Families, work, and an aging population: developing a formula that works for the workers

This article examines the intersection of family caregiving, work, and long-term care. Supporting families who provide care in order to minimize negative work effects while enhancing the acceptability of care options is of common concern to employers, state and federal policymakers, and the homecare professionals in the community-based care system. The contribution of families to the long-term care system, how employer policies have developed, how the public policy agenda has addressed family caregiving, and the importance of a more effective partnership on the state level are discussed.     

Families,Work, and an Aging Population

Abstract

This article examines the intersection of family caregiving, work, and long-term care. Supporting families who provide care in order to minimize negative work effects while enhancing the acceptability of care options is of common concern to employers, state and federal policymakers, and the homecare professionals in the community-based care system. The contribution of families to the long-term care system, how employer policies have developed, how the public policy agenda has addressed family caregiving, and the importance of a more effective partnership on the state level are discussed.     

Informing family policies: The uses of social research

Like the topic of family policy itself, research informing family policies is difficult to characterize. This article discusses how ideology and values influence research agendas and then describes three types of studies informing family policies: research defining social issues, evaluation research, and research about the policy-making process. Two case studies illustrate how social research informs family policy: in promoting gender equality in Scandinavia and in reforming child support in the United States. Values of individualism and the sanctity of the family have traditionally focused policy makers' and, hence, researchers' attention on individuals, not families, as the units of analysis. But dramatic shifts in family structure and functioning along with renewed public concern about family disintegration are placing families high on the policy agenda. Both “basic” and “applied” family scholars can contribute to a research agenda examining the factors promoting strong, effective families. She conducts research on gender and the life course, as well as on aging, families, and social policy. She received her Ph.D. in Sociology from the University of Minnesota. Her research interests in stratification, social policy, gender, and the life course include sex segregation in occupations, fertility, and work decisions and family policy.     

Long-term care policy and financing as a public or private matter in the United States

Effective approaches to assure adequate resources, infrastructure, and broad societal support to address chronic care needs are volatile and potentially unpopular issues that can result in many losers (those getting far less than they want) and few winners (those who gain access to scarce societal resources for care). In the United States, debates on long-term care involve a complex set of issues and services that link health, social services (welfare), and economic policies that often pit public and private sector interests and values against one another. Yet long-term care policies fill a necessary function in society to clarify roles, expectations, and functions of public, non-profit, for profit, individual, and family sectors of a society. By assessing and developing policy proposals that include all long-term care system dimensions, a society can arrive at systematic, fair, and rational decisions. Limiting decisions to system financing aspects alone is likely to result in unforeseen or unintended effects in a long-term care system that stopgap "fixes" cannot resolve. Three underlying policy challenges are presented: the need for policymakers to consider whether the public sector is the first or last source of payment for long-term care; whether government is seen primarily as a risk or cost manager; and the extent to which choice is afforded to elders and family caregivers with regard to the types, settings, and amount of long-term care desired to complement family care.     

Long-Term Care Policy and Financing as a Public or Private Matter in the United States

Summary

Effective approaches to assure adequate resources, infrastructure, and broad societal support to address chronic care needs are volatile and potentially unpopular issues that can result in many losers (those getting far less than they want) and few winners (those who gain access to scarce societal resources for care). In the United States, debates on long-term care involve a complex set of issues and services that link health, social services (welfare), and economic policies that often pit public and private sector interests and values against one another. Yet long-term care policies fill a necessary function in society to clarify roles, expectations, and functions of public, non-profit, for profit, individual, and family sectors of a society. By assessing and developing policy proposals that include all long-term care system dimensions, a society can arrive at systematic, fair, and rational decisions. Limiting decisions to system financing aspects alone is likely to result in unforeseen or unintended effects in a long-term care system that stopgap “fixes” cannot resolve. Three underlying policy challenges are presented: the need for policymakers to consider whether the public sector is the first or last source of payment for long-term care; whether government is seen primarily as a risk or cost manager; and the extent to which choice is afforded to elders and family caregivers with regard to the types, settings, and amount of long-term care desired to complement family care.     

A call for greater attention to the role of employers in developing,transforming, and implementing family policies

The authors contend that employer-initiated workplace policies should be considered as part of the patchwork that constitutes U.S. family policy. To provide a background, historical evidence of employer-initiated policies intentionally used as family policies is summarized. The view is then explicated that failure to take economic conditions and workplace policies into account may lead to faulty conclusions about the reasons for major changes in family life. The current status of selected employer-initiated workplace policies and recent trends is summarized. Next, some of the dilemmas inherent in considering connections between government- and employer-initiated policies are identified. Finally, suggestions for future directions are offered. The article should be considered with the following caveat in mind: the focus is exclusively on the influence of policies on families, but families are not merely reactive. She received her Ph.D. and M.B.A. from The Pennsylvania State University. Her research interests center on relationships between jobs and family life, with emphasis on work-family relationships in small businesses, and on adult workers as developing individuals. Her research interests focus on the intersection of social problems and family problems, including families and work, coping with unemployment, and adult children as caregivers of dependent parents. She received her Ph.D. from Purdue University.     

Do family policy regimes matter for children's well-being?

Researchers have studied the impact of different welfare state regimes, and particularly family policy regimes, on gender equality. Very little research has been conducted, however, on the association between different family policy regimes and children's well-being. This article explores how the different family policy regimes of twenty OECD countries relate to children's well-being in the areas of child poverty, child mortality, and educational attainment and achievement. We focus specifically on three family policies: family cash and tax benefits, paid parenting leaves, and public child care support. Using panel data for the years 1995, 2000, and 2005, we test the association between these policies and child well-being while holding constant for a number of structural and policy variables. Our analysis shows that the dual-earner regimes, combining high levels of support for paid parenting leaves and public child care, are strongly associated with low levels of child poverty and child mortality. We find little long-term effect of family policies on educational achievement, but a significant positive correlation between high family policy support and higher educational attainment. We conclude that family policies have a significant impact on improving children's well-being, and that dual-earner regimes represent the best practice for promoting children's health and development.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.     

The family caregiving career: implications for community-based long-term care practice and policy

Informal (i.e., unpaid) long-term care for disabled older adults is often chronic, but it is only recently that research has considered the longitudinal implications of family caregiving. In particular, investigators have conceptualized caregiving as a "career," and within the caregiving career, a number of diverse trajectories and transitions can occur. Following a summary of these findings, this paper considers how longitudinal caregiving research can influence and potentially address key policy and practice concerns, especially in the delivery and support of community-based long-term care (CBLTC) services. It is suggested that with the refinement of the informal long-term care literature, existing policy and practice to support caregiving families can be similarly advanced.     

Has Family Policy Come of Age? A Decade Review of the State of U.S. Family Policy in the 1990s

Family policy has come of age in the 1990s, yet it has not achieved a status commensurate with that of economic or environmental policy. Because family policy has been difficult to define, this review proposes an explicit definition of the term family policy and a companion implicit term, a family perspective in policy making It updates the rationale for family policy, arguing that family commitment at its core is particularly consequential in an individualistic market economy with a small social safety net. It chronicles recent developments including philanthropic commitments, state and federal policy initiatives, and the use of research to inform family policy making. Selected family policy issues including family and work conflict, long-term care, family poverty, and marriage, are overviewed. The paper concludes with developments during the decade in theory, methods, and dissemination that hold the potential for capitalizing on the current popularity of families as a theme in policy making.     

Child care policy: A need for greater advocacy

While some scholars have recognized the importance of child care to families in the United States (Kamerman, 2001; Waldfogel, 1998), child care has not been viewed as a core social policy concern in the United States. In this article, we provide an overview of child care needs in the U.S. followed by an analysis of three major federal programs that shape U.S. child care policy. The first, the Child Care Development Fund (CCDF), provides financial child care supplements to low-income parents to enable them to engage in paid labor. The second policy, The Family Medical Leave Act (FMLA), is technically a universally applicable policy enabling people to care for a family member in need, including all parents who choose to spend a few weeks of unpaid leave with a newborn child. The third is the U.S. tax policy, including child care exemptions, deductions and credits. We suggest that, though all of these policies exist to help families care for children, they fail the children and families that they are purportedly designed to help. We then discuss the crucial role that professionals who work with families and children can play in shaping U.S. child care policies.     

Family Policy and Complex Contemporary Families: A Decade in Review and Implications for the Next Decade of Research and Policy Practice

Prior Journal of Marriage and Family decade-in-review articles have grappled with the definition and role of family policy for research and policy practice while emphasizing its value to both. In this article, we begin with a broad conceptualization of family policy that encompasses actions intended to achieve explicitly stated goals for families (explicit policies) and those that affect families without an explicitly stated goal for doing so (implicit policies), which we believe provides a solid framework for guiding and understanding both research and practice in the field. Second, we review major U.S. policy initiatives in the past decade and their documented and potential effects on families. Third, we describe several key aspects by which contemporary families have become more diverse and complex. Fourth, we discuss the implications of ongoing family complexity for public policies. We conclude with a discussion about future research and policy development in the context of contemporary family complexity.     

Racial and Ethnic Differences in Family Caregiving in California

Abstract

Family caregivers are the main source of long-term care for older persons in the United States. At the same time, cultural values and beliefs shape decisions surrounding who provides care and whether families use formal support interventions to assist the caregiver. The current article examines how the family caregiving experience differs among racial and ethnic groups in terms of caregiver characteristics, service utilization, caregiver strain, and coping mechanisms. Telephone interviews were conducted in English and Spanish with a random sample of 1,643 respondents in California who provide care to someone age 50 or over. Bivariate analyses showed evidence of ethnic differences in the demographic characteristics of caregivers, intensity of care provided, caregiver health, level of financial strain, religious service attendance, formal service utilization and barriers to formal services. Odds ratios showed that White and African American caregivers were about two times as likely to use formal caregiver services as were Asian/Native Hawaiian/Pacific Islander and Latina American caregivers. Implied by these findings is the need for further understanding of caregiver service needs among diverse racial and ethnic groups.     

Foreign Domestic Workers and Eldercare in Singapore: Who Hires Them?

In Singapore, policy makers expect families to remain actively involved in the care of their frail older relatives, as manifestly expressed in its Many Helping Hands approach to long-term care. To enable families to fulfill this expectation, the government has enacted policies that encourage the hiring of foreign domestic workers (FDWs) to complement or supplement informal caregiving efforts. Using the Andersen Behavioral Model, we were interested in identifying caregiver and care receiver characteristics that might predict the hiring of FDWs. With data from a convenience sample of 488 informal caregivers, we ran logistic regression regressing the hiring of an FDW on various predisposing, enabling, and need factors. Of interest, enabling factors such as household income, housing type, and educational level were predictive of hiring an FDW in the home. Only one need factor, time spent in caregiving, was predictive of the increased likelihood to hire an FDW. Policies that encourage the marketization of care are likely to favor those with financial means and inadvertently ignore the caregiving burdens of lower income families. In addition, we suggest research and policies to ensure the well-being and protection of FDWs who have become a key component of the long-term care policy and practice in Singapore.     

Global Convergence: Aging and Long-Term Care Policy Challenges in the Developing World

Aging around the world poses a global challenge in eldercare. This challenge is particularly felt in low- and middle-income countries (LMICs), where population aging outpaces the development of aged care policies and services. This Perspective highlights the phenomenon of global convergence in several unsettling trends and challenges shared across LMICs. These include the weakening of informal family care systems for the elderly, growing need for formal long-term care of the frail and disabled who can no longer be adequately supported by family members, and mounting pressures for policy responses to tackle these societal challenges. It is argued that policymakers should take a proactive stance. That is, when family care for the elderly falls short and family caregivers are increasingly under strain, the government should step in and step up support to fill in the gap by developing appropriate policies and a continuum of long-term care services that are accessible and affordable for the majority of older people in need. Three general principles are then suggested with regard to long-term care provision, financing, and quality assurance, which transcend national borders and can be used to guide long-term care policymaking across LMICs.     

Priority: Home! A true priority? An analysis of the Federal Plan to Break the Cycle of Homelessness

Homelessness pervades every fabric of American society: it has plagued individuals and families, young and old, males and females. This paper analyzes and discusses the feasibility of a current proposal, Priority: Home? The Federal Plan to Break the Cycle of Homelessness, and the intended effects of its policies pertaining to the homeless. Specifically, the plan outlines the need for a continuum of care, a concept which promotes three stages to attain self-sufficiency: emergency shelter, transitional housing, and permanent housing. Providing support services and follow-up care are contingent on the success of the continuum. The plan therefore describes a comprehensive solution to address homelessness and requires that all levels of government participate in the process.     

The effects of federalism on policies for care of the aged in Canada and the United States

Debates about who should care for the elderly often center on the relative responsibilities of the state and family. In federal societies such as Canada and the United States, however, multiple governments are involved. This article compares and contrasts federalism in these two nations and its effects on the division of fiscal, administrative, and programmatic responsibilities for care of the aged between the national and regional (i.e., state, provincial) governments. Two major policy arenas, health care and social services, are examined, with particular attention focused on the roles played by the nongovernmental sector. Because most care of the aged is provided informally--a situation firmly rooted in the value systems and public policies of both nations--national and regional policies that assist family caregivers directly are examined. Policymakers at the regional level have been more active and often more innovative in constructing policies that are supportive of family caregiving, but in general, few programs of direct assistance exist in either nation and these largely depend on their geographic location. The article concludes with a discussion of the continued effects of federalism for future policies affecting care of the aged and suggests some approaches that can be undertaken to empower families in their caregiving roles.     

Filling a critical gap: measuring work policies that affect families globally

Work is a central element in most people's lives, and its adequacy and value cannot be measured by simple figures showing how many people have gained or lost jobs. Current measures of decent work are more comprehensive in terms of what matters to individuals, but deficient in their coverage of work policies that matter to families. In this article, we argue the importance and feasibility of measuring policies and laws that shape work quality, and in particular those that shape how work affects families on a global basis. We make the case that this policy area is especially critical under changing social conditions, and propose a manageable and feasible set of indicators permitting an assessment of the extent to which national labor policies facilitate the ability of working adults to meet the requirements of their jobs as well as the needs of their families. Methods are described and findings mapped for all UN countries in key areas including maternal leave, paternal leave, leave to care for children's health, leave to care for adult family members, and leave to meet other family needs.     

Developmental Processes in African American Families: An Application of McLoyd’s Theoretical Model

In accordance with McLoyd’s model of African American children’s development, we examined the linkages among family income, maternal psychological distress, marital conflict, parenting, and children’s outcomes in early and middle childhood, using a sample of 591 African American children from the National Longitudinal Survey of Youth. Income during early childhood had a direct effect on behavior problems and reading recognition in middle childhood. Income also had an indirect effect on the child outcomes via maternal psychological distress and parenting. In a comparison of African American and White families, marital conflict predicted children behavior problems only in White families. Findings suggest that family psychological and material resources influence parenting as well as behavioral and cognitive outcomes for African American children.     

The family's role in person-centered care: practice considerations

Effective implementation of person-centered care requires a shared understanding and commitment to make it a reality by administrative personnel, direct care providers, and residents and their family members. Long-term care facilities must seek ways to engage residents' families in person-centered care through its training, policies, care planning, and documentation. Doing so may require revisions to policies and work practices, and ongoing leadership efforts to maintain this care framework within the realities of staff turnover and regulatory requirements. Developing protocols and procedures that facilitate family members' communication with staff and build consensus and shared values will result in a system that represents and honors the unique perspectives, values, and needs of each resident receiving care. It is important for facility leadership to set the tone for acknowledging the importance of family involvement in person-centered care by modeling acceptance of concerns and criticisms as valid and by acknowledging that direct care providers, residents, and their family members have a voice in care decisions. Such an approach has the greatest chance of success in promoting person-centered care and the shared values necessary to ensure its successful implementation.