The relationship between elder care-giving and labour force participation in the context of policies addressing population ageing: a review of empirical studies published between 2006 and 2016

Children's Opportunities and Constraints in European Parent Care Over Time: A Within-Family Approach

The role of children's caregiving has received substantial attention in studies on care in old age. Previous research shows that children's care provision is strongly intertwined with both their individual and siblings' situation regarding employment and geographic parent-child distance. This study uses data from six waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), taking a within-family approach, to examine how caregiving is (re-)distributed between siblings over time. The provision of continuous parent care is observed more frequent and volatile in European countries with a family-based care system. The results from family fixed-effects regression models demonstrate that children working less than siblings persist in caregiving more. Living closest to parents facilitates children to keep up care efforts, while changing to living closest enhances the start of parent care. This study suggests that geographic distance is vital in the long-term organization of parent care between siblings.

The relationships between informal and formal social care for older people in England: A comparison before and after the Care Act 2014

Social care is an integral part of the UK welfare system and plays an imperative role in promoting the well-being of older people. This study investigates the impacts of receiving informal social care on formal social care use among community-dwelling older people in England before and after the implementation of the Care Act 2014. Data came from the Health Survey for England for the years 2011 to 2018 (N = 17,292). Bivariate probit models were used to address the endogeneity issue. The analysis shows that receipt of informal care substitutes for formal care. Informal care had a strong substitution effect on formal personal care before 2015, which was significantly weakened after 2015. While the receipt of formal personal care has been increasingly "carer-blind," that of formal domestic care depends on the availability of informal carers and personal affordability, which may result in unmet care needs.

The impact of "Aging with Medical and Caregiving" on family caregiving-Evidence from China's pilot cities for integrating medical and caregiving

Easing the pressure on family caregiving and addressing the shortage of manpower for family caregiving are significant challenges that China faces in responding to its aging population. This study utilizes data from the 2015 and 2020 China Health and Retirement Longitudinal Study (CHARLS) and employs a Difference-in-Difference method to investigate the impact of pilot policies that integration of medical and caregiving for aging individuals. The findings reveal that these pilot programs are successful in reducing the amount of time spent on family caregiving and the financial burden placed on families, effectively relieving the pressure associated with family caregiving. However, the effects of these programs differ depending on the level of disability, household registration, and the geographical location of the participants. Further analysis suggests that these pilot programs achieve these positive outcomes by increasing government investment in health and wellness funds and providing in-family medical and caregiving services.

Complements or Substitutes? Young Germans' Experience and Expectations with Financing Sources for Long-Term Care

Financing long-term care is a growing challenge in aging societies. To address this challenge, Germany created public long-term care insurance (DPV) more than 25 years ago. Germans still need to prepare for their own care throughout their life course to supplement public insurance. This study presents descriptive statistics and multivariate regression analysis to examine young Germans' experiences and expectations of the relationship between the DPV and private financing sources. We base our analysis on a proprietary data set of young Germans (16-39 years old) that oversamples those with caregiving experience and East Germans. We find that public long-term care insurance is a substitute for rather than a complement to other financing sources. Specifically, many young Germans do not count on public long-term care insurance to finance care. Instead, they see private funding sources as substitutes for long-term care insurance. Those who count on private long-term care insurance are between 48 and 70% less likely to count on DPV benefits. Experience with care increases the likelihood of young Germans expecting future public benefits by factor of six or 18, depending on the specific care familiarity. Young Germans are also more likely to count on future generations to support their own care than they expect themselves to support the care of their parents through the DPV. Given that the DPV provides basic universal insurance that requires some complementary private income sources, our findings suggest that young Germans, who will need to build some of these income sources throughout their careers, are underestimating the value of the DPV and overestimating their own ability to pay for long-term care. Policymakers will need to reduce the political risks to the DPV and increase young Germans' savings over the life-course to address this imbalance.

Grandparents' Experiences of Childhood Cancer: A Qualitative Study

A child's cancer diagnosis has a significant impact on the lives of grandparents. Grandparents experience the stress of worrying about both their adult children and their grandchildren. Our study aimed to explore the lived experience of grandparents of children diagnosed with cancer. A qualitative design involving semi-structured interviews was used and data were analyzed using reflexive thematic analysis. Twenty grandparents aged 41 to 77 years were interviewed. Six themes were identified: (a) Diagnosis: changing everything; (b) Aspects of treatment: A different world; (c) Sandwich generation; (d) Family: Worrying about everyone; (e) Balancing work; and (f) It's like suddenly a door opens. Our study demonstrates the life-changing impact of having a grandchild diagnosed with cancer. It expands on existing knowledge and shows that, due to an aging population and demographic changes, some grandparents must juggle the demands of caring for aging family members and working while supporting adult children and grandchildren.

The concept of informal care: ambiguities and controversies on its scientific and political uses

Starting from an analysis of the scientific and political uses of the concept of informal care, this paper raises questions and launches the debate on the causes and effects of its uses. Recognizing the diversity and the contradictions found across the use of the term, it explains how its predominant use in Europe can be problematic. First, although it is widely recognized that care is provided primarily by women, this gender dimension is not emphasized in a concept that obscures the sexual division. Second, it does not render explicit that informal care is work, despite being unpaid. Third, the allusion to informality is likely to generate confusion with informal employment of care workers. Finally, studies often focus exclusively on care provided by family members, without distinguishing the spaces in which the work takes place and the social relationships it involves, namely the family or community. In Europe, where documents from (non)governmental organizations focus mainly on long-term care related to demographic aging, it is the care crisis of formal care provision systems, faced with financial fragility, reduction in funds and insufficient supply to meet the demand, that brings informal care to the political and scientific agendas. This paper argues that it is necessary to define conceptual boundaries that allow international studies on the dimension and value of this care work to be compared. It also advocates the importance of making visible that this is work, unpaid and female-dominated, since this view supports action guidelines more focused on social transformation and empowerment.

Care Needs and Arrangements of Aging Immigrants in the United States

OBJECTIVES

To examine the need for and arrangements pertaining to personal care assistance among individuals 65 and older, and how life stage at migration impacts nativity differences in aging-related care.

METHODS

Using data from the Survey of Income and Program Participation (2001, 2004, and 2008), I examine the odds of needing care assistance, who provides care assistance, and the duration of time care assistance is needed, comparing U.S.-born individuals to migrants who arrived before age 50 ("earlier-life migrants") and those who arrived after age 50 ("later-life migrants").

RESULTS

While earlier-life migrants showed similar patterns to U.S.-born, later-life migrants showed higher care needs, were more likely to receive care from an adult child, and were particularly likely to need care for longer durations compared to U.S.-born.

DISCUSSION

Aging later-life migrants have strikingly distinct care needs and arrangements, with implications for individual and family well-being, especially considering their barriers to public support.

A Descriptive Qualitative Study of Foreign Caregivers of Older Adult Stroke Survivors

BACKGROUND AND OBJECTIVES

With a growing aging stroke population and the changing structure of the society, the demand for foreign caregivers has rapidly increased in Taiwan and many other developed countries. However, little is known regarding the perception, values, and abilities of foreign caregivers and how those may influence their quality of care. This study aimed to explore and describe the experiences of Indonesian foreign caregivers, the largest migrant working population in Taiwan, who reside with and provide support to older adults with stroke and their families.

RESEARCH DESIGN AND METHODS

By adopting a descriptive qualitative approach, we conducted semistructured interviews with 22 Indonesian caregivers (mean age: 36 years) who were providing care to community-dwelling older stroke survivors (age ≥ 65 years) in Taiwan. Data were analyzed through thematic analysis.

RESULTS

Six themes were constructed from the interviews: (a) foreign caregiver's background, (b) foreign caregiver's perception of the health and functional status of stroke survivors, (c) foreign caregiver's values and preferences, (d) consequences of caring for stroke survivors, (e) skills/abilities/knowledge of foreign caregivers to provide stroke survivors with required care, and (f) potential resources that foreign caregivers can use.

DISCUSSION AND IMPLICATIONS

Foreign caregivers described the positive and negative aspects of caring for stroke survivors. Differences in language, religion, culture, values, and expectations between foreign caregivers and stroke survivors influence the caregiving experience. These findings can help Taiwan and other developed countries to better support foreign caregivers providing critical care to older adults with stroke and their families.

Long-term care insurance, mental health of the elderly and its spillovers

The paper studies the effects of the long-term care insurance (LTCI) program in China on the mental health of older adults and the wellbeing of their families. We employ the staggered difference-in-differences approach based on the LTCI pilots from 2015 to 2017. First, we find the LTCI program improves older adults' happiness and reduces depression symptoms significantly. The effects on the improvement in memory and cognition are associated with the elderly with activities of daily living-related need for care. Second, the effects of LTCI are partially mediated through providing community services, relieving care burdens, and reducing the incidence of diseases. More importantly, LTCI coverage improves caregivers' physical health and social activities, reflecting its welfare spillover effects. Furthermore, the relationship between LTCI and mental health differs due to the difference in LTCI designs and older adults' demographic characteristics. This presents a need to consider mental health in the services and evaluation criteria of LTCI.

The Impact of Caregiving Length and Intensity on Labor Force Participation Among Middle-Aged Canadians: An Analysis of Canadian Longitudinal Study on Aging Data

OBJECTIVES

To assess the association between caregiving length/intensity and labor force participation among middle-aged Canadians.

METHODS

We used baseline data from the Canadian Longitudinal Study on Aging. Labor force participation status included working full-time, part-time, part retirement, complete retirement, and nonparticipation. We defined caregiving length as short-term versus long-term, and intensity as low, medium, and high. Multinomial logistic regressions and instrumental variable method were used.

RESULTS

Compared with non-caregivers, long-term and high-intensity caregivers were more likely to be completely retired, partly retired, and nonparticipants. Short-term and high-intensity caregivers were more likely to be completely retired, partly retired, and nonparticipants for women.

CONCLUSIONS

Our findings emphasize the importance of considering caregiving intensity and length. Prioritizing support for long-term and high-intensity caregivers and promoting partial retirement or part-time working opportunities could help retain caregivers in the labor force.

On children's motives to influence parents' long-term care insurance purchase: evidence from Switzerland

Long-term care (LTC) is not only a concern for elderly individuals but also for their adult children, as the latter often provide financial support and informal care to their elderly dependents. Adult children may therefore have strong incentives to have their parents purchase LTC insurance. Using data from a 2019 Swiss survey, this article first identifies a set of variables, including self-reported interest about LTC insurance, whether elderly parents live with their children and if the latter have provided informal help with personal care, which help predict the interest of adult children in having their parents covered against LTC risk. Second, it investigates the main characteristics of children's motives for influencing their parents to purchase LTC insurance, which are classified as either altruistic, i.e. related to parental well-being, or self-interested, i.e. related to the child's well-being. The results offer valuable insights for both policymakers and insurers when designing public LTC policies and LTC insurance products.

A longitudinal study on the consequences of the take-up of informal care on work hours, labour market exit and workplace absenteeism due to illness

Little is known about the effects of informal care-giving on employees' absenteeism due to illness. This paper therefore provides a longitudinal analysis of the consequences of taking on informal care-giving for men's and women's working hours and workplace absenteeism due to illness. Data were taken from the Dutch Labour Supply Panel (waves 2004–2018); 495 of the 6,452 male observations in this panel and 696 of the 5,961 female observations had taken on informal care-giving. It was tested whether respondents who became (intensive) informal carers were more likely than respondents who remained non-care-givers to reduce their work hours or stop working between waves t and t1, or to be absent from work due to illness in wave t1. (Multinomial) logistic regression analyses showed that taking on informal care reduced women's working hours when the care they provided was intensive, but not men's. The predicted probability of women reducing their work hours was 12 per cent if they had remained non-care-givers between waves t and t1, 15 per cent if they had started giving non-intensive care and 19 per cent if they had begun providing intensive help. In addition, starting to provide (non-intensive) informal care increased the risk of workplace absenteeism among both women and men. The study highlights the need for workplace policies that prevent female carers from reducing their work hours, and enable male and female carers to continue working in a healthy way.

Informal care provision among male and female working carers: Findings from a Swedish national survey

Introduction

Informal carers in paid employment–working carers (WKCs)—have complex support needs. However, little is known about WKCs’ pattern of informal care provision, the support they receive, the impact providing care has on their employment, and how these vary between male and female WKCs. This study describes the pattern of informal care provision and received support among Swedish WKCs.

Research method/Design

The study was a cross-sectional questionnaire-based survey of a stratified random sample of the Swedish population aged 18 or over. The questionnaire addressed the type and extent of informal care provided, support received and the impact of care provision on employment. Of the 30,009 people who received the questionnaire, 11,168 (37.3%) responded, providing an analytic sample of 818 (7.32% of respondents) employed or self-employed informal carers.

Findings

A typical Swedish WKC was a middle-aged female, providing weekly or daily care to a non-cohabitant parent, who experiences care as sometimes demanding and receives no formal support as a carer. Female WKCs were more likely than males to care alone and with higher intensity, to report a need for help in meeting their care-recipient’s needs, and to experience care as demanding. Approximately 17% of WKCs reported their employment had been affected due to caring, 40% their ability to work, and 31% their career development opportunities. Female WKCs’ ability to work was affected more than males’, and they were more commonly prevented from applying for work.

Conclusion

Swedish female WKCs compared to males provide more hours of informal care, across more care domains, more often alone. This places them in a challenging situation when combining paid work and care. Greater recognition of the challenges faced by WKCs is required in Sweden and other countries, as are policies to reduce gender inequalities in informal care provision in this group.

Becoming an informal care-giver: the role of work status incongruence

The ageing of the workforce suggests that many older adults will be combining work and care. While there is extensive evidence for the impact of informal care-giving on paid employment, there is less research on how work status may influence the provision of informal care. It has also yet to be established whether work preferences may influence the uptake of care-giving responsibilities, particularly for older workers. We investigated the impact of work status congruence on taking up informal care at two-year follow-up. A sample of 1,211 employed participants aged 55–70 years was surveyed over two consecutive waves. Involuntary part-time workers were more likely to provide care at Time 1 than involuntary full-timers, voluntary part-timers and voluntary full-timers. Participants were more likely to take up care if the opportunity costs of doing so were low, however, only for those whose preferences for more work were not met. There were no moderating effects of gender and economic living standards on the relationship between work status incongruence and provision of care-giving. Understanding the decision-making processes older workers undertake when taking up informal care are complex and must consider the influence of personal work preferences. These findings have implications for care and work-based policy given the importance of informal care in sustaining ageing-in-place policies.

Socioeconomic differences in informal caregiving in Europe

Disclosing socioeconomic differences in informal care provision is increasingly important in aging societies as it helps to identify the segments of the population that may need targeted support and the types of national investments to support family caregivers. This study examines the association between individual-level socioeconomic status and informal care provision within the household. We also examine the role of contextual factors, income inequality, and the generosity of social spending, to identify how macro-level socioeconomic resource structures shape individuals’ provision of care to household members. We use pooled data from the Survey of Health, Ageing and Retirement in Europe (SHARE, waves 1, 2, 4, 5, 6) and the English Longitudinal Study of Ageing (ELSA, waves 2, 3, 4, 6, 7). Poisson regression multilevel models estimate the associations between household socioeconomic status (education, income, and wealth), and country socioeconomic resources (income inequality and social spending as a percentage of GDP), and the likelihood of older adults’ informal care provision within the household. Results indicate that lower individual socioeconomic resources—education, income, and wealth—were associated with a higher incidence of older adults’ informal care provision within the household. At the macro-level, income inequality was positively associated while social spending was negatively associated with older adults’ care provision within the household. Our findings suggest that socioeconomically disadvantaged groups are more likely to provide informal care, which may reinforce socioeconomic inequalities. At the national level, more equitable resource distribution and social spending may reduce intensive family caregiving.

Associations between paid and unpaid work among Norwegian seniors: competition, complementarity or continuity?

A key issue in policy debates on active ageing is how to increase older people’s participation in both paid and unpaid work. This combined goal raises the question of whether the different activities compete for seniors’ time and energy or whether it is possible to achieve both, since such activities may instead complement one another. To address this issue, we examine associations between paid work, informal help provision and formal volunteering among 62- to 75-year-olds by using longitudinal data from the Norwegian Life Course, Ageing and Generation Study (2007, 2017). Our analyses show that both work exit and part-time work are associated with a higher probability of doing unpaid work in senior years compared with full-time work. However, previous engagement in unpaid activities matters considerably, regardless of paid work status. Individuals involved in informal help or formal voluntary work in 2007 were far more likely to do unpaid work 10 years later than those who were not involved. Since seniors who are already engaged in unpaid activities before leaving the labour market are likely to continue to provide informal help and volunteer, we argue that initiatives to stimulate combinations of paid and unpaid work in late careers may be advantageous.

The ageing of parent carers: classed and gendered care-giving patterns at higher ages

Increasing longevity has led to a rising number of adult children who are at higher ages when they provide care for their parents. Drawing on the lifecourse approach and exchange theory, the paper addresses similarities and differences in parent care between late middle-aged and older adult children. The study uses the UK Household Longitudinal Study, restricting the analysis sample to individuals aged 50 and older with a living parent or parent-in-law. It presents multivariate models to examine differences between late middle-aged (aged 50–64) and older (aged 65+) children in being a parent carer, providing intensive care, the duration of parent care and providing selected types of help to parents. The involvement in parent care increases among women up to the end of their seventh decade of life and for men up to their eighth decade of life. At higher ages, the proportion of parent carers decreases more strongly for women than men. Older carers have shorter care-giving episodes than younger carers, but there is no significant difference in the type of care provided. Even past retirement age, parent care remains classed and gendered, with women from lower social classes having the highest likelihood of providing intensive parent care in old age. Having dependent children or living in a non-marital union depress the likelihood of caring for a parent even past retirement age.

"I Could Not Manage This Long-Term, Absolutely Not." Aging in Place, Informal Care, COVID-19, and the Neighborhood in Flanders (Belgium)

Public health and care policies across OECD (Organisation for Economic Co-operation and Development) countries increasingly encourage aging in place, enabled by both formal care networks, and informal (family) care and social solidarity in the neighborhood. However, little is known about how a person’s neighborhood might affect their aging in place. The COVID-19 crisis unintendedly offered a good opportunity to observe the neighborhood’s role in the provision of care. Since formal care services were often limited during the lockdown, informal caregiving may have increased. However, intergenerational contacts in and outside of the household were strongly discouraged by governments worldwide, adding another layer of complexity to caregiving. The aim of this qualitative study was to assess how informal caregivers in Flanders managed to provide care to their care receivers, and what role the neighborhood played in this provision of care. Sixteen qualitative Skype and telephone interviews with informal caregivers were conducted between June and December 2020 to understand their experiences and coping strategies. Overall, most respondents increased their frequency of caregiving during the first lockdown. They took on the extra care needs during the lockdown themselves, and did not actively invoke any kind of neighborhood support. The significance of the neighborhood seemingly remained limited. This was often not because no help was offered, but rather due to a sense of pride or the fear of infection, and an increased effort by family caregivers.

Does Unpaid Caregiving Erode Working Hours Among Middle-Aged Chinese Adults?

Middle-aged adults are commonly confronted with the burden of paid work and multiple caregiving roles. This paper examines the relationship between weekly hours of unpaid caregiving and hours of work using data from the baseline survey of the China Health and Retirement Longitudinal Study. The analysis was conducted on a nationally representative sample of 3645 working-age Chinese adults aged 45-60 years who were not farming and had a young grandchild and/or a parent/parent-in-law. For women and men separately, we combined the use of a Heckman selection procedure and instrumental variables to estimate the relationship between weekly caregiving hours and hours of work. A caregiving threshold was also identified for women and men separately to allow for the testing of a kink and/or a discontinuity in this relationship. We found that for women, their working hours were initially unrelated to hours of caregiving before the threshold of 72 caregiving hours per week; then, their working hours experienced an almost two-fold increase at the caregiving threshold before falling by 2.02 percent for each additional hour of caregiving beyond the threshold. For men, their hours of work fell by 2.74 percent for each hourly increment in caregiving. Although a caregiving threshold of 112 h was identified for men, there was insufficient evidence for a statistically significant kink or discontinuity in this relationship. These findings provide support for a range of fiscal and human resource policies that target employed family caregivers in order to advance their well-being while also maintaining their work productivity.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11205-021-02692-w.

The effect of long-term care public benefits and insurance on informal care from outside the household: empirical evidence from Italy and Spain

This article uses cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) database to test the effect of both long-term care (LTC) public benefits and insurance on the receipt of informal care provided by family members living outside the household in Italy and Spain. The choice of Italy and Spain comes from the fact that informal care is rather similar in these two countries while their respective public LTC financing systems are different. Our results support the hypothesis of LTC public support decreasing the receipt of informal care for Spain while reject it for Italy. They tend to confirm that the effect of public benefits on informal care depends on the typology of public coverage for LTC whereby access to proportional benefits negatively influences informal care receipt while access to cash benefits exerts a positive effect. Our results also suggest that private LTC insurance complements the public LTC financing system in place.

Factors associated with health-related quality of life and burden on relatives of older people with multi-morbidity: a dyadic data study

BACKGROUND

This study aimed to identify factors associated with health-related quality of life (HRQoL) and the burden on the relatives of older people with multi-morbidity.

METHODS

A secondary analysis of baseline data from 296 dyads, including older patients with multimorbidity and their relatives, which were previously collected in a randomized study. The analysis was conducted to select correlated independent variables to enter a final linear regression analysis of two models with different endpoints: the relatives' HRQoL (EQ5D index) and burden (COPE index: Negative impact scale).

RESULTS

Sixteen variables correlated with the relatives' HRQoL, and 15 with the relatives' burden. Both the HRQoL and burden correlated with both patient and relative variables. A high HRQoL was associated with relatives' working/studying. A high burden was associated with caring for an older person with changed behaviour. A low burden was associated with the relatives' high scores on positive values of caring, quality of support and HRQoL.

CONCLUSION

Older persons and their relatives should be considered as a unit in the development of support of older people in order to increase the health and quality of life of both groups. To support and protect relatives from a high burden, potential measures could include improving the relative's HRQoL and strengthening their ability to find positive values in care and strengthening reliable and good support from others. The relatives' HRQoL explained the variation in the burden. However, the burden did not explain the variation in the HRQoL, which suggests that the relatives' HRQoL is not so readily affected by their burden, whereas the relatives' HRQoL can influence their burden. The variables used in the regression analyses where chosen to reflect important aspects of the relatives' and older persons' situations. The final models explained 38% of the variation in the relatives' burden but only 10% of the variation in their HRQoL. This could be important to consider when choosing outcome assessments in future studies.

The Impact of Informal Caregiving on Labour Supply Before and After a Parent’s Death

Most European countries are facing an ageing population, which points to a need for having as many people as possible of employable age working full time. The growing number of older people increases the pressure on health and care services as well as on family caregivers. Adult children are important care-providers in their parents’ final years. This study investigates how having a parent in need of care affects sons’ and daughters’ labour market participation. The question is investigated by analysing longitudinal data from the Norwegian life course, ageing and generation study. The empirical strategy is first to use register information about parents’ demise as an indicator for amplified care needs in the period prior to their death and explore patterns in labour market participation (employment and earnings) before and after the death of a parent. Then, register data are combined with survey data in order to separate caregivers from non-caregivers prior to the loss of a parent. The analyses show a negative employment trend in the years before and after the loss of a lone parent. They also show a different development in earnings between caregivers and non-caregivers. Caregivers have a weaker development in earnings both before and after the death of their parent compared to non-caregivers. The study concludes that caring for older parents has a negative impact on the children’s labour market participation in both the period with substantial caregiving needs and the period following the parents’ demise.