Squeezed in the Middle: Employed Caregivers in Canada

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Squeezed in the Middle Employed Caregivers in
Canada

• Dr. Linda Duxbury
• Sprott School of Business,
• Carleton University, Ottawa
• Linda_Duxbury_at_carleton.ca

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Outline

• Prevalence of employed caregiving
• Caregiver strain
• Risk factors for caregiver strain
• What can be done

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Employed Caregivers

• Our research focuses on three groups of employed
  caregivers
• Parents employed Canadians who spend time each
  week in childcare but do not any have elder care
  responsibilities,
• Elder caregivers employed Canadians who do
  spend time each week in eldercare activities but
  do not spend any time in childcare
• Sandwich group employed Canadians who spend
  time each week in both childcare and eldercare
  activities.
• Eldercare and sandwich groups further subdivided
  into three sub groups based on the location of
  the elderly dependent
• Elderly dependent living with respondent,
• Elderly dependent living nearby, and,
• Elderly dependent living elsewhere.

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Prevalence of Employed Caregiving in Canada
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Conclusions Employed Caregiving in Canada

• The majority of employed Canadians also have
  caregiving responsibilities
• Just over one in four (27.8) of employed
  Canadians have responsibilities for the care of
  elderly dependents a percent that as noted
  earlier, is likely to grow as the baby boom
  population ages.
• Almost one in five employed Canadians (16.8)
  have responsibility for both childcare and
  eldercare (i.e. they have dual demands at home
  and demands at work)

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Conclusions Employed Caregiving in Canada

• Only rarely do employed Canadians provide care to
  an elderly dependent who lives with them (the
  data would suggest that approximately 1.3 of the
  workforce is in this situation)
• Just over one in ten of Canadians provide care
  for an elderly dependent who either lives nearby
  (12.7) or in another location altogether (9.7)
  
• Twice as many employed Canadians have childcare
  responsibilities (54.2) than responsibility for
  the care of an elderly dependent (27.8)

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Caregiver Strain

• One of main consequences of multiple caregiving
  responsibilities is a type of stress called
  caregiver strain
• Three sources of caregiver strain were explored
  in our study
• Emotional (e.g. depression, anxiety, emotional)
• Physical (exhaustion)
• Financial

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Incidence of Caregiver Strain(2001 Study, n
33,211)
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Incidence of Various Forms of Caregiver Strain
(2001 Study, n 33,211)
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Conclusions Prevalence of Caregiver Strain

• Physical strain most prevalent form of Caregiver
  Strain.
• Approximately one in three employed Canadians
  report moderate to high levels of physical
  caregiver strain.
• Emotional strain is also problematic
• Approximately one quarter of the employed
  Canadians report moderate to high levels of
  emotional strain
• Financial strain is relatively rare for employed
  caregivers in Canada
• The percent of the working population that can be
  considered to be in the high risk group with
  respect to physical and emotional caregiver
  strain is very similar
• Employed Canadians are twice as likely to
  experience moderate levels of physical caregiver
  strain than emotional caregiver strain.

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Conclusions Prevalence of Caregiver Strain

• Employees who provide caregiving for elderly
  dependents who live with them experience the
  highest levels of financial strain, physical
  strain and emotional strain.
• Why
• These dependents in poorer health
• Harder to escape from demands of caregiving
• More demands on their time
• Employees in this situation are older themselves
  and poorer off financially

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Conclusions Prevalence of Caregiver Strain

• Employees in the sandwich group with a dependent
  in their home are less likely to report high
  levels of physical or emotional strain than those
  with eldercare only
• How does having children at home help?
• Children help with eldercare,
• Children provide emotional support to their
  parents,
• Children provide the employee with another role
  (that of parent) whose rewards can offset the
  frustrations and strains associated with the role
  of elderly caregiver (role expansion hypothesis)
• Having children has no impact on physical or
  emotional strain when elderly dependent lives
  elsewhere

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Conclusions Prevalence of Caregiver Strain

• Physical strain decreases as distance between
  elderly dependent and employee increases
• Emotional strain is due to the act of caring for
  an elderly relative, regardless of where this
  relative lives.
• People do not experience greater strain when the
  relatively lives far away
• The ability to easily visit/check on their
  elderly dependent does not exacerbate or
  alleviate this strain.

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Consequences of High Caregiver Strain The
Employer

• Our data shows a strong link between high
  caregiver strain and absenteeism
• Compared to their counterparts with low caregiver
  strain, employees with high caregiver strain
  were
• 13 times more likely to miss 3 or more days of
  work in a six month period due to eldercare
  problems
• Twice as likely to miss work because they were
  mentally, emotionally or physically fatigued.

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Consequences of High Caregiver Strain The
Employer

• We calculated
• the direct costs of absenteeism due to high
  levels of caregiver strain to be just over one
  billion dollars per year
• the indirect costs of caregiver strain to be
  another one to two billion dollars
• Also found that employers could reduce
  absenteeism by 8.6 if they could reduce high
  levels of caregiver strain

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Consequences of High Caregiver Strain The
Employee

• Our data shows a strong link between high
  caregiver strain and mental health problems
• Compared to their counterparts with low caregiver
  strain, employees with high caregiver strain were
  twice as likely
• to report high levels of depressed mood,
• to report high levels of perceived stress,
• to report high levels of burnout,
• to have sought care from a mental health
  professional,
• to say their health is fair/poor, to have made 6
  or more visits per year to a physician

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Consequences of High Caregiver Strain Demands
on Health Care System

• Our data shows a direct link between high
  caregiver strain and increased use of the health
  care system
• Compared to their counterparts with low caregiver
  strain, employees with high caregiver strain were
  twice as likely to
• say their health is fair/poor,
• have made 6 or more visits per year to a
  physician,
• have received care on an outpatient basis,
• have made 8 or more visits per year to an other
  health care professional,
• have required inpatient hospital care,
• have visited a hospital emergency room,
• have spent 300 in the last year for prescription
  medicine for their personal use.

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So Why Should We Care About Caregiver Strain?

• Reduction in demands on health care system
• Critical in time of escalating health care costs
  and shortages of health care providers
• Improved bottom line
• Reduction in prescription drug costs and
  absenteeism
• Retention of our older workers
• Critical in time of labour force shortages
• Improvement in mental health of employees/
  population
• Increases a countries competitive advantage

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Predictors of Caregiver Strain

• What causes caregiver strain?
• The answer obtained from this analysis is
  unequivocal the hours per week the employed
  individual spends in eldercare activities
• Predicts all three forms of caregiver strain
• Prediction so strong that if we know how much
  time an individual spends per week in eldercare,
  we have a good idea of how much strain they will
  report
• Physical strain is really about
• the physical (hours per week in care) and
• the emotional (individual feels personally
  responsible for the dependent) aspects of the
  role.

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Predictors of Caregiver Strain

• The families financial situation is also an
  important predictor of financial and emotional
  strain.
• In both cases, the tighter the families finances
  the greater the strain.
• Why is this the case?
• The lower the financial resources
• the less ability the respondent has to buy
  supports from outside the family,
• the more they need their job (i.e. cannot cope
  with demands at home by missing work, coming
  late)
• Financial strain decreases when the dependent
  lives nearby but not with the employed caregiver

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Reduction of Caregiver Strain

• Governments and employers need to look at ways to
  reduce the financial burdens associated with
  eldercare as well as the time crunch
• tax write offs,
• paid time off work (i.e. personal paid days off),
  
• supported care services in community
• flexible benefits which support elder care
  referral services
• Communities who wish to help their citizens and
  attract and retain labour need to invest in
  assisted eldercare facilities within their
  boundaries.

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Reduction of Caregiver Strain

• We can reduce physical strain by looking at
  mechanisms to reduce the amount of time an
  employee has to spend in care.
• respite care,
• eldercare referral services,
• assisted living eldercare facilities,
• home nursing services

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Predictors of Caregiver Strain

• Women are more likely than men to experience
  emotional strain
• This is cause for concern given the fact that
  this particular form of strain is strongly
  associated with
• Physical and mental health problems
• Increased absenteeism
• Reduced fertility

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Predictors of Caregiver Strain

• Why do women experience higher levels of this
  form of strain?
• Women are more likely to feel responsible for the
  care of the elderly dependent,
• Women are more likely to perceive that if they
  meet responsibilities at home they will not
  advance at work

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Reducing Caregiver Strain

• The job of elder caregiver fits Karaseks
  definition of a high strain job
• High demands and low control
• To decrease strain, therefore, one needs to
  determine how to
• increase control (i.e. perceived flexibility at
  the organizational end, community supports for
  eldercare) and/or
• reduce demands (i.e. community and government
  supports for people with eldercare)

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Reducing Caregiver Strain

• Research also identified a number of predictors
  at the organizational level of emotional strain
• Perceived flexibility high levels of flexibility
  associated with reduced strain
• The culture of the organization strain
  increases when employee
• works for an organization where family
  responsibilities limit advancement,
• does not feel comfortable using the family
  friendly supports that are available
• co-workers are not supportive of family
  responsibilities
• it is not acceptable to say no to more work
• management is not supportive of family
  responsibilities
• Note policies themselves were not predictive of
  caregiver strain

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The Sandwich Group

• The large amount of data collected in this study
  limits what can be addressed in a one hour talk
• Decided therefore to focus on sandwich group in
  particular as
• Little is known about this group
• They have a unique set of challenges
• Lessons learned from this group have application
  to both the parent and elder care only groups

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Sandwich Generation Definitions

• Term first coined in 1981 by Dorothy Millar to
  describe a segment of middle aged family members
  who provide support to both younger family
  members and older family members (i.e.
  multi-generational support)
• No agreement on what kind of support is required
  (is financial enough to qualify?)
• No agreement on how young a family member has
  to be before someone is in this generation

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Sandwich Generation Definitions

• In the recent past, caregivers were the middle of
  three generations
• Now can be 4 or 5
• Traditional Sandwich Those sandwiched between
  aging parents who need care and/or help and their
  own children
• Club Sandwich Those in their 50s or 60s
  sandwiched between aging parents, adult children
  and grandchildren or

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Sandwich Generation Definitions

• Club Sandwich Those in their 30s or 40s
  sandwiched between young children, aging parents,
  and grandchildren
• Open Faced Sandwich Single parent who also has
  responsibilities for the care of aging parents

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Sandwich Generation How many in this group?

• Disagreement over term means that there is also
  disagreement over how many are in this group
• Our data from 2001 Canadian National Work, Family
  and Lifestyle provides the following estimates
• 18 of Canadian workforce spend at least one hour
  per week in childcare and one hour per week in
  eldercare
• 4 of employed parents have elderly dependents
  living with them
• 32 of employed parents have elderly dependents
  living nearby
• 38 of employed parents have elderly dependents
  who live in another city

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Sandwich GenerationWhy has this become an issue?

• Increased life expectancy
• In 1900 average life expectancy was 47 years of
  age
• This had increased to 76 years of age by 2000
• Consequence expansion of the population of
  older adults
• Increased labour force participation of women
• No longer anyone at home to provide the care
• Fastest growing segment of our population is
  older Canadians
• Most rapid population growth is among people 85
  (the fragile elderly) most of whom are women

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Sandwich GenerationWhy has this become an issue?

• Delayed parenting
• Canadians are waiting until they are in their
  early 30s to have their first child
• Lower birth rates
• Means fewer family care givers to go around
• Children staying at home longer
• 2006 Census shows that 48 of 20 to 29 year olds
  in Canada still live at home!
• Community supports not there
• In the U.S. over 80 of long term care of elderly
  dependents is provided on an unpaid basis by
  family members

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Sandwich GenerationWhy has this become an issue?

• Policy makers are attempting to reduce the
  anticipated crisis in healthcare due to an aging
  population by encouraging family members to care
  for the elderly in the family home
• In Canada it has been estimated that to pay
  people to provide care that at this point in time
  the family is providing free would cost upwards
  of 6 billion per year
• It has been estimated that seventy five percent
  of those in the sandwich generation are in the
  workforce
• Reducing community and health care costs are
  costing organizations in terms of productivity

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Sandwich GenerationWhy has this become an issue?

• Because this is a relatively new phenomena, all
  players are confused about what their role
  should be
• Those in the middle feel guilt and uncertainty
  about level of care
• People feel reluctant to pay someone else to care
  for their parents
• Employers do not appreciate the extent to which
  this issue can cause problems for employees

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Sandwich GenerationCaregiving trends for Future

• Data would suggest that this is not a short term
  phenomena
• Why?
• Longevity increasing
• The number of fragileelderly increasing
• Family size decreasing
• Increasing number of working caregivers
• Increase in male caregivers
• Increase in long distance caregivers

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Those in Sandwich Group Experience Greater Work
Life Conflict High
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Those in Sandwich Group Experience Poorer Mental
Health High
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Those in Sandwich Group Experience More Problems
at Home High
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What it feels like to be part of the sandwich
group (from Voices of Canadians)

• Four years ago life was chaos it seemed
  hopeless in every area. At that time I had my
  brother with me, who has schizophrenia. My
  parents lived in a geared to income housing.
  Problems took me away from work repeatedly. My
  employer was very good. My parents and I decided
  for financial and support reasons to try buying a
  house together. I have the mortgages but we all
  contribute to expenses. My brothers schizophrenia
  has been under control for more than 3 years. and
  he is on Ontario disability. Recently, I sold my
  house to purchase a new style with no stairs for
  my parents. This means a larger mortgage which I
  probably can't pay off before retirement. Being
  the filling in the middle of the sandwich
  wouldn't be my first choice but I don't want my
  brother to be homeless.

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What it feels like to be part of the sandwich
group (from Voices of Canadians)

• As children grow older, priorities and
  lifestyle change. Things that I was concerned
  with 10 years ago before and after school
  childcare etc. no longer have any significance
  to me. Now as I prepare for children to go to
  university, financial concerns and eldercare are
  more important.
• Mother needs placement in home but there is a
  one 1 year waiting list. Right now driving a
  hour each way to look after her.

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What it feels like to be part of the sandwich
group (from Voices of Canadians)

• Just when you reach equilibrium, something new
  comes along. As the sole daughter of a
  progressively demented mother her husband is
  dead I have no one to share the responsibility
  with and there is no structure to support my need
  to support her. This is the number one source of
  my stress. Stressful things at work are easier
  to deal with they are frustrating but they
  dont hurt. Dealing with eldercare is much more
  personal it hurts the heart!

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What it feels like to be part of the sandwich
group (from Voices of Canadians)

• I go to an old folks home at suppertime 4 to 5
  times a week to feed an invalid mother as well as
  working part-time and taking care of a home, a
  husband and a son who still lives at home. My own
  time is very limited. My health and my marriage
  are both suffering but what can I do?
• My biggest stress is that my elderly parents
  live on the other side of the country. I am not
  always able to be there when they need my help.

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What it feels like to be part of the sandwich
group (from Voices of Canadians)

• The concerns I have about the health and
  happiness of my elderly parents are tremendous -
  on par with dealing with small children living in
  my home. Particularly devastating is the
  deteriorating health of my parents who are far
  away. I feel guilty about not being there.

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What it feels like to be part of the sandwich
group (from Voices of Canadians)

• My parents are only in their 50's. However, in
  the last 3 years _ since we had our son _ my
  mother lost her job and my father had to quit
  because of his health. WCB has denied his claim
  of work related illness. They have lost
  everything, so, I pay them what I can to take
  care of our son for 3 days and 2 nights a week
  while I work a compressed week. I drive over 50
  km each way to take him there. I have had to help
  them with medical and financial things since they
  became ill. My job is the easiest part of my
  life right now.

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What it feels like to be part of the sandwich
group (from Voices of Canadians)

• I look after 2 elderly parents who live next
  door to me - 75 and 80 - as well as two
  children, 10 and 13. Efforts to get home care
  failed after my mom's surgery. Have hired
  individuals who either quit or had to be fired.
  So I basically run two homes (yard work,
  shoveling, do my parents laundry). I work a full
  time 12 1/2 hour shift both day's and nights.
  Time for myself is limited. Days off are usually
  doing errands, medical appointments for my
  parents, helping children with school and house
  hold chores.

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Sandwich GenerationDimensions of the Challenge

• The average caregiver is a married women who is
  45 years of age
• Whole family feels effect as one in three elder
  caregivers spent less time with their families
• Research indicates that the average woman spends
  17 years raising children and 18 years helping
  aging parents

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Sandwich GenerationDimensions of the Challenge

• Terms such as second childhood commonly used to
  describe the needs of a frail or impaired older
  person
• This implies that caring for that individual is
  like looking after a child
• Evidence shows that this is NOT TRUE

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Sandwich GenerationDimensions of the Challenge

• Data indicates that the average person spends 8
  years in eldercare giving
• One in three provide care for 10 years
• Almost all people who provide eldercare reported
  helping their elderly dependent with finances
• Most common food, transportation and medication
• On average people caregivers helped with expenses
  for 2 to 6 years and spent a total of 19,525

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Sandwich GenerationDimensions of the Challenge

• Why can one mother take care of ten children but
  10 children cannot take care of one mother
• Every new thing your child does is growth. With
  my mother it is loss her personality is
  dissolving before my eyes

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Main Take Aways

• Eldercare is a societal issue
• In attention to this issue will negatively
  impact
• A countrys competitive advantage
• Employers ability to recruit and retain talent
• Health care delivery
• People can chose not to have children but they
  cannot chose to have parents
• The situation will become more challenging over
  time
• Changing how we look at this issue is key to our
  moving forward
• We are not going back
• Countries who do not address this issue will
  experience profound labour force and health
  issues