This Article Abstract Full Text (PDF) Services Download to citation manager PubMed PubMed Citation

Assistance Received by Employed Caregivers and Their Care Recipients: Who Helps Care Recipients When Caregivers Work Full Time?

Correspondence: Address correspondence to Andrew E. Scharlach, School of Social Welfare, University of California, Berkeley, 120 Haviland, Berkeley, CA 94720. E-mail: scharlach{at}berkeley.edu

	Abstract

TOP Abstract Methods Results Discussion References

 
Purpose: This study examined the association among caregiver labor force participation, employees' caregiving activities, and the amount and quality of care received by care recipients. Design and Methods:Telephone interviews were conducted with 478 adults who were employed full time and 705 nonemployed adults who provided care to a family member or friend aged 50 or older, identified through random sampling of California households. We assessed care recipient impairment and service problems; the amounts and types of assistance received from caregivers, family and friends, and paid providers; and caregiver utilization of support services.  Results: Care recipients of caregivers employed full time were less likely to receive large amounts of care from their caregivers, more likely to receive personal care from paid care providers, more likely to use community services, and more likely to experience service problems than were care recipients of nonemployed caregivers. Employed caregivers were more likely to use caregiver support services than were nonemployed caregivers. Implications:Accommodation to caregiver full-time employment involves selective supplementation by caregivers and their care recipients, reflecting increased reliance on formal support services as well as increased vulnerability to service problems and unmet care recipient needs. These findings suggest the need for greater attention to the well-being of disabled elders whose caregivers are employed full time.

Key Words: Caregiving • Employment • Service utilization • Care networks • Unmet needs

Role theory provides a general framework for understanding how employment might impact caregiving (Goode, 1960). From this perspective, the time demands associated with full-time employment have the potential to reduce the time and energy available for the performance of other roles, such as caring for disabled family members (N. F. Marks, 1998). Consistent with this competing demands hypothesis (Goode, 1960), most studies have found that employed caregivers provide less assistance than their nonemployed counterparts—an average of 6 to 10 hr of care weekly versus 18 hr of care provided by caregivers who are not employed (Boaz & Muller, 1992; Chapman, Ingersoll-Dayton, Neal, & Emlen, 1993; Doty et al., 1998; Stommel, Given, Given, & Collins, 1995). There also is some evidence that employed caregivers may be less likely to provide intensive or direct forms of personal care (NAC and AARP, 1997), although some other studies have not found substantial differences between employed and nonemployed caregivers with regard to specific care tasks (Rosenthal, Hayward, Martin-Matthews, & Denton, 2004; Spitze & Logan, 1991).

Previous investigators have given little attention to the effects of caregiver employment on the overall amount and adequacy of assistance received by disabled care recipients. Given their competing role responsibilities, it seems likely that employed caregivers' efforts may be supplemented with assistance from a variety of other informal and formal sources, including family members, friends, and paid providers (Stommel et al., 1995). In this study, we examined the nature of this supplementation, including the specific amounts and types of assistance that care recipients of employed caregivers receive and the adequacy of this assistance. Previous studies have provided some evidence that increased reliance on paid care providers, and decreased availability of caregivers to arrange and oversee care, may be associated with decreased feelings of safety and security among disabled care recipients, decreased satisfaction with care received, and greater residual unmet needs (Benjamin, Matthias, & Franke, 2000; Li, 2004).

Doty and colleagues (1998) conducted the most extensive study to date regarding the relationship between caregiver employment and the amount of care received by elderly care recipients. Utilizing data from the 1989 National Long-Term Care Survey and linked Informal Caregivers Survey, their study found that the total number of hours of assistance received by elderly care recipients was not associated with the employment status of their primary female caregivers, after controlling for a number of caregiver and care recipient characteristics. However, the sources of the care differed for the two groups. Care recipients received significantly fewer hours of care from their primary caregivers when those caregivers were in the paid labor force; however, they also received significantly more hours of assistance from paid providers and secondary informal sources. This study did not, however, examine differences between employed and nonemployed caregivers with regard to the specific types of care provided or the extent to which care recipient needs were met. Moreover, like most previous studies, it included only female employed caregivers, despite evidence that women and men may respond differently to work and caregiving roles (Sarkisian & Gerstel, 2004).

In this study, we also examined the possibility that labor force participation may affect the support received by caregivers themselves. Consistent with a role enhancement perspective (S. R. Marks, 1977), employment may confer social and personal resources that can help to ameliorate some of the potentially deleterious aspects of caring for a disabled family member (Pavalko & Woodbury, 2000). Indeed, researchers have not consistently found employed caregivers to experience higher levels of role strain than nonemployed caregivers, and some have attributed this finding to constructive characteristics of the workplace, such as access to informal and formal sources of caregiver information and support (Edwards, Zarit, Stephens, & Townsend, 2002; Lee, Walker, & Shoup, 2001; Norton, Parris Stephens, Martire, Townsend, & Gupta, 2002). For example, employed caregivers frequently have access to workplace counseling and information programs as well as informal contact with other employed caregivers who may be knowledgeable about available services or who may offer encouragement to use those services. In addition, employed caregivers are apt to be younger and have greater educational and economic resources, which may promote utilization of community services (Montgomery, Marquis, Schaefer, & Kosloski, 2002). However, it is possible that time constraints imposed by employment may prevent caregivers from obtaining the support they need, either because of limited discretionary time to seek assistance or because services may only be available during normal working hours (Houde, 1998). Most studies to date regarding caregiver service use have failed to find employment-related impacts (Cox, 1997; Kosloski, Montgomery, & Youngbauer, 2001); however, these studies have focused only on respite use and have been limited by convenience or clinical samples of existing service users. Recent analyses of data from the 1999 National Long-Term Care Survey (Center on an Aging Society, 2005) have found evidence of a positive bivariate association between employment and overall use of caregiver support services.

This study extends previous research regarding caregiver labor force participation by examining its implications for the sources and adequacy of care received by care recipients, utilizing data from a household survey of employed and nonemployed caregivers. In particular, based on the existing empirical and conceptual literature, we tested the following hypotheses: (a) Caregivers employed full time will spend less time in informal caregiving roles and provide less intensive care than will nonemployed caregivers, (b) their care recipients will receive more assistance from other informal sources than will care recipients of nonemployed caregivers, (c) their care recipients will receive more assistance from paid providers and will be more likely to use community support services than will care recipients of nonemployed caregivers, and (d) their care recipients will be more likely to experience problems with services and unmet care needs than will care recipients of nonemployed caregivers. We also hypothesized that employed caregivers would be more likely to use support services for themselves than would nonemployed caregivers.

	Methods

TOP Abstract Methods Results Discussion References

 
Sample
We derived data for this study from telephone interviews conducted in English and Spanish between March and August 2002 with a household sample of caregivers residing in California. Telephone numbers were sorted into working blocks of 100 contiguous numbers, then randomly sampled within working blocks. To ensure that some unlisted phone numbers were included in the sample, we supplemented the original list by using a working number as a seed from which one other number was generated by adding a constant. Surveys were completed by 19% of identified caregivers, consistent with the response rates of two similar national studies (NAC and AARP, 1997, 2004).

The final sample consisted of 1,643 individuals who were providing care to someone aged 50 or older. This sample represented 1 in 6 households, comparable to national estimates that approximately 17% of all U.S. households with a telephone contain at least one caregiver (NAC and AARP, 2004). The ethnic distribution of this sample was consistent with projections of the ethnicity of California caregivers from a national household survey of caregivers (NAC and AARP, 1997) and was relatively representative of the general California adult population, except for a slight overrepresentation of Latino respondents (25% vs 22% in the California population) and an underrepresentation of Asian respondents (5% vs 10% in the California population).

Of 1,384 respondents who provided their employment status, 478 (34.5%) indicated that they were employed full time and 705 (50.9%) said that they were either retired (n = 341), on a leave of absence (n = 54), or otherwise not currently employed (n = 310); 198 (14.3%) indicated that they were employed part time, and we excluded these from this study due to inadequate information regarding the number of hours they actually worked.

Measures
Caregiver and Care Recipient Demographic and Social Characteristics
We assessed a number of social and demographic characteristics that have been found to be associated with caregiver behavior (Fredriksen-Goldsen & Scharlach, 2001), including the following respondent characteristics: employment status (0 = not employed, 1 = employed full time), age (1 = 18–39 years, 2 = 40–49 years, 3 = 50–59 years, 4 = 60 years and older), gender (0 = man, 1 = woman), race/ethnicity (0 = non-Hispanic White, 1 = other racial or ethnic group), education (0 = high school graduation or less, 1 = college graduation), annual household income (0 = less than $30,000, 1 = $30,000 or more), health (1 = poor or fair, 2 = good, 3 = very good or excellent), marital status (0 = not married or living with partner, 1 = married or living with partner), responsibility for the care of children younger than age 18 in the home (0 = no, 1 = yes), and whether the respondent was the primary person responsible for the care of the care recipient (0 = no, 1 = yes).

We collected information from respondents regarding a number of care recipient characteristics: age (1 = 50–59 years, 2 = 60–69 years, 3 = 70–79 years, 4 = 80 years and older), gender (0 = man, 1 = woman), race/ethnicity (0 = non-Hispanic White, 1 = other racial or ethnic group), annual household income (0 = less than $20,000, 1 = $20,000 or more), relationship to respondent (1 = parent or parent-in-law, 2 = spouse or partner, 3 = other relative, friend, or neighbor), and current living arrangement (0 = not with respondent, 1 = with respondent).

Care Recipient Assistance Needs and Sources of Help
We asked respondents whether their care recipient needed assistance with personal care activities of daily living (ADLs; e.g., dressing, eating, bathing, or toileting; 0 = does not need assistance, 1 = needs assistance) or with each of five instrumental ADL (IADL) domains (transportation/shopping, household chores, managing finances, arranging for care, medical needs [e.g., taking medicines/changing bandages]; 0 = does not need assistance, 1 = needs assistance). For each type of ADL or IADL assistance the care recipient needed, we asked respondents to indicate whether the care recipient received assistance from the respondent (0 = no, 1 = yes), family or friends (0 = no, 1 = yes), or paid providers (0 = no, 1 = yes).

We asked respondents to indicate the total number of hours they spent helping the care recipient in an average week, as well as the total number of hours of care provided by family and friends and by paid providers. Because of highly skewed distributions with regard to the number of hours provided from each of these three sources, we constructed ordinal measures for the three variables, corresponding to quartiles in the observed distributions. We coded the resulting measures as follows: hours of care per week provided by respondents (1 = 1–4 hr, 2 = 5–13 hr, 3 = 14–39 hr, 4 = 40 hr or more); hours of care provided by family and/or friends (1 = 1–4 hr, 2 = 5–10 hr, 3 = 11–39 hr, 4 = 40 hr or more); hours of care from paid providers (1 = 1–5 hr, 2 = 6–21 hr, 3 = 22–99 hr, 4 = 100 hr or more). We also asked respondents to indicate whether their care recipients had used any community services (e.g., home delivered meals, adult day care, mental health services) in the past month (0 = no, 1 = yes).

Adequacy of Services Received by Care Recipients
We assessed the adequacy of services received by the care recipients by asking respondents to indicate whether they experienced difficulty in obtaining the services their care recipient needed, had problems with the services their care recipient was using, or thought that their care recipient needed other types of assistance than he or she already was receiving. We created a composite measure of service adequacy (0 = no service problems or unmet needs, 1 = service problems and/or unmet needs).

Caregiver Service Use
We assessed whether respondents were utilizing any caregiver support services by asking them to indicate which of 11 possible services they had received within the past year (e.g., information, education, counseling, support group, respite, legal advice) and the source of that assistance (e.g., family, friend, social service agency, health care provider, community organization). Because the vast majority of respondents who received assistance used only one type of service, we constructed a composite measure of caregiver service use reflecting the receipt of any of the 11 types of assistance from a formal provider such as a social service agency, health care provider, or other community organization (0 = did not use any formal support services in past year, 1 = used at least one formal support service in past year).

Analytic Methods
First we examined bivariate differences (using chi-square to test for statistical significance) between employed and nonemployed respondents with regard to each of the respondent and care recipient demographic and social characteristics, as well as care recipient ADL and IADL assistance needs. We then examined bivariate associations between employment and the following dependent variables: number of hours of care provided by respondent, by family members, and by paid providers; ADL and IADL assistance provided by respondent, by family members, and by paid providers; care recipient community service use; service adequacy; and respondent use of caregiver support services. We constructed a quasi-correlation matrix to examine the bivariate associations between each of the dependent variables and the various respondent and care recipient demographic and social characteristics in order to identify characteristics that might contribute to observed employment-related differences in each dependent variable. We calculated statistical significance using phi for associations between binary variables (2 x 2 tables) and Cramer's V for other analyses (larger than 2 x 2 tables). Finally, we examined associations among the various respondent and care recipient demographic and social characteristics utilizing the multicollinearity diagnostic statistics produced by linear regression analysis in SPSS 14 for Windows (SPSS, 2005).

We estimated regression models to examine the unique contribution of employment, in the context of other respondent and care recipient characteristics, on dependent variables found to have a significant bivariate association with respondent employment. We used stepwise logistic regression models to examine IADL assistance from family members, ADL assistance from paid providers, care recipient community service use, service problems, and respondent use of caregiver services. We used a polytomous universal model, an extension of the general linear model to ordinal categorical variables, to examine hours of care provided by respondents. In the first step of each regression model, we included all extrinsic variables found to have a significant empirical and conceptual association at the bivariate level with employment and with the particular dependent variable; we then entered employment status at Step 2. We included personal care needs in regression models where personal care was associated significantly with the dependent variable at the bivariate level, except for the regression modeling ADL assistance from paid providers; we excluded personal care from this regression because all care recipients receiving ADL assistance have personal care needs. For a similar reason, we excluded care recipient medical needs from the regression modeling IADL assistance from family and friends. Given the high variance inflation factors for caregiver race (2.47) and recipient race (2.54), we used only caregiver race in the regression analyses. We also excluded respondent income, because income is more likely a result of employment status rather than a contributor to it.

	Results

TOP Abstract Methods Results Discussion References

 
Caregiver and Care Recipient Characteristics
As shown in Table 1, respondents who were employed full time differed significantly from those who were not employed in that they were more likely to be younger than 60 years of age (² = 154.48, p <.001), male (² = 19.49, p <.001), non-White (² = 13.42, p <.001), college graduates (² = 52.49, p <.001); have annual incomes of $30,000 or more (² = 36.90, p <.001), be in very good or excellent health (² = 21.46, p <.001); care for children younger than 18 living in the home (² = 12.77, p <.001); and not have primary care responsibility for the care recipient (² = 11.24, p <.001). The two groups did not differ significantly with regard to marital status.

Assistance Provided by Paid Sources
Care recipients of employed caregivers were more likely to receive paid assistance with personal care (² = 7.37, p <.01) and more likely to use community services (e.g., home-delivered meals, adult day care, mental health counseling; ² = 24.15, p <.001) than were care recipients of nonemployed caregivers; however, the two groups did not differ significantly regarding the number of hours of paid care they received. Employed caregivers were more likely than nonemployed caregivers to indicate that they experienced difficulty in obtaining the services their care recipient needed, had problems with the services their care recipient was using, or thought that their care recipient needed other types of assistance than he or she already was receiving. Logistic regression analysis revealed that care recipients of employed respondents were 2.34 times as likely (95% CI = 1.37–4.00) to receive ADL assistance from paid service providers as were care recipients of nonemployed respondents after controlling for potentially confounding factors, and 1.90 times as likely (95% CI = 1.45–2.48) to use community services. We found that employed caregivers were 1.37 times as likely as nonemployed caregivers (95% CI = 1.03–1.82) to report service problems or unmet needs.

Utilization of Caregiver Support Services
Employed caregivers were more likely than their nonemployed counterparts to report having used at least one caregiver support service in the past year (² = 38.53, p <.001). Logistic regression analysis found that employed respondents were 2.24 times as likely as their nonemployed counterparts to report having used some kind of caregiver support service in the past year (95% CI = 1.76–2.86) after controlling for potential confounding factors.

	Discussion

TOP Abstract Methods Results Discussion References

 
Care Needs and Care Provision
Consistent with the competing demands perspective of interrole conflict (Goode, 1960), we found that caregivers who were employed full time were less likely than nonemployed caregivers to provide large amounts of assistance (e.g., 40 hr per week or more) to their disabled elderly care recipients. Given limited time and energy, it is not surprising that employed caregivers cannot easily take on the equivalent of a second full-time job. Although some employees reduce their work hours or leave the work force entirely, most employed caregivers may be able to more easily reduce their care activities than decrease their work hours. Most work environments do not provide employees sufficient flexibility to accommodate family responsibilities, and there is evidence that caregivers are more likely to reduce or abandon their caregiving activities than to leave the work force entirely (Moen, Robison, & Dempster-McClain, 1995).

Even though they are less likely to provide large amounts of care, employed caregivers are as likely as their nonemployed counterparts to provide moderate amounts of care (e.g., 14–39 hr per week); moreover, they help elderly individuals whose assistance needs are similar to those of elders cared for by nonemployed caregivers. Indeed, we found that the overall impact of employment is modest, suggesting that employed and nonemployed caregivers generally are quite similar with regard to the care they provide and the assistance that they and their care recipients receive. Our findings are consistent with other research that has found that employed individuals are about as likely as their nonemployed counterparts to provide elder care (Doty et al., 1998; Pavalko & Artis, 1997; Rosenthal et al., 2004), suggesting that employed caregivers attempt to fulfill traditional societal and familial norms regarding family care for elderly disabled relatives (Stohs, 1994).

Care Supplementation
Reduced amounts of care by caregivers who are employed full time appear to be offset by increased assistance from other informal and formal sources. These findings echo those of Doty and colleagues (1998), whose analysis of data from the National Long-Term Care Survey found that decreased care from employed caregivers was balanced by increased assistance from other sources, resulting in no overall difference in total hours of care received by care recipients of employed and nonemployed caregivers. However, employed caregivers also continue to be involved in the entire range of caregiving tasks. What results is a pattern of supplementation, reflecting the joint provision of care, rather than a pattern of specialization, which would be reflected in employed caregivers' adoption of certain types of care activities and avoidance of others (Stommel et al., 1995). Supplementation is selective, with employed caregivers relying more on formal care providers for intensive tasks such as personal care, making greater use of community services such as adult day care, and relying somewhat more on family and friends for household tasks.

The joint provision of care found among these employed caregivers also reflects a secular trend toward increased reliance on combinations of informal and formal sources of assistance by older adults with disabilities (Spillman & Pezzin, 2000). We should note, however, that these patterns are conditioned by social, cultural, and economic factors affecting the division of family care responsibilities. A study of African American caregivers, for example, found that caregivers' employment did not affect their care recipients' use of community services (Bullock, Crawford, & Tennstedt, 2003). Further research is needed to examine racial and cultural factors that may affect service use and how those factors interact with caregiver employment.

Perceived Impact on Care Recipients
We found that care recipients of employed caregivers were more vulnerable to service problems and unmet needs for additional assistance. This vulnerability may be a secondary effect of increased reliance on nonfamily care providers, exposing employed caregivers and their care recipients to barriers to obtaining care and problems with the care received. Studies of home care recipients, for example, have found that individuals receiving assistance from nonfamily care providers report less physical and psychological safety, less security, less comfort with the care provider, more provider shortcomings, and lower overall satisfaction with care than do those whose care provider is a family member (Benjamin et al., 2000). It is not known whether the care provided by non-family members actually is of poorer quality, whether care recipients are less satisfied because of intangible aspects of the care interaction that make family care more fulfilling or desirable, or whether caregivers simply are more likely to perceive service problems and unmet care needs when they are more dependent upon others to care for their disabled elders.

Caregiver Service Use
We found that employed caregivers were more likely than their nonemployed counterparts to use caregiver support services, consistent with the findings of the 1999 National Long-Term Care Survey (Center on an Aging Society, 2005). These findings may in part reflect employees' increased access to care-related information and services through their workplaces. Indeed, more than 25% of companies with at least 100 workers offer some kind of caregiver information or support programs for their employees (Wagner, 2003). Scholars have suggested that employed caregivers' greater access to information and caregiver resources might help them mitigate some of the potentially deleterious effects of their care responsibilities (Pavalko & Woodbury, 2000). Relatively little is known, however, about the extent to which employed caregivers or their elderly care recipients actively seek outside help in order to mitigate or avoid role strain, or the actual direct effects of these efforts. Longitudinal studies, preferably natural experiments or clinical trials, are necessary to unravel these effects.

Limitations and Research Implications
Our findings regarding employment and its association with assistance received by caregivers and their care recipients are based on data from a large, racially and ethnically diverse sample drawn using population-based sampling methods, unlike previous studies that often have relied on convenience samples. Inferences regarding causation or the actual effects of employment, however, are limited by this study's cross-sectional design and by relatively modest contributions of employment to the models we tested. Our study design, moreover, likely understates complex interpersonal processes underlying care and employment decisions and the use of formal support services by caregivers and their care recipients. We cannot rule out reciprocal paths; for example, some of the caregivers who were not employed at the time of this study may previously have left the work force because of especially challenging care situations or inadequate formal or informal support. Moreover, the internal and external resources that enable caregivers to continue working, rather than employment per se, may facilitate access to formal support services for caregivers and their care recipients. In addition, the results presented here reflect caregivers' perceptions rather than actual evidence of care behavior or care recipient well-being, suggesting the need for future research that includes reports from caregivers, care recipients, and formal and informal service providers.

Further attention is needed with regard to potential variations within, and interactions among, employment and care characteristics (Fredriksen-Goldsen & Scharlach, 2001). Indeed, characteristics of caregivers, their jobs, and their care situations may be as important as time limitations and number of roles in contributing to caregiver accommodations and their impacts (Cannuscio et al., 2004; Edwards et al., 2002). Number of hours worked, for example, is associated with reductions in care provision and care reception but only for caregivers who work at least half time; for those who work less than 18 hr per week, increases in work hours are associated with increased hours of care provided and received (Doty et al., 1998). The impact of employment on care provision, moreover, may be limited primarily to caregivers with especially demanding care situations (Stommel et al., 1995), which may have been underestimated in this study because of our inability to differentiate the intensity of care recipient personal care needs. Employment has been associated with decreased assistance primarily when care recipients are in very poor health (NAC and AARP, 1997) or have very high levels of disability (Doty et al., 1998), although employment apparently also is associated with lower levels of care provision when care recipients have relatively modest care needs (Doty et al., 1998).

Findings such as these suggest that the relationship between employment and care provision is more complex than traditional role theory predicts. Further research is needed regarding the accommodations made by caregivers, care recipients, and their families in an effort to manage the demands of multiple responsibilities, including employment and family care. Clinical and observational studies are needed that examine family interactional and decision-making processes regarding the division of care responsibilities and the use of external care resources. Of particular relevance for policy and practice is additional research regarding the ways in which formal and informal resources can assist caregivers and their care recipients to avoid breakdowns in employment or care provision when confronted with demanding care situations.

Practice Implications
Whereas most efforts to assist employed caregivers have focused on alleviating caregiver strain or improving job performance (Fredriksen-Goldsen & Scharlach, 2001), our findings suggest that experts should give increased attention to the needs of the disabled elders who rely on assistance from employed family members. As a first step, health and social service professionals should include caregiver employment and other availability constraints as potential risk factors in determining elders' vulnerability for unmet service needs. Professional assessments of disabled elders for home- and community-based services should routinely include caregiver labor force participation as part of a standardized caregiver assessment protocol (Family Caregiver Alliance, 2006). We also recommend more assertive efforts to identify vulnerable elders, including those with employed caregivers, through outreach programs at the workplace, in churches and other associations, and through the media.

The workplace represents a promising venue for offering information and services that benefit employed caregivers and their care recipients. Employer-sponsored resource and referral programs, caregiver fairs, lunchtime workshops, and other informational programs can help employees to learn about and access support services for themselves and their care recipients (Fredriksen-Goldsen & Scharlach, 2001; Neal & Hammer, 2001). Our findings especially suggest the importance of workplace programs and benefits directed at employees' disabled family members, such as in-home assessments, geriatric care management, and respite care (Neal & Hammer, 2001). Although only a limited number of employed caregivers in this study actually accessed support services through their places of employment, this represents an area of substantial potential for the strengthening of natural communities of support and for the expanding of caregiver services. Efforts should be directed at increasing the availability of employer-supported elder care programs as well as identifying effective strategies for overcoming potential attitudinal and organizational barriers to using programs once they become available.

Also needed is an overall increase in the availability and quality of in-home and community-based care to complement and supplement the support provided by family members who have competing role responsibilities. Especially important are community support services that are consistent with the limitations imposed by caregiver employment, including adult day health care centers that are open before and after normal working hours, emergency temporary respite services when usual care arrangements break down, and Web-based access to sources of care information and services. The American Business Collaboration for Quality Dependent Care provides a promising model of corporate investment designed to strengthen community infrastructure to enhance support for disabled elders and dependent children.

Conclusion
This study extends existing knowledge about employment and caregiving by examining secondary effects on the types and amount of care received by care recipients. We found that employed caregivers supplement care by relying more on formal care providers for personal care, in some cases relying more on family and friends for household tasks, and making greater use of other caregiver and care recipient support services. However, our findings also suggest that care recipients of employed caregivers may have a greater likelihood of care problems, prompting concern regarding the well-being of these care recipients as well as of their employed caregivers. There is a need for increased attention to the implications of caregiver employment on the disabled relatives for whom these caregivers are responsible, and increased consideration of interventions targeted to better meet the needs of older adults with disabilities whose caregivers are in the work force.

	Footnotes

 
This study was supported by an interagency agreement with the California Department of Aging and a generous gift from the Rose and Eugene Kleiner Family Foundation. We thank Kris Hele, Cara Goldstein, and Amanda Lehning for their assistance with article preparation.

¹ School of Social Welfare, University of California, Berkeley.

Decision Editor: Linda S. Noelker, PhD

Received for publication April 5, 2006. Accepted for publication March 26, 2007.

	References

TOP Abstract Methods Results Discussion References

 

• Benjamin, A. E., Matthias, R., & Franke, T., (2000). Comparing consumer-directed and agency models for providing supportive services at home. Health Services Research, 35 351-366.[Medline]
• Boaz, R. F., & Muller, C. F., (1992). Paid work and unpaid help by caregivers of the disabled and frail elders. Medical Care, 30 149-158.[Medline]
• Bullock, K., Crawford, S. L., & Tennstedt, S. L., (2003). Employment and caregiving: Exploration of African American caregivers. Social Work, 48 150-162.[Medline]
• Cannuscio, C., Colditz, G., Rimm, E., Berkman, L., Jones, C., & Kawachi, I., (2004). Employment status, social ties, and caregivers' mental health. Social Science & Medicine, 58 1247-1256.[Medline]
• Center on an Aging Society. (2005). Caregiving and paid work: Are there trade-offs?. Retrieved November 24, 2007 from http://ihcrp.georgetown.edu/agingsociety/pdfs/CAREGIVERS4.pdf.
• Chapman, N. J., Ingersoll-Dayton, B., Neal, M. B., & Emlen, A. C., (1993). Balancing the multiple roles of work and caregiving for children, adults, and elders. In M. B. Neal (Ed.), Balancing work and caregiving for children, adults, and elders (pp. 283–300). Newbury Park: Sage.
• Cox, C., (1997). Findings from a statewide program of respite care: A comparison of service users, stoppers, and nonusers. The Gerontologist, 37 511-517.[Abstract]
• Doty, P., Jackson, M., & Crown, W., (1998). The impact of female caregivers' employment status on patterns of formal and informal eldercare. The Gerontologist, 38 331-341.[Abstract]
• Edwards, A., Zarit, S., Stephens, M. A. P., & Townsend, A., (2002). Employed family caregivers of cognitively impaired elderly: An examination of role strain and depressive symptoms. Aging & Mental Health, 6 55-61.[Medline]
• Family Caregiver Alliance. (2006). Caregivers count too! A toolkit to help practitioners assess the needs of family caregivers. San Francisco: Author.
• Fredriksen-Goldsen, K. I., & Scharlach, A. E., (2001). Families and work: New directions in the twenty-first century. New York: Oxford University Press.
• Goode, W., (1960). A theory of role strain. American Sociological Review, 25 483-496.
• Hepburn, C. G., & Barling, J., (1996). Eldercare responsibilities, interrole conflict, and employee absence: A daily study. Journal of Occupational Health Psychology, 1 311-318.[Medline]
• Houde, S. C., (1998). Predictors of elders' and family caregivers' use of formal home services. Research in Nursing & Health, 21 533-543.[Medline]
• Kosloski, K., Montgomery, R. J. V., & Youngbauer, J. G., (2001). Utilization of respite services: A comparison of users, seekers, and nonseekers. Journal of Applied Gerontology, 20 111-132.[Abstract/Free Full Text]
• Lee, J. A., Walker, M., & Shoup, R., (2001). Balancing elder care responsibilities and work: The impact on emotional health. Journal of Business and Psychology, 16 277-289.
• Li, H., (2004). Barriers to and unmet needs for supportive services: Experiences of Asian American caregivers. Journal of Cross-Cultural Gerontology, 19 241-260.[Medline]
• Marks, N. F., (1998). Does it hurt to care? Caregiving, work-family conflict, and midlife well-being. Journal of Marriage and Family, 60 951-966.
• Marks, S. R., (1977). Multiple roles and role strain: Some notes on human energy, time, and commitment. American Sociological Review, 41 921-936.
• MetLife. (1999). The MetLife Juggling Act Study: Balancing caregiving with work and the costs involved. New York: MetLife Mature Market Institute.
• Moen, P., Robison, J., & Dempster-McClain, D., (1995). Caregiving and women's well-being: A life course approach. Journal of Health and Social Behavior, 36 259-273.[Medline]
• Montgomery, R. J. V., Marquis, J., Schaefer, J. P., & Kosloski, K., (2002). Profiles of respite use. In R J. V. Montgomery (Ed.), a new look at community-based respite programs: Utilization, satisfaction, and development (pp. 33–63). New York: Haworth Press.
• National Alliance for Caregiving and AARP. (1997). Family caregiving in the U.S.: Findings from a national survey. Bethesda, MD: Authors.
• National Alliance for Caregiving and AARP. (2004). Caregiving in the U.S.: Findings from the National Caregiver Survey. Bethesda, MD: Authors.
• Neal, M., & Hammer, L., (2001, June) A work-family sourcebook for employers: Supporting employees with child and elder care needs. Portland, OR: Portland State University.
• Norton, T. R., Parris Stephens, M. A., Martire, L. M., Townsend, A. L., & Gupta, A., (2002). Change in the centrality of women's multiple roles: Effects of role stress and rewards. Journal of Gerontology: Social Sciences, 57B S52-S62.[Abstract/Free Full Text]
• Pavalko, E. K., & Artis, J. E., (1997). Women's caregiving and paid work: Causal relationships in late midlife. Journal of Gerontology: Social Sciences, 52B S170-S179.[Abstract]
• Pavalko, E. K., & Woodbury, S., (2000). Social roles as process: Caregiving careers and women's health. Journal of Health and Social Behavior, 41 91-105.[Medline]
• Rosenthal, C., Hayward, L., Martin-Matthews, A., & Denton, M., (2004). Help to older parents and parents-in-law: Does paid employment constrain women's helping behavior? Canadian Journal on Aging Supplement, 23 S115-S130.
• Sarkisian, N., & Gerstel, N., (2004). Explaining the gender gap in help to parents: The importance of employment. Journal of Marriage and Family, 66 431-451.
• Spillman, B., & Pezzin, L., (2000). Potential and active family caregivers: Changing networks and the "sandwich generation.". Milbank Quarterly, 78 347-374.[Medline]
• Spitze, G., & Logan, J. R., (1991). Employment and filial relations: Is there a conflict? Sociological Forum, 6 681-697.
• SPSS. (2005). Statistical package for the social sciences 14 for Windows. [Computer software]. Chicago: Author.
• Stephens, M. A. P., Townsend, A., Martire, L., & Druley, J. A., (2001). Balancing parent care with other roles: Interrole conflict of adult daughter caregivers. Journal of Gerontology: Psychological Sciences, 56B P24-P34.[Abstract/Free Full Text]
• Stohs, J. H., (1994). Alternative ethics in employed women's household labor. Journal of Family Issues, 15 550-561.[Abstract]
• Stommel, M., Given, B. A., Given, C. W., & Collins, C., (1995). The impact of the frequency of care activities on the division-of-labor between primary caregivers and other care providers. Research on Aging, 17 412-433.[Abstract]
• Stone, R. I., & Short, P. F., (1990). The competing demands of employment and informal caregiving to disabled elders. Medical Care, 28 513-526.[Medline]
• Wagner, D. L., (2003). Workplace programs for family caregivers: Good business and good practice. San Francisco: Family Caregiver Alliance.

This Article Abstract Full Text (PDF) Services Download to citation manager PubMed PubMed Citation