Isolation and remoteness: Supporting family caregivers in hard-to-reach communities

The Bottom Line

  • The aging of the population presents several challenges for the health and social services system, particularly in rural and remote communities where there is a shortage of workforce and a lack of access to certain services.
  • Family caregivers in hard-to-reach communities are at greater risk of unequal access to health and social services.
  • Three areas of support and interventions are needed by family caregivers in hard-to-reach communities: overcoming isolation, acquiring skills and knowledge and increasing accessibility to services.

Eighty percent of older adults and people with health problems are cared for at home by family members and friends. In countries that are part of the Organization for Economic Co-operation and Development (OECD), 10% of adults provide informal (unpaid) care for family members or friends. This percentage is around 20% in Canada, which represents more than 8 million Canadians.(1)

In a context where families have fewer children to care for their aging parents, where women are increasingly affected by caregiving duties (and juggling many other priorities) (1) and where children sometimes live more than an hour away from their parents ( 2), it should come as no surprise that family caregivers carry a heavy burden and experience physical, emotional and financial problems (among others). This is particularly the case in hard-to-reach communities, where there is great distance from urban centres or where services are scattered or scarce, In these communities, older adults are often more dependent on their family.  But what is known about support for these family caregivers?

What does the research tells us

A systematic review examined 14 studies published after 2012, which was the European year of active Ageing and Solidarity between Generations, that focused on helping family caregivers in rural and hard-to-reach communities.(3) These studies have been carried out in the United States (7), Sweden (3), Portugal, in Canada, Australia and Thailand.

Overall, the research evidence resonates with findings from other systematic reviews or related studies: few caregivers receive enough recognition, support or training.(4) However, the review clearly identified three areas of support and intervention needed by family caregivers in hard-to-reach communities: overcoming isolation, acquiring skills and knowledge and increasing accessibility to services.(3) 

Overcoming isolation
Caregivers often feel discouraged, isolated and stressed by the intensity of the task and the magnitude of the care, which can lead to physical health problems and depression. These problems tend to increase in remote areas where transportation services and support for caregivers are less likely to exist, which may exacerbate the feeling of social and geographic isolation.

Caregivers need psychosocial services to improve their mental health and enable them to provide quality care to their loved ones. There are different types of support, whether individual or group meetings or even by phone. Just being able to chat with people who share similar stories helps reduce stress, create a social network and share best practices to care for their loved one (and for themselves).

Acquiring skills and knowledge
Since the health problems of older adults are often complex, many family caregivers would benefit from specialized training to help them better manage symptoms and know how to provide optimal care. They would thus be able to play their role to prevent adverse events with much more confidence and success, while decreasing their level of stress.

Certain technologies can to overcome (to some extent) the limited access to services. Most studies have used technological tools to reach caregivers in remote areas, which has improved skills while reducing feelings of social isolation, depression and stress. However, studies also show that the benefits of technologies are the same as those of telephone support, which could, for example, be used for people with limited ease or comfort with new technologies.

There are therefore several solutions for training caregivers, giving them the tools to develop their skills to care for their loved ones (making them confident in their abilities), including workshops given by experts, educational softwares, printed guides, videos and webinars, telephone support, videoconferences given by a psychologist, physician or social worker, etc.

Increasing accessibility to services
Many studies pointed out that psychological and educational support is compounded by the inaccessibility of services in rural and remote areas. In addition, although the use of technological interventions may reduce the cost of providing certain services, because workshops, webinars, etc. can be posted on a website available to all caregivers, the studies examined in the review didn't reveal other reasons to prefer them to in-person support.

The reality of living and providing care to loved ones in hard-to-reach communities remains complex. It is thus important for policymakers to engage family caregivers and other adults in designing programs and services that meet their needs. Caregivers are experts of their communities, knowing what challenges they are facing and potential solutions that could address them.

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Author Details


  1. Sinha M. Portraits of caregivers, 2012. Statistics Canada, Ottawa : Canada, 2015.

  2. Vezina M, Turcotte M. Caring for a parent who lives far away: The consequences. Statistics Canada, Ottawa : Canada, 2010.

  3. Morelli M, Barello S, Mayan M, Graffigna G. Supporting family caregiver engagement in the care of old persons living in hard to reach communities: A scoping review. Health and Social Care in the Community, 2019, 27(6): 1363-1374.

  4. Wilson MG, Gauvin FP, Ploeg J. Citizen brief: Improving care and support for unpaid caregivers in Ontario. Hamilton, Canada: McMaster Health Forum, 8 November 2014. 

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.