium—The
Hungerford Memorial Auditorium—where major civic functions
are held. There is a post office in the town but no mail
carriers; hence, the residents who can afford it rent boxes
in the post office. Residents are, however, able to purchase
stamps and do all their mailing at the Eatonville Post
Office. Those who cannot afford to pay for mail box rental
have their mail sent to the Maitland or Orlando Zip Codes,
and these are delivered to their residences.

115
Politics
As noted earlier, the Mayor is the chief executive of
the town. Included in the city staff is the Police
Department (one chief of police and five officers) and a Fire
Department of three persons. The Mayor and Council members
are elected officials.
Housing
Most of Eatonville's residents own their homes.
Eatonville is about 95 percent owner occupied. The mayor of
Eatonville told the researcher "the people who are living in
their homes will do so until they die, then these homes will
be passed on to the next generation. This has been going on
for years because they are a close-knit community." There
are three sets of low income apartments in Eatonville. These
are West Community Apartments, Oakpark apartments, and
Kennedy apartments. These were built under Section 8 of the
Housing and Community Development Act of 1974 (Economic
Specialist, 1986) . Under this Section of the Act, rent
supplements were replaced by a new but basically similar
plan, the program for leased housing. None of these
residences are specifically designed for or allocated to
senior citizens.
Religion
Religion, plays a major role in the lives of the
majority of the people of Eatonville. The black church is an
integral part of the community's existence, although it does

116
not seem to dominate the lives of all the people. There are
10 churches in the town. The major ones are St. Lawrence
African Methodist Episcopal, Macedonia Missionary Baptist,
Mt. Carmel Baptist, Open Door Baptist, Church of God and
Christ, Healing Crusade Mission, Revival Center, and Church
of God by Faith. All residents are able to worship in a
church that is within walking distance. The oldest church is
the St. Lawrence African Methodist Episcopal Church; however,
the largest is the Macedonia Missionary Baptist Church.
Churches in the community provide a range of activities not
only for their members but for the community at large.
Recreation
The people of Eatonville do not suffer from a lack of
recreation. The small size does not deter the municipality
from providing recreation for its residents. There is a
community swimming pool, tennis courts, and softball fields.
In 1985 the council appointed a Recreation Committee to
develop a comprehensive recreation program for the elderly as
well as for the youth. The program was completed by the end
of Summer 1986 and implemented early that Fall. Other
recreation programs are carried out as cooperative efforts
among the schools, the community and the churches. The
municipality hosts various programs for its citizenry. These
include parades such as the one held annually to commemorate
the birthday of the late Reverend Dr. Martin Luther King,
Jr., roasts, and beauty pageants.

117
The town of Eatonville with its many lakes is
strategically located. This location, however, could be a
contributor to the town's backward development. The close
proximity of other townships, which makes all their support
systems available to the people of Eatonville, contributes to
the lack of its development. The result is that the town
lacks several supports such as a clinic, a bank, a pharmacy
and a mail carrier. There are very few jobs for young
people, and this may be a contributing factor to Eatonville's
drug problem which has escalated over the past 2 years. The
residents of Eatonville do not complain much, but older
residents do find it very difficult to carry on daily life
because they have to go out of the town for almost everything
except church attendance. The commercial park, which was
expected to boost the job offerings for young people, was a
disappointment in that there were not many jobs offered. The
clientele of a major wholesale store located in the Park is
mainly persons from the neighboring white communities who can
afford to purchase in bulk. The residents of the town do not
benefit from this enterprize.
One major influence on the Town of Eatonville's
development is Florida's Interstate Highway 4 (Figure 4-1).
This highway traverses the state from Daytona on the east
coast to Tampa on the west coast. The highway, built in 1964-
65, passes through the center of Eatonville on its way north
to Orlando. Although there is no highway entrance or exit

118
Figure 4-1: Schematic Represention of the Place of the town
of Eatonville in the East Orlando Community

119
ramp at Eatonville, Interstate-4 gave the town a new exposure
(Otey, 1989).
The year 1987 witnessed the celebrating of the
centennial of the Town of Eatonville. At this time tribute
was paid to its founding fathers and to those citizens who
had contributed to its growth and development through the
years.
Caregivina in Eatonville
The care given to elderly persons in the Town of
Eatonville was found to be effected by seven different
methods utilizing both the formal and the informal support
systems. Most senior citizens were dependent to some extent
upon a person (or persons) for assistance. Dependence is
defined here "as the extent to which the means necessary for
survival are not directly available to the individual through
his or her own efforts, but must, to some extent, be obtained
from others" (Clark, 1972:263). Clark speaks of six types of
dependency that seem to be distinguishable in terms of
cultural meanings and behavioral dynamics. These are (1)
Socioeconomic dependency, (2) Developmental or transitional
dependency, (3) Dependency of crisis, (4) Dependency of non¬
reciprocal roles, (5) Neurotic dependency, and (6) Dependency
as a culturally-conditioned character trait (Clark,
1972:264). Although Americans place a great deal of emphasis
on individuality and freedom, Clark (1972:263) noted that
this particular imperative, when applied to the case of the

120
aged, forces many elderly people in our society to make an
unhappy choice between denial on the one hand and self¬
recrimination on the other.
Presentation of the findings includes in part a
quantitative analysis based on a sample of 71 elderly
persons. However, vignettes are used to highlight the use of
services in Eatonville by its elderly residents. The persons
dominating these vignettes are not being treated as simple
respondents in a survey but are being treated as informants
in the anthropological sense about the system and the town.
The vignettes describe illustrative cases of the levels of
dependency and the types of formal and informal support
networks of elderly persons in Eatonville. In each vignette
there is a given level of dependence and a given type of
support each receives.
The researcher believes vignettes to be a useful medium
through which to illustrate topics such as caregiving
networks in studies employing the type of methodology as is
done here. They appear to be one of the means which best
illustrates to the reader how individuals and their kin come
together to make up a community as well as the intertwining
of these individuals with their community.
Sample for Interviews and Quantitative Analysis
A convenience sample of seventy-nine (n = 79) elderly
black persons was taken representing approximately 50 percent
of the total black elderly population of the community which

121
is estimated as 159. The resultant data, however, is based
on a sample of 71 persons (n = 71). Eight (n =8) of the
original sample had to be excluded because, although they
lived on the periphery of the town and participated in its
social life, they did not fall within the official city
limits of Eatonville. Boundary changes resulted in this
situation. It is not clear whether these boundary changes
were effected after the 1980 census. A total number of 115
persons representing older persons, caregivers, church and
community leaders, political leaders and county agency
personnel were polled.
Obtaining the sample was not straightforward. No
directory of elderly persons existed. The snowball sampling
procedure was employed. In this precedure the researcher
chooses one or more informants which may generate information
about other persons which leads the observer to contact one
of these others as a second informant, who in turn directs
him or her to a third informant and so on until there is an
extensive chain of contacts (McCall and Simmons, 1969). The
researcher first visited two of six elderly ladies who had
been contacted during a pilot study which she had conducted
in the summer of 1986. From them were obtained the names of
six others. Following this a visit was paid to the Town
Hall, from which there was a possibility of obtaining a
listing of senior citizens. This visit proved futile.
Twenty registration slips were left with the clerk to be

122
completed by senior citizens who visited the town hall to pay
their water bills. The next agency that was targeted was the
Senior Citizens' Center at the Wymore Career and Vocational
School. A short list consisting of ten persons was obtained
from the director of the center. This list, together with
the names that had previously been obtained, served as the
catalyst. Only names and telephone numbers were available,
no addresses. The researcher also met with six senior
citizens who were in attendance at the center on the day of
the visit. Appointments were made to visit with them in
their homes. These visits proved useful not only for
obtaining personal information but also for obtaining
information about other senior citizens in the town with whom
these persons were acquainted. Of note is the observation
that most senior citizens in the community keep an updated
telephone listing of several other senior citizens. This
list is their main mechanism for communicating with each
other and it proved very useful since names and telephone
numbers could be obtained. This procedure was repeated at
each visit until a comprehensive telephone listing of a large
number of the senior citizens in the town was made. This
snowball sampling technique was the method used to obtain the
majority of subjects for this study. The remainder of the
sample was selected through contacts made at the county
surplus food distribution center.

123
Introductory telephone calls were made to these persons
explaining the project and requesting a visit. Most were
amenable while some were a bit skeptical. For those who did
not respond positively, a short visit to the home became
necessary. After explaining the reason for the visit, there
was very little problem arranging future visits. Telephone
networking as practiced by many senior citizens in the town,
played a major role since those that were visited called
others and told them about the researcher and the research.
This helped tremendously. During the 12-month period of the
research multiple visits were paid to each respondent. Quota
sampling method was used to sample government and community
officials. With this method of sampling, the observer is
aware of certain formal categories of organization members
and determines beforehand that he/she will interview and
observe at least a few persons from each of these categories
(McCall and Simmons, 1979). The categories sampled were
county officials, officers of the Area Agency on Aging and
the Older Americans Council, members of the Town Council
and administration, nurses, clergymen, teachers, police,
firemen, community workers, philanthropists, and local
businessmen.
Measurement of Variables
Although the study is primarily qualitative, 18 major
independent variables were measured quantitatively. These
include socio-economic status, health status, living

124
arrangements, and kinship patterns based on family and
friends.
Questions centered around ownership patterns of dwelling
units, number of health problems, marital status, disability,
household size, living arrangements, and economic status.
The ability to perform the Activities of Daily Living (ADLs),
the Instrumental Activities of Daily Living (IADLs), sources
of income, and the use of leisure time were also examined.
When elderly persons were physically or mentally unable to
respond to the interview (n =1) , or participate in the
discussions, data from their closest other were used.
Operationalizing the Major Variables
In order to assess the care given to the elderly persons
of Eatonville, 18 major variables utilizing the following 40
independent indicators are analyzed.
Ace of Respondent
Respondent age is an interval variable ranging from 65
to 93.
Gender of Respondent
Respondent gender is a dichotomous variable coded one
when the respondent elderly person is female.
Marital Status
Marital status of the respondent is coded 0-4. This
nominal variable is coded zero if the respondent has never
been married, one if the respondent is married, two if the

125
respondent is separated, three if the respondent is divorced
and four if the respondent is widowed.
Residential Status
This variable has these dimensions:
Born in Eatonville is a dichotomous variable coded one
when the respondent was born in Eatonville.
State of birth is a dichotomous variable coded one when
the respondent was born in Florida.
Years in Eatonville is an interval variable ranging from
2 to 86.
Living Arrangements
Two variables deal with this aspect of life.
Ownership of the dwelling unit is a dichotomous variable
coded one for own.
Number in household is a continuous variable ranging
from 1 to 7 including the respondent.
Pi sabi1ity
Disability of elderly persons is an indicator of the
need for both formal and informal caregiving. For the
purposes of this study, respondents were labeled disabled if
they were blind, wheelchair-bound or bedridden. Disabled is
a dichotomous variable coded one for yes.
Health Status
Five variables determine the health status of
respondents. Hypertension, diabetes and arthritis were
selected for special treatment since they are the most

126
common forms of chronic diseases affecting black elderly
persons.
Number of health problems. Number of health problems is
a continuous variable ranging from 0 to 7.
Hypertension. Hypertension is a dichotomous variable
coded one for yes.
Diabetes. Diabetes is a dichotomous variable coded one
for yes.
Arthritis. Arthritis is a dichotomous variable coded
one for yes.
Other. All other ailments that the respondent reported
are recorded under other. Other is a dichotomous variable
coded one for yes. This variable is used to determine
impairment of the respondent. Respondents ailments are
recorded in terms of numbers and severity based upon self
reports and researcher observations.
Number of ADL Tasks
For the purpose of this research, activities of daily
living were dressing, bathing, feeding, toileting, and
transfering, e.g., from bed to chair or commode and vice
versa, or from one part of the house to another. An interval
variable was created ranging from one to five
representing the number of ADL tasks which the respondent was
able to perform unassisted.

127
Number.,,of IADL Tasks
Seven instrumental tasks were used. These were grocery
shopping, managing finances, housework, yardwork, meal
preparation, transportation, and administering medications.
Number of IADL tasks is a continuous variable ranging from
zero to seven. Again the number recorded was the
number of tasks that the respondent was able to perform
without assistance.
SQciQzEcQnQmic Status
Occupation and income were used as measures of socio¬
economic status.
Occupation. Occupation is measured using the
Hollingshead Occupation Scale coding from one to nine.
Homemakers were not originally included in the occupation
scale. In this study they were coded four because that
coding included practical nurses, foremen, restaurant
managers, machinists, storekeepers, and decorators which are
occupations with similar manual skill requirements and
prestige. Eatonville is a low income community and hence if
these ladies worked outside of the home they would be
expected to hold positions equivalent to those listed.
Income. The income of elderly persons is usually
derived from various sources. Income based on dependence on
the respondents' children or other relatives indicated a
sometimes unstable source of income, necessitating caregiving
in one form or another, formal or informal. Income based on

128
Social Security could indicate financial hardships as well.
Income based on Social Security and/or pension was an
indication that the respondent's former occupation fell into
a category above service industry or seasonal work. Four
indicators representing the main sources of household income
are used. These are Social Security (SS), Supplemental
Security Income (SSI), pension, and holding a current job.
These are the sources reported by the elderly respondents.
Social Security. Social Security is a dichotomous
variable coded one when the respondent is a recipient of
Social Security.
Supplemental Security Income. The Supplementary
Security Income (SSI) program is a federal program enacted
by Congress as a part of the Social Security Amendments of
1972, to guarantee that the annual income of an older or
disabled person would not fall below a minimum level.
Eligibility for SSI benefits is based on a categorical
requirement and on limits on income and resources (Kutza,
1981:39). Supplemental Security Income is a dichotomous
variable coded one when the respondent is a recipient of
SSI.
Pension. Pension is a dichotomous variable coded one
for respondents who benefit from a pension. This includes
Veterans Pension.
Current job. Current job is a dichotomous variable
coded one for respondents who were currently working. This

129
applied to those holding part-time as well as full-time
positions.
Family
Respondent's family is comprised of three indicators
which are the living children, grandchildren, and siblings of
the respondent.
Number of children. Number of children is an interval
variable ranging from 0 to 11.
Number of grandchildren. Number of grandchildren is an
interval variable ranging from 0 to 22.
Number of siblings. Number of siblings is an interval
variable ranging from 0 to 8.
Care Receiver
Respondents who were care receivers were those who were
receiving assistance with at least one ADL and two IADLs.
Care receiver is a dichotomous variable coded one when the
respondent is a care receiver.
Caregiver
Some respondents are caregivers. They administer unpaid
assistance primarily to relatives, but some administer care
to neighbors and friends. Caregiver is a dichotomous
variable coded one for those respondents who in some way are
caregivers.
Formal Support
Formal support is constructed by summing positive
responses to the use of six indicators. These are Medicare,

130
Medicaid, Surplus Food, Food Stamps, Day Care, and Others.
Thus, it has a theoretical range of 0 to 6.
Medicare. Medicare began in 1966 as a federally
financed health-insurance program for persons aged 65 and
over, and in 1972 it extended benefits to the disabled and
persons suffering from end-stage renal disease. Medicare
consists of two parts, the Hospital Insurance Program (Part
A) and the Supplementary Medical Insurance Program (Part B) .
Hospital Insurance helps pay for hospital care and for
posthospital care in so-called extended care facilities or
through home health programs. The Supplemental Medical
Insurance Program is a voluntary program in which almost
everyone aged 65 or over may enroll. Part B helps pay for
physicians' services and outpatient services. To be eligible
to receive Medicare Part A benefits, an individual must be
(1) aged 65 or over and receiving or entitled to Social
Security or Railroad Retirement benefits as an insured
worker, or be a dependent or survivor of an insured worker;
(2) disabled and eligible for Social Security or Railroad
Retirement benefits for 24 or more consecutive months. To be
eligible to receive Medicare Part B benefits, an individual
must pay a monthly premium and be entitled to Medicare
Hospital Insurance, or be aged 65 or over and a citizen and
resident of the United States. Benefits under Medicare are
subject to certain copayment and deductible provisions

131
(Kutza, 1981:36-39). Medicare is a dichotomous variable
coded one for beneficiaries.
Medicaid. Medicaid is a Medical Assistance Program
authorized under provision of Title XIX of the Social
Security Act, as amended. Unlike Medicare, Medicaid is not a
health-insurance program. Instead, it is a federal-state
program of medical assistance for the needy and for certain
other low-income persons who are aged, blind, disabled, or
members of families with dependent children. Benefits under
the Medicaid program are medical-care services for which full
or partial payment is made directly to the providers of
services on behalf of eligible beneficiaries (Kutza, 1981:40-
43). Medicaid is a dichotomous variable coded one for
beneficiaries.
Surplus food. Surplus food is a dichotomous variable
coded one for recipients of this benefit.
Food stamps. For a household to be eligible for food-
stamps benefits, its income after deduction must fall below
the poverty line annually set by the Office of Management and
Budget. Each month an eligible household receives an
allotment of stamps, the number determined by the amount it
would cost to purchase a "Thrifty Food Plan" (as determined
by the Department of Agriculture for various Family sizes)
less 30 percent of the household's net income after
deductions (Kutza, 1981:48). Food stamps is a dichotomous
variable coded one for yes.

132
Day care. Day care is a dichotomous variable coded one
for yes.
Other. Elderly persons are recipients of other formal
supports. These include rental subsidy, utility supplement,
chore/home repair services, home nursing services, homemaker
services, home-delivered meals, and shopping assistance.
Other is a dichotomous variable coded one for yes.
Informal Support
This major independent variable was constructed using
the indicators spouse, children, family, church, neighbors
and friends. It is based on the support the respondent
receives from each of these groups that make up the informal
network. It is not a measure of the quantity or quality of
support received but whether or not respondents benefit from
some kind of assistance from each group. The range of this
variable is from zero to five.
Spouse. Spouse is a dichotomous variable coded one for
yes .
Children. Children is a dichotomous variable coded one
for yes.
Family. Family is a dichotomous variable coded one for
yes .
Church. This is a dichotomous variable coded one for
yes .
Neighbors and/or friends. Neighbors and/or friends is a
dichotomous variable coded one for yes.

133
Agency Awareness
Although there are formal agencies such as Area Agencies
on Aging which exist for the sole purpose of serving elderly
persons who are not institutionalized, one common observation
is that those who are in need of help often lack knowledge
regarding these sources of help. They therefore do not know
where to go to get help. Some elderly persons may be in
receipt of help from one agency but are ignorant of the
existence of other agencies which are in place to provide
other supports such as home-delivered meals. The variable
Agency Awareness includes other agency awareness and meal
awareness.
Other agency awareness. This variable summarized
responses to questions posed by the researcher, complaints
made by respondents, as well as on observations made by the
researcher. Other agency awareness is coded two for high
awareness, one for medium awareness, and zero for low
awareness.
Meal awareness. Many elderly persons, especially those
living alone are in need of home-delivered meals. Although
this is a service provided by the formal support system, many
are unaware of its existence. Meal awareness is a subjective
coding based upon the respondent's knowledgeability regarding
this service. Meal awareness is coded two for high, one for
medium, and zero for low.

134
Indication for the Need for More Help
Elderly persons are recipients of assistance from both
the formal and the informal network systems. Many however do
not receive as much help as is necessary to reduce fear and
anxiety. The need for more help was assessed based on two
factors. The respondents' statements and the observations of
the researcher. More help needed is a dichotomous variable
coded one for yes.
Summary
The setting and methodology have been presented in this
chapter. In order to address the care of black elderly
persons and in an attempt to reveal inter-relationships of
the formal and informal support systems and the black family,
the community selected is small, that is less than 3,000
population and is predominantly black. In order to generate
the data surrounding the phenomenon of black elderly
caregiving, a methodology is employed to facilitate
observation of persons, objects and events, time and locales.
Quota sampling was the procedure used to sample county
officials, and local and church leaders, while snowball
sampling procedures were used to sample the elderly
population of the community.
Research questions focused on the role of the family as
service agent, as well as on knowledgeability about, use of,
and access to formal services. Forty independent indicators
were isolated for quantitative descriptive analysis, thereby

135
integrating field interviews with structured data collection.
Kinship patterns were determined based on an overall
assessment of family relations and on the literature which
states that low-income families usually have stronger kinship
ties than middle-income families; Eatonville is primarily a
low-income community. The historical demographic, political
residential, social, and religious components have been
addressed. A pilot study conducted by the researcher in
Eatonville in 1986 was beneficial to the larger study.
Chapter Five presents the major findings from the data. One
of the outcomes of the interviews is the construction of
Vignettes. These vignettes are presented in Chapter five
and are used as a means of presenting the qualitative
analysis.

CHAPTER FIVE
FINDINGS AND DISCUSSIONS
There are several interrelated purposes of this study.
The overall purpose is to examine caregiving for frail black
elderly persons in the Town of Eatonville, Florida. Within
this general purpose, the researcher is first concerned with
the role of the extended family in caring for functionally
disabled elderly persons in an all-black community. Second,
the researcher will examine the role of friendship, church
and other informal groups in providing care. Third, the role
that the formal caregiving system, governmental and publicly
funded, plays will be explored. Fourth, the researcher will
be concerned with the interrelations between the formal and
informal caregiving and support systems in the Town of
Eatonville.
In pursuing these purposes, several questions are
raised. First, does the elderly person need help, and if so,
does he or she know sources of help, that is, is there
awareness of formal and informal sources? Second, if there
is a helper, is the primary helper provided by a formal
agency? And, is there need for more help? Third, do people
know where to go to get help (agency or nonagency)? A final
136

137
set of questions asks whether the fact that formal services
are available but are not being utilized is explained by the
ignorance of their existence, preference, culture, or
problems with access? Do the people in this community
perceive a lack of access to the formal services system? And
are their needs adequately met?
One example of care given to an elderly black person is
Mrs. Brown. She is an 86-year-old widow who lives alone with
her 38-year-old daughter in a large and attractive house.
The house is beautifully furnished and Mrs. Brown's living
room is resplendent with trophies which were awarded to her
son who was a professional athlete. Mrs. Brown is not
allowed to do anything at home. Her daughter who holds a
full-time job does everything for her and drives her when she
has to go out. Mrs. Brown attends the senior citizens
daycare center everyday. She has been doing this since its
inception. In 1989 the center was transferred from
Eatonville (a black community with a black program director)
to Winter Park (a predominantly white community with a white
program director)). Mrs. Brown described her experience with
the move, and noted that, although the folks were white,
"they were O.K." She mentioned that they still did some of
the activities that they did at the former center. "There
are no problems," she said. "We sing and all that. You know
'white people' they’ll do anything you tell them to." Mrs.

138
Brown is disenchanted with the local municipality. She
states
I no longer attend the public meetings. I am not
happy with how they are run. People are not
allowed to get up and say what they want. You have
to speak through another person, and I don't agree
with that. I know what I want to say and how I
want to say it. So if I can't say it myself I
don't bother to go to the meetings.
Mrs. Brown was referring to a ruling by the Town Council
regarding town meetings. The ruling was that if there was a
group idea to be brought to the council then one person
should be given the responsibility as spokesperson for that
group. The case of Mrs. Brown's caregiving is not typical of
what takes place in Eatonville. Life is not as uncomplicated
for all its elderly citizens. Culture plays a significant
role in the giving and receiving of care in this community.
Culture as it involves kinship patterns is very evident.
There is a great deal of dependency upon friends and
neighbors. This is especially evident with those elderly
persons who are living on their own.
Ignorance of available formal supports for elderly
persons has very often resulted in family members
experiencing more than their share of the stress and burden
which accompany taking care of an elderly relative. This is
especially acute when that elderly relative is frail and
suffers from Alzheimer's disease. Many relatives of
Alzheimer's disease patients are reluctant to
institutionalize their loved ones.

139
Based upon findings from a study, Cantor (1983) reported
that spouses report the greatest degree of physical and
financial strain, and that the extent of impact on the
everyday life of the caregiver appeared to be clearly related
to the closeness of the kinship bond and was most severe in
the case of spouses who lived in the same house as the
Alzheimer's patient. It is not uncommon for family members
to give up their jobs to care for the ill relative (Clark and
Rakowski, 1983). The situation of many of the respondents to
this study appear to fit these criteria.
The findings of this study are presented in two ways.
First, vignettes are utilized to summarize the qualitative
findings, and second, a quantitative descriptive analysis is
presented and discussed. Vignettes are not case studies in
the true sense, and in this research they are used to study
and indicate the range of dependency and type of support used
by elderly residents of Eatonville (Figure 5-1). Six
Vignettes are presented.
Vignette #1
Mr. Duffus* is 76 years old, married, and suffers from
Alzheimer's disease. He lives alone with his 59-year-old
wife who takes care of him on a full-time basis. Mr. Duffus
who is in an advanced stage of his disease was unable to
respond to any questions so his wife provided the researcher
with all of the information. In 1980, when Mr. Duffus'
‘Pseudonyms are used throughout this text.

140
condition worsened, Mrs. Duffus had to quit her full-time job
as a nurse's aide in a hospital in order to stay home and
take care of him. It is not uncommon for family members to
give up their jobs to care for the ill relative (Clark and
Rakowski, 1983). Mr. Duffus' other ailments include a
chronic heart condition, fluid in his lungs, a history of
spinal meningitis 27 years ago, and prostate surgery. He is
incontinent and has to be watched all the time. He is unable
to go to the bathroom by himself and has to use a bed pan.
Mrs. Duffus reports that Mr. Duffus is incapable of using the
bedpan or urinal without supervision. His doctor gave them a
prescription for a commode chair, but he is unable to use it.
His doctor and Mrs. Duffus had hoped that this would have
relieved Mrs. Duffus by removing one of her burdensome tasks,
that of supervising the visits that Mr. Duffus makes to the
bathroom.
Mrs. Duffus assists her husband with all ADLs except
feeding himself, but even this, she states, has to be
supervised. He was in a semicoma for about 6 months and has
had to learn to walk again. Mrs. Duffus has to work at least
2 days per week doing domestic work in order to supplement
their only income which is from Social Security. She reports
that they could not cope financially if she did not work.
The only other support they receive is in the form of surplus
food which is distributed every 2 months and does not include

141
the basic food requirements. The package consists of
raisins, butter (which is salted), honey, and cornmeal.
Although this man is not bedbound, or wheelchair bound,
he is homebound, spends most of his time sitting on their
enclosed porch and stares vaguely all the time, while
mumbling incoherently. All the doors of the house, in which
they live alone, have to be kept locked at all times. The
porch is, however, quite airy and so he gets a lot of fresh
air and the neighbors can see him when his wife has to go
out.
Mr. Duffus is left alone at home when his wife goes to
work and the neighbors keep an eye on him. This appears to
be dangerous since, if there were a fire or if he should
fall, there could be serious repercussions. The researcher
visited the house several times while on rounds and got no
response from a knock on the door. Once Mr. Duffus was
observed sitting on the porch, and the other times the
researcher was aware that he was inside the house but was
unable to respond. The neighbors reported that they had seen
him moving around in the house earlier. This is the extent
of the support that the Duffus' receive from their neighbors.
The couple have two sons and two daughters ranging in
ages from 37 to 40 years. One daughter who lives 1 mile away
checks on them regularly but is unable to offer any
assistance at respite for her mother because she has to take

142
care of her own family. They also have three granddaughters
residing in Orlando, 4 miles away. Nothing was said about
the other children. None of the children or grandchildren
offer any financial assistance.
Mrs. Duffus is a very pleasant lady, who takes very good
care of her husband but her stress burden is obvious. She
performs all the IADLs including doing the yardwork. Mrs.
Duffus reports that she is not "one hundred percent" well.
She is hypertensive and, although the disease has been
controlled, she sometimes feels very tired. Mr. Duffus is
currently on medication for his heart condition, his
respiratory condition, and his hypertension. His wife has to
administer the medication at all times. He visits his doctor
by appointment, and she drives him to these appointments.
Her main concern is having to leave him on his own whenever
she goes to work or goes out. She also complained that there
was no one who could take over if she were ill or had to go
away for a few days.
Mrs. Duffus was not aware of any source of formal
support that she could receive. She did not know about
respite services and home help. She spoke uncomplainingly of
physical and mental burn out, although she "[does] not object
to taking care of him." Her concern for him was similar to
that shown by a mother for a child. She sometimes takes him
for walks so that "he can get out a little." They have an
attractive home with a well kept yard. Mrs. Duffus complains

143
of some backache and of sometimes feeling very tired. The
stress burden compounded by the physical burden is one of the
major concerns for caregivers. More could be done for this
couple in the form of assistance but knowledge about
available formal services is lacking. It was evident that if
the knowledge was there, some of these services could
definitely have been accessed.
Three problems can be identified in this household, in
which there is an elderly male care-receiver. There is a
financial problem which forces Mrs. Duffus to go out of the
household to work while taking care of her husband full-time,
and this despite the fact that the nature of his illness
demands full-time care. The second is the health of Mrs.
Duffus, the caregiver. Based upon findings from a study,
Cantor (1983) reported that spouses report the greatest
degree of physical and financial strain, and that the extent
of impact on the everyday life of the caregiver appeared to
be clearly related to the closeness of the kinship bond and
was most severe in the case of spouses who lived in the same
house as the Alzheimer's patient. One can expect Mrs.
Duffus' health to deteriorate if she does not get some help
soon. The problem lies not only with her physical health,
but also with her mental health.
A third problem is the lack of family support, that is,
some person or persons on whom Mrs. Duffus can call to
relieve her. In the absence of this informal support the

144
answer to their problems lies in the formal support system.
They need financial assistance. This could be in the form of
food stamps to supplement their Social Security. If they
received this, Mrs. Duffus would not have to go out of the
home to work. Mrs. Duffus, although a fit looking lady,
complains that she has to do a lot of lifting. Fortunately
she is a well built lady and he is a small frail man. The
assistance of a home health nurse even once per week would be
a great help to Mrs. Duffus. The stress burden which is
evident could be alleviated by Mrs. Duffus being able to
attend an Alzheimer's support group.
It was evident that family physicians are not doing
their job properly in the case of this patient. It is the
physicians duty to be familiar with the types of assistance
available to families with frail and functionally disabled
elderly persons at home, and advise their relatives
accordingly. Respite care is very badly needed. It should
be possible for Mrs. Duffus to leave her husband in a
facility for short periods of time while she enjoys a break.
The cost of this service should be the responsibility of the
formal system. Another service that would be of help is day
care. Mrs. Duffus would then be spared the guilt and worry
when she has to leave Mr. Duffus at home alone.
Alzheimer's disease is known to last from 2 to 20 years;
it leads to permanent disability, and eventually to death.
There is no cure for the disease, which can be mild,

145
moderate, or severe. Persons with Alzheimer's disease need
constant supervision (Doty and Caranasos, 1987) . The family
should learn about the disease and what to expect. Mrs.
Duffus seemed to be quite conversant with her husband's
illness and was trying to cope as best as she could.
Although many relatives of Alzheimer's disease patients are
reluctant to institutionalize their loved ones, the existence
and/or accessibility of an Alzheimer's support group would be
of great help to Mrs. Duffus. It was obvious that if Mrs.
Duffus knew of the existence of these services, and if they
were accessible, she would avail herself of them.
Unfortunately, none of these services are available in the
community.
Mr. Duffus is an example of dependency mainly on the
informal support system. This dependence however, can be
attributed to a lack of knowledge of formal support systems
that are in place to assist him and his caregiver spouse.
Vignette #2
Mr. Noble is a heavy-set 220 pound, 76-year-old male who
lives with his wife in their three-bedroom house. He has
been retired for 25 years. His medical ailments are
hypertension and congestive heart failure. He has a problem
walking about the house without the assistance of a stroller
or a stick. He owns crutches that he uses from time to time,
depending on the condition of his legs. His hearing is
impaired and he uses a hearing aid. Recently he has been

146
attempting to walk around the house without the aid of the
stroller. He used to go for short walks out on the street
but has given this up since his most recent illness 6 months
ago when he was diagnosed with congestive heart failure. He
utilizes both the formal and the informal support systems.
He depends upon the paramedics at the local fire department
in the event that he should fall. His wife, who is a slender
69-year-old lady, is not able to lift him by herself. He has
an emergency response button which is activated at the fire
station. The couple report a response time of less than 5
minutes from the paramedics. The small size of the town is
also an advantage since it does not take more than 10 minutes
from one end of the town to the other. Mr. Noble dresses
himself but needs assistance with his bath. He prepares his
own lunch whenever his wife goes to work. She does so 1 or 2
days per week, doing housework, to supplement the family
income which is from Social Security. They receive Medicaid
for assistance with medical expenses. He spends most of his
time reading, sitting in one place since he cannot move about
too much. His wife performs all but one of the IADLs. Mr.
Noble is able to administer his own medication without
assistance.
Mrs. Noble has her own health problems although she is
not incapacitated by them. She is hypertensive, suffers from
arthritis, and has had a bilateral mastectomy and radiation

147
therapy for breast cancer. She is on medication for her
hypertension.
Mr. Noble depends on the formal and the informal
systems approximately equally. The Nobles are knowledgeable
about how to access the formal support system and hence
utilize the services provided by this system to complement
the informal system. From this we learn that if elderly
persons are aware of the services which are available, then
they are likely to utilize these services.
Vignette #3
Mrs. Barton is an 89-year-old widow who lives alone and
is confined to a wheelchair. She has been living at her
current residence, a two-bedroom apartment in a low income
complex about 3-1/2 years. She pays rent of $285 per month
and does not receive a rent subsidy. Mrs. Barton formerly
resided with her 75-year-old niece in an adjoining community
for 3 years. It was this niece who had persuaded her to move
to Florida to live with her when her doctor recommended that
she move to California from New Jersey where she lived for
over 49 years with her husband. She was a certified foster
parent, and for 35 years fostered more than 80 children for
the State Board of New Jersey. She also raised four other
children, two of whom were her nieces and one her only son.
Her husband died in 1980 and her health started to
deteriorate after that.

148
Mrs. Barton has a medical history of three strokes,
gastric ulcers, gall bladder surgery, nephrectomy (removal of
one kidney, in 1949), arthritis, osteoporosis, and being
involved in an automobile accident in which she suffered a
broken collar bone. She has severe problems with her hips as
a result of her arthritis and osteoporosis. She has not been
able to drive since the automobile accident and finds it
difficult to get into or out of automobiles. Mrs. Barton,
like several others in the community, chews snuff. She also
spends several dollars each week on mail offers which appear
fraudulent. These offers usually request that a certain
amount of money be sent and in return the sender would
receive some article or articles. It was not always definite
that the sender would receive something in return. Mrs.
Barton tells a sad tale about her care receiving:
Her niece had promised to take care of her in
return for which Mrs. Barton spent a lot of money
to repair the niece's house, refurbish it with new
awnings, install a new cooker with hood, and buy a
new washing machine. She had a new front screen
door installed and pays for all the landscaping
each month. In total, Mrs. Barton reports that she
has spent in excess of $3,000 on her niece's
property. She sold two houses and brought all the
cash with her to Florida and her niece knew of
this. She continued to give her niece a lot of
money to spend on the house. When her niece felt
that her money was running out, she evicted her.
Mrs. Barton had nowhere to go and rode around in a
taxi for an entire day after being told by the
nursing home to which she had a referral that they
could not accommodate her. Eventually the taxi
driver feeling some compassion for her, took her to
the only motel in the town and she stayed there for
3 months. Meals-on-wheels provided her with meals
and the management was very kind to her. She met a
lady while at the motel who proved to be a good

149
friend and who helped her with her laundry and
transportation. It was from this motel that Mrs.
Barton moved into the apartment in which she now
resides.
Mrs. Barton is very knowledgeable about the various
formal support services. This is reflected in her
utilization of these services. She keeps all emergency and
other telephone numbers within arm's reach. She has been
confined to her wheelchair for 8 years. She uses a stroller
sometimes and also owns a pair of crutches. She has not used
the crutches for a long time. She fell once and so "she is
now scared of using them." She has an emergency response
buzzer which is activated at the Fire department and alerts
the paramedics, who respond immediately, usually within 3
minutes. This was substantiated by the Chief of Fire
Services who told the researcher of "a false alarm at this
lady's apartment one morning, when she had accidentally
bumped the buzzer and was not aware of this." This gentleman
was not aware that the researcher knew this lady. Mrs.
Barton was the second elderly person in whose home the
researcher encountered this emergency alert buzzer, although
there were several frail elderly persons living alone who
demonstrated a need for these emergency buttons. Response to
these alerts is one service provided by the Municipality, but
many of the town's elderly persons are not aware of its
existence.
Mrs. Barton takes care of all her ADLs but has a problem
with washing her feet. A nurse visits once per week and

150
washes her feet on those visits. A cleaning lady from
homemakers comes in on Thursdays. She receives meals-on-
wheels because her doctor advised against her sitting in the
wheelchair in front of the cooker to prepare her meals.
Someone from homemakers comes in to pay her bills and her
physician makes house calls. When the researcher visited her
in October 1989, she reported that her doctor had not been in
to see her that month and that when she called his office,
his nurse informed her that he no longer made house calls.
She was upset, since he had not informed her of this change.
Formerly, a nurse from home nursing services visited her to
take her blood pressure, but "she no longer comes either."
The Older Americans Council "sends a van to collect her to go
to the clinic, but she has stopped going because the current
driver of the van refuses to come inside the apartment to get
her in her wheelchair to take her to the hospital." Mrs.
Barton reports that the driver claims that she is not
supposed to enter the residence. She observes that the
previous driver used to be more helpful and caring while the
current driver is very inattentive. She attributes this to
the fact that the previous driver was a black male, who
probably empathized, stating that he would wish the same
treatment for his mother should she find herself in this
situation. The current driver is a white female.
Mrs. Barton uses physician's services, home nursing
services, homemaker services, home chore services,

151
transportation services and meals-on-wheels. She is a good
example of someone who relies almost exclusively on formal
support services, and has been victimized by her informal
support system. She receives Social Security, widows
insurance, and receives Medicare health insurance. She used
to receive $10 in food stamps but has ceased doing so since
she experienced difficulty "getting them." She reports that
she would have to pay someone $2 to go and get the Food
Stamps and sometimes she could find no one to do so, so she
now forgoes this service. Mrs. Barton claims that she should
have received a widow's pension from the firm that her
husband had worked for, for more than 22 years. She claims
that lawyers, who had made promises to get this pension from
the company, just "took all her money" without results.
Mrs. Barton also reports problems with her bank account,
stating that her bank notified her that some person, or
persons, had withdrawn over $1,000 from her account. She was
informed after the fact; she had "not authorized anyone to do
this and had not signed any checks for that amount." She
notes that she had left all of her documents at her niece's
house when she was evicted and thinks that this is the
explanation. She also notes that she received phone calls
from her bank, informing her that her niece wanted
information about her account. She has now asked the bank
not to give information or money to any unauthorized person
or persons. Mrs. Barton is very alert, her home is very neat

152
and clean, and she takes care of herself on the days when she
has no help. She performs all her ADLs and utilizes her
telephone fully. She, however, complains of hearing problems
which started about 6 months ago. She takes care of all her
finances, administers her own medication, and prepares some
meals. That is the limit of her IADL performance. A
neighbor, another elderly lady, helps her with her shopping,
and the children in the neighborhood come daily and put out
her trash. She reports that she likes this arrangement with
the children, since if anything happened to her they would be
the first to know and could alert someone. She speaks of the
cooperation of the lady who manages the apartments, and the
help that another lady used to give her but no longer does.
Mrs. Barton is very happy with her current living
arrangements. She "used to pay her niece $225 per month for
a tiny room" and now she has "a nice comfortable apartment"
all to herself. She sounds almost grateful to her niece for
having evicted her, since she now "has peace of mind and is
more relaxed" than she was when living with her niece.
Mrs. Barton has one son, who resides in Philadelphia,
and one granddaughter. She has two nieces living within a 3-
mile radius. She reported that when she first moved into her
apartment, her nephew moved in with her. About 6 months
after he moved in she had to ask him to leave because he was
a drug user, and he used to have his drug-using friends
"crowding her residence." She reports that she was always

153
very scared because she knew what drug addicts could and
would do to obtain money to support their habit. She reports
that he died about 5 months ago from a heart attack.
Noninstitutionalized frail elderly persons depend on
both the formal and the informal support network for services
which will enable them to remain in their own homes. The
type of support system most utilized depends upon factors
such as living arrangements, available familial support,
available community services, and available formal support
services. Those elderly persons who have no relatives or
close friends will be found to depend more on the formal
support network for assistance in these situations. In these
cases formal care is a substitute for the informal care that
does not exist. It has been found that users of formal
services are more likely to be female, older, former
housewives, widows, and that they usually live alone
(Chappell, 1985; Shanas, 1979). Mrs. Barton is one such
elderly person who fits into the description of those elderly
persons who is almost totally reliant on formal services for
their well-being. Mrs. Barton, who does not receive many
visitors, and spends a lot of time in her house is an example
of how the formal support system can assist persons to live
comfortably and dignified lives in their own homes. She was
excited that soon she would be having house guests. She was
looking forward to the visit of her son at Thanksgiving and

154
that of her granddaughter at Christmas. Mrs. Barton is
almost totally dependent on the formal system.
Vignette #4
Although there are those elderly persons who are not
intimidated with the Formal Support Network, some elderly
persons are fearful of utilizing these services. Several
factors account for this behavior, but culture seems to play
an important role. Mr. Hines is one such frail elderly
person. Mr. Hines is an example of an individual who is
almost totally independent but who receives some assistance
from the informal care system.
Mr. Hines is an 86-year-old widower who lives by
himself in his own house. Mr. Hines used to be a
chef. He moved to Eatonville 27 years ago. Mr.
Hines has no children. He has no siblings or
relatives living in the area. He has no family
doctor, makes no visits to the doctor or to the
clinic. He is the only respondent encountered by
the researcher who did not have a family physician.
He is in very poor health and is badly in need of
medical assistance. He has no form of
transportation and cannot help himself. The house
in which Mr. Hines lives is dirty, smells bad, and
it is very dark. He has a single light which is in
the kitchen. There are no outside lights and no
room lights. He had a space heater going in the
hallway. Everywhere, the room was untidy and seemed
overcrowded with junk.
The researcher visited Mr. Hines early one Saturday
evening. She wanted to locate his house since
several persons in the town had told her about the
help that a local philanthropist had given to Mr.
Hines. This gentleman had reroofed Mr. Hines'
entire house and when he was interviewed by the
researcher the next day, he told her that his crew
had also cleaned out a section of the house and had
also cleaned the yard. This philanthropist also
told the researcher that he was the only person
whom Mr. Hines would allow to do anything to his
house.

155
Mr. Hines was ill when the researcher visited, and
had not left his house for several days. He had no
food in the house and had not eaten. He was very
much in need of care. The researcher questioned
his neighbors, who reported that they used to
assist him. One neighbor claimed that her son used
to clean the yard, and that she used to assist him
with his laundry. She had to stop doing the
laundry because the clothes were usually so dirty
and smelly when she received them, that she could
no longer take them to her house where she also had
her small grandchildren. Her son had also stopped
cleaning the yard and running errands because of
Mr. Hines' behavior.
The neighbors seemed to have stopped their caring for
several reasons. The main one was that Mr. Hines refused to
seek medical help or the assistance of the Health and
Rehabilitation Service or the County health service because
he claimed that his house would be taken away from him, and
he could not allow this to happen. The consensus among Mr.
Hines' neighbors was that he belonged in a nursing home. Mr.
Hines did not agree, however, since he was convinced that he
would lose his house to the government. The researcher was
accompanied by one of his neighbors to the store to purchase
food for Mr. Hines. At a seminar, which the researcher had
organized with the cooperation of one of the local churches
for local church leaders and elderly persons the following
Monday, the researcher called upon members of the community
to help this gentleman. When the researcher returned to the
community 2 weeks later, she was informed by this neighbor
that Mr. Hines had been placed in a nursing home, because

156
there was just no one to take care of him, and he was
incapable of doing it himself.
Prior to being institutionalized, Mr. Hines was totally
dependent on the informal system even though his situation
required the opposite. His could be an example where culture
plays a major role and dominates his behavior. He does not
even appear to have any friends.
Vignette #5
In many instances elderly persons in a community receive
most of their assistance from persons in the community who
are unrelated to them. These persons, who are termed
"affiliated family," are unrelated persons who take on roles
similar to those of relatives, joining in work or recreation
(Strong and DeVault, 1989). Mrs. Gooden is a beneficiary of
the affiliated family.
Mrs. Gooden is a 93-year-old widow who lives alone
in her own house. Mrs. Gooden formerly owned the
lot of land adjacent to her house along with the
one her house is on, but she had to sell it to
raise funds to pay her hospital bills. She has
resided in Eatonville for 73 years. She has been
married three times and widowed as many times. She
has no children. She has brothers and sisters,
also nieces and nephews whom she helped to rear and
to whom she refers as "her" children. Mrs. Gooden
is hypertensive and is on medication for her
hypertension. She visits her doctor regularly.
She also has problems with her legs, probably the
result of arthritis. Mrs. Gooden has worked as a
maid for "white folks." She has also been a
seamstress. Most of her life however, was spent as
a hairdresser. She had her own hairdressing salon
at her house. Mrs. Gooden gets around her house
with very little assistance.

Mrs. Gcoden performs a_. her ATI* and or.e 1 ACT—rr.it cf
administering her own medication. She receives ns assistance
her relatives. K:v»v»r, she h3.3 fr.ends who come in and
rath* ner and he_p her set crested sometimes. She has a
hairdresser vr.o comes every :v; weeks to rare care cf her
hair. She cstabs it herself daily. She dees all her 'small'
laundry. After being in hospital or.te, she recuperated in a
small nursi.ro home owned by a lady who has since become a
gc-cc friend. This lady continued to take care cf Mrs.
Gooden1s laundry lor her a long time after her d-scharee from
the nursing noire.
'ecent.
n 1:
Lacy has had some problems
with arthritis in her hands- and tar. r.c lcr.ger do the laundry,.
Diilerent people come to c_ean her house. ¿r.e does a .itile
eacn day herself.
There was a lady. Miss Chambers, whom Mrs. Gooden
claims lived -in her for a icr.c lime; vet she
tc help with the
It was "this" lady,
tc love, who "turned
never pa_a rer-t, nor cfferi
utilities, or garbage bills,
whom Mrs . Gooden, ha a .earned
her back on her" at the end, and who was
responsible for Mrs. Gooden nearly losing her home.
When Mrs. Gc-oder. was hospital1 red six years ago,
Miss Chambers die not get all her xa_i tc ter.
Among these were the ta:: notices ter her property.
These notices haa to be signed and returned to the
rol lector of taxes. The text tr.ina that Mrs.
Gooden knew, she was «bout to be evicted from ner
debt hat been sold to someone,
enough to cal. her ano apprise
her about the situation. Mrs. Tooder. with no
relatives or friends tc- help out was distraught.
Two ladies in the community, who knew Mis. 1 coder,
only as a member of the cc aw unity, heard about her
plight and lock up the challenge to save Mrs.
coober.1 s home. 7 h^y ccr.iszi^j six churches ir_
community and asked fcr financia, r.elp sc that they
ocula pay off Mrs. Gocden's tax cebt thus enaciir.c
home because her ta
This person was kin

159
Baptist Church—along with Mrs. Binns and Mrs. Sinclair, to
discuss the problem since both caretakers agree that some
legal advice is needed. "Those churches that do not want to
be involved will be given the opportunity to say whether or
not they want to remain in the will. Those that agree to
remain in the will must come together and retain a lawyer to
do the necessary legal work to avoid any problems in case
anything should happen to Mrs. Gooden." Mrs. Binns stated
that at a previous meeting some good suggestions had been
made about the future of the "little" house. It was
suggested that it should be kept "working for the community."
A board of directors could be set up, and it could be used
for purposes such as temporary residence for a homeless
family or for families who had lost their home through a fire
or whose home was being repaired, or it could be used for
some youth activities. The churches would support it. No
one would receive any money from it.
Mrs. Binns, who works for the municipality, reports that
the police check on Mrs. Gooden's home every night because
she has been there by herself for years. This supports
information supplied to the researcher by the Chief of Police
regarding services provided for elderly persons in
Eatonville.
Mrs. Sinclair, the second caregiver, is married and
works part-time. The nature of her work enables her to

160
assist Mrs. Gooden during the day whenever there is need.
She speaks of having "adopted" Mrs. Gooden. She does
for her out of the kindness of her heart, not for any reward.
She has known Mrs. Gooden for several years. As an elderly
person, "her heart goes out to her." She states
It seems people no longer have time to help out
others, so two years ago I took Mrs. Gooden on as a
project. I take care of all her business since she
is in her 94th year. She has sisters and brothers
and nieces and nephews. She also has relatives
living here in town including a brother who goes
around every now and then, but no one does anything
for her.
Mrs. Sinclair does all of Mrs. Gooden's shopping and
most of her laundry. While Mrs. Sinclair's mother was
staying with her last year, someone else took care of Mrs.
Gooden's laundry, but now that her "mom" is no longer with
her she has started once more to take care of the laundry.
Every now and then, she transports her to the doctor, "but
there are taxi cabs which Medicaid supplies to take these
elderly people to their doctors and other appointments."
About 3 weeks ago Mrs. Sinclair drove Mrs. Gooden to get her
glasses. She also does all her banking for her. With
reference to the problems that Mrs. Gooden had experienced
with her house, Mrs. Sinclair's response was
Mrs. Gooden had failed to sign and return the
document for her homestead exemption. A card is
sent each year, and if this is not signed and
returned to the collector of taxes by April, there
is an announcement in the newspaper and people
start watching for this with the intention of
purchasing the certificates towards ownership of
the property. The tax office then sends a notice
of reminder. This is the office in Orlando and has

161
nothing to do with the Eatonville Town Hall. If
there is still no response, the certificate is sold
to anyone who wants to purchase it. This person
then sends a notice to the homeowner that if the
taxes are not paid he or she would purchase the
property.
When Mrs. Sinclair and Mrs. Binns, the co-caregiver,
heard about the situation, they approached the churches in
the community and they all came up with the money so that
"Mrs. Gooden would not lose her home."
Mrs. Sinclair supervised the assessment made for repairs
to be done to Mrs. Gooden's house by meals-on-wheels, a
division of the Older Americans Council and the Department of
Community Affairs, when they came to evaluate the amount of
work that needed to be done. This involved the replacement
of windows and doors. Mrs. Gooden had experienced problems
from persons who had tried to break into her house, having
the knowledge that she was old and lived alone. She also
lived in a section of town that was experiencing tremendous
problems with those involved with crack cocaine. There was
also work to be done to repair a leak in the kitchen. Mrs.
Sinclair contacted the department that has responsibility for
this. She was happy that all of this work would be done at
no cost to Mrs. Gooden. Mrs. Sinclair visits Mrs. Gooden
once or twice per week. She is concerned that Mrs. Gooden is
on her own.
She needs someone to stay with her but we have not
been able to find the right person. She (Mrs.
Gooden) would like to have a couple living in with
her. She has two bedrooms. She doesn't go to
church anymore since she has a bladder problem.

162
She really wants to attend church, but it just is
not convenient.
Mrs. Sinclair had another elderly lady whom she used to
assist with going to the grocery store and shopping, etc.
She had "to give it up" as it proved to be too burdensome;
she found it hard to cope. She also has to give some
assistance with transportation to her 83-year-old mother-in-
law. She worries about being unable to do what she would
like to do "for these senior citizens" but "there is just too
much. I have been trying to get others from my church to
help out, especially the younger people, who could go around
and see what assistance they could give to help out the
elderly in the community."
Mrs. Sinclair is a kind person whose children are all
grown. She lives with her husband who has a night job. She
is employed as a school-crossing guard and works part-time at
a laundromat which is owned by her sister-in-law. She is a
Deaconess in her church and is also the church recording
secretary. Close friends of Mrs. Sinclair report that for
several years Mrs. Sinclair would not learn to drive.
Because she did not have a driver's license, she had to rely
on her friends for transportation. They persuaded her to
learn although she was at an advanced age, and she did. Mrs.
Sinclair admits all of this, and in her sweet way remarked,
"Now that I can drive myself I can help several others,
especially senior citizens, by providing them with
transportation."

163
Mrs. Gooden depends on both the formal and the informal
systems. Her main dependence is, however, on the informal
system in the form of "affiliated family" or "fictive kin."
She demonstrates medium awareness of the formal support
system. She has had house repairs through the formal system
and enjoys meals-on-wheels.
Vignette #6
Mrs. Hammond is an 86-year-old widow. She is the oldest
living native resident of the community. She lives in her
own home. It used to belong to her parents, along with the
lot alongside it. She gave this lot to her stepdaughter, who
sold it. This has upset Mrs. Hammond very much. Mrs.
Hammond states that it is traditional that family-owned land
in Eatonville be handed down so that families will always be
neighbors. This was evident with several homes that were
visited by the researcher. The neighbors were related. They
were either siblings or otherwise related. Mrs. Hammond's
neighbor, on the other side, is a cousin. Widowed for
several years, Mrs Hammond used to share her home with her
only son until his death in 1987. He was her only child and
she still grieves for him. For approximately 2 years now,
Mrs. Hammond has had a lodger who is also a senior citizen.
She has a lodger "because she cannot live alone anymore."
Mrs. Hammond, without realizing it, is practicing a simple
form of shared housing which benefits both herself and her
lodger (Streib et al., 1984).

164
Despite her health problems, Mrs. Hammond is an active
person who until 1 year ago still drove her car. She stopped
driving because of problems with gout in her legs and the
loss of sight in one eye. Mrs. Hammond is hypertensive and
suffers from arthritis. Her arthritis, she reports, is her
main problem. She is on medication for arthritis,
hypertension, and gout. Some years ago she fell and hurt her
hip but never had it treated. She uses ace bandages because
of the swelling that she experiences in her legs. She has
slight hearing problems. She has had surgery on her left eye
for cataracts and now sees very well with that eye. However,
she lost her sight in her right eye because of glaucoma. She
visits the eye clinic in Altamonte Springs where she has been
going for some time, and where she had her eye surgery
performed. In February of this year, Mrs. Hammond had
surgery for breast cancer. During her recuperation at home,
a nurse visited her daily to give her a bath, etc. At that
time too, her niece, who lives in the community, took a 2-
week vacation to take care of her. Mrs. Hammond performs all
of her ADLs and all IADLs excepting her yard work with which
she gets some assistance from her nephew when he is well
enough. He too is a senior citizen, and he suffers from
chronic respiratory disease. Mrs. Hammond reports that she
exercises in her bed in the mornings before getting up. She
also takes walks along her street daily, but she has a little
problem walking and has to be careful not to fall. She

165
sometimes walks out to the main road to get the bus to the
shopping center, the mall, and sometimes to visit sick
persons at the hospital which is a short distance away. She
has, however, stopped the bus rides to the hospital since the
walk from the bus stop to the wards has become impossible for
her.
Mrs. Hammond used to be a beautician. In her early
years she "held jobs such as housekeeper and companion to a
writer." She receives Social Security, and Medicare. Her
Social Security income is her only income. She subsidizes
this with the small amount she receives from rent. Because
of her meager income, she has to prioritize her expenditures.
Sometimes she cannot fill her prescriptions "because the
medications are so expensive." After paying her water bill
and her utility bills she has very little left over for food
and transportation. She showed the researcher four bottles
of medication and tells her how much she has to spend per
month.
Mrs. Hammond has several relatives living in the
community. However, she is most dependent on her 75-year-old
stepdaughter who has a car and helps her out with
transportation. Her stepdaughter, whom she raised, sometimes
takes her to church. But since Mrs. Hammond has started
attending the early church services, she either walks or a
friend takes her. Mrs. Hammond's stepdaughter worries a lot
about her and, whenever Mrs. Hammond is ill, she has her move

158
her to retain her home. This they were able to
achieve, and Mrs. Gooden is very grateful.
Thanks to the generosity of the people in her community,
Mrs. Gooden was saved from eviction from her home. Mrs.
Gooden, in a gesture of gratitude, has willed her house and
property to these six churches. She was advised by Miss
Chambers to remove the churches from her will, but this she
refused to do. Mrs. Gooden reports that Miss Chambers told
her that she had a lawyer who could remove the churches from
her will since she had too many people in her will. Mrs.
Gooden refused to comply with Miss Chambers' advice.
Mrs. Gooden's two caregivers, Mrs. Binns and Mrs.
Sinclair, are happy to be assisting her. They are not
related to her and are not even close family friends. They
are what some refer to as "fictive kin." They speak about
Mrs. Gooden with reverence and compassion. The two ladies
divide the assistance that is needed between them. Mrs.
Binns holds an office position, and so she handles all the
"paper" work. She reports that Mrs. Sinclair takes care of
the day-to-day necessities. Mrs. Binns has been "involved"
with Mrs. Gooden for about 3 years. She reports that Mrs.
Gooden has no relatives who have come forward to assist her.
Mrs. Binns documented the request of Mrs. Gooden and has sent
a copy to all the churches involved.
The Tuesday following the Sunday on which the researcher
interviewed Mrs. Binns, there was to be a meeting with the
pastor of the town's largest church—Macedonia Missionary

166
in with her. Mrs. Hammond reports that "that worked before
she felt that her age no longer allowed her to move into
someone else's house." She prefers to be "in her own home
whenever she is ill."
Her stepdaughter also has the problem of a being
caregiver to a very old aunt who is nearing 100 years of age,
and for whom she is totally responsible. She does all her
shopping, etc., and actually performs most of her IADLs.
This stepdaughter is very stressed from having the
responsibility for these two older relatives. Mrs. Hammond
reports that this is the reason why "she withholds
information about her health from her stepdaughter." She
feels that her stepdaughter has too much to cope with. This
stepdaughter is widowed, hypertensive, has a history of
respiratory disease, and has problems with her knees. She
has had complete knee replacements and her problems have
recently recurred, forcing her into hospital for more
surgery.
Prior to her breast surgery, Mrs. Hammond attended the
senior citizens daycare center every day. She always drove
herself. When she stopped driving she was picked up by the
bus that was available for the center. Now, "I just do not
feel up to it" she states. It was at the center that the
researcher first met Mrs. Hammond 3 years ago. She has been
a participant at the center since its inception. She is an
active member of three social clubs, including the Key Chain

167
Club, which is a charity club having a maximum membership of
25. These members are "all Christian women," she states, and
everyone cares for each other. There is a long waiting list
of potential members. The annual membership subscription is
$10. The meetings are held in the Winter Park Women's Club
building, and the Key Chain Club pays an annual fee of $200
to the women's club for use of its facilities. The three
clubs to which Mrs. Hammond belongs are mainly charity clubs
dedicated to doing charity work in their community. The
members are all black women. These clubs are not, however,
in the geographical district of Eatonville but are in nearby
Winter Park.
Mrs. Hammond started the Black Beautician's Club in 1946
and was its president for 14 years. This group disbanded in
the 1970s. Mrs. Hammond has a display of trophies which she
received from state conventions, and the local municipality.
Mrs. Hammond is transported to club meetings by friends who
take her shopping after meetings. Sometimes they even go to
visit other elderly residents who are known to be ailing.
This assistance with transportation means a lot to Mrs.
Hammond.
Mrs. Hammond is replete with history of the community.
She knows all the older members of the community and their
families. She was able to tell the researcher where the
founding fathers of Eatonville were buried, at the corner of
West and Eaton Streets. This is a small "burial ground"

168
which is not obvious as such because the graves are unmarked
and there are no tombstones and no signs. The younger
generation is not aware of its existence and, some years ago,
it was divided in half, and houses now stand on a section of
it. This, Mrs. Hammond notes, was due to a lack of knowledge
because most of the then political administration were not
even aware of its significance. However, when the town
council recently tried to use the other section as a
playground Mrs. Hammond says that she objected and had to
attend a council meeting to have this revoked.
Mrs. Hammond receives a small amount of support from
both the formal and the informal systems. She however does
not like to "trouble anyone" and so tries to live an
independent life. Mrs. Hammond worries about her dependency.
This worry could be explained in terms of nonreciprocal
roles.
The above vignettes present the qualitative analysis of
the findings of the research which was primarily based on in-
depth interviews conducted by the researcher. These
vignettes are employed to illustrate how some of the elderly
persons in the community of Eatonville utilize support
services. The findings indicate that elderly persons who
reside in the Town of Eatonville receive care from both the
formal and the informal support networks. The level of
dependence is on a continuum from none to completely
dependent (Figure 5-1). From these vignettes, it can be

Level of Dependence
Type of
Support Used
Figure 5-1:
Diagram showing the combinations of level of dependence and type
described in each of the six vignettes of elderly persons in the
of support
community.
169

170
deduced that elderly black persons are a non-homogeneous
group. Nearly all research on elderly persons, generally,
and caregiving, specifically, treat the elderly as a
homogeneous group despite the fact that the literature shows
that differences should exist. The vignettes presented
support the theories that elderly persons, and especially
black elderly persons, are not a homogeneous group. Having
presented the Vignettes as a way of capturing the essence of
the qualitative data, we now turn to the kind of information
that was gained from the quantitative analysis of the
interviews.
Quantitative Descriptive Analysis
Table 5-1 delineates characteristics of all 71
respondents in the sample of elderly persons. Of the
respondents, 35.2 percent (n=25) are males and 64.8 percent
(n=46) are females. In terms of age, and in keeping with
current usage in the gerontological literature, the sample is
made up of the old, 56.3 percent (n=40), the old-old 32.4
percent (n=23), and the oldest-old 11.27 percent (n=8). The
average age is 74.6 years, and 43.7 percent (n=31) are 75
years or older. If the "cross-over" phenomenon is applied,
then of those who are 75 years old, many will probably live
for another 10 or 15 years. The findings from this research
will be analyzed under three major headings. These are (1)
family, (2) impairments, and (3) caregiving.

171
Table 5-1: Characteristics of Eatonville's Black Elderly
Sample
Characteristics N %
GENDER:
Male
25
35.2
Female
46
64.8
Average Age 74.6 years
DISABLED:
Yes
8
11.3
No
63
88.7
NUMBER OF HEALTH PROBLEMS:
None
2
2.8
One
11
15.5
Two
21
29.6
Three
22
31.0
Four
9
12.7
Five
3
4.2
Six
2
2.8
Seven
1
1.4
Average Number of Health Problems
= 2.66
CHRONIC DISEASES:
Hypertension
44
62.0
Diabetes
8
11.3
Arthritis
31
43.7
OTHER AILMENTS
60
84.5
ACTIVITIES OF DAILY LIVING:
One
2
2.8
Three
2
2.8
Four
3
4.2
Five
64
90.1
INSTRUMENTAL ACTIVITIES OF
DAILY LIVING:
None
4
5.6
One
5
7.0
Two
1
1.4
Four
3
4.2
Five
6
8.5
Six
12
16.9
Seven
40
56.3

172
Table 5-1—continued
Characteristics
N
%
CARE RECEIVER
26
36.6
CAREGIVER
30
42.3
FORMAL SUPPORT:
Medicare
23
32.4
Medicaid
50
70.4
Surplus Food
13
18.3
Food Stamps
4
5.6
Day Care
16
22.5
Other
17
23.9
INFORMAL SUPPORT:
Spouse
11
15.5
Children
23
32.4
Family
19
26.8
Church
26
36.6
Neighbors and Friends
44
62.0
OTHER AGENCY AWARENESS:
High
29
40.8
Medium
32
45.1
Low
10
14.1
MEAL AWARENESS:
High
27
38.0
Medium
28
39.4
Low
16
22.5
MORE HELP NEEDED
23
32.4
NEED HELP
32
45.1
FORMAL SUPPORT:
None
2
2.8
One
35
49.3
Two
21
29.6
Three
7
9.9
Four
5
7.0
INFORMAL SUPPORT:
None
12
16.9
One
19
26.8
Two
23
32.4
Three
11
15.5
Four
5
7.0
Five
1
1.4

173
Family
The family plays a critical role in providing informal
support for its elderly members. This, however, is not the
total extent of the family's involvement in caregiving for
elderly persons, in that family members who are a major
source of assistance for impaired elders are likely to
influence the elders' use of formal services (Bass and
Noelker, 1987) . The support that families give to their
elderly relatives is examined, and the findings are presented
under the headings of offspring (children and grandchildren)
and living siblings, migration, economics, occupation and
work, income source, and marital and living arrangements.
Information regarding the place of birth was also found to be
useful since in many instances this determined proximity of
family members which in turn influenced the frequency of
visits to frail elderly persons.
Children, grandchildren and siblings
Sixty-nine of the 71 in the sample reported having from
0 to 11 children (Table 5-2). (There were two who furnished
no information.) The average number of living children based
upon the 69 who reported is 3.2. These children are reported
to be living as far away as California and as close as
Orlando. Some were even residents of Eatonville who lived
within walking distance of their parents.
The number of grandchildren reported ranged from 0 to
22. Forty were not able to report how many grandchildren

174
Table 5-2: Summary Table of Elderly Sample by Offspring
and Siblings
Characteristics
N
%
NUMBER OF LIVING CHILDREN:
None
11
15.9
One
16
23.2
Two
11
15.9
Three
8
11.6
Four
6
8.7
Five
1
1.4
Six
3
4.3
Seven
3
4.3
Eight
4
5.8
Nine
2
2.9
Ten
1
1.4
Eleven
3
4.3
Unreported
2
2.9
NUMBER OF GRANDCHILDREN:
None
16
51.6*
One
2
6.5
Two
3
9.7
Three
3
9.7
Six
1
3.2
Nine
1
3.2
Ten
1
3.2
Twenty-one
2
6.5
Twenty-two
2
6.5
NUMBER OF SIBLINGS ALIVE:
None
37
52.1
One
16
22.5
Two
7
9.9
Three
2
2.8
Four
3
4.2
Five
4
5.6
Six
1
1.4
Eight
1
1.4
*This could be the result of loss of contact with children.

175
they had because their children had either moved away or had
not kept in touch with them. One gentleman reported that his
wife had left him over 40 years ago taking the children with
her, and that he had not seen them since. He, however,
reported that one child calls him on the phone quite
frequently. Another male reported a similar situation. Even
those who had reported none seemed uncertain of the validity
of their statements because of similar situations. They had
lost touch with children who were living in other states,
long distances away, and so they were not aware of the number
of the grandchildren they had. The average number of
grandchildren based upon the 31 who reported is 4.13. Some
respondents have children and grandchildren forming a part of
their households.
The number of siblings documented in Table 5-2
represents living siblings. A total of 52.1 percent (n=37)
reported no living siblings. The remaining 47.9 percent
(n=34) reported a number of siblings ranging from one to
eight. The average number of living siblings is 1.15. Using
averages in this situation is only an exercise. Based upon
the ages of the respondents, it is expected that most of
their siblings would be deceased. The averages were obtained
purely to estimate some kinship relations regarding
caregiving. Siblings usually form a good support group in
most instances and in some instances are providing various

176
types of support to some of the elderly persons in
Eatonville.
One such case is a recently widowed male, Mr. Foster,
whose younger sister helps him with meal preparation and
house cleaning. Mr. Foster suffers from chronic respiratory
problems. His 86-year-old aunt also gives him assistance in
meal preparation. When he is well he assists his aunt by
cleaning her yard and sometimes driving her to the store.
Another person, Mrs. James, is alone most of the time.
She has an adopted grandson who is a drug addict and is
unreliable as a housemate. She relies upon her sister who
lives about one mile away, mainly for moral support. Mrs.
James' husband suffers from Alzheimer's disease and resides
in a nursing home in nearby Winter Park.
There are several other cases: Mrs. Downer, a divorcee,
has a sister who lives across the road from her, and who
spends a lot of time with her. The sister of Mr. Hewan, who
is a bilateral amputee and wheelchair-bound, takes care of
him on a full-time basis. He is separated and she is
divorced. Others report siblings in other parts of Florida
with whom they keep in touch, while others report regular
telephone conversations with siblings who reside in other
states.
Migration
Only 7 percent (n=5) of those in the elderly sample was
born in the Town of Eatonville; 49.3 percent or (n=35) of the

177
respondents were born in the state of Florida. The majority
of those not born in Florida, 39.4 percent (n=28) were born
in Georgia. Of the remaining 8 persons in the sample, 2 each
were born in Alabama and Virginia, and 1 each in Jamaica,
West Indies, Mississippi, New York, and Pennsylvania. Among
those from other states who had migrated to Eatonville in the
early years, some had relatives who had visited this all
black community and had spoken highly of Hungerford school;
consequently, they had moved to Eatonville, because they
wanted their children to receive a good education in a
nonsegregated school. I found that most of the relatives of
these elderly persons were living some distance away and were
not able to visit as often as their elderly relatives would
wish. Some of these elderly persons have been instrumental
in having their relatives relocate to Eatonville or to other
parts of Florida. This was the method used to bring Mrs.
Thane and her family to Eatonville.
Mrs. Thane, who is 84 years old and was born in Georgia,
has resided in Eatonville for 58 years. She tells of the
circumstances that led her and her family to move there. She
states that both of her parents had moved to Eatonville in
the early years of its founding. After her husband
visited them by himself, he decided to make it his home. He
returned to Georgia for her and their seven children. She
tells of how impressed her husband was with everything here:
the low cost of land, the schools and the fact that it was an

178
all-black community. She had to work very hard to assist her
husband with the children and to enable them to get a good
education. Today, all her children are either professionals
or paraprofessionals. Mrs. Thane continues to work in nearby
Winter Park as evening companion to an elderly white lady who
is not allowed to be on her own. She is also an avid
gardener growing her own vegetables which she sometimes
sells.
Other residents had fallen in love and married
Floridians who settled in Eatonville after their parents
purchased land there.
Occupation and work
The position of Eatonville, surrounded by the white
dominated communities of Maitland and Winter Park has meant
that many of its residents, most of whom were found to be
either blue collar or service workers (Table 5-3), would be
assured work in the homes of white families as maids and
gardeners. Others would find work in Daytona Beach and
Orlando. Some worked on roads while others were truck
drivers.
Findings regarding previous or current occupation
revealed that only one person fell into the higher executive
classification (Table 5-3). This was the mayor of the town,
who was also the president of the largest private
organization in the town, Eatonville Diversified. Two people
(2.8 percent) were administrators and lesser professionals,

179
Table 5-3: Current and/or
Previous
Occupation
CLASSIFICATION
SCORE
N
%
Higher executives..Mayor
9
1
1.4
Administrators
and lesser professionals
8
2
2.8
Minor professionals
Managers, small business
7
1
1.4
Semiprofessionals
6
8
11.3
Clerical & sales workers
5
2
2.8
Skilled manual, small
business,homemakers
4
12
16.9
Semi-skilled
3
17
23.9
Unskilled score
2
13
18.3
Menial service
1
15
21.1
Total
71
99.9
Classifications are based on the Hollingshead Occupational
Scale

180
while 23.9 percent (n=17) were semi-skilled, 18.3 percent
(n=13) were unskilled and 16.9 percent were skilled manual
workers or owned small businesses.
Income source
Most of these elderly persons were dependent on Social
Security alone as their source of income. Of the total 94.4
percent (n=67) were receiving Social Security, and for 43.7
percent (n=31) Social Security was their only source of
income. Only 25.4 percent (n=18) were receiving any form of
pension. Income from a combination of Social Security and
Pension was available to 16.9 percent (n=12). Of the total,
12.7 percent (n=9) were receiving SSI and only 1.4 percent
(n=l) had this benefit as the only source of income. Seven
percent (n=5) were receiving both Social Security and SSI,
while one person had income from a combination of Social
Security, SSI, and a Veteran's benefit from her husband who
was institutionalized. Nearly one-third 29.6 percent (n=21)
were currently working to enhance household income. The
majority were doing housework 1 or 2 days per week. This
number included two ladies who were over 80 years old. Two
single-person households were receiving rental supplements,
one was receiving an energy supplement, and two persons who
were raising young children were receiving AFDC as well as
Social Security. One of these was a widow with a young
orphaned grandson attending school, and the other a couple
with twin great grandchildren.

181
From the above data, and based on observation, except
for one elderly lady, persons receiving SSI were only those
whose Social Security payments were so low that they were
also entitled to SSI. One isolated case was found where one
respondent was receiving SSI only. The explanation for this
was that there was a problem in establishing her date of
birth. No documentation of her date of birth can be located,
hence she cannot receive Social Security. She has lived in
Eatonville 54 of her 68 years and has attended schools in the
State of Florida only.
The majority of black persons, who today are elderly,
were employed in low paying jobs while they were full time in
the labor force. The result of this is that they are still
as poor today as they were then. They subsist on small
Social Security incomes which is inadequate for their
everyday expenses. One way that government could alleviate
their economic situation is to supplement this income with
SSI for everyone found in this situation. However, very few
of them qualify for this grant. The fact that more of
Eatonville's elderly population are not eligible for SSI
could be attributed to home ownership, since many of them own
houses (it was pointed out earlier that many inherited modest
homes) and are therefore ruled ineligible by virtue of the
value of these homes. The small numbers receiving a pension
is an added indication that not only were these jobs low-
paying but they were not tenured. The data in Table 5-3 show

182
that most (63.4 percent) had an occupation classification of
3 or less indicating that they were either semi-skilled (23.9
percent, n=17), unskilled (18.3 percent, n=13) or performing
menial service (21.1 percent, n=15). As noted earlier, the
majority worked in homes in nearby affluent towns.
Education, or the lack of it, was a large contributor to
the economic situation of these elderly persons. Most had
been educated to the elementary school level only, and only
one elderly male was found to be functionally illiterate.
This gentleman had, however, been employed as a truck driver
most of his life.
Although the economic situation of these elderly persons
forced them to live relatively simple lives it was found that
except for two persons, all were visiting their physicians
regularly. Most of these visits were for treatment for some
form of chronic disease. They were benefitting from some
form of health insurance in the form of medicare or medicaid,
but they had to pay for their medications and some were
taking several different pills. Many were unable to afford
to pay for these medications on their small Social Security
income. Mrs. Hammond explained her predicament in these
terms: "I do not always fill my prescription. I first pay
my utility bills and all others, then I purchase my groceries
and if there is anything left over I will have the
prescription filled." This was echoed throughout the
community.

183
Marital and living arrangements
Findings regarding marital and living arrangements are
presented in Table 5-4 and discussed under (1) home and
landownership and (2) household composition. Of the 71
elderly persons studied 39.4 percent (n=28) are married, and
46.5 percent (n=33) are widowed (Table 5-4). There is an
equal number of those who are divorced and separated, that is
5.6 percent (n=4) of each category. Only 2.8 percent (n=2)
have never been married. A breakdown of those who are
married (Table 5-4) reveals that there were 13 females and 15
males, that is, approximately an equal number of both sexes
are married. Of those who are widowed, however, 81.8 percent
(n=27) are females. The proportion of those living alone
(35.2 percent, n=25) reveals that 76 percent (n=19) are
widowed and that, of the widowed living alone, 78.9 percent
(n=15) are female.
Home and land ownership
Home ownership is an important feature of the residents
of Eatonville. 77.5 percent (n=55) own their own homes and
less than a quarter (22.5 percent, n=16) are renters of their
residence. Of those who are renters, 37.5 percent (n=6) live
in low-income housing, one person lives in an ACLF, and one
is a lodger with another elderly person who is widowed, (an
arrangement which could be classified as 'share a home') in
the gerontological literature. One person lives in a house
rented from her son, and one lives in a granny flat for which

184
Table 5-4: Summary Table of Marital, Residence and Household
Status
Characteristics N %
MARITAL STATUS:
Married 28 39.4
Widowed 33 46.5
Divorced 4 5.6
Separated 4 5.6
Never Married 2 2.8
PLACE OF BIRTH:
Born in Eatonville 5 7.0
Born in Florida 35 49.3
HOME OWNERSHIP:
Own 55 77.5
Rent 16 22.5
NUMBER IN HOUSEHOLD:
One 25 35.2
Two 25 35.2
Three 8 11.3
Four 8 11.3
Five 2 2.8
Six 0 0.0
Seven 3 4.2
Average No. in Household = 2.07

185
she pays rent to her daughter. In addition, two females, one
widowed and one divorced, and both aged 76 years, live alone
as do two males, one of them receiving a rental subsidy for
the house which he rents. The one male who owns his own home
lives in a trailer in his backyard while renting out his
three-bedroom house on the same premises. He is recently
widowed, and found the house too large for a single male.
Black ownership of all the land in Eatonville was found
to be very important to its residents. Those who purchased
land in the early days had obtained double lots and even
today some of these double lots are visible. Some have given
the second lot to their children who have built houses on
them resulting in siblings and children often found to be
neighbors. Those who sold the second lots traditionally did
so to relatives or other black persons. One 86-year-old
respondent who was born in Eatonville complained bitterly
when she discovered that her stepdaughter had sold the land
she had given to her to someone outside of the family. She
felt that it should have been handed down to a relative, or
if it had to be sold it should have been sold to a relative.
It is also not unusual to see cousins as neighbors, based
upon how the people of Eatonville feel about their property.
As the Mayor remarked when he was asked by the researcher
about retirement facilities for elderly persons: "This is a
closeknit community, people take care of one another, and

186
those who own houses remain in them until they die, then they
pass them on to family members" (Interview, May 1986).
Household composition
Information regarding who shares the home with an
elderly person or with elderly couples is found to be
important when considering caregiving or carereceiving. Are
the elderly persons the primary residents or are they the
secondary residents, that is, did they move into the
household of a child or other relative or did a child or
other relative move into the home of the elderly person?
There was only one situation found where an elderly person
had moved in with an adult child. This elderly person was
Mrs. Hewan. She is 95 years old and has been widowed for 10
years. She formerly resided in an ACLF in Winter Park along
with her husband. Upon the death of her husband she moved to
Eatonville to live with her adult daughter and grandson.
When the residences were classified into households by
the researcher, the 71 elderly persons studied were found to
reside in 57 homes but there were 58 households according to
economic arrangement. This is because one elderly male
resides in the residence of another elderly person but only
as a paying lodger. They operate separate household
accounts. For the purposes of computing various statistics
only 57 households will be used for analysis since
household finances in terms of actual dollars are not
included in the study.

187
Of the 57 elderly households, 43.9 percent (n=25)
represent elderly persons who are living alone. It was found
that 35.2 percent of the sample lived alone, and that 72
percent (n=18) of these are females.
Fourteen percent (n=8) of the households were made up of
married couples living by themselves. In six of these
households, both spouses were over 65 years old, but in the
other two, the husbands were over 65 years while the wives
were younger women, both in their fifties, who spend most of
their time taking care of their elderly husbands. One of
these husbands is in an advanced stage of Alzheimer’s
disease, while the other is disabled and suffers severe
attacks of seizures. The wife of the elderly male who
suffers from seizures is herself disabled according to HRS
standards since she suffers from chronic respiratory disease
and is unable to perform most of the Instrumental Activities
of Daily Living.
Of these elderly persons 12.3 percent (n=7) had others
besides spouses in their households and 29.9 percent (n=17)
had others living in their homes but had no spouses. All of
the households which included others other than spouses were
female headed. Relatives living with these elderly persons
were mainly grandchildren and great grandchildren for whom
these elderly persons had assumed total responsibility. This
is a situation which is pervasive throughout black households
in the United States and represents what has been termed

188
"informal adoption" (Hill, 1972). The importance of the
informal adoption network among black families has been
functional in that it has been found to solidify and tighten
kinship bonds since many black women are reluctant to put
their children up for adoption. It has been suggested also,
that "when they are formally placed, black children are more
likely than white children to be adopted by relatives" (Hill,
1972:7) .
A breakdown of the families of elderly persons found in
Eatonville by household composition, revealed a departure
from what is found in the gerontological literature regarding
living arrangements. The situation is usually that the older
person moves in with a younger member of the family, in most
instances a child. The opposite situation of younger
relatives moving in with the elderly person was found, which
led the researcher to abandon classical models of elderly
living arrangements and instead develop a 14 category
classification model. This seemed to find application in and
to better describe the situation which obtains in Eatonville.
The researcher embarked upon this exercise because she was
interested in seeing who was taking care of whom in these
elderly households.
Based upon their composition, the households of elderly
persons in Eatonville are found to be comprised of the
following: (1) Single persons only; (2) husband and wife
only (n=8); (3) husband, wife and adult child or children

189
(n=2); (4) husband, wife, adult child, and children of adult
child (n=l); (5) husband, wife and grandchildren only (n=l);
(6) husband, wife and great grandchildren under 15 years old
(n=l); (7) widow and adult female child only (n=l), widower
and adult female child only (n=l); (8) widow, adult child and
grandchild (n=l); (9) widow with grandchildren only (n= 4);
(10) widow with great grand children only (n=l). The
researcher felt that this particular arrangement needed to be
isolated, in that elderly persons who have great
grandchildren living with them find themselves returning to
what marriage and the family theorists refer to as the
youthful phase of the family life cycle, in that these
children are usually of school age and place strong demands
on their caregivers (Strong and DeVault, 1989) . In this
instance the child was a 16-year-old girl who was attending
the local high school; (11) widow with grandchild/children
plus greatgrandchild/children (n=3) . One of these, Mrs.
Walker had raised the grandchild since she was 2 years old.
(12) Females alone with other than offspring (n=3). One of
these ladies has a teenage niece living with her and she
reports that this child has lived with her since she was a
very small girl. Another elderly lady has an adopted
teenaged grandson with a drug problem. He has lived with her
since he was a baby. The third lady in this group has a male
cousin, his wife and his son in residence. The cousin's wife
is her paid caregiver. (13) Mixed households (n=l). These

190
households are termed mixed by the researcher because they
comprise both offspring of the elderly person as well as
nonrelated persons. The head of the household in this case
is a divorcee. Her adult daughter, the daughter's two
children and three foster children, make up the household.
Only one such household was found; (14) Never married elderly
person with relatives or nonrelatives (n=l). In the only
situation found, this lady's home is a licensed foster home
and she had one adult foster person in residence. He is
retarded and has been in her care for over 15 years.
Each household had its own peculiarity. The ones that
were particularly distressing were the households where
elderly persons were taking care of great grandchildren (n=4)
on their own. These were children attending school and the
heavy responsibility that this brings with it is familiar to
all. In one instance the caregivers were two elderly persons
over the age of 80 years. Not only were these two elderly
persons overburdened, although they loved these children and
loved caring for them, but they were constantly in fear that
harm might come to the children. Their greatest fear was
associated with the major drug problem that the town was
experiencing. They were fearful of the children being
kidnapped. So paranoid were they that they would not even
send the children to the store on their own. They complained
bitterly about the absence of their son, the children's
grandfather. They had not seen him in a very long time
♦

191
although he resided in Tampa. The parents of the children
did not visit or send monetary support at any time. This is
a situation which the researcher repeatedly observed
throughout this study.
As mentioned earlier, 25 households had single persons
only, 8 had married couples only, and 1 had two nonrelated
elderly persons sharing a home. This reveals that 24
households comprised elderly persons and their offspring.
Only three of these households had children of elderly
respondents residing in them; hence, among the remaining 21
households several grandchildren and great grandchildren were
found to be residing. The majority of these households were
female headed and based upon previous experiences these
respondents reported that these children would be their
responsibilities until adulthood, and even beyond.
Impairments
Impairments are analyzed in terms of the Activities of
Daily Living (ADLs) and the Instrumental Activities of Daily
Living (IADLs).
Activities of Daily Living-ADLs
The maximum number of ADLs that each respondent in this
study is expected to perform is five. Most respondents have
no problem performing two or more. Only 2.8 percent (n = 2)
are able to perform only one ADL. The two persons are (1) a
76 year old male who suffers from Alzheimer's disease. He is
reported as being able to feed himself with some assistance.

192
The other is an 82-year-old male who is legally blind. He
reports being able to dress himself without assistance.
Table 5-5 reports findings related to Activities of
Daily Living. The column 'need help' refers to persons who
are receiving some assistance but are in need of more help.
It reflects instances, based on caregiver reports, where the
burden of assistance for the caregiver is becoming almost
unbearable. This is the case of the wife of the elderly
gentleman with Alzheimer's disease. She reports that
"I do not mind doing these things for him, but my back aches
so, and there is no one to help." She assists her husband
with all but one activity of daily living, that is, feeding,
and even then she has to give him some assistance.
The persons who care for the other elderly persons who
need assistance report that they need more help with these
activities, especially with transferring from chair to bed or
commode and vice versa. Unfortunately all but one of the
five elderly persons who need assistance are living in two
person households. Their spouses have the difficult task of
taking care of their daily needs without assistance from the
formal support system. One respondent who needs assistance
with bathing, weighs over 200 pounds. He sometimes falls
and his wife is unable to lift him. In these circumstances
they activate his emergency buzzer which brings an immediate
response from the fire station which is equipped with

193
Table 5-5: Summary Table of Activities of Daily Living
ADL Number performing ADLs
unassisted assisted need help*
(N=71)
N
%
N
%
N
%
Bathing
64
70
7
9.9
7
9.9
Dressing
70
98.6
1
1.4
1
1.4
Feeding
69
97.2
2
2.8
1
1.4
Toileting
67
94.4
24
5.6
2
2.8
Transferring
69
97.2
2
2.8
2
2.8
*denotes those
who
are assisted
but
need more
help
state-of-the-art equipment and has two Emergency Medical
Technicians. The one who is not in a two member household
has a full-time paid caretaker. This caretaker sometimes
calls upon her son or her husband to assist her with the
lifting and transferring.
Instrumental Activities of Daily Living (IADLs)
For the purposes of this research, the maximum number of
IADLs which can be performed by each elderly person is seven.
Some of these activities are more problematic than others and
some are more complex than the ADLs which are related more to
personal self care. IADLs include grocery shopping, managing
finances, housework, yardwork, meal preparation,
transportation, and administering medication.

194
As shown in Table 5-6 only 5.6 percent (n=4) reported
inability to perform any of these functions; 56.3 percent
(n=40) were performing all of these functions; 18.3 percent
(n=13) were able to perform 4 or less; and 81.7 percent
(n=58) were performing 5 and above. Table 5-7 reports
findings on the ability of respondents to perform the
Instrumental Activities of Daily Living. The greatest need
for help is with grocery shopping, transportation, and
yardwork, with 43.7 percent reporting that they need
assistance with these activities. Managing finances (26.8
percent), housework (18.3 percent) and administering
medication (12.7 percent) were ranked in that order from
highest to lowest. The majority of the respondents, 90.1
percent, reported the ability to prepare their own meals.
Transportation seems to be a real problem in the
community. The buses are not routed through the sections of
the town where the need is greatest. That is, where elderly
persons without cars reside. Also, the buses are not
equipped with steps which can be lowered for the elderly.
Elderly persons complain of having to walk long distances to
get the bus and also state that they have to do "too much
climbing" to get onto the buses. Considering that they must
do the bulk of their shopping, prescription filling, and so
on, in nearby towns, then transportation seems to be the
number one need. They also must visit physicians outside of
the town. Most respondents reside in homes that have yards

195
Table 5-6: Summary Table of Instrumental Activities of
Daily Living
IADL
(N-71)
Unassisted
N %
N
Assisted
%
Need
N
.help
%
Grocery shopping
40
56.3
31
43.7
31
43.7
Managing finances
52
73.2
19
26.8
19
26.8
Housework
58
81.7
13
18.3
13
18.3
Yardwork
40
56.3
31
43.7
62
87.4
Meal preparation
64
90.1
7
8.9
7
8.9
Transportation
40
56.3
31
43.7
31
43.7
Admin, medication
62
87.3
9
12.7
9
12.7
to be kept. Yard cleaning becomes quite a chore for elderly
frail persons. Some choose to give up the luxury of a large
house and gardens for small apartments. Mr. Hoard, who has
received several awards for best kept gardens,is one such
person. This 78-year-old widower reports that he was unable
to keep the yard going and so when he lost his wife a few
years ago he moved into a low income apartment. But only 7
percent of these elderly persons reside in apartments. Most
need help with yardwork. Mrs. Salter is an 84-year-old widow
who lives alone. She reports that she paid someone to take
care of her yard, but because she could not supervise him, he
took her money and went off without doing the work that they
had contracted to be done. It was observed that the need for

196
assistance with these functions increased with age. The
oldest-old having the greatest need.
Careaiving
Elderly persons in Eatonville were found to be
caregivers as well as care receivers. They received support
from both the formal and the informal systems (Table 5-7).
Of the 71 respondents 26 (36.6 percent) were found to be in
receipt of care while 30 (42.3 percent) were givers of care.
The care receivers were beneficiaries of Medicaire (32.4
percent), Medicaid (70.4 percent) surplus food (18.3
percent), food stamps (5.6 percent) day care (22.5 percent)
and other assistance (23.9 percent) from the formal support
system. Those who were receiving support from the informal
support system were receiving most of this support from
neighbors and friends (62.0 percent). Assistance from the
church (36.6 percent) was the next in line, while assistance
from children and family at 32.4 percent and 26.8 percent
ranked lower. Spouses were found to be providing the least
amount of assistance; 11 persons (15.5 percent) stated that
they were receiving assistance from their spouses. Although
this number seemed low, it must be borne in mind that there
were only eight married couples living by themselves (that
is, without other relatives) and that 25 respondents lived
alone.

197
Table 5-7: Summary Table of Caregiving Characteristics of
Eatonville's Elderly Sample
Characteristics
N
%
Elderly Care receiver
26
36.6
Elderly Caregiver
30
42.3
FORMAL SUPPORT:
Medicare
23
32.4
Medicaid
50
70.4
Surplus Food
13
18.3
Food Stamps
4
5.6
Day Care
16
22.5
Other
17
23.9
INFORMAL SUPPORT:
Spouse
11
15.5
Children
23
32.4
Family
19
26.8
Church
26
36.6
Neighbors and Friends
44
62.0

198
Cross Tabulations of Quantitative Data
Although participant observation was the main method of
study used for this research, it seemed appropriate to
supplement the qualitative findings with some quantitative
data.
Means and standard deviations were calculated for
internal level data (Table 5-8). Significance tests also
were calculated based on the chi-square statistic for
cross-tabulations of several variables which were
measured empirically. The results of these tests are
presented only to support the descriptive information
regarding formal and informal support resulting from
in-depth interviews and observation. That is, the intent
is not really testing statistical significance but to
describe interrelationships. Nonparametric measures of
association appropriate to the level of measurement were used
to assess the strength of association (Table 5-9). The use
of these statistical measures is intended to serve as an aid
in describing the findings and not as a precise test of
hypotheses.
Cross tabulations were used to examine the relationship
between (1) the need for help and the elderly respondent
serving as a caregiver; (2) formal support and informal
support; (3) agency awareness of formal support; (4) more
help needed in terms of age and sex of the respondent,

199
Table 5-8: Means, Standard Deviations and Other Values of
Major Variables
VARIABLE
N
MEAN
STANDARD
DEVIATION
MINIMUM
VALUE
MAXIMUM
VALUE
STD ERROR
OF MEAN
Age
71
74.58
7.26
65.00
93.00
0.86
Years in
Eatonville
71
37.34
21.47
2.00
86.00
2.55
Number in
household
71
2.28
1.47
1.00
7.00
0.17
Number of
health
problems
71
2.66
1.36
0.00
7.00
0.16
ADLs
71
4.79
0.75
1.00
5.00
0.09
IADLs
71
5.65
2.19
0.00
7.00
0.26
Number of
children
69
3.23
3.13
0.00
11.00
0.38
Number of
grandchildren
31
4.13
7.26
0.00
22.00
1.30
Number of
siblings
71
1.5
1.75
0.00
8.00
0.21
Formal
Support
71
1.73
1.03
0.00
5.00
0.12
Informal
Support
71
1.73
1.21
0.00
5.00
0.14

200
Table 5-9: Results of Tests of Significance and Measures of
Association
Variables Chi-square Statistic Measures of
Association
N=71 P-value
Need help x caregiver
0.223
Kendall's Tau-B =
=-0.144
Formal Support x
Informal Support
0.181
Gamma = 0.298
Agency Awareness
x Formal Support
0.383
Gamma=0.124
More help needed
x Age
0.267
Pearson Correlation^ . 249
Stuart's tau-C=0.243
More help needed
x Sex
0.958
Kendall's Tau-B = 0.006
Pearson Correlation^.006
More help needed
x disabled
0.259
Kendall's Tau-B =
Pearson correln.=
0.134
0.134
More help needed
x Formal Support
0.145
Kendall's Tau-B
Pearson correln.
= 0.274
= 0.270
More help needed
x Number of health
problems
0.309
Kendall's Tau-B
= 0.252
More help needed
x informal Support
0.084
Kendall's Tau-B
= 0.193
More help needed
x Other agency
awareness
0.002*
Pearson correln.=
Kendall's Tau-B =
-0.3551
-0.312
* denotes significance
at the p =
.05 level

201
disability of the respondent, formal support, number of
health problems and informal support.
Need help by caregiver
The relationship between the need for help and serving
as a caregiver was examined; only a weak negative association
was found that suggests that elderly persons who were
caregivers were not significantly more or less likely to need
care than those who were not caregivers. Thus, knowing
whether or not these elderly persons are caregivers, did not
help determine whether or not they are in need of help. The
case of Mrs. Bernard illustrates this empirical finding.
Mrs. Bernard is the stepdaughter of Mrs. Hammond. She
is 75 years old, is hypertensive, has a chest problem, and
has had complete knee replacement. She, however, not only
assists her stepmother, Mrs. Hammond, but has sole
responsibility and is the primary caregiver for an aunt who
is over 90 years old, is very frail, and was recently
hospitalized for major surgery. This old aunt was finally
placed in a nursing home. Mrs. Bernard recently had some
problems with her knee and was admitted to the hospital for
further surgery. One suggestion of her physicians was that
she reduce the amount of driving that she does in order to
take pressure off her knee. She is worried however, since
she does all the shopping and errands especially for her
elderly aunt.

202
Mrs. Bernard definitely needs help, especially to assist
her in taking care of her aunt and stepmother. Her
stepmother helps herself 90 percent of the time and only
needs help with transportation. If the situation arises, as
in recuperation from a hospital stay (this has been the
experience more than once), Mrs. Bernard's stepmother moves
into Mrs. Bernard's home to facilitate her stepdaughter not
only with caregiving but to reduce the caregiver stress which
comes from worry when she remains in her own home. The
stepmother reports that Mrs. Bernard worries a lot even when
she has no reason to.
Formal support by informal support
Formal support includes Medicare, Medicaid, surplus
food, day care, Food Stamps and such supports as rental
subsidy, home delivered meals, utility subsidy, house
repairs, home health care, homemaker services and chore
services.
Informal support includes assistance from children,
spouse, church, neighbors and friends, and family. Only a
weak to moderate positive correlation was found between the
use of informal supports and the use of formal supports.
Gamma = 0.298. This finding suggests that persons in need of
help may have been using both forms of support and were not
substituting one for the other as will be demonstrated in the
vignettes which follow.

203
Agency awareness by formal support
It does not appear that knowledge of support systems
dictated the use of formal support. Only a weak association
was found between agency awareness and the use of formal
support systems. That is, although one or two persons were
high on awareness, they did not seem to appear to access the
services. A test of association yielded a Gamma = 0.124,
showing that there was only a weak correlation between the
use of formal services and respondents1 awareness of other
agencies. This supports the theory that black elderly
persons are reluctant to use the formal support system even
if they are aware of its existence. This could be due to (1)
fear of rebuffs on the part of the potential receiver, (2)
insensitivity of those responsible for distribution of
these services, and (3) physical problems with accessing
services.
One example of this problem was the difficulty that some
persons experienced in collecting the food stamps awarded to
them. This led them to forego the food stamps rather than
deal with the problem of collecting them. Mrs. Barton who is
wheelchair-bound and lives alone reported that she had to pay
someone $2 to collect $10 in food stamps, but before this she
had to find someone to do it. This demonstrates that older
people need methods designed to enable them to access these
supports with the least possible difficulty.

204
More help needed by age
Age was not found to determine the need for more help.
No difference was noted between, the old, the old-old, and
the oldest-old. Measures of Association revealed only a
moderate correlation between being older and stating that
more help is needed (Tau - C = .243) . No difference was
noted between, the old, the old-old, and the oldest-old.
More help needed by sex
Almost exactly the same proportion of males and females
stated that they needed more help. Of 25 males (32 percent,
n=8) and of 46 females (33 percent, n=15) reported the need
for more help. This demonstrated that there is no
correlation between gender and the need for more help.
More help needed by disabled status
There are 8 disabled persons in the sample. Of these
four (50 percent) reported that they needed more help. Only
30 percent of the non-disabled said that they needed more
help. Because of the small number of disabled persons, only
a weak and nonsignificant correlation was observed between
the 'disabled' variable and the need for more help.
A better understanding of this can be obtained from the
situations of the four persons indicating a need for more
help. There are three males and one female.
The first male is in an advanced stage of Alzheimer's
disease. His wife who is his only caregiver has to work 2
days per week to supplement their small Social Security

205
income. While she is away at work however he is left alone
at home. This indicates a need for help with home sitting or
finances. An increase in financial help would mean that his
wife would not have to work. On the other hand, working
these days is probably good for her mental health and could
be a respite from the stress and burden she experiences
taking care of an Alzheimer's patient all day, every day.
Help is also needed with respite care. This would relieve
his wife who reports that she would like to visit her
relatives in Georgia but is prevented from doing so since she
cannot take her sick husband along with her and she has no
one to come into the home and stay with him if she has to go
away. The wife, who responded to all queries regarding her
husband, was ignorant of any services which could assist her
in terms of respite care, or home help.
The second male is 84 years old and blind. He lives
with his 83-year-old wife and two twin great grandchildren,
aged 11 years (a boy and a girl). These elderly people
receive no assistance from the parents of the children or
from any other relatives. These relatives "do not even visit
or call on the telephone," states his wife. This elderly
couple last saw their son, who lives in Tampa and is the
grandfather of the twins, when he came back to Eatonville to
bury his wife 3 years ago. The son's children live in
Orlando and Tampa but they never visit nor call. Since
losing his sight, the couple have been without transportation

206
in their home. They rely totally on friends to take them
shopping and to go to the bank. But, "people are not so
helpful today," states the wife. "They are afraid of being
sued if they have an accident since their cars are not
registered as public transportation."
This household is badly in need of help with
transportation. With the added responsibility of two young
children who attend school and a blind husband, the wife of
this frail elderly gentleman is greatly in need for some kind
of help with household chores. She also spends some time in
the yard cleaning it, indicating a need for help with yard
work. There is also financial need. This household receives
$59 in food stamps for Aid to Families with Dependent
Children (AFDC). Their expenses include Taxes (1988)—$148
(they receive homestead exemption); house insurance—$350;
car insurance—$350 (their car is an antique); tag—$11.
This couple is in need of someone to advise them. It
would appear that they should get rid of a car which just
sits in their carport. It is highly unlikely because of
their ages and their health status, that either of them will
ever be able to drive it and they cannot afford a chauffeur.
The only justification for keeping a vehicle which they are
not using and which is costing them $361 annually would be
that they were waiting until their great grandchildren attain
the age when they can obtain a driver's license.

207
The third male is 76 years old, suffers from seizures,
and lives with his 55-year-old wife who is disabled according
to HRS standards. She suffers from chronic respiratory
problems, is arthritic and hypertensive. She has had to stay
at home for several years to take care of her husband on a
full-time basis. This couple live by themselves. They
receive some assistance with household chores from the formal
support system, but the wife does all the cooking and house
tidying in between visits by the cleaner. They have eight
living children. Their oldest daughter lives in Hawaii. The
child who resides closest to them is a daughter who works and
lives about 2 miles away. She visits regularly and takes
care of their laundry and all of their shopping. She can be
reached by telephone should they need her during the day.
She also has to take time off from work whenever they have to
visit the doctor.
The chief complaint of this couple is that caregiving is
a burden for their daughter. They could be more independent
if transportation was provided to take them shopping and to
the doctor. They also wished that they could receive some
assistance with their laundry. They are unaware that these
services exist, and that all that is necessary is to apply to
the appropriate agencies. This couple also need counseling
regarding their health care. The researcher observed that
the husband smokes. The space in their living room where
they seem to spend most of their waking hours is limited and

208
all the doors and windows are kept closed. This is
definitely harmful for his wife who is "asthmatic, rests very
badly at nights," and reports that "she has to sleep during
the day to make up for this." Another observation by the
researcher was that both husband and wife chewed snuff.
The only female is 70 years old, has a history of
strokes, and is paraplegic. She spends one half of her day
in a wheelchair and the other half in bed. Her only child, a
son, resides in New York City. He manages all her affairs
from that distance. She has a paid female caregiver who is
also an in-law. This caregiver, along with her husband and
son, lives in the house with this feeble impaired elderly
lady. Prior to this arrangement 3 years ago, this elderly
lady had lived alone since the death of her husband in 1981.
She received all her assistance from neighbors and friends.
Her neighbor, an 86-year-old lady who lives across the road,
was her main help. During that period, she received meals-on-
wheels but was unable to manage. Although she now has
someone to take care of her on a full-time basis, this lady
still demonstrates that she is in need of a great deal of
care.
The caregiver is unsupervised, a situation which needs
remedying since this lady is not receiving the care she
deserves or needs. Although she owns a nice big house, she
is kept locked away in a rear bedroom. She does not receive
fresh air or sunlight, although Eatonville enjoys good

209
climate with a lot of sunshine. Friends and neighbors
complain about her condition. She keeps her money in her bed
along with everything else. Most of the time she cannot
locate items and the researcher observed her searching
through the bed clothes whenever she needs her comb, or a
letter, or her money. It would appear that her relatives,
who, she reports, do not pay rent, use her home as a cheap
means of living while they do not reciprocate by giving her
the assistance she needs.
Some distant relatives, who live in the community, and
who formerly assisted this lady, have now refused to do so.
They state that her son is the one who stands to inherit
everything, although he is not there to assist and does not
visit regularly. These relatives living nearby and able to
assist perceive no possible gain from doing so, because of
the son's likely inheritance.
More help needed by formal support
Some respondents were found to be receiving some form of
formal support but indicated that this was inadequate and
that, in order to cope, they needed more support. Of
interest, those who said that they needed more help were
those who were receiving formal support in the form of either
Medicare or Medicaid as their primary support. In some
instances this was the extent of formal support that they
received, besides their meager Social Security. In most
instances this was not a true indication of formal assistance

210
since all elderly persons received one or the other since
Title XIX of the Social Security Act entitled some of them to
Medicaid and Title XVIII entitled all to Medicare. In
essence, then, all were receiving medical services. Of the
23 who reported a need for more help, the need appeared to be
for other formal supports such as day care (only 1 was
receiving day care), home help, house repairs,
transportation, food stamps (n=2 receiving), surplus food
(n=3), and utility subsidy.
The findings suggest that those who were using more
formal supports were unlikely to say that they needed more
help. Measures of association (Kendall's Tau-B = 0.274.)
showed a weak trend for those using more formal supports to
also be likely to say that they needed more help.
More help needed by number of health problems
A maximum number of seven health problems was reported.
The three most common chronic health problems reported were
hypertension, diabetes, and arthritis. Health problems were
broken down into those who had zero to three and those who
had in excess of three. Seventy-nine percent reported zero
to three health problems, and 21 percent reported more than
three health problems. Only one respondent reported seven
health problems. Only 2.8 percent (n=2) reported no health
problems. Data on the frequency of the three most chronic
health problems of elderly persons mentioned above.

211
Of the three chronic health problems, only one person
reported suffering from all three, 36.6 percent (n=26)
reported two, 40.8 percent (n=29) reported suffering from
one, and 21.1 percent (n=15) reported none. Hypertension
ranked highest among the three chronic diseases with 61.9
percent of the sample (n=44) reported diagnosed
hypertensives, arthritis ranked second with 43.7 percent
(n=31) diagnosed arthritics, and diabetes ranked third with
11.3 percent (n=8) diagnosed diabetics. In addition, 84.5
percent (n=60) reported that they suffered from other health
problems, which included cancer (n=12: 9 females and 3
males), stroke (n=5) , seizures (n=l), chronic respiratory
disease (CRD) (n=4), cardiovascular disease (n=20), glaucoma
(n=7), cataracts (n=ll) , legally blind status (n=l), hearing
impaired status (n=9), neurological problems (n=2),
Alzheimer's disease (n=2), early signs of dementia (n=l),
blood disease (n=2), gastro-intestinal disease (n=2), genito¬
urinary disease (n=4) [3 of these suffered from
incontinence], Parkinson's disease (n=l), and one person
reported diagnosed with low blood pressure (LBP).
The variable More Help Needed is a dichotomous variable
eliciting a yes/no response. Only one person reported seven
health problems, and the response to Need More Help was yes.
Of those reporting six health problems, 50 percent (n=2)
responded yes; of those reporting five health problems, 66.67
percent (n=2) responded yes, of those reporting four health

212
problems, 44.44 percent (n=4) responded yes, of those
reporting three health problems, 31.82 percent (n=7)
responded yes, of those with two health problems, 33.33
percent (n=7) responded yes, and of those who reported only
one health problem, 9.09 percent (n=l) responded yes. The
Measure of Association, (Kendall's Tau-B = 0.252) showed a
moderate trend for persons with more health problems to state
that they needed more help.
These results indicate a moderately positive correlation
between the number of health problems one has and stating
that more help is needed. Thus, it appears that those with
the most health problems (1) use more formal support
services; (2) use more informal support services; and (3)
feel that they still need more help.
Table 5-10 was constructed by combining the number of
health problems. When this was done, of those reporting 4 to
7 health problems (n=15), 53 percent (n=8) indicated that
they needed more help, but only 27 percent (n=15) of those
reporting 0-3 health problems (n=56) indicated that more help
was needed. This suggested that those with more health
problems were in need of more help.
It was observed earlier that Hypertension ranked highest
among the chronic health problems. Seventy-five percent of
those who were hypertensive are females (n=33) representing
46.48 percent of the entire sample. Except for one lady,
they are all under the care of a physician and on medication

213
Table 5-10: Degree
Health
of Help Needed
Problems
Based on the
Number of
More help
Number
of health problems
needed
0-3
4-7
total
No
31 (73%)
7 (47%)
38
Yes
15 (27%)
8 (53%)
23
Total
56 (100%)
15 (100%)
71
for control of their disease. They visit their physicians on
the average every 2 months. Their major complaint had
nothing to do with the disease but was about the cost of the
medications prescribed by physicians, yet the researcher
found none with a generic drug.
Arthritis ranked second among chronic health problems.
Although 43.7 percent of the sample (n=31) reported that they
suffered from arthritis, there was no evidence of crippling
due to the disease. Most reported that their doctors
prescribed pain pills. Some, however, used home remedies for
its treatment. Remedies reported included such as green
rubbing alcohol shaken with banana skins until it took on a
black coloration, kerosene oil to which salt had been added
and shaken until it dissolved. Both of these were used for
rubbing the joints or affected areas. Others used various
off the shelf externally applied medications.

214
Diabetes ranked third among the chronic health problems
with 11.3 percent (n=8) reporting being diagnosed with this
disease. They were all on medication for its control and
were visiting their doctor at least once every 2 months.
More help needed by informal support
Five mechanisms of Informal Support were studied.
Knowledge of these supports was necessary in order to enable
the researcher to determine the role that kinship played in
the support of these elderly persons. Quantity of supports
was not what was being analyzed but rather the types of
supports. Hence, they were not a continuous variable, but
each was analyzed separately for its own merit. The informal
supports that were analyzed are (1) Children, (2) Spouse, (3)
Church, (4) Neighbors/friends, and (5) Family (Table 5-1).
The majority, 32 percent (n=23), were found to be
receiving spousal support. Of these 39.13 percent (n=9) said
that they needed more help. Only 26.75 percent (n=19)
reported receiving some support from their children. Of
these, 36.8 percent (n=7) reported that they needed more
help.
Only a weak association between the two variables was
found (Kendall's Tau-B = 0.193), indicating a weak tendency
for those using more informal support to state that they
needed more help. This could be explained by assuming that
the more one uses these services the more one comes to be

215
aware of what services are available or it may be a function
of need.
When the informal supports were grouped into two
categories (1) Relatives = spouse + children + family and (2)
Community = church + neighbors/friends, it was found (Table 5-
11) that 37 percent of those who were receiving support from
relatives indicated a need for more help while only 25
percent of those receiving support from the community
indicated this need. This suggested that relatives were not
giving the support that was expected of them from the
literature and from their elderly relatives.
Table 5-11: The Need for More Help Based on Type of Informal
Support Received
Need More
Relatives
Community
Help
N
%
N
%
Total
No
27
63
21
75
48
Yes
16
37
7
25
23
Total
43
100
28
100
71
Similarly, when the community was broken down into (1)
church and (2) neighbors/friends (Table 5-12), 55 percent of
those who were receiving support from the church said that
they needed more help while only 20 percent of those whose
main support was from their neighbors and friends indicated

216
Table 5-12: The Need for More Help Based on Type of
Community Support Received
More Help
Church
Neighbors/friends
Needed
N
%
N
%
Total
No
5
45
4
80
9
Yes
6
55
1
20
7
Total
11
100
5
100
16
that they needed more support. This could suggest either
that the church needs to play a greater role in the support
of its elderly, or perhaps that only those in the worst
circumstances turn to the church for help. Pastors of
churches in the community when interviewed, did not deny that
the church needs to play a greater role in providing care for
elderly members. The findings suggest that there is more
faith in the support that these elderly persons receive from
the community than in the support received from relatives.
The general comment was made that "children and grandchildren
only came around when they wanted something." This was also
the general theme about help from children. There were
reports of children borrowing money from their elderly
relatives. There was also a report of elderly relatives
obtaining second mortgages on their homes to lend to
grandchildren. These loans were never repaid. One elderly

217
lady even reported that her daughter would snatch her money
from her hand.
More help needed by other agency awareness
Agency awareness was coded on a scale of low, medium,
and high awareness. Coding was purely subjective in that no
particular index was used. Responses were used to document
this variable. Those who responded that they had no
knowledge of agencies from which they could receive help were
coded low. Those who had some very limited knowledge were
coded medium, while those who were knowledgeable about agency
sources and the help they could receive from them (and in
some instances were actually accessing this assistance) were
coded high.
Twenty-three respondents (32.4 percent) reported that
they needed more help. Of these 34.8 percent (n=8) were
among those in the low awareness group; 39.1 percent
(n=9) were from the medium awareness group; and 26.1 percent
(n= 6) were from the group described as being high on
awareness. Significance test result P-value (0.002)
indicated that there was some significance between stating
that more help is needed and being aware of the agencies from
which help can be received. This is quite an interesting
finding. The majority of those in the medium or high agency
awareness groups stated that they did not need any more help.
An interpretation of this could be that these respondents
were not only aware of the supports that was available to

218
them, but they were actually accessing these supports.
However, of those demonstrating a lower agency awareness, 14
percent (n=10) the majority (n=8) stated that they needed
more help.
Of those with low awareness 80 percent needed more
help. Out of those with medium and high awareness those
needing more help were 28 percent and 21 percent,
respectively. This finding suggests that making people more
aware of available support systems could reduce their need
for more help since they seem to access depending upon
awareness.
Discussion
The findings suggest that elderly persons of Eatonville
are in need of more help. The problem seems to be one of
information. Those who were aware of services appeared to be
using these services. However, agencies do not appear to be
disseminating the information that could help these senior
citizens achieve a better feeling of well being. Although
the discussion of the findings is based on a sample of 71
elderly persons, vignettes are also used to highlight the use
of services in Eatonville by its elderly residents. The
persons dominating these vignettes were not treated as simple
respondents in a survey but as informants in the
anthropological sense.
The care given to the elderly persons in Eatonville was
found to be effected by six different methods utilizing both

219
the formal and the informal support systems. Most senior
citizens were dependent to some extent upon a person (or
persons) for assistance. Culturally, these elderly persons
are noncomplaining. It is known that those who complain a
lot and at all times receive attention. The role of the
church comes into play here. An aging society has
implications for religious institutions within our society.
Coupled with this, the literature on black families expounds
the role that the black church plays in supporting black
families.
The findings suggest that the elderly people of
Eatonville receive more support from neighbors and friends
than they do from the church. Caregiving in a community is
the responsibility of all of its institutions. Only when all
of these institutions are playing their roles can the older
persons in these communities expect to experience a better
quality of life and live their final years in peace and
happiness.
Ignorance of available formal supports for elderly
persons has very often resulted in family members
experiencing more than their share of the stress and burden
which accompany taking care of an elderly relative. This is
especially acute when that elderly relative is frail and
suffers from Alzheimer's disease. Many relatives of
Alzheimer's disease patients are reluctant to
institutionalize their loved ones. The situation of the

220
respondents who make up the vignettes appear to fit all of
these criteria.
Summary
The findings of this research indicate that elderly
persons who reside in the Town of Eatonville receive care
from both the formal and the informal support networks. The
level of dependence is on a continuum from none to completely
dependent. The services which are available range from
informal to formal with a middle range where both of these
services are "Mixed." That is, some elderly persons utilize
informal services, some utilize both informal and formal in
equal proportions, and some are totally dependent on the
formal support system for their care.
The findings suggest however, that formal and informal
support systems necessary for providing a good quality of
life for noninstitutionalized elderly citizens of Eatonville
are inadequate. These persons appear to have limited
awareness of the various services that are available through
government agencies to assist them with their IADL functions.

CHAPTER SIX
CONCLUSIONS AND IMPLICATIONS
The purpose of carrying out this study was to examine
how much, and from whom, in the formal and in the informal
system, caregiving was received by elderly persons in the
town of Eatonville, Florida. The researcher was concerned
with, and sought answers to, several questions. First, the
role that extended family plays in caring for its frail
elderly members was studied. Then, the roles of friendship
groups, the black church, and other informal groups were
examined in their provision of care to these elderly persons.
Third, the roles of the formal caregiving system, as
represented by government and publicly funded organizations,
were explored. Finally, the researcher was concerned with
the interrelationship between the familial, formal and the
informal caregiving and support systems in the town of
Eatonville.
These questions were raised in the hope of eliciting
answers that would have an impact on the well-being of the
elderly. What need did the elderly have for help? Were the
elderly who needed help aware of the sources of help that are
available, both formal and informal? Did they receive the
221

222
help? If it was found that help was being received, the
researcher was interested in knowing whether this help was
that of an informal caregiver, or whether it was provided by
the formal system.
The researcher also elicited answers to questions which
would reveal whether these elderly persons knew where to get
help should the need arise. That is, were they knowledgeable
about the formal and informal agencies that were in place to
provide these services to which they were entitled. Finally,
the researcher sought answers to whether there actually were
formal services available, but not being utilized by these
elderly persons in the community for reasons such as (1) a
lack of knowledge regarding their existence, (2) a preference
not to access them due to cultural reluctance, or (3)
insurmountable problems with accessing these services.
Implications for Future Research
This is an exploratory study, and the findings strongly
suggest that more studies of this nature are needed in order
to fully assess the situation of black elderly persons
throughout the nation. Studies of black elderly persons who
reside in multi ethnic communities are especially needed.
The dearth of such studies could be a contributory factor to
the scant attention which is paid, to communities such as
Eatonville, by our policy makers.
The findings were contrary to expectations based on the
literature, i.e., that the extended family was in place to

223
take care of Eatonville's elderly population. The lack of
family support experienced by these elderly persons led the
researcher to conclude that the time has come for the
demythologizing of the role that the black extended family
system plays in taking care of its elderly members. It also
led the researcher to think about future research as well as
any change in direction if this project had to be done all
over again. One major problem that the researcher found was
that, with such a small sample, it was not possible to arrive
at answers which could lead to generalization. However,
through the literature and through observations made through
travel, the researcher feels that what was taking place in
Eatonville could be what is happening to elderly persons
nationwide. If the opportunity arose for future research,
the researcher believes that instead of concentrating on such
a small sample, questions could be better answered if the
entire elderly community is studied.
Policy Implications
Since the 1920s and 1930s the family structure has
changed so much that only an idealist would wish to return to
the "good old days." Architecture, family size, work
patterns, migration, and lack of knowledge regarding the
increased complexities of the illnesses experienced as people
age all alter the role of the family in the care of older
persons. Value systems in the U.S. are undergoing
modification. Many younger people today have no qualms about

224
turning their backs on the older generation. Today's black
elderly are suffering silently and lack enough socio-economic
supports to make them comfortable and happy in their final
years of life.
Blacks in the U.S. are described as not taking advantage
of the supports and services available in the formal
structure, relying instead on the informal structure for
services. Speculation as to the reason why blacks may rely
so heavily on family members is that they have minimal
expectations for receiving effective service from social
service agencies. This may especially be the case for older
blacks, who have a painful history of inequality, rejection,
and ejection when it comes to dealing with such agencies
(Dancy, 1977). Dancy further notes that elderly blacks often
lack full knowledge or understanding of the services/benefits
to which they are entitled, they are cynical about promised
services, and have no influence whatsoever on programs and
services. Few meaningful and needed services are located in
their communities.
This research suggests several problems that exist when
today's black elderly persons are studied in relation to
family. Change and modernization are reflected in migration
of family members who would previously be found at home
living with, and taking care of older members of their
families. Children of aged parents after supporting their
own children and families have very little left with which to

225
financially assist their aged parents. A common theme, which
ran through the complaints of several of the respondents, was
that they received little, if any, support from relatives,
especially their children. It was often pointed out that the
children would visit when they needed something, and that if
they performed a favor for their elderly parent, they would
expect something in return. There are those who contend that
the family can help elderly members to access such things as
home care. A finding from this research is that the family's
contribution is very limited. It was also found that the
formal system does not fill the gap left by the discrepancies
of the informal system. It is necessary then, that both
these services act in concert to take care of elderly
persons. These two services are necessary as complements to
each other to enable elderly persons to live out their final
days as least stressful as possible.
This research attempted to examine how black elderly
persons access the formal and informal support networks that
are in place to benefit all elderly persons. The informal
help-giving network was found to be at work, through friends,
neighbors and the church. This network was found to provide
a pivotal resource for these elderly black persons.
Neighbors, in particular, were found to help with
transportation, home care, and personal care.
For the black older person, the church has served as a
focal point with the ministers or religious leaders acting as

226
brokers. Findings suggest, however, that the church in the
community could expand its role for the benefit of its
elderly members. The black church will have to assume the
mandate where the formal services have failed black elderly
persons. The church may have to do more to assist with
transportation, medication payments, yardwork, and daily
calls to senior citizens who live alone. Visitation cannot
be spasmodic but has to be consistent and, if possible, must
extend to providing daily respite for those caregivers who
are desperately in need of reducing their stress and burden.
Finally, the black church could play a larger role in
disseminating information about available services for black
elderly persons.
The need for help was quite obvious to the researcher,
especially help with IADL functions. The informal support
system could play a greater role in affecting this. These
people need help, especially with yardwork, but their
greatest need was for transportation. Lack of transportation
is a crucial problem. Buses remain unreachable. The city
government needs to play a greater role in seeing to it that
some type of individualized transportation system be put into
place.
Elderly persons must be put in touch with the services
to which they are entitled; the fact that they have to go
outside of the town for basic services exacerbates the
situation. Few of Eatonville's elderly residents knew where

227
to go for help. Few were benefitting from the formal support
services. The majority were unaware of what services existed
and how to access them. The noncooperating aspects of black
culture were not found to play a role in the failure to
access formal services. Ignorance was the major reason for
not taking advantage of available services. Rather than
leaning on an insufficient informal system, the government
needs to put into place easily accessible systems which will
provide care for elderly persons. Crucial to this are the
provisions of enough funds so that their basic necessities,
food and health care, can be met.
Having examined the support system in this community, we
now address some suggestions for policies which it is hoped
will redress some of the inequalities to be found regarding
black elderly persons not only in this community but
nationwide. More day care should be provided for these
elderly persons. That which currently exists is inadequate
for the numbers that should be accommodated. If special
programs are not feasible, existing transportation systems
need to be made physically and financially accessible to
these senior citizens .
If there is no extended family, elderly persons are also
devoid of potential counselors. The formal system will need
to fill the gap where this is concerned. There seems to be a
need for professional counseling. These counselors could
also serve as advocates for elderly persons. In this

228
capacity, these counselors could arrange for services to
support statements of need and facilitate the delivery of the
services necessary to meet those needs. Counselors assigned
to small communities such as Eatonville could be the missing
link necessary to improve the effectiveness of formal
services which already exist.
The municipality of Eatonville needs to play a more
pivotal role in overseeing that benefits accrue to its senior
citizens. The municipality needs to be more informed and to
make information on the elderly more available. There
appeared to be little information regarding elderly persons.
The municipality could utilize its administrative center for
the collection and dissemination of information to its
elderly persons. Finally, the municipality must lobby for
more representation on the appropriate boards and committees
in the county and in the state.
An example of how poorly this information is sometimes
disseminated is the case of the hidden smoke alarms. Smoke
alarms were purchased for the purpose of making them
available free of cost and installation to elderly residents
of the town. In the course of my research, I found the smoke
alarms stored at the fire station. They remained there,
unused, because the elderly persons in the community were
still unaware of their existence. When this situation was
called to the attention of the authorities by the researcher,
the response was that a 'notice' had been placed in a local

229
newspaper. The town does not have its own local newspaper
and so the elderly persons remained ignorant of this much
needed and important service. Other avenues of information
could have been used. For instance, notice slips could be
included in water bills.
Black elderly persons need to be informed. They need
counseling regarding guardianship. One elderly lady lost her
home and is now a resident in a nursing home because she
lacked the proper counseling. Another would have suffered
the same fate had it not been for the assistance of the
informal system through two ladies in the community. The day
care center, which was a very convenient place for elderly
persons of the town, and a place where they could spend a
part of their day, has been transferred to a neighboring
town. This has proven very difficult for those who formerly
attended and some have discontinued their attendance.
Elderly people need such services especially when they are
living alone. Another feature of this center was the
provision of one well balanced hot meal each day. Nutrition
is a problem of the elderly, and this was one way of
alleviating this problem.
Not only is there a need among this group to know what
services are available, but they also need assistance in
accessing these services in such a way that they will not
feel rejected nor ejected. A common theme in black and
minority literature is that elderly black persons often lack

230
full knowledge or understanding of the service/benefits to
which they are entitled and that they are cynical about
promised services. Most older black people have no influence
whatsoever on programs and services, and hence very few
meaningful and needed services are located in their
communities. Problems arise, too, when local governments of
black communities do not take the time to develop programs
that will support their elderly citizens.
In the area of economics, government must play a more
equitable role in order for older black persons to be able to
manage financially. These are persons who start out very
poor. If they are not given extra financial support, they
can expect to suffer for the rest of their lives. Support is
needed in the form of supplements such as rent supplements,
utility supplements, day care, food stamps, surplus food, and
assistance with payments for medication. Those who are
willing and able to work should be assisted in finding
employment to supplement their small Social Security income.
It is time that there be a radical change in the percentage
of older black persons who live below the poverty level.
It may be that all low income elderly persons need to
receive Supplemental Security Income rather than basing this
income on a means-test that excludes homeowners. What took
place during the 1980s was a raising (in constant dollars) of
AFDC and Food Stamp income eligibility cutoffs, thus reducing
benefits for poor persons (Storey, 1982) . Change in

231
direction for certain income security policies and
substantial budget reductions during the Reagan era greatly
affected low-income assistance into which category the
majority of black elderly persons fall. There needs to be a
reversal of the policies that resulted in this situation.
What is taking place in Eatonville would appear to be a
microcosm of the greater society. The major issue here is—
how do we go about doing something that will result in a
better life for elderly black persons across the nation?
Malnutrition is rife among older persons and is
constantly addressed by dieticians concerned with the diet of
elderly persons. One way to reduce malnutrition in the
elderly population is for elderly persons to have easy access
to shopping areas where they can purchase appropriate foods.
Free rides on city buses could be offered during off-peak
hours. As the price of food escalates, the real income of
these older persons on fixed incomes diminishes. They are
unable to purchase the appropriate kinds, quality and
quantity of foods even if they receive government assistance
or other supplemental income. The charge that nutrition
centers impose for lunches that they provide should be
removed. Many complain that they cannot afford the $1.25
daily charge for the meal and the 25 cents charge for the
bus. They therefore opt to remain at home rather than attend
the center. Elderly persons need to be educated about
nutrition. They should be discouraged from using vitamin

232
supplements and should be encouraged to get their dietary
vitamins from fresh fruits with skins, and from green and
yellow vegetables, and to get their calcium from skimmed milk
and low fat dairy products. As government continues to leave
these elderly persons short of funds, it does not make sense
to advise them to eat what they cannot afford.
There are other problems with the formal support system
that need to be addressed. Eatonville is in dire need of a
bank, a pharmacy, a health clinic, and a shopping center.
These are basic amenities which would make the lives of
elderly persons less stressful. Their mental health is just
as important as their physical health. Programs must be put
in place that will facilitate regular visits from some person
or persons whether it be from the formal or the informal
support system, the important thing is that it be consistent.
Primary health care and education need to play a greater
role in the life of these persons. In addition to nutrition
elderly persons need to be educated about medication, safety,
(especially in the home) , ways to gain access to the formal
system, and compliance. Elderly persons alone cannot bear
the blame when health care providers polymedicate and are
responsible for iatrogenic diseases among the elderly. One
elderly woman visited by the researcher had a large number of
medicine bottles whose contents had to be taken at varied
times. She did not seem to remember which ones she had taken
or when. Health care providers should take all this into

233
consideration when prescribing more than three types of
medication for elderly patients.
Today, the HIV virus is at the top of medical and health
care discussions, yet we very rarely or never hear it being
directed to elderly persons. The elderly need to be educated
about AIDS, especially elderly men who sometimes spend time
in the company of prostitutes. Blacks and minorities make up
a large part of the 37 million Americans without health
insurance. Medicaid has become an important source of
payment for many of them. A 1982 Robert Wood Johnson survey
found that 20 percent of blacks and 13 percent of Hispanics
use Medicaid as their only source of health insurance.
Adequate health screening must be easily accessible and not
convey the derogatory impression that the older person is a
welfare recipient or a second class citizen. Our society
should censure those health care providers who insist on
displaying a hostile paternalistic attitude when dealing with
poor older persons.
It is necessary to be aware of the living arrangements
and caregiving of these persons. Elderly persons must be
educated about guardianship. One elderly lady in the
community has been forced into a nursing home because she
lost her home and all of her belongings. Nonpayment of
unauthorized loans resulted in a foreclosure on her home
which, unknown to her, had been used as collateral. Health
education interventions should be directed at improving the

234
awareness of these individuals and communities about
controllable risk factors associated with the causes of
excess death and disability.
Due to the small sample and the homogeneous community
studied, the findings of the present research are not
generalizable to all formal organizations specifically
designed for elderly persons, such as Area Agencies on Aging.
Nevertheless, local agencies were targeted to examine the
manner in which they operated to benefit these elderly
persons. The findings suggest that, until recently, the
agency responsible for Eatonville, the East Central Florida
Regional Planning Council's Area Agency on Aging (AAoA), did
not have a subcommittee with specific responsibility for
minority affairs. There is now one in place, but this seems
to be more in form than in substance. Nine of the 11 Area
Agencies on Aging in Florida are private, nonprofit
corporations under separate independent boards of directors
(Stokesberry, 1985). Stokesberry (1985) observes that "if
those boards of directors do not have accurate minority
representation, then the special needs of that population
will not have funds allocated at the time when appropriations
are divided" (Stokesberry, 1985:33). Such agencies either
should be public, not private, organizations, or more closely
monitored by public agencies.
When I visited the local AAoA that serves Eatonville, a
meeting with the person with responsibility for minority

235
affairs was impossible. Several attempts were made without
success. When I complained, the response was that he was a
"private" person. I was unable to obtain even a telephone
number at which he could be reached although the newspapers
carried an article lauding the fact that he exists. How can
agency personnel be responsive to community needs if they are
as "private" and inaccessible as this person?
In a small way I am attempting to help implement some
changes in Eatonville. Since completing this research, I
have paid two return visits to the town. There has been an
election, and I have pledged to assist the new mayor with
programs pertaining to the town's senior citizens. I am also
in frequent contact with some of the elderly residents of the
town to keep informed of what is taking place. One 86-year-
old called to inform me about a dinner that the Town's
Council had hosted on their behalf and to say that she felt
my research had sown the seeds for events such as these.
Churches are in contact and have invited me to attend their
senior citizen's days in the near future. I had conducted a
seminar at the St. Lawrence African Methodist Episcopal
Church prior to ending the field research. The seminar
participants who signed in were church leaders, including one
retired clergyman, community leaders, and senior citizens.
Booklets with information concerning caregiving for the
elderly, which I had requested from the AARP, were
distributed to the participants. I spoke to the group about

236
caregiving, what it entails and also about "Formal and
Informal Supports for Elderly Persons" in a community such as
theirs. This was well received and a question and answer
period followed. I was thanked by those attending and was
invited to hold similar seminars at other churches in the
community. This activity led me to think about future
research as well as any change in direction if this project
had to be done all over again.
The final question which now surfaces is this: After
such a study, what can be done to raise the national
consciousness to the plight of black elderly persons. I
feel that the key to assisting elderly black persons in their
quest to live out their final days as problem-free as
possible rests with good caregiving. Formal and informal
caregiving for these persons is germane to their mental
health, and as the year 2000 approaches, it is hoped that
governments, relatives, and friends will realize the role
that they need to play in their actualization.

APPENDIX A
CODING
VARIABLES
COLUMNS
CODE
I.D.#
1-2
(Code from sheet)
Age
3-4
(Code from sheet)
Gender
5
( M = 0 , F = 1)
Marital Status
6
0 = Never 1= Married
2 = Separated
3 = Divorced
4 = Widowed
Born in Eatonville
7
0 = No 1 = Yes
State of Birth
8
1 =Florida 0= Not FL
Years in E'ville
9-10
00 - 99
Living Arrangements
11
Rent = 0 Own = 1
# in household
12
(code # from sheet)
Disabled
13
0 = No 1 = Yes
# health problems
14
code # from sheet
(0-9)
hypertension
15
0 = No 1 = Yes
diabetes
16
If II
arthritis
17
II II
other
18
II If
ADLs
19
\/ = 5 code # (0-5)
IADLs
20
\/ = 7 code # (0-7)
Occupation
21
code 00-9
237

238
Hollingshead Scale
Social Security
22
0 = No
1
= Yes
SSI
23
0 = No
1
= yes
Pension
24
0 = No
1
= yes
Current Job
25
0 = No
1
= yes
Children
26 - 27
code #
of children
Grandchildren
28 - 29
code #
of
grandchildren
Siblings
30
code #
of siblings
Care receiver
31
0 = No
1
= Yes
Caregiver
32
0 = No
1
= Yes
Medicare
33
0 = No
1
= Yes
Medicaid
34
0 = No
1
= Yes
Surplus food
35
0 = No
1
= Yes
Food stamps
36
0 = No
1
= Yes
Day Care
37
0 = No
1
= Yes
Others
38
0 = No
1
= Yes
Children
39
0 = No
1
= Yes
Spouse
40
0 = No
1
= Yes
Church
41
0 = No
1
= Yes
Neighbors or
Friends
42
0 = No
1
= Yes
Family
43
0 = No
1
= Yes
Other Agency Awareness 44
0=Low
1=
=medium
2=high
Meal Awareness
45
0=Low
1=
=medium
2=high
46
0 = No 1 = Yes
More help needed

APPENDIX B
SURVEY OF CAREGIVING RESPONSIBILITIES
The questions on this survey ask about your caregiving
responsibilities—that is, any activities you do in order to
take care of, or provide care for, an older family member or
relative. These activities could range from shopping for
another person who cannot do their own shopping to tending to
a bed-bound or home-bound person. Your answers will be kept
in the strictest confidence and will only be used in
preparing my dissertation for my doctoral degree and possibly
conference papers. If, at any time, the information is to be
used for publication your permission will be sought before
doing so. Please be open and candid in giving your
responses.
What
age group
do you fall
into ?
(1)
Under 30
i years
(5)
46-50 years
(2)
30 - 35
years
(6)
51 - 55 years
(3)
36 - 40
years
(7)
56 - 60 years
(4)
41 - 45
years
(8)
61 or older
2. What is your marital status ?
(1) Single
(2) Married
(3) Widowed
(4) Divorced/Separated —
3. And are you...
(1) Female
(2) Male
4. Please indicate below your general job classification.
(1) Clerical/Support
(2) Management
(3) Production
(4) Technical
(5) Service/Other
239

240
5.How many children do you have living at home who are ..
(Please circle the appropriate number or numbers)
a. I have no children living at home
b. Number of children under age 6 1 2 3 4/more
c. Number of children 6-18 years old 1 2 3 4/more
d. Number of children 19 or older 1 2 3 4/more
6.If others besides children live with you, please
indicate below which people live with you. (Check all
that apply)
a.
spouse
b.
father or mother
c.
father-or mother-in-law
d.
a brother or sister
e.
aunt or uncle
f.
another relative
a.
a friend
h.
other
7.How many persons aged 50 or older do you have caregiving
responsibility for ?
(1) One (2) Two (3) Three or more
IF YOU ANSWERED "1" FOR QUESTION 7, USE "COLUMN A" FOR
YOUR ANSWERS TO QUESTIONS 8 -15. IF YOU CARE FOR TWO
PEOPLE, PLACE YOUR RESPONSES FOR THE SECOND PERSON IN
"COLUMN B". IF YOU CARE FOR MORE THAN TWO PEOPLE, USE
COLUMNS A AND B TO RECORD YOUR RESPONSES FOR THE TWO PEOPLE
WHO REQUIRE THE MOST AMOUNT OF CARE FROM YOU.
8.Where does the person for whom you COLUMN A COLUMN B
have caregiving responsibility live? (Personl) (Person2)
(1) In your home
(2) In their own home (near yours)
(3) In their own home (a distance
from yours)
(4) Other (specify)

241
9. If you indicated that a person you are
caring for lives in their own home, how
often do you visit with them ?
(1) Never
(2) Monthly
(3) More than once a month
(4) Weekly
(5) Almost every day
10. Please provide the following information
about the person (s) you are caring for.
a. Person's age
b. Sex (M=Male F=Female)
c. Relation to you (Father,Mother)
d. How long have you been caring
for the person
11. Who provides most of the care for COLUMN A COLUMN B
the person (s)? (Please check only one)
(1) You
(2) Your spouse
(3) Your father or mother
(4) Your children
(5) Father- or Mother-in-law
(6) Your brother or sister
(7) Brother- or sister-in-law
(8) Other relative
(9) Friend
(x) Outside paid help
(y) Other (specify)
12. Currently, which of the following
problems (if any) are experienced by the
person(s) you are caring for? (check
all that apply).
a. Vision (Glaucoma,cataracts)
b. Hearing impairment
c. Stroke
d. High blood pressure
e. Heart problems
f. Swollen legs or ankles/
circulation problems
g. Cancer
h. Diabetes
i. Drug/Alcohol abuse
j. Memory loss/ disorientation
k. Depression
l. Sleep disorders

242
m. Constipation
n. Diarrhea
o. Uncontrollable elimination functions.
p. Alzheimer's Disease
q. Arthritis
r. Bone fracture/breaks
s. Dizziness problems
t. Respiratory problems
u. Other (specify) ....
v. None of the above
13. Did any of the following events happen
to the person(s) to cause the need for
you to provide care for them?(check all that apply.
a. Major illness/ injury
b. Hospitalization
c. Death of spouse
d. Retirement
e. Laid off or fired from job
f. Other (specify)
14. What kinds of help do you provide to COLUMN A COLUMN B
the person(s)?(check all that apply)(Personl) (Person2)
a. Direct financial support
b. Manage person's finances
c. Do household chores for person such
as shopping, cooking, laundry,
maintenance of living quarters....
d. Assist person with personal care
(dressing, bathing, feeding,
toileting etc.)
e. Provide help moving about in the
house or apartment
f. Provide transportation
g. Administer medications
h. Provide companionship by personal
visits or by telephone
i. Make or receive telephone calls for
person
j. Arrange/coordinate outside help for
person
k. Other (specify)

243
15. How many hours per week do the following
people spend in providing care for the
person(s) you are caring for ?
a. You hrs hrs
b. Others living within your
household hrs hrs
c. Friends/relatives living outside
your household hrs hrs
d. Paid outside help hrs hrs
16. For each of the categories of activities below, please
indicate how often your caregiving responsibilities
interfere with these activities.
Most of
the time Often Sometimes Se 1dom
(1) (2) (3) (4)
Never
(5)
a.Outside Activities
(Clubs, shopping, etc)
b.Work or job
c.Other family
responsibilities
(spouse, children
etc)
17. Other than help provided by you or another family
member, do(es) the person(s) receive help from an
outside source?
(1) Yes (2) No (If 'No', go to #20)
18. If 'Yes' above, which of the following kinds of help
do(es) the person(s) receive ? (Check all that apply.)
Outside help used for:
a.
b.
c.
d.
e.
f.
g-
h.
i.
j •
k.
.Homemaking chores (cooking, laundry, etc.)
.Repairs/maintenance to the household
.Personal care
.Companion services
.Nursing services
.Home delivered meals
.Counseling
.Adult day care/Senior Center
.Transportation
.Telephone monitoring or reassurance
.Other (specify)

244
19.Which one of the following has been most helpful in
providing information about outside resources available
to help in providing care for the person or persons you
are caring for? (Please check only one.)
(1) Family physician
(2) Visiting nurse or other health care professional
(3) Clergy
(4) Counselor/social worker
(5) Employee assistance or counseling program
(6) Friends/ family
(7) Other (specify)
(8) None of the above
20.Do you or do you not need additional assistance in order
to continue providing care to the person(s)? (please
check only one) .
(1) I do not need assistance, I can continue to
provide care.
(2) I need some assistance, but generally I can do it
myself.
(3) I need considerable assistance in order to
continue.
(4) Even with assistance, I may not be able to
continue.
21.When were you last able to take a vacation that allowed
you some time away from your caregiving
responsibilities? (Please check only one)
(1) Less than 6 months ago
(2) Between 6-12 months ago
(3) Between 13 months and 2 years ago
(4) More than 2 years ago
22.How helpful would specific information on the following
topics be in assisting you with your caregiving
responsibilities?
Not Very Somewhat Very
Information on: Helpful Helpful Helpful
(1) (2) (3)
a. Specific illnesses
b. Home care
c. Community resources
d. Housing options
e. How to choose a nursing home....
f. Useful tips for caregivers

245
g. Support groups for caregivers..
h. Effective communications
i. Questions to ask your physician
j. Normal aging process
k. Stress management
l. Mental incapacities and aging..
m. Other (specify)
23.If you work, how many days (if any) have you lost from
work during the past 6 months for the following reasons.
(Enter the number of days for each reason).
a. Illness(es) days
b. Family emergencies days
c. Crisis/emergency with person(s)
being cared for days
d. Lack of sleep days
e. On-the-job accident days
f. Other (specify) ... days
g. Check if no days lost in past 6 months
24. Is there someone with whom you can discuss your personal
problems or family life issues? (Check all that apply).
a. No one
b. Friend/family member
c. Clergy
d. Counselor/Social worker
e. Family physician/other health care
professional
f. Co-worker
g. Company nurse etc.
h. Other (specify)
25. During the past 6 months, have you suffered from any of
the following? (Please check all that apply)
a.
Frequent headaches
b.
Weight gain or loss
c.
Skin disorders
d.
Nervousness
e.
Unusual drowsiness
f.
Inability to sleep
g-
Other (specify)

246
Additional Comments:
That completes the questionnaire. Thank you very much
for your time.
The questionnaire is a modification of that prepared under
the auspices of the AARP Women's initiative for The Survey of
Caregiving Responsibilities.

APPENDIX C
INFORMATION SHEET
to be administered in the Town of Eatonville
1. Gender: M F (Please circle appropriate category).
2. What is your date of birth or your age?
3. Were you born in Eatonville? Yes No
4 . If you were not born in Eatonville, please indicate the
State in which you were born
5. How many years have you lived in Eatonville?
6. Do you own or rent your dwelling unit?
own
rent
other Please specify
7. What is your current Marital Status?
married
widowed
divorced
separated
single/never married
8. How many people are currently living in your household
How are they related to you
9. Are you physically impaired? Yes No. If yes, list
your impairments
10. Are you disabled? Yes No. If yes, state the
nature of your disability
11. Are you able to bathe, dress, and feed yourself without
assistance? Yes No
12. Are you able to perform light housework? Yes No
247

248
13. Are you able to do your own shopping and banking, etc.?
Yes No
14. What was or is your occupation?
15. What are your main sources of income?
Social Security
Pension
Children
Other relatives
Savings/investments
Other - Please specify
16. How do you spend your days?
17.What is your general attitude towards Nursing Homes?
18.Are you currently taking care of anyone, relative/friend
Yes No If yes explain briefly
COMMENTS:

APPENDIX D
CHARACTERISTICS OF EATONVILLE'S ELDERLY
ACCORDING TO AGE COHORT
Characteristics 65-74 75-84 85+ Total
n% n % n% n%
N
40
56.3
23
32.8
8
11.0
71
100
AVERAGE NUMBER
OF HEALTH
PROBLEMS:
2
.7
2
. 4
3
.8
CHRONIC HEALTH
PROBLEMS:
Hypertension
23
52.3
14
31.8
7
15.9
44
100
Arthritis
13
41.9
13
41.9
5
16.2
31
100
Diabetes
8
100.0
0
0.0
0
0.0
8
100
FREQUENCY OF
CHRONIC HEALTH
PROBLEMS:
0
10
66.7
4
26.7
1
6.7
15
100
1
16
55.2
11
37.9
2
6.9
29
100
2
13
50.0
8
30.8
5
19.2
26
100
3
1
0.0
0
0.0
0
0.0
1
100
CAREGIVER:
Yes
22
73.3
7
23.3
1
3.3
30
100
CARERECEIVER:
Yes
7
28.0
10
40.0
8
32.0
25
100
MORE HELP
NEEDED:
(i.e. of those
currently
receiving help)
Yes
11
41.8
8
34.8
4
17.4
23
100
249

appendix e
POSITION OF ORANGE COUNTY IN THE STATE OF FLORIDA
250

APPENDIX F
POSITION OF THE TOWN OF EATONVILLE
251

REFERENCES
Aday, L. A. and R. Anderson. 1974. "A Framework for the Study
of Access to Medical Care." Health Services Research.
9:208-220.
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BIOGRAPHICAL SKETCH
Sylvia Cicily Claire Earle Lawson was born in Goodwill
district in the Parish of St. James, Jamaica, West Indies, on
January 30, 1936, as the eighth child of Eunice and Stanford
Earle. Ms. Lawson has had a long career in radiation
oncology technology, and teaching including the position of
Clinical Supervisor in the Radiation Therapy department at
Shands Hospital at the University of Florida. She earned her
professional diplomas in Radiation Therapy and Diagnostic
Radiography from the College of Radiographers, London (1957,
1958), and is a Fellow of the College of Radiographers,
London, England. Ms. Lawson also holds the Certificate in
Nuclear Medicine from The Royal Marsden Hospital and Royal
Cancer Institute, London, the Further Education Teacher’s
Certificate from the City and Guilds, London, and the Higher
Diploma in Radiation Therapy and Teachers Diploma from the
College of Radiographers, London (1970). She earned a
Bachelors of Science in political science from the University
of the West Indies in 1978, a Master of Arts in political
science from the University of Florida in 1984, and expects
to earn the Doctor of Philosophy in sociology from the
University of Florida in 1990.
269

270
Ms. Lawson has two children: Deirdre Mae and Peter
Alwyn. Deirdre is pursuing the M.D. degree at the University
of Florida, and Peter will enter Emory University School of
Business Administration as a graduate student in August 1990.

I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality, as
a dissertation for the deqree of Doctor of Philosophy.
Lee A. Crandall, Chair
Associate Professor of Socioloqy
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality, as
a dissertation for the degree of Doctor of/Philosophy.
)er F. Gubrium, Cochair
Professor of Sociology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequatey in scope and quality, as
a dissertation for the degree of/^octor of Philosophy.
Herman-Vera
Associate Professor of Sociology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality, as
a dissertation for the degree of Doctor of Philosophy.
Kc/UaJ Ronald L. Akers
Professor of Sociology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adeqjiate, in scope and quality, as
a dissertation for the degre^o^Doqpbr of Philosophy.
Paul R. Duncan
Associate Professor of Sociology

I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality, as
a dissertation for the degree of Doctor of Philosophy.
il-
William A. Kelso
Associate Professor of Political
Science
This dissertation was submitted to the Graduate Faculty
Department of Sociology in the College of Liberal Arts and
Sciences and to the Graduate School and was accepted as
partial fulfillment of the requirements for the degree of
Doctor of Philosophy.
August 1990
Dean, Graduate School

UNIVERSITY OF FLORIDA
3 1262 08556 7229



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