development of university of wisconsin family assessment caregiver scale (uw-facs)

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Development of University ofWisconsin Family AssessmentCaregiver Scale (UW-FACS)Jan R. Greenberg PhD a , Todd Monson MPH b & Jack GesinoDSW ba Assistant Professor, School of Social Work, University ofWisconsin, Madison, WI, 53706b Director of Social Work, Department of GeriatricPsychiatry, Institute of Living, Hartford, CT, 06106Published online: 14 Oct 2010.

To cite this article: Jan R. Greenberg PhD , Todd Monson MPH & Jack Gesino DSW (1992)Development of University of Wisconsin Family Assessment Caregiver Scale (UW-FACS),Journal of Gerontological Social Work, 19:3-4, 49-68, DOI: 10.1300/J083v19n03_05

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Development of University of Wisconsin Family Assessment

Caregiver Scale (UW-FACS): A New Measure to Assess Families Caring for a Frail Elderly Member

Jan R. Greenberg, PhD Todd Monson, MPH Jack Gesino, DSW

ABSTRACT. The purpose of this research was to construct a reliable and valid instrument to assess the functioning of families as caregiving systems. Five dimensions of family functioning relevant to caregiving were identified: validation, fatnily of origin, problem solving, roles, and boundaries. A 21-item scale was constructed to measure these 5 dimensions. The scale was administered to 83

Jan R. Greenberg is Assistant Professor, School of Social Work, University of Wisconsin, Madison, WI 53706.

Todd Monson is Director, Pre-Admission Screening Community Health De- partment, 525 Portland Skeet. Minneapolis, MN 55415.

Jack Gesino is Director of Social Work, Institute of Living, Department of Geriatric Psychinby, Hanford, CT 06106.

This research was supported by a grant from the University of Wisconsin Graduate School, Madison, WI. An earlier version of this paper was presented at the annual meeting of the Gerontological Society of America, Minneapolis, MN. The authors wish to thank Marion Becker, Wayne Caron, Leslie Cox, Su- zanne Hanna, Gail Hunt, Dennis McQuade, Martha Vincent, Pam Weiss, Linda Szafranski and the clinicians at the Nursing Home Re-Admission Screening Program in the Hemipin County Community Health Department, Minneapolis, MI for their assistance in developing this family insinunent. Also, the authors wish to thank Drs. Marsha Seltzer and Teme Welte and Ms. Christine Robitschek for their comments on earlier drafts of this paper.

Journal of Gerontological Social Work, Vol. 19(3/4) 1993 O 1993 by The Haworth Press, Inc. All rights reserved. 49

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JOURNAL OF GERONTaLOGICAL SOCIAL WORK

family caregivers. As predicted, the scale correlated significantly with clinical ratings of the family's overall functioning. the demee -. - of family stress, aind the caregiver's mental health.

Though numerous family gerontologists have called attention to the fact that caring for an elderly family member is a "family affair" (Cutler, 1985; Niederehe & Fruge, 1984; Herr & Weakland, 1979; Springer & Brubaker, 1984; Watson & Wright, 1984), measurement has focused on the level of the individual caregiver rather than the family as a system (Poulshock & Deimling, 1984; Robinson, 1983; Zarit, Reever, & Bach- Peterson, 1980). For example, the most widely used measure of family burden is the Zarit et al. (1980) caregiver burden scale. The scale items focus on the intra- and interpersonal experiences of the caregiver, and not the functioning of the family as a caregiving unit. As a result, there is considerable data on the burdens faced by individual caregivers, but little is known about how family systems organize to meet the needs of elderly parents (Matlhews, 1987; Matthews & Rosner, 1988).

Assessment instruments that capture family system processes are widely used in research and practice involving families wilh young children and adolescents (Epstein, Bishop, & Baldwin, 1982; McCubbii & Thompson, 1987; Moos, 1974; Olson, Portner, & Lavee, 1985; Skinner, Steinhauer, & Santa-Barbara, 1983). In their present form, however, these inslrumenki have at least two major problems when applied in clinical geriatric practice. First, a number of the scale items may be inappropriate when addressing relationships between aging parents and their adult children. Second, and more importantly, dimensions of family functioning relevant to providing care for an elderly parent are absent. These diien- sions include family boundaries, family of origin experiences, and family support and validation of the primary caregiver. Though the existing family scales are useful guides in constructing an assessment scale for families in later life, they require major modifications to be useful to practitioners working with an older population. A major gap in family gerontology, therefore, is the availability of a reliable and valid measure that assesses caregiving at the family system level. The purpose of this research is to fill this gap.

Based on a review of Ule family assessment and caregiving literature, and consultations with experienced gerontological practitioners, five aspects of family functioning relevant to the process of caring for an elderly relative were identified: validarion, family of origin, problem solving, roles, and boundaries. Validation refers to family behaviors that

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Greenberg, Monson, and Gesino 51

acknowledge, support, and appreciate the primary caregiver's role in the family. To what extent do other family members value the caregiver's role and understand the difficulties associated with !his role? Several researchers have noted that caregivers appreciate knowing that their f t ~ - lies understand their situation and feel that their families support and value their caregiving role (Archold, 1983; Brody, Hoffman, Kleban, & Schoonover, 1989; Cutler, 1985; Noelker & Poulshock, 1982; Zarit & Zarit, 1982; Zarit et al., 1980). Brody et al. (1989) found that caregivers felt rewarded when they perceived that other family members understood their efforts in caring for the parent. In a review of the literature on caregiving, Horowitz (1985) concludes Ulal it is the caregiver's perception of family support rather than the actual level of support that emerges as a critical variable predicting lower levels of burden.

As Brody (1985) noted, caregiving occurs within an historical context of family relationships. The construct, family of origin, captures the historical context of the caregivercare recipient relationship during the years prior to the elder's illness. If the spouse is the primary caregiver, does the well spouse feel that her or his disabled spouse was available and supportive during their earlier marital years? When an adult child provides primary care, one wants to assess to what extent the adult child feels that his or her parent was nurturing and supportive during the adult child's childhood and young adulthood. Based on their extensive clinical experience, Boszomenyi-Nagy and Sparks (1973) theorized that by act- ing responsibly and fairly toward their children, parents accrue merits and their children acquire debts. As adults, children feel an ethical obligation to repay their parents for their past support and assistance. Providing care to an aging parent may be one means available for adult children to feel that they have satisfied tliese debts to their parents. Based on their clinical experiences, Gwyther and Blazer (1984) reported that adult children who felt deprived of parental care in childhood express more anger around caregiving than those who felt that their parents were available for hem during their childhood. Since caregiving often reactivates unre- solved family of origin issues, and since feelings about past relationships influence the experience of burden, (Brody, 1966; Gwyther & Blazer, 1984; Herr & Weakland, 1979; Ward, 1978) family of origin experiences assume a central role when assessing family caregiving and its potential strains and burdens.

Problem solving refers to the family's ability to resolve problems associated with caregiving,, including the ability to identify problems, discuss problems, and explore alternative solutions. Families are continu- ally faced with having to make decisions about caregiving. Families, for

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52 JOURNAL OF GERONTOLOGICAL SOCIAL WORK

example, may have to resolve family differences concerning the elder's need for help or safety in his or her present living situation. If the parent's condition deteriorates, families are faced with the decision to seek more formal services. change work hours. or move the elder to a more supportive living envhnmek The way in.which a family communicates about careeivinr! ~roblems influences the emotional costs associated with ~ a r e ~ i v i n g ( 0 ~ ; & Oyer, 1976). A family member may deny that a problem even exists, or accuse others of exaggerating the extent of the parent's illness (Gwyther & Blazer, 1984; Chenoweth & Spencer, 1983; Barnes, Raskind, Scott & Murphy, 1981). The fact that caregiver intervention programs devote considerable effort to teaching families problem solving and communicalion skills is striking evidence that many families have difficulties talking about and resolving problems related to caregiving (Lovett & Gallagher, 1988; Woods, Niederehe, & Fruge, 1985; Zarit & Zarit, 1982). Thus, in assessing the family and developing intervention strategies, the practitioner is interested in evaluating the family's problem solving skills, including its ability to identify problems, commu- nicate about problems, generate alternative solutions, and resolve problems without becoming paralyzed by conflict.

Roles refer to the caregiving tasks Ulat family members are required to perform. The sharing of caregiver tasks reduces caregiver burden not only by providing the primary caregiver with respite, but also by acknowledging the caregiver's needs. Though one family member may provide primary care, research indicates that caregivers experience less burden when other family members are involved (Brody et al., 1989; Fengler & Goodrich; 1979; Horowitz, 1985; Niederehe & Fruge, 1984; Montgomery, Gonyea & Hooyman, 1983; Hartford & Parsons, 1982). With the increasing participation of women in the labor force, the sharing of caregiving tasks within the family takes on additional significance.

Boundary issues revolve around the inclusion or exclusion of family members and formal supports as participants in the family caregiving system. The negotiation of family boundaries occurs at two levels: (a) between subsystems within the family; and (b) between the family and the formal service system. When faced with the care of an elder member, one of thc fist tasks confronting the family system is that of developing an internal structure to accomplish caregiving tasks. Cath (1972) noted that the primary caregiver may block Ule caregiving efforts of other family members. Malthews and Rosner (1988) presented a case in which two sisters formed a coalition against a thud sister and effectively excluded her from participating in caregiving. Or a family member may become cut-off from the family and therefore, no longer be a family resource to help relieve the caregiving burdens of other family members.

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Greenberg, Monson, and Gesino 53

Brody (1981) and Gwyther and Blazer (1984) reported that middle- aged caregiving daughters are frequently caught between the competing demands of two families: the family consisting of their parents and the family consisting of their husbands and children. They recognized that adult children often are pulled between responsibilities to their family of procreation and those to their family of origin. Thus, one of the major struggles for families caring for an older person is to negotiate the boundary between their family of procreation and their family of origin.

The boundary between the family and the formal service delivery system also must be negotiated. To what extent is the family open to help from the formal service delivery system, and under what conditions? Sussman (1977) proposed that a major family task is to act as a mediator between the care recipient and formal service delivery system. To the extent that the family is unwilling or unable to use formal services, the needs of the care recipient may go unmet (Brody, 1985; Horowitz, 1985). Based on their clinical practice, Gwyther and Blazer (1984) concluded that middle-class adult children are often uncomfortable reaching out to professionals for formal help with caregiving problems. Families may believe that they are responsible for their relatives' care, and thus, unwilling to utilize outside services. Thus, caregiving brings with it several potential boundary problems, as boundaries both within the family and between Lhe family and the formal service delivery system must be negotiated.

In summary, based on an extensive review of the literature, 5 dimensions of family functioning were identified: validarion, family of origin, probletn solving, roles. and boundaries. These family dimensions are frequently cited in research studies on caregiving as playing a dominant role in understanding the stress of caregiving and the family's ability to cope with the burdens of care. We recognize that these 5 dimensions do not capture the complete domain of family caregiving functioning. No one scale can hope to completely measure a domain as complex and varied as family functioning. These 5 dimensions were chosen, however, because the growing body of research on caregiving indicates that they are central to assessing the ability of a family to function adequately in the caregiving role.

PROCEDURES USED TO DEVELOP UW-FACS

A pool of items measuring each of these dimensions was constructed using two approaches: first, items from assessment scales for families with children and adolescenls were adapted to be appropriate to families

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in later life; second, Uuee family therapists with expertise in aging were asked to develop items lo measure each construct. From these two sources, a pool of ninety-five items was generated.

Following the development of Lhis pool of items, 10 family gerontologists were asked to judge the content validity of each item as an indicator of validation, family of origin, problem solving, roles, and boundaries. The experts also rated each item on a 7-point scale ranging from I indicating "highly dysfunctional family behavior" to 7 indicating "highly functional family behavior." This additional rating of each item was made to determine whether there was consensus among the clinicians that the statement represented a functional or dysfunctional family caregiving behavior. Nine of the 10 judges completed the form; one judge returned the form half-completed. Responses from Ule judge who partially completed the ratings were not used in determining the content validity of the items.

The data from the judges were used to develop a set of items to adequately represent these 5 dimensions of family functioning. The following criteria were established for selecting items: (1) at feast 6 of the 9 judges agreed on the underlying dimension measured by Ule item; and (2) the average functional/dysfunctional rating of h e item among the 9 judges was below 3.0 or above 5.0 indicating that there was consensus among the judges that the item represented either a functional or dysfunctional family interaction. Items also were chosen to achieve a balance between those measuring functional family interactions and those measuring dysfunctional family interactions. Based on these criteria, 4 items, on average, were selected as indicators for each of the 5 dimensions of family functioning. Based on preliminary reliability analysis, one item was dropped from the subscale roles because of its low correlation with the other scale items. The final scale consists of 21 items, in which respondents are asked to indicate on a 5-point Lier t scale the extent lo which they agree/disagree with the statement. In computing subscales, items are . recoded so that a high score represents a functional caregiving family system. The total score is calculated by summing across the 21 items. The scale is given in Table 1.

The scale was administered to 83 spouses or adult children who were primary caregivers to frail elderly family members 65 years of age and older who were receiving home care services from the Hennepin County Nursing Home Pre-Admission Screening Program, Minneapolis. MN. The primary respondent also provided standard demographic information on him or herself and the care-recipient. The Hennepin County screeners, who hold public health nursing and social work degrees, completed a

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Greenberg, Monson, ond Gesino 55

clinical rating scale on the family. The rating scale asked the clinician to make the following global ratings of the family: (a) the family's overall functioning as a caregiving system to the frail elderly member, with a 1 representing a highly dysfunctional caregiving situation and a 7 indicating a highly functional caregiving situation; (b) the level of stress that the family was experiencing in the caregiving role, with a I representing no stress and a 7 representing a high level of stress, (c) the primary caregiver's mental health, with a 1 representing poor mental health and a 4 representing excellent mental health; (d) the family's organizational skills to accomplish caregiving tasks, with a 1 representing highly disorganized and a 7 representing highly organized; and (e) family conflict, with a 1 representing no conflict and a 7 representing high conflict. The screeners also indicated if there was any evidence of abuse or neglect of the frail elderly member. The rating of abuse or neglect was based on the screeners expert clinical judgment that the caregiver had been abusive of the elder or neglectful of his or her needs. Only clients who had been on the caseload for at least 6 months participated to ensure that the screeners had sufficient knowledge about the family to make an accurate assessment.

HYPOTHESES

To examine the construcl validily of UW-FACS, the following hypotheses were tested:

1. The UW-FACS subscale scores and the total scale score would be positively correlated with the global clinical rating of the family's functioning. We expected that the global clinical rating would be highly correlated with the total UW-FACS score (r > .40) because Ule UW-FACS total score, if valid, should most closely reflect the multidimensional quality of a clinician's global assessment of the family.

2. The UW-FACS would be negatively correlated with the stress that the family was experiencing in the caregiving role.

3. The UW-FACS would be positively correlated with the caregiver's mental health.

We expected only a moderate correlation (i.e., in the .20 range) between the UW-FACS score and measures of caregiver stress and ahe caregiver's mental health. The research literature indicates that family stress and mental health are influenced by a number of other factors including the caregiver's physical well-being, the presence of other slressful life events, and the frail elder's cognitive and behavioral status

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2 Table 1

UW-Family Assessment Careviver Scale (Adult Child Version) .

The following questions focus on your family relationships. For these questions,

FAMILY refers to your brothers, sisters, and other adult relatives involved with your

parent's care. After reading each statement, circle the number that describes the

degree to which you agree or disagree with the statement.

- -

Strongly Disagree Neither Agree/ Agree Strongly

Disagree Disagree Agree

1 2 3 4 5

- - ~-

1. While growing up, I never seemed able to please my parent(~).

2 . When the need arises, family members are willing to help with my parent's

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Some family members have a d i f f i c u l t time accepting help from people

outside the family.

Everyone i n my family knows what is expected of them i n helping care for

my parent. a

In my family, it feels l i k e some family members are always teaming up

against others i n the family.

While growing up, it bothered me that my parent (s ) helped out some family

members more than others

When we have problems with my parent's c a r e , we are p re t ty good a t coming

up with different ways t o solve them.b

Family members are able t o accept help e a s i l y from one another. .

When we have a disagreement, we are usually able t o t a lk things out .

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Table 1 (continued)

10. Family members seem t o understand the d i f f i cu l t i e s of car ing fo r my parent.

11.. I feel caught between r e spons ib i l i t i e s t o my spouse/partner and chi ldren, and

responsibi l i t ies t o my parent(s) .

Family members generally ask one another f o r their opinions about my parent 's

care.

Family members c r i t i c i z e one another. a

Some family members deny t h a t a problem ex i s t s for my parent.

Most family members do t h e i r f a i r share i n helping ca re f o r my parent. b

Family members a re considerate of one another's needs.

Some family members refuse to speak t o one another.

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18. When I needed help i n the p a s t , I could count on my parent(s) .

19. There is still tension i n my family about things t h a t happened years ago.

20. When a problem comes up about my paren t ' s care , family members consu l t one

another before making a decis ion.

21. Looking back over my childhood, I think my parents did a good job r a i s i n g me.

a ~ t e m from Moos (1974)

b ~ t e m from Skinner e t a l . (1983).

Items making up subscales : Validation: 11, 14, 18 Family of or igin: 1 , 6 , 18, 19, 2 1 Roles : 2 , 4 , 15 Problem Solving: 7 , 9 , 12, 14, 20 Boundary : 3 , 5 , 8, 11, 17

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(Horowitz, 1985). Thus, though we predicted that these variables would be significanlly correlated with the UW-FACS score, we hypothesized that they would be only moderately correlated.

4. The UW-FACS lotal score would be positively correlated with the clinician's rating of the organization ability of the family to accomplish caregiving tasks.

5. The UW-FACS total score would be negatively correlated with family conflict.

6. The UW-FACS total score would not be related lo the socioeconomic status of the family. Family functioning measures often reflect the values of the educated middle-class. Since this measure was developed to be used across socioeconomic groups of family systems, it. should not be correlated with the family's socioeconomic status. The respondent's education was used as an indicator of socioeconomic status,

7. Families in which there was evidence of abuse or neglect would score significantly lower on UW-FACS than families for which there was no evidence of abuse or neglect.

Correlational analysis was used to test the first 6 hypotheses. Hypothe- sis 7 was tested using a t-test. The reliability of the scale was established using Cronbach's alpha as a measure of internal consistency.

RESULTS

Referring to Table 2, the sample consisted primarily of adult daughters in their 50s who were employed full-or parl-time, married and living apart from their elderly parents. Seventyeight percent of the caregivers were women and 79% of the care recipients were women. The mean age of the spousal caregivers was 72.5, and the mean ages of Ihe adult children were 53.3 and 47.5, for daughters and sons, respectively. The average age of the care recipient was 80. Whereas the majority of the adult children were working full-or part-time, only one caregiving spouse was employed. Seventy-nine percent of the care recipients were women in their early 80s who were widowed and living alone. All of the respondents were white.

The Cronbach alpha reliabilities for the subscales were as follows: validation 58; family of origin .56; problem solving .70; roles .72, and boundaries .56. The 21-item scale had an aloha reliabilitv of .85. The global clinical ratings of family functioning Gas signific&ly correlated with each of the individual subscales: validation (r = .27. v c .01): family of origin (r = .19, p c .05); problem solving (r = .ZS,'~ c .01);

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Greenberg, Monson, ar~d Gesko 61

roles (r = .26, p < .01) and boundaries (r = -38, p < .001). The total family score correlated significantly with clinical ratmgs of family functioning (r = .36, p < .001) but not above .40 as hypothesized.

In support of hypothesis 2, the UW-FACS total score was negatively related to the level of caregiver stress (r =.-.21,p < .01), with higher levels of family functioning associated with lower levels of caregiver stress. As predicted by hypothesis 3, the UW-FACS total score was positively renated lo the clinical rating of the caregiver's mental health (r = .27, p < .01), indicating that caregivers who had high scores on UW-FACS, i.e., reported their family as having characteristics of a functional family caregiving system, were rated by the clinicians as experiencing good or excellent mental health. Consistent with hypothesis 4, the UW-FACS total score was positively correlated with the clinicians rating of the organizational ability of the family (r = .30, p < .01), with higher functioning families rated by the clinicians as being more organized than lower functioning families. As predicted in hypothesis 5, the UW-FACS score was negatively correlated with clinical ratings of family conflict (r = -.20, p < -05). Consistent with hypothesis 6, there was a nonsignificant relationshio between the familv score and the respondent's education (r = .12, p > 105). Contrary to hi- pothesis 7, no significant relationship was found between the total family score and the presence of abuse or neglect (1 = .83, p > .05).

DISCUSSION AND CONCLUSION

The results of this study provide evidence for the reliability and validity of UW-FACS as a measure of family caregiving functioning. The correlations of UW-FACS with the clinical ratings, referred to as validity coefficients, are comparable to those found in the gerontological literature (Poulshock & Deimling, 1984; Robinson, 1983; Zarit et al., 1980). Though the correlation between the global clinical rating and total UW- FACS score is slightly lower than desired, Thomdike (1982) reminds us that validity coefficients are often discouragingly small because of the problems of unreliability in the criterion measure, not the predictor. A newly created measure cannot be expected to predict that part of the criterion that is error variance. Thus, it is common to obtain validity coefficients in the .20 to .30 range. Given the rigorous procedures employed to judge the content validity of the items, and the fact that the validity coefficients are statistically significant and produce a similar pattern across the multiple clinical ratings, these data provide consistent evidence for the validity of UW-FACS.

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The purpose of this study was the development of a screening family assessment instrument that included items representative of the major domains associated with functional caregiving family systems. Though the reliability of the total scale is high, as it should be with a screening instrument, the reliabilities of two subscales, boundaries and family of origin, are low. The particular sample studied may be one reason for the lower than expected reliabilities for these two subscales. The range on the boundary subscale may have been reduced because the caregivers were receiving public service, and thus demonstrated their willingness to use formal services. The range on the family of origin subscale also may have been restricted because it was more difficult to recruit highly dysfunctional families into this validity study. If we had been more success- ful in recruiting lhese dysfunctional families, presumably there would have been a larger variance on the family of origin scale. Given the lower than desired reliabilities on the subscales, therefore, we strongly recommend that they not be used apart from the total scale. The subscale scores may be helpful in pointing out problem areas to guide clinical intervention but an overall assessment of the family should be guided by the pattern across all 21 items.

The lack of a significant relationship between abuse and the UW- FACS is possibly a function of the difficulty in identifying abuse. Though it has been estimated that approximately 3% of the elder population experiences abuse (Pillemer & Fielhor , 1988), only a small frac- tion is officially reported, in part, due to the fact that in many circum- stances there is no obvious physical evidence of abuse. Research suggests that only about 50% of the cases of alleged abuse are substantiated (Greenberg, McKibben & Raymond, 1990). Problems of successfully detecting abuse, therefore, are considerable and future research will re- examine the relationship between UW-FACS and abuse using a multiple indicator approach to measuring abuse.

The popularity of family assessment measures brings with it several potential misuses, the most serious being the labeling of a family as pathological without recognizing or acknowledging the strengths or resources of the family system. This family scale is not a diagnostic instrument to identify pathology, but rather an instrument intended to help the practitioner identify both family strengths and vulnerabilities, to develop a holistic and balanced assessment of the family, and to help guide family system interventions that build upon the family's existing resources. By administering the tool to Ihe primary caregiver, for example, the practitioner may find that the family shares caregiving tasks and success-

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Greenberg, Monsor, and Gesino 65

fully resolves problems as they occur, but that the family has problems accepting help from formal service providers. An appropriate treatment strategy would utilize the family's problem solving skills and willingness to share caregiving responsibilities to increase the permeability of the family's boundary to resources outside the family.

For practitioners with limited family systems training, the tool has proven very useful in training practitioners about the dimensions and indicators of family caregiving functioning, and has provided hem with a standardized procedure for gathering data on these various dimensions of the family system. This family measure, however, should be used along with a battery of other instruments measuring the cognitive and functional status of the disabled family member, the burden on the caregiver, and the socioeconomic situation of the family. This family tool was developed to provide an assessment of family processes around car&iving, and should be viewed only as one component of a total client assessment.

There are several limitations of the generalizability of this sludy. The study participants were white, predominanlly adult daughters or wives who were high school educated and living in an urban area with a large Scandinavian population. All of the respondents were clients of the Pre- Admission Screening Project and were planning for eventual nursing home placement of their relative. Though we had professionals from minority backgrounds review the instrument to help minimize cultural biases, we recognize hat the inslrument may reflect the majority cul- lure's definition of what constitutes a healthy family caregiving system. Future studies will need to investigate the validity of this measure with different populations and across different settings. In summary, Silliman, Sternberg, and Fretwell (1988) state that the

evaluation of family functioning should be a standard part of the assessment of the frail elder. But we cannot expect Ulis of practitioners until researchers provide the necessary tools. UW-FACS is a first step toward filling this need. This family functioning inslrumenl measures the proper- lies of the family as a caregiving system in contrast to the usual focus on the personal experience of the individual caregiver. These findings provide evidence for the reliability and validity of UW-FACS as a measure of family caregiving functioning. The instrument has proven useful as a tool to train practitioners in family geriatric assessment, and as a standardized protocol for collecling information on families as caregiving systems.

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development of university of wisconsin family assessment caregiver scale (uw-facs)

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