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Causes, Consequences, and Moderating Factors of Strain ofCaregiving Among Employed CaregiversLinda Duxbury, PhD,Sprott School of Business, Carleton University, Ottawa, OntarioChristopher Higgins, PhD,Ivey School of Business, Western University, London Ontario1
Table of ContentsChapter One: Introduction1.Employed Caregivers2.Objectives of This Study3.Relevance of this study to key stakeholders4.Structure of this report588910Chapter Two: Literature Review1.Defining the key concepts1.1.Informal Caregiving1.2Caregiver strain2.Informal Caregiving: The Canadian Context2.1Aging Population2.2Rising elder care demand2.3Shrinking availability of formal care2.4Shift to informal care for elderly2.5Decreasing supply of informal caregivers2.6Value of Informal Caregiving2.7Challenges with respect to disability3.Prevalence of caregiving 173.1Prevalence of informal caregiving: “sandwich generation” caregivers3.2: Prevalence of informal caregiving: time in role3.3: Prevalence of informal caregiving: caregiving tasks3.4: Gender differences in the prevalence and intensity of caregiving3.5: Impact of employment on prevalence of caregiving4.Determinants of caregiving5.Motivation to provide care6.Consequences of caregiving6.1Impact on caregivers6.2Impact on employers6.3Impact on society6.4Challenges of caregiving for the “sandwich generation”7.Framework of caregiver strain, its predictors and moderators7.1Caregiver strain7.2Causes/predictors of caregiver strain7.3Moderators/predictors of caregiver strain8.Dealing with caregiver strain8.1Caregiver network strategies8.2Employer support8.3Community support8.4Public policy9.Areas for future 833353638404142454546464648
Chapter Three: Methodology1.The Questionnaire1.1The Caregiving Section of the Survey1.2Predictors1.3Caregiver Strain1.4Outcomes1.5Moderators2.Statistical Analyses2.1Frequencies:2.2Means2.3Between Group Comparisons2.4Factor Analysis2.5PLSChapter Four: Profile of .4ModeratorsChapter Five: Caregiving5.1Caregiving Demands5.2Why Take on Caregiver Role?5.3Caregiver Strain5.4Caregiving Intensity5.5Subjective Caregiver Demands5.6Key Outcomes of Caregiver StrainChapter Six: Testing the Models6.1Prediction of Caregiver Strain6.2Prediction of Total Role Overload6.3Prediction of Work-Life Conflict6.4Prediction of Organizational Outcomes6.5Prediction of Employee Well-being6.6ModerationChapter Seven: Conclusions7.1What do we know about the caregivers who answered the survey?7.2Can we quantify the work and family demands of employed caregivers?7.3Prevalence Of Caregiver Strain in Canada's workforce7.4What factors put Canadian employees at risk of caregiver strain?7.5What can be done to reduce caregiver strain?7.6Why should employers and employees care about caregiver strain?7.7Caregiving more problematic for female employees than male employees7.8Employees with multi-generational caregiving responsibilities are ferences1103
Causes, Consequences, and Moderating Factors of Strain ofCaregiving Among Employed CaregiversLinda Duxbury, PhD,Sprott School of Business, Carleton University, Ottawa, OntarioChristopher Higgins, PhD,Ivey School of Business, Western University, London OntarioPreambleTwo decades ago (1991), we conducted our first national study of work-life conflict in Canada to“explore how the changing relationship between family and work affects organizations, familiesand employers.” Almost 21,000 employed Canadians participated in this research. Just over tenyears ago (2001) we undertook our second national study of work-life conflict in Canada todetermine how the "demographic, social and economic changes that occurred throughout the1990's increased the percent of the Canadian working population at risk of high work-lifeconflict." Just less than 32,000 employed Canadians took part in this study. In 2011-12 weundertook a third national study of work-life balance in Canada. Just over 25,000 employedCanadians participated in this study. Findings from this study are provided in a series of threeresearch reports:Report One: Revisiting Work-Life Issues In Canada: The 2012 National Study on BalancingWork and Caregiving in Canada was released in October, 2012. This report can be found athttp://sprott.carleton.ca/duxbury/Report Two: Causes, Consequences, and Moderating Factors of Strain of Caregiving AmongEmployed Caregivers uses the 2011-12 survey data to explore the link between caregivingdemands, caregiver strain (emotional, financial and physical strain associated with the care of anelderly dependent) and role overload, work-life conflict, employee well-being, andorganizational well-being.Report Three: Caregiving in Canada: A View From the Trenches uses qualitative interview datacollected from in-depth interviews with 150 employed male and female caregivers to explore thecosts and benefits of two forms of caregiving (eldercare, multi-generational caregiving) toCanadians and the firms that employ them. It also focuses on what can be done to reduce thestrains associated with caregiving.This series of reports should provide business and labour leaders, policy makers and academicswith an objective “big picture” view on the current situation with respect to work-life conflictand employed caregiving in Canada. It is hoped that the production of three specialized reportsrather than one massive tome will make it easier for the reader to assimilate key findings fromthis rich and comprehensive research initiative.4
Chapter One: IntroductionIn the new millennium dependent care is not just a question of care for children. Demographic,social, economic, and policy changes have made family care of older relatives an issue ofextreme importance to policy makers, families, researchers and employers (Sims-Gould &Martin-Matthews, 2008; Fast & Keating, 2000). The growth of interest in eldercare as a ‘workand family’' issue can largely be attributed to its position at the nexus of a number of importantsocio-demographic trends including: Population ageing: As the baby-boom generation moves towards middle age, and theirparents toward old age, the per cent of the population aged 65 years or older and requiringcare is projected to increase. The sheer number of people living longer will increase theprobability of having an elderly relative in need of at least some assistance (Sims-Gould &Martin-Matthews, 2007). Health-related factors: Medical advances that enable people with disabilities and healthproblems to live longer, inevitable declines in health that come with age, increased survivalafter catastrophic illness and injury, and new patterns of chronic illness and disability haveall changed the landscape of care needs (Joseph & Hallman, 1998; Fast & Keating, 2000). Health-care restructuring: Health care reforms that emphasize early discharge andcommunity-based care have shifted responsibility for care from formal to informalcaregivers, and redistributed a considerable amount of eldercare to the community. Thispolicy reform has made it necessary for informal caregivers to provide higher levels of carefor frail, ill and disabled people at home (Fast & Keating, 2000). Increased labour force participation of women: Female family members (predominantlywives, daughters and daughters-in-law) have traditionally borne the lion's share ofresponsibility for the unpaid labour of family care-giving (Joseph & Hallman, 1998;Decima, 2004; Pavalko & Gong, 2005). The fact that two-thirds of these women are alsoemployed in the labour force has made eldercare a work and family issue (Fast & Keating,2000). Changing structure of families: The capacity of families to meet the expectations requiredby health services restructuring is affected by the changing structure of families, whichtoday are smaller, more diverse, more complex and less stable, have less free time and breakup more often. Families are also more diverse in terms of structure, patterns of functioning,and heritage (Grunfeld et al., 2007; Fast & Keating, 2000). Declining fertility rates: Declining fertility rates mean that Canadian families are smallertoday than they were thirty years ago. The 2006 census reported that the average number ofchildren per family living at home in 2006 was 1.2. These data, taken to their logicalconclusion, suggest that within the next few decades, children will be required to providesupport for a larger number of elderly family members.5
Demographic projections suggest that society has yet to feel the full effects of the challenges ofproviding eldercare. There is consensus in the literature that the demands and expectations forcare will continue to grow with the number of Canadians over 65 expected to double by 2026.According to Statistics Canada, the 2011 census determined that "The number of seniors aged65 and over increased 14.1% between 2006 and 2011. This rate of growth was more than doublethe 5.9% increase for the Canadian population as a whole."1 These data confirm Brink's (2004)prediction that the number of people requiring care will grow significantly in the future. As thebaby-boom generation moves towards middle age, and their parents toward old age, a higherproportion of workers will simultaneously and/or sequentially be involved in combining paidemployment with providing care and support to an ailing spouse or partner, parent, in-law orother older relative (Lero & Lewis, 2008, pg. 391). According to the Canadian CaregiverCoalition (2001), it is not a matter of “if you become a caregiver, but when.” Clearly, the time isnow for a definitive study on caregiving.As part of this study we undertook a comprehensive literature that examined caregiving in all itscomplexities and reviewed what is currently known about “employed caregiving” in Canada (seeChapter Two of this report). This review determined that much of this literature in this area dealtwith and/or debated the following issues: The extent and nature of employed caregiving (i.e., tasks performed, the burdens ofemployed caregiving, the coping strategies used by employed caregivers). The context under which employed caregiving is performed (i.e., the role of restructuring inhealth care, workplaces and communities). Anticipated changes in the number of employed caregivers over time and the future ofemployed caregiving in Canada. The impact of caregiving on the employed caregiver (i.e., consequences and challenges). The impact of employed caregiving on employers, society and the economy.Several conclusions can be drawn from the research that has been done to date on caregivers: Families maintain the primary responsibility for the care of chronically ill and disabledelderly family members (Montgomery, Gonyea & Hooyman, 1985). Most caregivers are looking after only one individual, but close to one in ten (8%) arelooking after a second family member (Decima, 2004). The typical caregiver is age 46, female and works outside the home - the exemplar of the“sandwich generation” (Marks, 2006).1Statistics Canada, The Daily: 120529a-eng.htm6
Providing care appears to affect the mental health of caregivers. Caregivers haveconsistently higher rates of depression than non-caregivers (Pavalko & Gong, 2005). While the per cent of employees providing care is small at any given time, adults are morelikely than not to provide care at some point in their lives with the greatest proportion ofcaregiving occurring in midlife, a time when most employees are also juggling work andother family responsibilities (Pavalko & Gong, 2005). Caregivers provide a range of tasks in looking after their family member, the most commonbeing providing medication, paying bills, driving them to destinations (e.g., doctor visits)and assisting with lifting and moving. These tasks are performed by a large majority ofcaregivers, although less than half report doing so on a daily basis. The incidence andfrequency of tasks performed are related to the nature of a recipient's disabilities (e.g., liftingassistance with older, physically disabled individuals) (Decima, 2004). A significant proportion of caregivers are paying out-of-pocket costs to provide care to theirfamily members (Decima, 2004). The contributions made by informal caregivers are extremely important. Care provided by afamily member or friend can have a value related to the quality of life of the care recipientthat cannot be replaced by any amount of formal services (Health Canada, 1999). Family members who are providing care may need support in the caring role, both to helpthem meet the needs of the person requiring care, and to help them meet their personal orfamily needs during the time they are caregivers (Health Canada, 1999). There is a persistent gendered division of labour in the allocation of caregiving work, withwomen, regardless of employment status, income and family structure, being more likelythan men to perform the intensive personal and physical care tasks (Campbell et al., 1998;Neal et. al., 1993; MacDonald, Phipps & Lethbridge, 2005; Rajnovich, Keefe & Fast, 2005;Williams, 2004). Compared to women, men do different amounts as well as different types of care work andin different combinations with paid work and formal care help (Guberman 1999; Rajnovichet al., 2005; Pavalko & Gong, 2005; Pyper, 2006).7
1.Employed CaregiversAnalysis of the existing literature revealed a number of gaps in our knowledge about employedcaregivers (see Chapter Two). These shortcomings informed the development of our researchprogram on employed caregivers.A caregiver is operationally defined in this study as someone who provides a broad range offinancially uncompensated ongoing care and assistance, either by necessity or choice, directly tofamily members who are in need due to physical, cognitive, or mental health conditions.Eldercare is a form of caregiving that relates to the special needs and requirements that are uniqueto senior citizens. These definitions are consistent with those used by the Canadian CaregiverCoalition (2001) and Fast and Keating (2000). Eldercare is different from childcare in that ittends to increase in amount and intensity over the course of caregiving (Morris, 2001). The timingof care is also different. Caring for children spans many years, carries a fairly predictable patternand changes occur slowly with time. Caregiving, on the other hand, is less predictable and varieswidely in duration (Pavalko, & Gong, 2005).The focus in this study is on employed caregivers – individuals who are caregivers (as definedabove) but also engage in paid employment. Our definition of employed caregivers includes twomain groups: (1) Employees with responsibilities for the care of an adult dependent, and (2)Employees in the sandwich group (i.e., people who are dealing with their own dependent childrenwhile at the same time attending to the needs of aging parents).2.Objectives of This StudyThe study described in this report was designed to meet the following objectives:1.To better understand which employees take on the role of caregiver and why.2.Quantify the work and family demands facing employed caregivers in Canada.3.To estimate the prevalence of caregiver strain in Canada’s workforce, identify what factorsput employees at risk with respect to such strain and what can be done to reduce caregiverstrain.4.To quantify the impact caregiving has on employees who provide care as well as theorganization that employees them.5.To determine the impact of gender and caregiving situation on the above issues.To meet this last objective we compare the findings obtained from the male and femaleemployees in the sandwich group (i.e. employees who have children at home and also provideeldercare) to their counterparts with those attained with the men and women in the eldercare onlygroup.8
3.Relevance of this study to key stakeholdersOur decision to restrict our focus to employed individuals providing care to family members canbe justified as follows. First, as noted above, this group is large, encompasses the majority ofemployed caregivers and is growing. Unfortunately it is also understudied and our knowledge ofthe challenges faced by employed caregivers (especially those with multigenerational caregivingdemands) is limited (Fast & Keating, 2000). Part of the problem seems to be that research oncaregiving appears to have “fallen between the gaps” in terms of research agendas. Most researchon caregiving has been confined to the gerontological and family studies literatures and hasfocused on caregiver burden and caregiver strain (Montgomery, Gonyea & Hooyman, 1985;Schene, Tessler, & Gamache, 1994; Sims-Gould & Martin-Matthews, 2007). Few researchers inthese fields have looked at how to best combine the competing needs of paid work and caregiving(Fast & Keating, 2000; Montgomery, Gonyea & Hooyman, 1985; Pyper, 2006). While someresearchers in the workplace policy and work-family domains have studied the balance betweenwork and caregiving, most of the work in these disciplines has focused on the balance betweenemployment and caring for younger children (Pavalko & Gong, 2005). This research study seeks,therefore, to inform policy makers by providing a focus on this understudied group.Second while the growth of caregiving demands has lead to an increase in research on the topic,the findings vary and comparability is limited because of a lack of consistency and clarity indefinitions of caregiving (Pavalko & Gong, 2005; Montgomery, Gonyea & Hooyman, 1985). Theproblem is exacerbated by a lack of consensus in the research literature with respect to how bestto measure caregiving as well as the consequences of caregiving (i.e., burden, strain) and the lackof a clear theoretical framework to guide research (Schene, Tessler and Gamache, 1994). Pavalkoand Gong (2005) articulate these concerns by noting that at this point in time neither researchersnor policy makers know much about the structural conditions either at work or in the communitythat reduce the burdens faced by employed caregivers. Our study will address these issues byrestricting our study to one broadly defined group, employed caregivers, one theoreticalperspective (role overload) and the use of well established and valid measures from the literature.The large sample size will also allow us to conduct in-depth gender-based analyses. Suchanalysis is necessary given that the research in this area has identified a gendered division oflabor in the allocation of caregiving work (Campbell and Martin-Matthews 2000; Morris 2004;Rosenthal and Martin-Matthews, 1999; Grunfeld et al., 1997; Gignac et al. 1996).Third, our choice of employed caregivers was guided by the fact that a number of researchers(e.g., Pavalko & Gong, 2005; Ansello & Rosenthal, 2007) have expressed concerns with the factthat much of the research in this area focuses on the cost to the employer of introducing policiesand practices to support caregivers. They go on to note that little data are available that talk aboutthe costs associated with not supporting caregivers in their need to combine paid employment andcaregiving. Our study should open these hidden costs and invisible contributions to public viewand, we hope, to the scrutiny of researchers and the consideration of policy-makers and serviceproviders.Fourth, our choice of sample reflects our belief that the challenges faced by, and the supportsneeded by, employed caregivers are likely to be different from those experienced by caregiverswho are not in Canada’s labour force - an assumption that we intend to empirically examine in9
this report. Findings from this study should, therefore, inform both policy makers and employerswho wish to develop policies and programs to address the concerns of employed caregivers.Fifth, our focus on emp
Report Two: Causes, Consequences, and Moderating Factors of Strain of Caregiving Among Employed Caregivers uses the 2011-12 survey data to explore the link between caregiving demands, caregiver strain (emotional, financial and physical strain associated with the care of an
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