It is estimated that there are 734,400 care giver households in New York State (9.6% [±] 0.8% of all households). Categorization of all care givers on a 5 level “intensity of care” measure reveals that, on average, care givers provide 22.1 hours of care per week. Highest intensity level 5 care givers (9.2% of all care givers), provide, on average, 88 hours of care per week and account for 36.3% of all care giving. The annualized market contribution of all care givers to the NYS health care system is estimated at between $7.5 and $11.2 billion dollars. The combination of care levels 4 and 5 contributed 70% of all care giving and account for about $5.2 billion in market value. Level 4 and 5 care givers are more likely than other care givers to report difficulties including the recent death of the care-receiver (p < 0.001), financial and employment setbacks (p < 0.001), emotional stress from worrying about the patient’s future condition, dealing with cognitively impaired, physically unmanageable, opinionated, virtually immobile patient’s, and insufficient support from family members (p < 0.05). Nevertheless, they also report such rewards as feeling grateful for improving the quality of the care receiver’s life (43.5%) as well as love (17.2%). Of the nearly 15% of NYS care givers who used adult day care services, all reported that these services met their needs fully or partly. However, of the 85% who did not use the service, 33.5% were negative about it. And while use of adult day care services increases with intensity of care level, there is resistance to adult day care particularly among level 3 care givers, with negative statements from 46.8% of them.

Previous age-related sense of control studies have largely focused on active, community-dwelling aged individuals and have excluded elderly persons who are frail. This study compares sense of control and life satisfaction as determined through rating scale administration between two frail, dependent samples: nursing home residents and homebound elderly. Differences in control scores were statistically significant for those who were homebound expressing higher perceived personal control than nursing home residents (p < .001). Sense of control has no correlation with either life satisfaction or length of stay in the nursing home cohort.

Senior Reach program outcomes for older adults referred for care management and mental health services through a Gatekeeper model were examined in this study and compared with the Spokane Gatekeeper model. The two programs were compared for seniors served on service variables and outcome ratings for isolation, depression, and functioning. Approximately 41% of seniors served by both programs were referred by nontraditional sources: community gatekeepers. Findings indicate that individuals served by the Senior Reach program demonstrated significant improvement in reduction of isolators (such as social isolation), improved functioning, increased optimism about the future, increased positive activities with others, decreased emotional disturbance, and improvements on the Geriatric Depression Scale. Additional program comparisons and findings are discussed. Findings for the Senior Reach program demonstrate that the gatekeeper approach to training community partners is effective in finding at-risk seniors and meeting their needs, resulting in positive impacts on their lives.