Elderly wives caring for disabled husbands have special needs and problems.

Through interviews it was

discovered that morale scores of disabled husbands and their wives were associated; although morale
was generally low, it was possible to dichotomize the wives into high and low morale groups. Wives
with low morale scores were particularly in need of support if institutionalization of the husband
was to be minimized. Isolation, loneliness, economic hardship and role overload were the most
frequently mentioned problems of the low morale wife.

Wives of Elderly Disabled Men:

The Hidden Patients1

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Alfred P. Fengler, PhD,2 and Nancy Goodrich, BA,3

Most research on the disabled and their
families has focused on the incapacitated mem-
ber of the family. Far less research has looked
at the impact of illness upon the spouse; even
fewer studies have assessed the particular needs
and problems of the elderly spouse.
Background
Klein etal. (1967), Lopata (1973) and Town-
send (1957) have called attention to the diffi-
culties and strains of relatives, particularly
spouses, in caring for older family members.
Grad and Sainsbury (1963) have pointed out
in their studies of home care of the mentally ill
in England, that one of the crucial problems
faced is the effect that care has on the people
the patient lives with. Their work shows consis-
tently that "elderly patients present their families
with more than twice the number of severe prob-
lems" than younger patients. If the patient had a
long illness, which is more likely among the
elderly, the effect on the family was significantly
greater than when the patient's i IIness was acute.
When comparisons were made of the relief felt
by families of mental patients hospitalized for
treatment vs those patients treated in a com-
munity care center, the families of higher age-
groups were relieved significantly more in a
hospital setting, indicating that a spouse's respite
from continued care was highly valued.
'Research supported by the Vermont Office on Aging.
J
Dept. of Sociology, Univ. of Vermont, Burlington, VT 0 5 4 0 5 .
'Director, Retired Senior Volunteer Program, 215 College St., Burlington, VT
05401.
Golodetz et al. (1969) were especially sensi-
tive in recognizing the significance of the care-
giving work role of the female spouse.
She is not trained for her job, a priori. She may have
little choice about doing the job. She belongs to no
union or guild, works no fixed maximum of hours.
She lacks formal compensation, job advancement
and even the possibility of being fired. She has no job
mobility. In her work situation, she bears a heavy
emotional load, but has no colleagues or supervisor
or education to help her handle this. Her own life and
its needs compete constantly with her work require-
ments. She may be limited in her performance by her
own ailments (Golodetz et al., 1969).
Such spouses, called "responsors," are ex-
pected to respond to the need for care and to
take the responsibiIity for caring for the incapaci-
tated patient. Three-quarters of the people
studied by Golodetz were over 60 and more than
one-half of these "responsors" had significant
illnesses of their own. Many needed care them-
selves as wel I as gu idance. These authors felt that
wives provide a special kind of care and "com-
mitment and sympathy that can invaluably
complement professional detachment" (Golo-
detz, 1969). Given this special attribute, they
bel ieve the spouse is often as needy as the patient
and that "attention must be paid to this woman
as she carries on her task." (Golodetz et al.,
1969).
In response to the growing concern over the
psychological and economic costs of institu-
tionalization, what are the capabilities of
modern families and community services as
primary alternative sources of long-term care for

Vol. 19, No. 2,1979 175

the disabled elderly? Research indicates that
single, childless, divorced and widowed people
are more likely to be institutionalized than those
who have family support (Palmore, 1976; Town-
send, 1965; Treas, 1977; Wawzonik, 1974).
Since women generally marry men older than
themselves and also live longer, they are much
more likely to assume the caregiver role than
their husbands would. Research indicates that
there is a "comparative paucity of substitute
caregiving sources" (Shanas, 1968; Townsend,
1965) leading one to conclude that "in old age
a man often seems to depend more on his wife
jointly, in a northern New England city, by the
Retired Senior Volunteer Program and the Visit-
ing Nurses Association. The study took place
during the year 1976-1977. Men who had been
recommended to participate in the workshop by
the Visiting Nurses Association, personal physi-
cians, and other health-care workers, were
randomly assigned to a workshop project or to
a control group and were followed over a period
of six months. These were men who had been
inactive for an extended period of time because
of their disabilities.
The husbands' ages ranged from 65 to 86 and

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than she on him." Grad et al. (1975) found that the wives from 59 to 81. The median age for
aged women with dementia were at greater risk the husbands was 73 and the wives 67. Most of
of being referred to community psychiatric the husbands had working class positions prior
services than aged men were. They reasoned to retirement (e.g., carpentry, farming, sheet
that an aged woman was less likely to have a metal working, mechanic, watchmakers, rail-
spouse to look after them. Even when the spouse road worker and furniture construction). About
was present the social role of the aged husband 80% of the men suffered from cardiac disabilities
"equipped him less well to look after a sick which affected mobility, use of limbs, senses,
spouse and run the home than did that of a and in about 20% of the cases, communication
woman similarly placed." In addition, being (aphasia). Many had multiple afflictions. Two
younger than their spouses, older women are men were amputees, two hemaplegics, one suf-
less likely than older men to suffer a severe con- fered from multiple sclerosis and a number of
dition that hinders them from providing major men were afflicted with disabling arthritis, dia-
care for disabled spouses (USDHEW, 1971). betes and cancer. The wives, as will be discussed
later, were not without chronic ailments of their
The Issues own. Generally, however, they were consider-
This paper will examine the special needs and ably more mobile and able than their husbands.
problems of elderly wives caring for husbands The men and their wives were administered
life satisfaction scales A & B (Neugarten et al.,
who are disabled or have severe chronic ill-
1961), a series of social and health indicators,
nesses. First, we will ask whether being married
and the participant group was also asked about
as opposed to being single, widowed or divorced
their feelings toward the workshop. Fifteen of the
affects the likelihood of institutionalization
34 men in the two groups were married. Their
among disabled men. Second, is there a price
spouses were interviewed to determine whether
paid by the nondisabled caregiving wife? Does
they had noticed differences in the morale of
a husband's lowered life satisfaction, due to his
the husbands and to see whether they them-
incapacity, impact on his wife's life satisfaction? selves had been affected indirectly by the work-
And finally we will ask why some wives seem to shop participation of their husbands.
adjust and accept the caregiver role better than
other wives. What factors seem to ease the Senior year nursing students trained in inter-
wife's adjustment and what does this tell us view methods interviewed both the husbands
about the kinds of support and services that will and their wives at three different times approxi-
mately two months apart. One year after the third
be most successful in meeting the special needs
interview had been administered another set of
of the spouse and, by implication, avoiding the
interviews was administered to just the work-
costs, both psychological and economic, of
shop participants and their wives. Since a num-
institutionalization.
ber of the men were aphasics, short answers and
indirect methods had to be utilized and interpre-
The Family Study tations by the wife, however suspect, were oc-
The impact of the husband's disability on the casionally utilized.
wife's morale and life-style emerged from an In spite of the difficulties of doing this kind of
evaluation study of a volunteer workshop in a research, multiple interviews, on-site observa-
setting for older handicapped males operated tions, and case materials allowed us to obtain a

176 The Gerontologist

fairly thorough understanding of the nature of
living with a handicap and, of more importance
for the present report, living with a handicapped
person. Frequently, the interviewers reported
that the wives were victims as much as were their
disabled husbands. Therapists, service workers,
physicians and even the workshop project,
which was being evaluated, were responsive to
the husband's condition. But who was con-
cerned about the less physically disabled
spouse? And what would happen to the husband
should the wife herself break down?
estimates that two-thirds of these married men
would be institutionalized if their spouses could
no longer provide some assistance or care for
them.
Interdependence of Husbands' and Wives'
Morale
Unfortunately, there was no way to measure
the life satisfaction of either the husband or the
wife before the disabling condition occurred.
Thus, we do not know directly if or how wives'
life satisfaction scores were affected by the hus-

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bands' disabling illnesses. However, we can
The Wife as Caregiver compare life satisfaction scores of our sample
Townsend (1968) in his study of factors con- with those of respondents in a national study
tributing to institutionalization found that per- carried out by Harris (1975). The median LSIA
sons who had been I iving alone were significant- scores of the wives of our sample (covering all
ly less infirm than persons living with their chil- three time periods) was 21 while for the hus-
dren or with others. Moreover, among persons bands it was 19. The scores ranged from 6 to 32
living alone, those with no relative living nearby for the wives and from 3 to 34 for the husbands.
tended to be less infirm than those with relatives A maximum score would have been 36. In the
nearby. Since the presence of a supportive national study, however, the median life satisfac-
relative seems to provide an alternative to insti- tion scores for both men and women over the age
tutional ization it should fol low that the presence of 65 was 26. Even low income or very old elder-
of a wife would allow a more handicapped man ly (over 80) in the national sample did not have
to remain at home. median scores as low as our sample.
Although it is difficult to judge whether higher The low scores of the husbands can likely be
rates of institutionalization would have resulted explained by the association of health status and
among the married men if their spouses had life satisfaction. A number of studies (Bull &
refused to assist them (or if they themselves be- Aucoin, 1975; Cutler, 1973; Edwards & Klem-
came incapacitated) the higher degree of in- mack, 1973) have argued that commonly as-
capacity of the married compared to the unmar- sumed correlates of life satisfaction such as
ried men tends to lead to this conclusion. For voluntary association participation can be
example, four of the married men suffered from accounted for by the higher status and better
aphasia or slurred speech and two were legally health of the participants. Spreitzer and Snyder
blind. None of the unmarried men were blind (1974) found that perceived health and financial
and only one was aphasic and he lived with three adequacy were the major predictors of life satis-
devoted, unmarried sons. Although the majority faction particularly for the group over 65. Pal-
of single men reported some difficulty in walk- more and Luikart (1972) argue that health is not
ing, they did not need mechanical aides to main- only the strongest variable "but that it alone
tain mobility. However, more than one-half of accounts for the large majority of the explained
the married men use either a walker or wheel- variance in life satisfaction."
chair. Significantly, about one-third of the The wife's lower morale, since she herself was
married men, but none of the unmarried, re- rarely severely disabled, must at least in part be
ported that they needed help in either feeding related to that of her husband's disabling condi-
or dressing themselves, or both. tion. Braham et al., (1975) for instance found in
Obviously, we are not concluding that all un- a study of patients with multiple sclerosis that
married, blind, aphasic or wheelchair bound one of the most difficult problem areas was the
elderly are institutionalized. It does seem, how- spouses' reaction to the illness and its effect on
ever, that without some outside support the like- their children. In our sample in answer to the
lihood for institutionalization increases. One of scaled items of LSIB, frequent comments were
those alternative sources of support is the wife. made about husbands' illnesses. And although
Given the present capabilities of community the LSIA scale did not ask for specific comments,
services, the local Visiting Nurses Association many were freely given and frequently related

Vol. 19, No. 2,1979 177

to the husband's illness, giving further indication
of the conscious significance of this condition.
For example, the "most important thing in your
life right now" was for their husband to get better
or show improvement. The wife does not plan
ahead because of a spouse's stroke ("We live
day to day since D's stroke") and frequent refer-
ences were made to the unexpectedness of this
condition.
Why were some wives seemingly better able to
cope with their husband's disability than other
wives? Could we identify some of the factors
that may have facilitated this ability to cope
which in turn resulted in relatively high life satis-
factions? Obviously, because of the limited
sample size, the results can only be suggestive at
this point.

"I only thought other people had strokes. Not my Coping Supports
husband."
"No one expects to have illness in the family." Health and income. Other research shows

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income and health status to be important factors
"I didn't expect this mopping up the bathroom, in affecting life satisfaction. Although all the men
changing him and doing the laundry."
were disabled in some respect there was a range
"I cry a lot because I never thought it would be this of disabilities which could be associated with a
way." range of life satisfactions. Perhaps those with the
less disabling condition had the higher life satis-
One wife who did perceive continuity in her life factions. Comparing our six low life satisfaction
noted that "I was taking care of babies at 20. (LLS) wives with our six high life satisfaction
Now I'm taking care of my husband." (HLS) wives, we find that the husbands of all six
LLS wives use a walker, cane or wheelchair to get
around while almost the same number (five of
Differentiated Life Satisfaction Scores six) of husbands of HLS wives do also. Only one
In spite of the overall generally low scores husband among the HLS wives seems pretty
there was a range of scores from low to high for unrestricted with regard to mobility. Three of
both husbands and wives. An average score of six husbands of LLS wives and two of six hus-
all three administrations of the LSIA and LSIB bands of HLS wives needed help in feeding and
scales was calculated for each participant and dressing themselves. Two aphasic husbands
these two scores in turn were averaged together were among the six LLS wives while there were
to give one final score. The scores of all the hus- no aphasics among the HLS wives. When the
bands and all the wives were then rank ordered wives were asked how they felt about their hus-
from low to high in life satisfaction. The result band's condition, the responses were quite
was that five of the six lowest scoring wives were similar for the two groups. They were generally
married to the lowest scoring men and five of worried, frustrated, sad, resigned and impatient.
the six highest scoring wives were married to the Finally, in turning to the wives themselves, it
highest scoring men. is interesting that a subjective measure asking
Although we seemed to have an association the wife to rate her own health showed little
we would not be able to establish the direction. difference between the two groups. Only two of
Did the husband's high morale cause the wife to the wives (one in each group) were seriously
have a higher satisfaction with life? Or did the disabled themselves, although all the wives
wife's ability to cope increase the morale of her mentioned having at least one chronic condi-
husband? Whatever the direction, it seemed tion. The most common ailments were arthritis,
plausible to argue that a change in the morale of cataracts, and circulation problems. Two wives
one partner would have an effect on the other. in the HLS group did mention they had a history
Thus, if we learned more about the problems and of heart problems, one having had heart failure
needs of the wives, policies could be developed within three weeks of the interview. Overall,
which might improve the wife's morale and, as then, the similarities in the disabling health
a consequence, the husband's as well. conditions of the two groups were more striking
Since six wives seemed to cluster at the lower than the differences. The two aphasic husbands
end of the continuum (11 to 16) and six at the in the low life satisfaction group were the major
higher end (27 to 30) we decided to investigate exceptions. Obviously, the inability to commun-
those factors which seemed to discriminate be- icate with one's spouse may be a more serious
.tween wives with high and low life satisfaction. loss than the ability to move around. This may

178 The Gerontologist

 lead to a major loss of companionship and cer-
tainly a greatly reduced ability to understand
each other's needs on a whole range of daily
living decisions.
Turning to the question of income, it was
impossible to secure reliable and complete
information about actual income. However,
when we asked whether the wives felt their in-
come was adequate, only one of the HLS wives
felt their income was inadequate, or only barely
adequate, compared with five of the six LLS
wives. Low income obviously reduced access
to means that might make living with a handi-
capped person more bearable. It also enhances
the likelihood thata wife must work, thus leading
to role overload. Finally, research indicates that
low income elderly are more isolated with less
access to friends, neighbors, relatives, and con-
fidantes than high income elderly (USDHEW,
1974).
Role overload. Related to the significance
of perceived financial inadequacy among the
LLS wives, three of the six LLS wives and zero of
the six HLS wives had full-time jobs. One of the
six HLS wives had a part-time job which allowed
her to do much of her work at home and, when
making short messenger trips, to have her hus-
band accompany her.
For the employed wives, putting in a full day
of work and then coming home to a husband
who needed a great deal of care was extremely
tiring. One wife had had two emotional col-
lapses because of her husband's condition. She
worked the evening shift at a nursing home to
earn money but was finding it too much to both
work and care for her husband by herself. She
had sought help from a psychiatrist and a social
worker and had received emotional support
from a local priest. Another working wife re-
marked: "Demands are constant. There's no
break even though it does help to have a home
health aide in during the week."
Other wives resented the constant caretaking
of multiple patients. As discussed earlier (Treas,
1977), the four generation family will become
increasingly common in the future with a gener-
ation of frail elderly in their 80s depending on
their children of 60. One LLS wife whose hus-
band suffered from an advanced stage of multi-
ple sclerosis requiring a great deal of care also
had to comfort a mother whose husband was
dying. When he died, the mother's depression
and demands on her daughter became exces-
sive. "I get down when she talks about there
Vol.19, No. 2,1979 179
being no point in living. Mother's expectations
of me are getting unreasonable. I can't continue
to cart her around because I can't leave my hus-
band alone." To make the care burden even
worse the wife owned an old arthritic St. Bernard
who had to go out three to four times a night "but
I can't stand to have him put away."
Some indication of the demands on the wife/
caretaker can be found in their evaluation of the
workshop for their husbands. The wives of
husbands who attended the workshop were very
grateful for the interlude it afforded them even
though it only met for about four hours once
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every two weeks. Without exception, the wives
mentioned that the workshop met too infre-
quently. One wife commented that "Thursday
is the only time when I get a day to myself."
Another said: "It's a day I can call my own. You
can do what you want. It's a pleasure to have
some time for myself. I can relax and let go."
Intimacy and companionship. Most of our
sample consisted of working class couples.
Studies of working class families indicate that
segregated roles are common (Bott, 1971;
Komarovsky, 1962; Rainwater, 1962; Town-
send, 1957). Townsend (1957) reports that even
after retirement a tradition of segregation which
had been built up over a lifetime persists in
financial and domestic affairs. Wives of handi-
capped or disabled spouses may be suddenly
called upon to accept responsibilities that their
husbands are unable to fulfill. They become
family breadwinners, carry out new domestic
chores, and make major decisions in areas
formerly assumed by their husband. In a less
segregated relationship the additional responsi-
bilities might seem more familiar and less bur-
densome.
In segregated relationships communication
and sharing are likely to be lessened between
spouses with kinship and friendship ties taking
precedence (Townsend, 1957). The wives were
asked whether there was someone they felt close
enough to talk to about things that really both-
ered them. Of the six HLS wives the husband
was mentioned 11 times of the 18 possible oc-
casions (three time periods) while in only two
of the 18 possible choices was the husband
selected as a confidant among the LLS wives.
Many of these LLS women suddenly found them-
selves spending more time with their husbands
than ever before and also having greater re-
sponsibilities toward them. The resources they
have available to share with each other in this
new state of confinement are limited. "I never
could talk to my husband. I could just cater to
him." However, the demands are greater now
and increased time spent with the spouse often
means greater isolation and less time spent en-
gaging in meaningful activities as well as less
time spent with other more significant confi-
dants. The situation is not that different from the
wife who annoyingly finds her recently retired
husband underfoot all day with Iittle to do except
get in her way and make new demands on her
time (Fengler, 1975). As one LLS wife remarked:
"I was a volunteer at the Red Cross and before
"If my husband was healthier we could go places.
I can't make plans with my husband sick. I wish I
could travel but I have to take care of my husband."
"I feel penned in. I miss not being able to hop in the
car and leave when I want to. We were always so
free. I used to think because your family is grown
you can do as you please but it hasn't turned out that
way for me. It should be that way. We used to be able
to go many places."
We asked the wives how frequently they go
out of their apartment and how frequently they
took a ride in the car. Surprisingly to us there was

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that a nurse and x-ray technician. I've had to find no difference between the HLS group and the
things to get me out of the house since my hus- LLS group on these questions. For example, four
band retired. I'm a people lover and he isn't." of six of both groups said they rode in the car
Unfortunately, she has found this increasingly more frequently than once a week.
difficult to do as his condition deteriorates, he However, one-half of our LLS group worked
requires more care, and he becomes more irrit- daily and had to ride in a car to work. Others may
able. "Last week at the doctors I wanted to walk have gotten out of their house or apartment
out on him. I was so mad. He's getting so bitchy. si mply to go to the doctor. The quality or "mean-
The woman who is here during the day to do ing" of the ride out did show a difference. When
exercises and care for him has had trouble with asked whether they felttheir rides in the car were
him. I thought she was going to leave last week." "adequate for their needs," five of six of the HLS
Although the involvement in a job would seem group said "yes" while only one of five of the
to have the advantage of getting the wife out of LLS group said "yes." They desired more free-
the household, this seems to be offset by the dom for expressive and personal pursuits rather
exhaustion that results from too many additional than simply commuting to their jobs or fulfilling
responsibilities. routine instrumental tasks.
One study of husbands of disabled women
Isolation. "The sense of isolation in house- found that the husbands tended to "miss the
hold units was palpable" according to Golodetz companionship of their wives in activities they
et al. (1969) study of "responsors" of handi- previously enjoyed outside the home such as
capped patients. The husbands discussed this visiting friends and seeing movies" (Skipper
frequently in their interviews. Friends died or et al., 1968). Among the wives of our handi-
drifted away after the disability. This was certain- capped men, an occasional trip might be men-
ly the most frequently mentioned concern of the tioned with great enthusiasm although tempered
patients' wives particularly those with low life by the recognition of limitations and sacrifices.
satisfaction. Four of the six LLS wives said they One wife responded she was happiest this week
felt lonely "often" or "always." On the other about going out for a hamburger at McDonalds
hand, four of six of the HLS wives said they rarely with her husband. However, she also remarked:
or never felt lonely. "It's difficult to go out. He feels limited by the
Old activity and friendship patterns are dis- steps." Another wife is struggling to increase
rupted, often quite suddenly. There is little plan- her husband's independence by encouraging
ning for the future, and beneath the surface are him to learn to use the bathroom at night. Her
feelings of resentment as wives recall things hope is that they will eventually be able to travel.
they would have done if their husband had not Finally, a wife may have given up traveling with
become disabled. her husband but seeks a means of getting away
for herself. One wife was trying to make plans to
"I become especially lonely in the afternoon. I want go to California for a week but could not find
to go out but must cater to my husband." someone to stay with her husband.
"Before H's illness I had it made. I didn't appreciate The sense of isolation is probably heightened
it. Everything came at once when H. became sick. I in this sample by the long cold snowy winters
don't know how to plan. There is no retreat for the of New England which keeps everyone indoors
handicapped." and hinders social interaction. The interviews

180 The Gerontologist

which were completed in the spring elicited for her husband. The husband jokingly replied
many comments about more frequent ventures that the grandchildren frequently "babysit me."
outside and increased interaction with friends Other times he stays at their son's or daughter's
and neighbors as a result of the warmer weather home. Every weekend the family comes together
and ice free sidewalks. for dinner at the parents' home. The wife was
quick to say that without the help of her family
Social support - friends, relatives and neigh- she did not feel she could adequately care for
bors. One of our interviewers felt so con- her husband.
cerned about the wife's state of confinement that Another proud couple is quick to point out
she "babysat" with the husband for a weekend the many pictures of their children along the
while the wife went away. In another case, while wall. A son visits them every day and a brother
the wife was in the hospital for a short stay, helps "a lot" with chores around the house. One
friends stayed and cared for the disabled husband, disabled through blindness, lives with

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husband. a brother who helps with general tasks around
It became apparent that having support from the home. One son lives in the area, calls daily,
friends, sympathizers, children or relatives dif- and visits at least once a week. Another son
ferentiated many wives in the HLS group from living in Massachusetts visits less frequently.
those in the LLS group. Although difficult to es- Although less frequently referred to, friend-
tablish precise visitation and support patterns, ships can also be important. Only one of six of
not one of the six of the LLS group mentioned that the LLS group said they spent time with friends
their children or relatives visited more frequently or neighbors while three of five of the HLS group
than once a week while four of six of the HLS said they did spend time with friends or neigh-
mentioned that their children visited more fre- bors. All six of the LLS group wished to see more
quently than once a week. One wife reported of their close friends while only one of six of the
that her husband's only daughter seldom visits HLS group report this. "We would like to see
and her son-in-law had stated clearly he would more friends. We always had a lot of company
not help them out. Another couple has children before the stroke. I miss that." Deaths also
who phone at least once a week but live in other tended to restrict the friendship network and the
states. They would love to see their children enforced isolation and disruption of social
more often but can't. Other relatives live in the activities would only make it more difficult to
area but do not want to visit. "I have fought with establish new contacts. Both husbands and
them about this but it does no good." Many of wives feel this loss, although husbands seem to
the wives did not want to impose on their chil- feel the loss more intensely. One remarked "I
dren because "they have their own problems just lost my best friend. There's no one to talk to.
and don't want to hear about mine." Another I don't feel there's any point in living all the time
remarked that "sometimes I'd like to get out because all my friends are dead." Needless to
more but my daughter takes me and she is busy say this man's confidante was not his wife nor
with her family too." Thus, although Shanas was he her confidante.
et al., (1968) found that increasing disability
does not necessarily decrease the number of
contacts between parents and children, it does Policy and Practice Implications
change the direction of the contacts. This Morale of wives of disabled men, although
"change in direction" and the inability of overall fairly low, was higher when they per-
parents to reciprocate visits may lead to some ceived their income as adequate and when they
strain in attempts to avoid being an imposition. were not employed full-time. The degree of
Nevertheless, for most of the families in the disability of the husband was not a factor in
HLS group, support of both an expressive and differentiating a wife's morale unless the hus-
an instrumental nature was freely and frequently band was aphasic. Children, relatives and
offered. These families were not isolated from friends who visited or assisted the wife were
their children as much research on intergenera- often important social supports for high morale
tional relations has already demonstrated wives. In addition, high morale wives felt they
(Harris, 1975; Shanas et al., 1968; Townsend, were able to travel in the larger community on
1957). One HLS wife reports that she is able to expressive errands. They were not simply com-
get out for her own recreational needs because muting to work or making trips to the doctor's
the family all take turns "out of love" in caring office. And, finally, they valued their husbands

Vol. 19, No. 2, 1979 181

 as confidantes and companions and thus were
less likely to feel trapped in the house with a
stranger.
Further research should explore the impor-
tance of other family situations such as wife-
care by the husband, child-care of ailing parents
and even neighbor assistance. It is striking how
little research has been done on childrens' roles
in the care of ailing parents as well as on other
aspects of community-based, nonprofessional
care in the home.
It would be erroneous to assume that the best
solution for all disabled men is home care by a
nondisabled spouse. A number of studies have
indicated that while the family can play an im-
portant role in the encouragement and rehabili-
tation of the disabled it can also retard rehabilita-
tion and cause excessive psychological and
economic strain on family relationships (Litman,
1966; Parsons & Fox, 1952; Safilios-Rothschild,
1970; Wawzonik, 1974). Rejection or overpro-
tection resulted in poor responses to treatment
and rates of recovery (Lewis, 1966). Litman
(1966) found that improvement in activities of
everyday living is achieved when a nondisabled
spouse's expectations for independence exceed
those of the disabled partner.
To what extent can a spouse, particularly a
wife, become an effective part of a therapy team?
What balance between comfort, encourage-
ment, and scolding seems to produce the best
responses for working class wives and how effec-
tively can these wives be counseled or taught
these motivational skills? Should an important
distinction be made between the wife who cares
for a husband capable of rehabilitation as op-
posed to many of our wives whose husbands will
likely show no improvement and probably
further deterioration?
Certainly, a need to communicate with other
wives who had disabled husbands could provide
an important support network. In a fourth wave
of interviews of wives of workshop participants,
every wife in this subsample was asked and ex-
pressed an interest in joining and participating
in such a group. In two cases, wives, who had
met each other through their husbands' partici-
pation in the workshop, expressed satisfaction
in being able to discuss their situations with
each other. Rathbone-McCuan (1976) advocates
that social workers hold regular open meetings
with family members as it is essential that there
be "discussion of common problems expressed
by families in maintaining the aged members
as part of the family unit."
182
Rathbone-McCuan (1976) also advocates a
day-care program which she found can reduce
family tension by "supplementing the burden
of care and preventing further emotional depen-
dence on the family unit." Physicians, social
workers, counselors and other support units such
as educational and informational groups must
work closely with the entire family and not just
the disabled patient (Eggert et al., 1977; Litin,
1957; Nielsen et al., 1972; Overs & Bellnap,
1967; Wawzonik, 1974). Robertson (1977)
suggests that families can avoid permanent
institutionalization of their elderly members who
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require long-term care if hospitals will institute
a "floating bed" or "intermittent readmission"
policy. A service house in Goteberg, Sweden
features one floor that is especially designed to
cater to about 20 elderly and handicapped per-
sons on a short-term basis while their families
are ill or away on vacation. Making homemaker
services available to married couples where
only one member is seriously disabled could free
up more time for the caregiver.
Financial assistance paid directly to families
who wish to keep older relatives at home would
be both a humane and an economically justifi-
able policy for the government to follow. Butler
(1977, 1978) feels that "if even a fraction of the
sums used to support older people in nursing
homes were available to help families provide
for their elders we would see a significant de-
crease in the number of those in institutions." In
Sweden tax-free payments of as much as $450 a
month can be paid directly to a family that takes
care of a chronically sick or handicapped person
at home.
Since life satisfaction scores of husband and
wife seem to be associated it would follow that
helping the wife will indirectly benefit the
patient husband. A number of the husbands
were very much aware of the burden they cre-
ated for their wives. One noted that "this illness
has been as much hers as mine." Another re-
marked: "I want to get better and relieve the
strain on my wife. I feel helpless now. This is a
bad time. I really get upset when I feel I've let
her down . . . I feel so helpless and need so much
help that it's very discouraging." At the last inter-
view both the wife and the husband of the above
statement alluded to the fact that things would
be better if he was not around in a few years. The
interviewer commented, "she didn't say any-
thing maliciously or spitefully. She just stated it
as a wish. Her husband stated that he hoped that
he would be dead soon also."
The Gerontologist
 We should also not overlook the fact that more
women are working outside the home than in the
past and that the divorce rate has been on the
increase in recent years. It is possible that future
generations of spouses will not make the per-
sonal sacrifices of the women in our sample.
There was no indication that any of the wives
had considered such an action.
Many of these wives need help and support
as much as their husbands do. It is vitally impor-
tant for society to explore all possible means to
care for its older, disabled citizens in the most
supportive, loving and least costly fashion. It is
also essential that help come not "after the fam-
ily no longer can" butwhile the family isactively
involved in caregiving (Tobin, 1978). Such sup-
port must include the caretakers, as their tasks
are often as complex and needy as the patient's.
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