Family Caregivers Report Weak Coordination With Medical Professionals

Significant gaps were identified in how care for older adults with disabilities is coordinated across family caregivers, medical professionals, and paid caregivers.¹ The findings, published in JAMA Network Open, suggest that while family caregivers rarely shoulder care responsibilities alone, communication and collaboration with the medical system often remain fragmented and insufficiently responsive to caregiver needs.

Family caregivers are critical to patient care and quality of life; patients may rely on unpaid or family caregivers, paid caregivers, or both. However, research has indicated that some patient groups, such as those on Medicare Advantage plans,² receive shorter length of stay for home health, have fewer visits by their home health, and have lower rates of improving self-care.

This cross-sectional analysis included the 2023 National Health and Aging Trends Study (NHATS) and the linked National Study of Caregiving.¹ Researchers used a weighted sample of 2811 family and unpaid caregivers assisting community-living adults 65 years or older with disabilities. Most caregivers (87.6%) reported that the older adult received help from at least 1 other care partner—typically medical professionals (76.4%) or other family caregivers (62.8%), with paid caregivers involved less frequently (23.2%).

Using an adapted relational coordination index (RCI), a measure of shared goals, shared knowledge, mutual respect, and communication frequency, the researchers found relational coordination to be weak with medical professionals (RCI, 3.10) and moderate with paid caregivers (3.80) and other family caregivers (4.20). Higher relational coordination was consistently associated with caregivers who were related to the older adult, cared for individuals with higher needs, or provided high-intensity assistance.

Caregiver role intensity played a substantial role: those providing more than 20 hours of care per week reported stronger coordination across all groups than those providing fewer hours. For example, relational coordination with medical professionals climbed from 2.97 among lower-intensity caregivers to 3.47 among those providing more than 20 hours per week.

Supportive services also mattered, particularly caregiver training. Family caregivers who received role-related training reported markedly stronger relational coordination with medical professionals (RCI, 3.63) compared with those who did not (3.05). Other services were also associated with stronger coordination, although effects varied by type.

Caregivers’ experiences with medical professionals differed dramatically depending on how frequently they interacted with clinicians and whether clinicians engaged them directly. Relational coordination was rated lowest (2.33) among caregivers who never interacted with medical professionals. Among those who did, coordination remained weak for caregivers who said they were rarely listened to or asked about their understanding of care plans. In contrast, caregivers who interacted frequently with clinicians and were routinely listened to, consulted, and asked about needed help reported strong relational coordination (4.0 and above).

The study also found mixed associations between relational coordination and caregiving-related strain. Emotional difficulty and participation restrictions were consistently linked with lower coordination, while physical difficulty showed no association. Financial strain was associated with relational coordination only in the context of interacting with medical professionals.

Demographically, caregivers coordinating with paid caregivers were more likely to be adult children aged 55 to 64 assisting older adults with dementia or significant mobility and self-care limitations. Spousal caregivers were the most likely to coordinate with medical professionals, while nonrelatives were the least likely to coordinate with paid caregivers.

Overall, the findings highlight the central role of communication, particularly with clinicians, in shaping caregivers' experiences and potentially influencing care quality for older adults with disabilities. The authors noted that relational coordination with medical professionals remains notably weak and that structured support, such as caregiver training and more intentional clinician engagement, may offer meaningful avenues for improvement.

“Few family caregivers engage in care work alone,” the authors concluded. “Further study is needed to determine if weak relational coordination with medical professionals may be remediated through training and supportive communication.”

References

1. Wolff JL, Fabius CD, Wu MJ, Freedman VA. Family caregiver experiences coordinating care of older adults. JAMA Network Open. 2025;8(11):e2544315. doi:10.1001/jamanetworkopen.2025.44315
2. Bonavitacola J. Patients on Medicare Advantage receive shorter, less intensive home health care. AJMC^®. March 6, 2024. Accessed November 18, 2025. https://www.ajmc.com/view/patients-on-medicare-advantage-receive-shorter-less-intensive-home-health-care