Paid family caregiving: a review of progress and policies

Policymakers in the United States have begun to examine solutions that encourage increased sharing of caregiving responsibilities between government and family. Initiatives in Sweden and the United Kingdom are now in place. Support includes a care leave policy implemented at the federal level, paying salaries to family members when caregiving is a regular job, providing job training to salaried caregivers when their personal caregiving experience ends, community-based programs for caregivers, and allowances to be used for providing care to an elderly person. In the United States, 13 states pay caregivers as Medicaid providers. Policymakers have considered tax incentives and, in 1975, U.S. Senate Bill 1161 was introduced but failed as an attempt to provide cash subsidies to families caring for the elderly. A proposal has been made to expand the Temporary Disability Model to include care of family members of all ages by providing adequate wage replacement to assist caregivers. At present, 34 states provide some type of economic support for caregivers. Research is needed to determine what types of programs are most acceptable and beneficial to caregivers as well as cost effective for government.     

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 good daughters: Acculturation and caregiving among Mexican-American women

This study explores the dynamics of informal care of the elderly in Mexican-American families. Quantitative and qualitative data drawn from interviews with caregivers are presented, which illustrate how acculturation affects the caregiving experience itself and its consequences in terms of stress, burden, rewards, and overall satisfaction. The burden of caregiving for both highly acculturated and less acculturated caregivers was substantial, but there were dramatic differences between the groups in levels of satisfaction. Contrary to expectations, the less acculturated caregivers experienced greater stress, burden, and significantly lower satisfaction even though they were more clearly fulfilling role obligations and they had more family members available to assist with caregiving. Implications for policy and practice are discussed.     

Freedom or money? The dilemma of migrant live‐in elderly carers in times of COVID‐19

As a consequence of the lockdown measures imposed by the Belgian government to fight against COVID‐19, migrant live‐in elderly carers had to choose between safeguarding their job — at the detriment of their personal freedom, their health and their working conditions — and safeguarding their freedom but losing their job — at the detriment of their economic survival and that of their families. This article explores this dilemma from an intersectionality perspective. In order to understand their experience in times of COVID‐19 and their response to this dilemma, I analyse their position as women, as migrants, as elderly care workers, as family breadwinners and as ‘quasi‐family members’ in the families of their employer — which correspond to five interlocking systems of oppression.     

Does caregiving increase poverty among women in later life? Evidence from the Health and Retirement survey

Given the rapid aging of the U.S. population and reductions in federal funding, elder care has become a major issue for many families. This paper focuses on a long-term consequence of elder care by asking how caring for elderly parents affects women's subsequent risks of living in poverty. Using longitudinal data from the Health and Retirement Study, we examine whether and how caregiving for parents in 1991 increases women's risks of living in households with incomes less than the poverty threshold, receiving public assistance, and receiving Medicaid in 1999. Our findings illustrate that caregiving in earlier life raises women's poverty risks in later life by intensifying the negative effects of stopping work and declining health on women's economic well-being.     

Family caregivers of the elderly: quality of life and coping in Estonia

The purpose of the study was to analyse the assessments of elderly people aged 65 and more about family caregiving as a factor influencing their quality of life and coping. The study is based on the project SUFACARE—‘Supporting family carers and care receivers in Estonia and in Finland’—in the framework of which the Institute of Social Work of Tallinn University carried out postal surveys in 2010. The Estonian survey was conducted in Tallinn and Lääne-Viru County. The total number of respondents was 581 (70% female and 30% male), of whom 98 (n=74 female and n=24 male) were family caregivers. Caregiving has not influenced the physical and mental health of caregivers, the reason being that many people who receive care are not of very ill health or suffer from dementia. People mostly take care of their spouses. Based on the Estonian Family Law Act (RT I 2009, 60, 395), adult descendants are required to provide maintenance if their relatives are not able to care for themselves. Caregivers whose health is below average consider caring to be physically demanding. We cannot speak of the social isolation of respondents who have care duties—they communicate actively and do not feel lonely. Women report caregiving to be physically strenuous more often than men. The mental health of male caregivers is better—fewer male respondents claimed to feel unhappy or depressed compared to female respondents.     

Challenges for Studying Care After AFDC

Mandatory work and low wages after the end of AFDC may propel changes in the caregiving of children and dependent elders in single-mother families. This article suggests some challenges facing researchers who will examine care in single-mother families. Drawing on a qualitative study of care in the last years of welfare, and on social network analysis, it suggests how changes in resources, networks, and norms may affect practices of care and also make it difficult to discover the changes.     

Long-term care of the disabled elderly: do children increase caregiving by spouses?

Do adult children affect the care elderly parents provide each other? We develop two models in which the anticipated behavior of adult children provides incentives for nondisabled elderly parents to increase care for their disabled spouses. The “demonstration effect” postulates that adult children learn from a parent’s example that family caregiving is appropriate behavior. The “punishment effect” postulates that adult children may punish parents who fail to provide spousal care by not providing future care for the nondisabled spouse if and when necessary. Thus, joint children act as a commitment mechanism, increasing the probability that elderly parents will provide care for their disabled spouses. We argue that stepchildren provide weaker incentives for spousal care because the attachment of a stepchild to a stepparent is likely to be weaker than the attachment of children to parents in a traditional nuclear family. Using data from the HRS, we find evidence consistent with the hypothesis that joint children provide stronger incentives than stepchildren for nondisabled elderly parents to provide care for their disabled spouse.     

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.     

Linking Elderly to Holistic Care Services through Integrated Communication Technology: The Personal Emergency Link Service Rendered by the Senior Citizen Home Safety Association in Hong Kong

Through a Personal Emergency Link system, the Senior Citizen Home Safety Association has rendered 24-hour care to more than 111,000 service users in Hong Kong who are mostly vulnerable seniors and chronic invalids living alone or living with their elderly spouses/caregivers only. This article will describe how the Personal Emergency Link system is used to link seniors living in the community. Measures taken to prevent failure of the system will be described. With the use of different technology applications, many human touches and warm caregiving are rendered to the elderly and needy.     

Space,time, and self: Rethinking aging in the contexts of immigration and transnationalism

Critical gerontology views aging as a social construction that reflects the intersections of micro-processes with the macro-level forces of individual aging experiences. In the contexts of immigration and transnationalism, however, the macro-structural conditions, dynamics and experiences of aging have become further diversified and complicated. The dearth of empirical and explanatory knowledge in this area has inhibited us from comprehending aging in a changing world. Drawing on data from a study of Chinese grandparents' experiences of transnational caregiving in Canada, this article examines the impacts of such experiences on three interconnected dimensions – spatial, temporal and cognitive – of aging. Although the practice of transnational caregiving allows skilled immigrant families to mobilize care resources outside Canada, it has not only ruptured the traditional trajectories of aging for their elderly parents, but also complicated the inequalities that they have to bear on individual, familial and transnational levels. I argue that the critical examination of aging in the context of transnational caregiving helps us take into consideration those dimensions (such as place, space, time, and knowledge) that are changed by immigration processes, and rethink aging from a broader perspective that links seniors' experiences with their relationship with their adult immigrant children's families and macro-structures outside national borders.     

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.     

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.     

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.     

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.     

Dementia Problem Behavior and the Production of Informal Caregiving Services

Informal caregivers of individuals with Alzheimer's disease spend a considerable amount of time providing care. In this paper, we use Grossman's health production and Becker's time allocation models to develop a model of informal care provision to elderly dementia patients. In our model, time inputs produce caregiving services, which provides utility to the caregiver, but reduces leisure. We assume that time is less productive of services on the margin as the disease progresses. In this framework, an increase in patients' disease severity does not necessarily increase informal caregiver time input. The cost of formal care establishes a reservation price for informal caregiving. When the costs of informal caregiving rise above this reservation level, the patient is institutionalized. We test empirically the effect of deterioration in the patients' condition, proxied by both disease severity and dementia problem behavior, on informal caregiving time. We find that dementia-related problem behaviors and functional limitations significantly increase inputs of informal caregiving time. Patients' problem behavior exerts a modifying effect on functional limitations, and patients' comorbidities have no effect on informal caregiving time.     

Social Work Practice with Older Soviet Immigrants

ABSTRACT

With the recent sociopolitical changes in the Former Soviet Union, significant numbers of older Soviets have arrived in the U.S. with their families. Soviet immigrants who enter the U.S. are no longer automatically considered political refugees, which has limited their entitlement to services. Recent changes in public welfare and immigration policy place the responsibility for care of elderly members solely on the family. While caring for older adults is stressful for any family, new immigrants may be especially burdened since they have limited knowledge of services, few coping resources to provide adequate care, and little experience resolving cultural conflicts with their older parent. By using a practice model designed to evaluate late-life caregiving situations, two case scenarios are presented to examine practice and service delivery issues of older Soviet immigrants and their families.     

Elder abuse: factors related to perceptions of severity and likelihood of reporting

This study examined factors that affect assessments of abuse as depicted in scenarios in which a caregiving daughter abuses her elderly mother through over-medication. College students (N = 239) read scenarios that varied in terms of the past quality of the caregiver/elder relationship and whether or not the elder adult was depicted as suffering from dementia. The role of the participants' own family caregiving experiences also was explored. Results from a factorial ANOVA showed that individuals who perceived the relationship as difficult and whose parents had served as caregivers rated the behavior in the scenario as more abusive and were more willing to notify authorities than participants in other conditions. Results are discussed with a focus on educating families and those working with elderly populations.     

Reciprocities in caregiving relationships in Danish elder care

This article examines the nature of the reciprocal relationships between elderly people and both their informal caregivers and home helpers in Denmark. One of the key results concerns the importance that elderly care recipients attached to various forms of reciprocity. The two major ones were hospitality and gift giving. While informal caregivers see their caregiving as normative or as generalized reciprocity, many stressed that the elderly person's personality and their expressions of gratitude and appreciation (symbolic reciprocity) were important factors facilitating caregiving. Home helpers spoke of satisfaction in helping others, but also underlined the fact that they could see some good role models for their own old age. The results are analyzed on the backdrop of the nature of the Danish welfare system, which provided liberal pensions and benefits. This indirect reciprocity enabled elderly people to retain their ability to participate in reciprocal social relations and preserve their integrity and independence.     

“The show must go on”: Behind the scenes of elderly spousal caregiving

Based on interviews with ten caregivers and on observations of their daily behavior, the present article sets out to clarify why, despite the burdens of care-giving, elderly individuals care for their spouses at home, even when the option to institutionalize them is available. Unlike traditional ways of approaching this question, founded on emic models, the analysis presented in this article is mainly an etic one, based on the dramaturgical approach. The findings indicate that caregiving is a stage for self-deceptive playacting, allowing caregivers to suspend time, awareness, and anxiety in a way that would not have been possible had they institutionalized their spouses. The study shows that features of caregiving, usually portrayed as burdens and hardships, serve in fact as coping mechanisms, which may explain elderly people's willingness to care for their spouses in their own homes.