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Jeon YH, Simpson JM, Comans T, Shin M, Fethney J, McKenzie H, Crawford T, Lang C, Inacio M. Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence. Age Ageing 2023; 52:afad195. [PMID: 37890521 PMCID: PMC10611449 DOI: 10.1093/ageing/afad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/04/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programmes, Veterans' Affairs Community Nursing (VCN) and Home Care Package (HCP). METHODS Our national, population-based retrospective cohort study and cost analysis used existing, de-identified veterans' claims databases (2010-19) and the Registry of Senior Australians Historical Cohort (2010-17), plus aggregate programme expenditure data. This involved 21,636 VCN clients (20,980 aged 65-100 years), and an age- and sex-matched HCP cohort (N = 20,980). RESULTS Service factors associated with lower risk of care home admission in the VCN cohort were periodic (versus continuous) service delivery (HR 0.27 [95%CI, 0.24-0.31] for ≤18 months; HR 0.89 [95%CI, 0.84-0.95] for >18 months), and majority care delivered by registered nurses (versus personal care workers) (HR 0.86 [95%CI, 0.75-0.99] for ≤18 months; HR 0.91 [95%CI, 0.85-0.98] for >18 months). In the matched cohorts, the time to care home admission for VCN clients (median 28 months, IQR 14-42) was higher than for HCP clients (14, IQR 6-27). Within 5 years of service access, 57.6% (95%CI, 56.9-58.4) of HCP clients and 26.6% (95%CI, 26.0-27.2) of VCN clients had care home admission. The estimated cost saving for VCN recipients compared to HCP recipients over 5 years for relevant government providers was over A$1 billion. CONCLUSIONS Compared to an HCP model, individuals receiving VCN services remained at home longer, with potentially significant cost savings. This new understanding suggests timely opportunity for many countries' efforts to enhance community-based care services.
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Affiliation(s)
- Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Judy M Simpson
- School of Public Health, University of Sydney, Sydney, Australia
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Mirim Shin
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Judith Fethney
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Heather McKenzie
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tonia Crawford
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Catherine Lang
- Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Maria Inacio
- Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
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2
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Fan H, Wang Y, Gao J, Peng Z, Coyte PC. The Effect of a Long-Term Care Insurance Program on Subjective Well-Being of Older Adults with a Disability: Quasi-Experimental Evidence from China. J Appl Gerontol 2023; 42:438-446. [PMID: 36366866 DOI: 10.1177/07334648221138282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
China launched its long-term care insurance (LTCI) program for older adults in 2016. Although the scheme has shown some promising outcomes, little is known about whether it improves subjective well-being. This study explored this topic among older persons with a disability and identified the underlying mechanisms associated with the channel of this effect using data from a national survey. The LTCI program was shown to improve the subjective well-being among older persons with a disability and this effect increased over time. The LTCI program has great positive effect among women and those who lived alone compared to their counterparts. Mechanism analysis revealed that the main channel by which the LTCI program has positive effect occurred through the satisfaction of long-term care needs and improved self-reported health. This study suggests promising benefits of the LTCI program for older Chinese adults.
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Affiliation(s)
- Hongli Fan
- School of Insurance, 47855Shandong University of Finance and Economics, Jinan, China
| | - Yingcheng Wang
- School of Insurance, 47855Shandong University of Finance and Economics, Jinan, China
| | - Jinyan Gao
- School of Insurance, 47855Shandong University of Finance and Economics, Jinan, China
| | - Zixuan Peng
- Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, ON, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, ON, Canada
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Lee HY, Short S, Lee MJ, Jeon YH, Park E, Chin YR. Improving the quality of long-term care services in workforce dimension: expert views from Australia and South Korea. Arch Public Health 2022; 80:112. [PMID: 35392975 PMCID: PMC8988374 DOI: 10.1186/s13690-022-00872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 03/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background The long-term care workforce is an essential factor in the provision of qualified long-term care services. Identifying workforce issues can help developing countries in East Asia and the Pacific prepare for the increase in the older population. Their experiences can be used as lessons for other countries. This study aimed to identify the workforce issues that should be addressed in order to provide high-quality long-term care services for older adults. Methods In-depth interviews and content analysis were conducted with a purposive sample of long-term care experts. There were eight participants from Australia and 14 from South Korea. The participants were questioned on important workforce issues to improve the quality of long-term care services. These were open-ended questions that comprised ideas derived from the literature. Major themes were systematically and comprehensively classified and coded to examine recurring comments and themes. Results The issues in the two countries were very similar: labor shortages, inadequate working conditions, insufficient career and staff training, and the need of counselors or consultants for finding proper services. There were also differences in terms of competency of the service operators and their corresponding multicultural competency. Conclusions Providing high-quality long-term care service requires multipronged approaches to workforce capacity and work environment. An adequate and competent workforce should be established to match the service needs of the older population. To improve quality, better working conditions and improved motivation to work in care for older people should be considered. Concurrently, each country would need a workforce strategy tailored to different conditions and environments. This should include policies to induce an influx into the workforce.
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Affiliation(s)
- Hyo Young Lee
- Department of Health Administration, Dongseo University, Busan, Republic of Korea.
| | - Stephanie Short
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Mi-Joung Lee
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Yun-Hee Jeon
- School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Eunok Park
- College of Nursing, Jeju National University, Jeju-si, Republic of Korea
| | - Young-Ran Chin
- Department of Nursing, Chungwoon University, Chungnam, Republic of Korea
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4
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Browne-Yung K, O'Neil D, Walker R, Corlis M, Smyth A, Putsey P, Laver KE, Fernandez E, Cations M. Perspectives of professionals on the safety and accessibility of aged care for Care Leavers and Forgotten Australians. Australas J Ageing 2021; 41:42-49. [PMID: 33960580 DOI: 10.1111/ajag.12948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/29/2020] [Accepted: 02/24/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Little is known about how prepared the aged care system is to meet the specific needs of Care Leavers and Forgotten Australians. We explored service provider and advocate perspectives about the barriers and facilitators for appropriate and safe care for this group. METHODS Three focus groups with sixteen professional stakeholders examined the ways aged care support is accessible and inaccessible for Forgotten Australians. RESULTS Participants noted structural and organisational features that act as barriers to best practice aged care. It was perceived that funding models and processes provide insufficient opportunity to develop trust with professionals and access tailored care. Once engaged with aged care services, the sector lacks the psychological literacy required to tailor care to manage the complex needs and preferences of Forgotten Australians. CONCLUSION Systemic and organisational change that promotes increased flexibility, trauma-informed care and non-residential housing options will improve the safety and accessibility of aged care for Forgotten Australians.
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Affiliation(s)
- Kathryn Browne-Yung
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Diana O'Neil
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Helping Hand Aged Care, North Adelaide, SA, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Megan Corlis
- Helping Hand Aged Care, North Adelaide, SA, Australia
| | | | | | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.,Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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5
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Culph J, Clemson L, Scanlan J, Jeon YH, Laver K. Promoting occupational therapy interventions in the Australian community aged care sector. Aust Occup Ther J 2021; 68:228-235. [PMID: 33415736 DOI: 10.1111/1440-1630.12717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND With the introduction of consumer-directed care in the Australian community aged care sector, there are more opportunities for occupational therapists to provide evidence-based services that meet consumer needs. There is also an increasing requirement for health professionals to promote their interventions to consumers. Particularly for the implementation of new programs within organisations. However, occupational therapists have historically neglected widely promoting the role of occupational therapy services for older people. This study examines the perceptions of occupational therapists and their managers in promoting their service; the Care of People in their Environment (COPE) Program. METHODS This study utilised a qualitative interpretative description; including 28 in-depth interviews. Purposeful sampling ensured a variety of occupational therapists from different health contexts. Thematic analysis captured key emergent themes related to promoting occupational therapy interventions and implementation. RESULTS Many occupational therapists were apprehensive about promoting or selling their services and interventions. Greater levels of confidence in promoting the program were present when the program aligned with traditional models of service delivery and organisational processes. Occupational therapists described having limited opportunity to directly promote the program to consumers as community case managers were mostly the main contact at the organisation. There was limited consideration of promotion strategies and therefore limited enactment of strategies by organisations. Not-for-profit and non-government organisations recognise that the changed community aged care market provided new business opportunities. CONCLUSION With changes in the Australian aged care system, occupational therapy has great opportunity to provide diverse, evidence-based interventions driven by the needs of consumers. Reframing the notion of 'selling', to empowering consumers to be more informed about their options, will allow occupational therapists to build confidence in their promotional skills. Promoting evidence-based programs will have positive outcomes for the visibility, professional identity and recognition of occupational therapy.
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Affiliation(s)
| | - Lindy Clemson
- The University of Sydney, Camperdown, NSW, Australia
| | | | - Yun-Hee Jeon
- The University of Sydney, Camperdown, NSW, Australia
| | - Kate Laver
- Flinders University, Bedford Park, SA, Australia
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6
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Jeon YH, Krein L, Simpson JM, Szanton SL, Clemson L, Naismith SL, Low LF, Mowszowski L, Gonski P, Norman R, Gitlin LN, Brodaty H. Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: a pilot trial. Aging Ment Health 2020; 24:1916-1925. [PMID: 31345051 DOI: 10.1080/13607863.2019.1642298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To test feasibility and potential effects of the interdisciplinary Home-bAsed Reablement Program (I-HARP) that integrates evidence-based strategies and cognitive rehabilitation techniques into a dementia-specific, bio-behavioural-environmental intervention.Methods: A parallel-group randomised controlled pilot trial was conducted in Sydney, Australia, targeting community-dwelling people with amnestic mild cognitive impairment or mild/moderate stages of dementia and their carer (n = 18 dyads). I-HARP comprised: up to 12 home visits by registered nurse, occupational therapist, and psychologist, tailored to the individual client's needs; <A$1000 for home modification/assistive devices; and individual carer support, all provided over four months. Additional allied health services were recommended when necessary. Clients' daily activities, mobility, mood, caregiver burden, and quality of life were assessed at baseline, four months and 12 months. Semi-structured interviews were conducted with I-HARP participants post intervention.Results: Of 51 dyads who expressed interest in participation, 25 were eligible, with 76% consent rate (19/25 eligible dyads consented), and high adherence to the program (all nine intervention group participants completed and complied). Challenges included: need for better carer and allied health support, with more targeted recruitment points to speed up the process. The I-HARP group showed favourable effects across most outcomes at short-term (4 months) and longer-term (12 months) assessments. However, wide Confidence Intervals (CIs) point to the degree of uncertainty around interpretation of these results.Conclusion: The delivery of I-HARP, a dementia-specific reablement program and the trial design concerning randomisation, screening and consent procedures, were deemed feasible, acceptable and appropriate for the target population group. Building on the success and lessons from the pilot, a larger trial is currently underway.
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Affiliation(s)
- Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Luisa Krein
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Judy M Simpson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,ARC Centre of Excellence in Population Ageing Research, The University of Sydney, Sydney, Australia
| | | | - Lindy Clemson
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre and School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre and School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Peter Gonski
- Division of Aged and Extended Care (Southcare), Sutherland Hospital, South Eastern Sydney Local Health District, Sutherland, Australia
| | | | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Henry Brodaty
- School of Psychiatry, UNSW Sydney, CHeBA (Centre for Healthy Brain Ageing) and Dementia Centre for Research Collaboration, Australia
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Rahman M, Efird JT, Kendig H, Byles JE. Patterns of home and community care use among older participants in the Australian Longitudinal Study of Women's Health. Eur J Ageing 2019; 16:293-303. [PMID: 31543724 PMCID: PMC6728407 DOI: 10.1007/s10433-018-0495-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The aims of this study were to investigate patterns of home and community care (HACC) use and to identify factors influencing first HACC use among older Australian women. Our analysis included 11,133 participants from the Australian Longitudinal Study of Women's Health (1921-1926 birth cohort) linked with HACC use and mortality data from 2001 to 2011. Patterns of HACC use were analysed using a k-median cluster approach. A multivariable competing risk analysis was used to estimate the risk of first HACC use. Approximately 54% of clients used a minimum volume and number of HACC services; 25% belonged to three complex care use clusters (referring to higher volume and number of services), while the remainder were intermediate users. The initiation of HACC use was significantly associated with (1) living in remote/inner/regional areas, (2) being widowed or divorced, (3) having difficulty in managing income, (4) not receiving Veterans' Affairs benefits, (5) having chronic conditions, (6) reporting lower scores on the SF-36 health-related quality of life, and (7) poor/fair self-rated health. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting.
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Affiliation(s)
- Mijanur Rahman
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New Lambton Heights, NSW 2305 Australia
- Department of Statistics, Comilla University, Comilla, 3504 Bangladesh
| | - Jimmy T. Efird
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New Lambton Heights, NSW 2305 Australia
| | - Hal Kendig
- Research School of Population Health, Australian National University, Canberra, 0200 Australia
| | - Julie E. Byles
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New Lambton Heights, NSW 2305 Australia
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Gietel-Basten S, Scherbov S. Better way to measure ageing in Oceania that takes life expectancy into account. Australas J Ageing 2019; 38:e98-e102. [PMID: 31250971 DOI: 10.1111/ajag.12692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to improve the measurement of ageing in Oceania taking into account characteristics of populations and, in particular, changes in life expectancy. METHOD Using past and projected life tables, we calculated prospective old age dependency ratios (POADRs) to 2060, placing the boundary to old age at a moving point with a fixed remaining life expectancy (RLE) for thirteen territories of Oceania. RESULTS In some territories, POADRs grow less rapidly than old age dependency ratios (OADRs). For example, in Australia and Guam, the OADR is forecast to increase from 0.20 and 0.07 in 1980, respectively, to 0.45 and 0.39 in 2050-55, while the POADR is forecast to increase from 0.17 and 0.07 to 0.19 and 0.19, respectively, over the same period. CONCLUSION Policymakers may consider this more rational approach to measurement when considering holistic policy responses to both current issues relating to ageing and mitigating against future challenges.
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Affiliation(s)
- Stuart Gietel-Basten
- Division of Social Science, The Hong Kong University of Science and Technology, Kowloon, Hong Kong SAR
| | - Sergei Scherbov
- World Population Program, International Institute for Applied Systems Analysis, Laxenburg, Austria.,Laboratory on Demography and Human Capital, Russian Presidential Academy of National Economy and Public Administration, Moscow, Russian Federation
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O'Loughlin K, Loh V, Kendig H. Carer Characteristics and Health, Wellbeing and Employment Outcomes of Older Australian Baby Boomers. J Cross Cult Gerontol 2018; 32:339-356. [PMID: 28612171 DOI: 10.1007/s10823-017-9321-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Supporting caregivers and enabling continued workforce participation are central strategies in Australia's response to an ageing population, however these strategies have potential disadvantages for carers, particularly women, including reduced workforce participation and retirement income, and poorer health status. This paper explores the nexus between paid work and caregiving for Australia's baby boomer cohort as this group faces unprecedented pressures to manage paid work alongside caring longer and more intensively for family members, including grandchildren. A sample of 1261 men and women aged 60 to 64 completed the 2011-12 Life Histories and Health survey, a sub-study of the New South Wales 45 and Up Study. The survey collected data on sociodemographic, psychosocial, life history and health-related variables including caregiving and employment status. Around a third (32.5%) of the sample (52.2% female) were involved in some type of caregiving at the time. Compared to non-carers, carers reported lower workforce participation (45.8% versus 54.7% for non-carers) as well as poorer health, more mobility difficulties, lower quality of life and lower self-rated SES. Carers who also cared for grandchildren were more likely to be in part-time or no paid work compared to other carers. Working carers tended to be more highly educated, have fewer mobility difficulties, better self-rated health and higher SES than non-working carers. Male carers were more likely than female carers to be in full-time or no paid work. Results indicate that reduced workforce participation and health status of caregivers varies by gender and type of caregiving. Policy reforms are recommended to mitigate these adverse consequences on those providing care, their families, employers and the community.
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Affiliation(s)
- Kate O'Loughlin
- Ageing, Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Camperdown, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), Sydney, Australia
| | - Vanessa Loh
- ARC Centre of Excellence in Population Ageing Research (CEPAR), Sydney, Australia
- School of Psychology, University of Sydney, Camperdown, Australia
| | - Hal Kendig
- ARC Centre of Excellence in Population Ageing Research (CEPAR), Sydney, Australia.
- Centre for Research on Ageing, Health, and Wellbeing, Research School of Population Health, Australian National University, Canberra, ACT, Australia.
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