The relationship between caregiving and employment. A study of stress in employed and unemployed caregivers of elderly persons

The need for persons to provide care on an informal basis to frail and dependent elderly persons has generated a "caregiving crisis" in this country. Middle age women, the traditional caregivers for most generations, are no longer readily available to provide informal care. Instead, they are likely to be struggling to cope with the dual demands of paid employment and family responsibilities. Significant differences exist between employed and unemployed caregivers in relation to age, marital status, gender, personal health status, and caregiver-care recipient relationships. However, no differences exist in relation to the amount of stress experienced as a consequence of caregiving responsibilities. Occupational health nurses have an ideal opportunity to help employed caregivers cope with their caregiving responsibilities both at the worksite and in their personal lives.     

Differences in family caregiver outcomes by their level of involvement in discharge planning.

Family caregivers play vital roles in assisting elders after they are released from the hospital. Although health care professionals advocate involving family caregivers in discharge planning for elders, little is known about the extent to which this involvement benefits or jeopardizes the caregiver's health and their perceptions of the caregiving experience. The purpose of this study was to determine whether the level of family caregiver involvement in discharge planning for an elder made a difference in caregiver health, discharge planning satisfaction, perception of care continuity, preparedness to assist the elder, and acceptance of the caregiving role 2 weeks and 2 months postdischarge. The sample consisted of 130 family caregivers for elders hospitalized with heart failure. Telephone interviews were conducted 2 weeks and 2 months postdischarge. The findings indicated that family caregivers who reported more involvement in discharge planning had significantly higher scores on satisfaction, feelings of preparedness, and perception of care continuity 2 weeks following the elder's hospitalization than those who reported little or no involvement in planning. Caregivers who reported more involvement in planning also were more accepting of the caregiving role. At 2 months postdischarge, caregivers who reported more involvement in discharge planning reported better health and more acceptance of the caregiving role than those who had little or no involvement in planning.     

Juggling work and elder caregiving: work-life balance for aging American workers.

As the American work force ages, the demands of caring for aging relatives increase. Family caregiving often interferes with workplace responsibilities, creating physical, emotional, and financial stress for caregivers. Employers must address the productivity losses created by absenteeism of workers who struggle with work-life issues created by caregiving roles. Occupational health nurses must understand the factors that affect workers in their caregiving roles and make appropriate nursing interventions. They are in key positions to help aging employees and their employers face the increased demands on work-life balance created by elder caregiving.     

Paid work and unpaid help by caregivers of the disabled and frail elders.

Informal caregiving by women, and to a lesser extent by men, is a major source of assistance for the chronically disabled and most dependent older persons living in the community. However, because women's commitment to career employment may diminish, this source of help at the time when (according to demographic trends) the number of very old Americans will increase, the effect of employment on the time they devote to informal caregiving is an important social and economic issue. This study examines two related research questions: 1) how the time allocated to paid work affects the time devoted to unpaid caregiving and 2) how caregiving responsibilities affect work outside the home. The results differ for full-time and part-time work. Estimating a simultaneous equation model, it was found that 1) full-time employment by caregivers reduces the time they allocate to providing unpaid help by 20 hours a week and 2) female caregivers were much less likely than their male counterparts to have full-time jobs. Results also indicate that 1) part-time employment by caregivers has no statistically significant effect on caregiving and 2) caregiving has no effect on women's part-time employment.     

Caring for the frail elderly at home: toward a theoretical explanation of the dynamics of poor quality family caregiving

Using the grounded theory approach, 39 family caregivers were theoretically sampled using newspaper advertising to explore their perceptions of providing home care for frail elders and to generate a theoretical model that describes the dynamics of good quality and poor quality family caregiving; explains the relationships among certain contextual and perceptual variables and the behaviors exchanged by elders and caregivers; and identifies points where interventions by nurses could be effective. The model consists of five constructs that were identified from the data and were staged within the framework provided by symbolic interactionism and social exchange theory. The five constructs and two related driving forces provide a partial explanation for the quality of family caregiving and a beginning explanation for the phenomenon of elder abuse.     

Hip fracture: family caregivers' burden and related factors for older people in Taiwan

Aims. The purpose of this study was to explore the burden experienced by caregivers during the transition from hospital to home. Background. With a growing older population, home‐based care has gradually gained more recognition. Most older people with hip fracture in Taiwan have to be discharged at a relatively early stage. Therefore, the caregiving tasks falls on the families. Methods. A total of 98 older people with hip fracture and their caregivers were interviewed. The sample was selected from three medical centres in Taipei, and questionnaires were collected at one week and one month following hospital discharge. Results. (i) Family caregivers were usually women (63.3%) with spouses being the primary caregivers in most cases (30.6%). About one‐third of caregivers took care of other family members on top of their responsibilities caring for the sick elders at home, and 77.6% shared the care tasks with others. (ii) The caregivers experienced moderate burdens. About 91.8% of caregivers reported ‘I feel sad watching the elder's health deteriorating’, 84.9% reported ‘I must keep an eye on the elder constantly’ and 56.7% reported ‘Taking care of the sick elder at home makes me feel exhausted’. (iii) Caregiver burden and the functional level of older people were adversely correlated. (iv) Caregivers who were unable to access other resources for help and/or had provided care to the older person prior to the fracture resulting in hospitalization experienced a higher burden. Conclusions. These findings should be helpful in the formulation of evidence‐based discharge planning and home health care services. Relevance to clinical practice. Comprehensive discharge planning and developing social support systems for family caregivers to reduce caregivers burden are needed.     

Family medical leave. An employee benefit for working caregivers of elderly family members

Future trends include a decrease in the number of adult children, an increase in the number of individuals over age 65, single parent families, working women, and individuals with no health care insurance. As more women with multiple roles and responsibilities enter and continue as part of the work force, employers recognize the need for support of family issues. Currently many employers lack initiative to make these needed changes. The occupational health nurses' role in relation to future policy for working caregivers includes assessment of how employment and caregiving impact work performance, job satisfaction, and health; and participation in defining public policy issues.     

Giving voice to informal caregivers of older adults.

This study focused on the experiences of informal caregivers of older adults and explored whether employment, use of home-care services, or other factors influence the health of caregivers and their ability to manage their caregiving and other responsibilities. Focus groups conducted with 26 caregivers and personal interviews with 4 caregivers identified 12 themes under 5 conceptual areas: caregiver health, relationships, independence, employment, and use of home-care services. The findings reveal that caregiving coupled with other responsibilities can have serious health effects. Participants spoke of the tenuous balance of decision-making control between caregiver and care recipient. Many caregivers expressed a desire to be included as part of the formal health-care team. Implications for nursing are discussed.     

Competing demands for time and self-care behaviors, processes of care, and intermediate outcomes among people with diabetes: Translating Research Into Action for Diabetes (TRIAD)

OBJECTIVE

To determine whether competing demands for time affect diabetes self-care behaviors, processes of care, and intermediate outcomes.

RESEARCH DESIGN AND METHODS

We used survey and medical record data from 5,478 participants in Translating Research Into Action for Diabetes (TRIAD) and hierarchical regression models to examine the cross-sectional associations between competing demands for time and diabetes outcomes, including self-management, processes of care, and intermediate health outcomes.

RESULTS

Fifty-two percent of participants reported no competing demands, 7% reported caregiving responsibilities only, 36% reported employment responsibilities only, and 6% reported both caregiving and employment responsibilities. For both women and men, employment responsibilities (with or without caregiving responsibilities) were associated with lower rates of diabetes self-care behaviors, worse processes of care, and, in men, worse HbA_1c.

CONCLUSIONS

Accommodations for competing demands for time may promote self-management and improve the processes and outcomes of care for employed adults with diabetes.Diabetes self-management entails a complex set of health behaviors. For people living with young children or dependent adults and for those who work outside the home, caregiving responsibilities and/or expectations in the workplace may be barriers to self-management (1).We conducted a cross-sectional analysis using data from Translating Research Into Action for Diabetes (TRIAD), a multicenter prospective observational study of diabetes care in managed care, to assess whether there are associations between competing demands for time and diabetes self-care behaviors, processes of care, and intermediate health outcomes.     

Fatigue among elders in caregiving and noncaregiving roles

Fatigue is a complex symptom prevalent in informal caregiving. When role demands exceed caregiver resources, fatigue ensues and caregiving can be compromised. The purpose of this study was to compare perceptions of fatigue among older adults (N = 92) caring for spouses with Alzheimer's disease, Parkinson's disease, or cancer with a control group of older adults (N = 33) whose spouses required no extra care. Caregiving elders reported more fatigue, less energy, and more sleep difficulty than did control participants. All caregiving groups reported similar levels of fatigue, energy, sleep, and self-reported health even though there were marked differences regarding spousal status. Health care providers can support older caregivers in monitoring their own health and in recognizing the need for services that support the caregiving role.     

Immigrant caregivers: characteristics of the care provided to dependent elders

In Spain, care in dependency has traditionally fallen to family members but this situation is changing. The existence of a model based on the family's contribution used to enable dependent elders to remain at home; however, social changes such as the crisis of the informal caregiving system, which has been extensively discussed in the literature is leading to the collapse of this situation. In an attempt to respond to this crisis, society has resorted to contracting immigrant women to carry out family care. Responsibility and caregiving is thus transferred to these women and is financially remunerated. Thus, family caregiving of the elderly provided by immigrants is presented as an important resource for care. The care of dependent elderly individuals is often the only opportunity for immigrant women who arrive in Spain in search of better conditions to become incorporated into the labor market. The dispersion of studies on immigrant care highlights the invisibility of this phenomenon. Based on a literature review, the present study highlights the situation of the family care provided by immigrant women and outlines the characteristics of this type of care. The relationship between caregiving and the conditions in which this care takes place is described. Given their situation, immigrant caregivers have a heavy burden of care and limited respite from caregiving responsibilities.     

Nurses as caregivers of elderly relatives: negotiating personal and professional boundaries.

Recent changes in patterns of care provision for the elderly have led to an increasing reliance on family care. Although caring has been found to be a central and common feature of the personal and professional lives of many women, this paper discusses the challenges faced by women who provide care in both their work and their family lives ("double-duty caregivers"). The author argues that the separation of paid caregiving and unpaid family caregiving in the conceptualization of elder care is problematic, particularly for health-care professionals. Findings from a qualitative study with registered nurses providing care to elderly relatives revealed that these women are located at the juncture of public and private domains of caregiving, where they must constantly negotiate the boundaries between their professional and personal caregiving roles. The findings highlight the need to explore the interface between women's family and work lives and the need for policies that promote the health of double-duty caregivers.     

Wholism for aging families: meeting needs of caregivers

Family caregiving of a frail older person is an increasingly common phenomenon. Caregivers are confronted with new roles and responsibilities that provide both challenges and opportunities. Family issues that require expert nursing attention include role reversal, unresolved conflicts, caregiver immersion, elder mistreatment, and caregiving from a distance. Comprehensive geriatric assessment provides a foundation for intervening with families. Nurses are instrumental in providing a family perspective that meets the needs of frail older persons and their caregivers thus providing wholistic care.     

Stress on caregivers of the elderly

This article considers the health threats to a vulnerable population, caregivers of the frail elderly who are maintained in the community. A model of competing care demands is derived from Orem's self-care theory and from caregiver literature to propose that the caregiver, when faced with dwindling resources of energy, time, and money, is forced to choose between self-care and dependent care of the elder. Often, the individual neglects his or her own health to continue to give care. The suggested research projects presented here assess those nursing interventions that complement and support caregiving.     

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample This study explored the needs of family caregivers during the transition from hospital to home. Data from 37 face-to-face interviews with 16 caregivers before discharge and at 2 weeks and 1 month after discharge were subjected to constant comparative analysis. Findings revealed changes in family caregivers' needs during the discharge transition. While preparing to take caregiving responsibility, caregivers reported a need for various types of information. After the discharge, but before home caregiving settled into a pattern, they needed help with caregiving practices. After reaching a pattern for providing family care, caregivers frequently reported needs for continuous emotional support. These findings provide a basis for transitional care services such as discharge planning and home health care services.     

Use of formal community services by elders and their family caregivers 2 weeks following hospital discharge*

Early identification of elders who need care following hospitalization might enhance their health and the health of family members who help them with managing their care. The purpose of this study was to: (a) identify pre-discharge predictors of resource use following hospitalization; (b) describe the formal community services used by elders and their family caregivers during the 2 weeks following hospitalization; and (c) determine whether there is a difference in hospital re-admissions between elders who receive community nursing services compared with those who do not receive any services. The sample consisted of 185 elder/caregiver dyads in which the elders were hospitalized for an acute episode of a chronic condition. Both patients and family caregivers were interviewed before discharge and 2 weeks post-discharge. The findings indicate that pre-discharge functional ability and age are statistically significant predictors of home care services used 2 weeks post-discharge. The findings also suggest that elders who receive visiting nurse services are less likely to be re-admitted to the hospital.     

Gender, time, and money in caregiving

Nurses and scholars in other disciplines have examined the consequences of caregiving on the caregiver in behavioral and attitudinal terms, under the general rubric of "burden." This paper considers caregiver burden in less commonly used labor and economic terms. In addition to expanding nursing's conception of caregiver burden, this approach highlights issues gender-specific to the majority of caregivers, women. Housework is used as a model for women's unpaid work. Based on this model, studies are reviewed in which hours and dollars are measures of caregiving burden. Some specific calculations of the value of elder kin care are given. It is urged that the economic consequences of caregiving be routinely considered and evaluated when nurses in practice and/or research address the needs of caregivers.     

Gendered elder care exchanges in a Caribbean village

Caregiver gender research often translates into caregiver accounts of the care they provide for an elder parent or spouse, limiting an understanding of other community members'involvement and the actual gendered elder care activities performed and caregiver benefits received. This article describes women's and men's actual involvement in elder care. These findings are part of a four-phase ethnographic community study that includes in-depth network analysis of elder households. One-hundred and forty-three informal adult caregivers assisted 15 elders in obtaining the things they needed to live, providing 244 care activities. One-hundred and three women provided 194 care activities, and 40 men performed 50 care activities. In exchange, the frail elders gave the women caregivers 132 benefits and the men 54 benefits. Women and men differed in the amount and type of care involvement, as well as their motivational mechanisms for involvement in elder care.