Although the relationship between the informal and
formal care systems has been studied in a variety of settings,
including home care [36–38], there are inconsistent findings
about whether they substitute or complement one another.
For instance, Zhu et al. [35] found that the utilization
of formal home care and informal care was not influenced
by the use of the other, and yet, there is empirical
evidence that the two care systems are complementary
[36, 37]. The theoretical basis and empirical support for
both these approaches to understanding the link between
formal and informal care systems are problematic [38]. First,
the “partner relationship” between paid and unpaid care
providers is espoused primarily by formal service providers
and administrators as a way to limit financial expenditures of
formal home services. In other words, the complementarity
of the two systems is less compatible than is often assumed.
Second, the analysis that guides most empirical studies on
the relationship between formal and informal care systems
is premised on the gendered assumption that the two are
distinct entities, with family care rarely depicted as “care
work”. This view not only simplifies the relationship between
formal and informal caregiving, but it also fails to capture the
specific commonalities and discerning differences between
them. Thus, the differences between the two care systems
with respect to power, status, authority, and resources are
rarely considered in these studies. One exception, however,
was Ward-Griffin and Marshall [38] who found home care
nurses and family caregivers of older chronically ill elders
living in Canada engaged in a bidirectional labour process
of “work transfer”, one that depended on the “free” labour
of family caregivers. Although this particular study sheds
light on the complexity and interconnectedness of formalinformal
care and points to the need to conceptualize eldercare
as work, regardless of who does it, it did not focus on
dementia home care.