Anne Martin-Matthews

We share the care: family caregivers' experiences of their older relative receiving home support services.

Although both family care and home support are considered essential components of home-based health-care, the experiences of family caregivers who have a relative in receipt of home support services are not well understood. Little is known about what aspects of home support services assist family caregivers or hinder them in their caregiving. This study examines family members experiences of the home support services received by their elderly relatives. Based on a previous Canadian study of contributions in family caregiving, we developed a conceptual model for understanding multiple contributions in caregiving. The present study used this conceptual model to guide the analysis of data from in-depth interviews with family caregivers (N = 52), completed August 2007-April 2008, who have or had an older relative in receipt of home support services in British Columbia, Canada, in the previous 12 months. Verbatim transcripts were read, re-read and independently coded by three members of the research team to identify common themes. Themes relating to direct care (care provided directly to the elderly person) and assistive care (care provided to one caregiver by another) were identified. In discussing the direct care provided by workers, family members emphasised dissatisfaction with instrumental assistance provided by home support workers while also stressing the importance of affective assistance. In commenting about assistive care there were three key themes: caring together, care management, and quality assurance and monitoring. In conclusion, the important role of home support in providing relief for caregivers is highlighted and implications for caregiver policy are discussed.

Care management and care provision for older relatives amongst employed informal care-givers

ABSTRACT This paper examines care management, or ‘managerial care’, a type of informal care for older adults that has been relatively neglected by researchers. While previous research has acknowledged that care-giving may involve tasks other than direct ‘hands-on’ care, the conceptualisation of managerial care has often been vague and inconsistent. This study is the first explicitly to investigate managerial care amongst a large sample of carers. In our conceptualisation, care management includes care-related discussions with other family members or the care recipient about the arrangements for formal services and financial matters, doing relevant paperwork, and seeking information. The study examines the prevalence of this type of care, the circumstances under which it occurs, its variations by care-giver characteristics, and its impact on the carers. We drew from the Canadian CARNET ‘Work and Family Survey’ a sub-sample of 1,847 full-time employed individuals who were assisting older relatives. The analysis shows that managerial care is common, distinct from other types of care, a meaningful construct, and that most care-givers provide both managerial and direct care. Care management includes both the orchestration of care and financial and bureaucratic management. Providing managerial care generates stress amongst women and interferes with work amongst men, and the aspect that generates the greatest personal and job costs amongst both men and women is the orchestration of care.

Situating ‘Home’ at the Nexus of the Public and Private Spheres Ageing, Gender and Home Support Work in Canada

This article examines the provision of in-home health and social support services to elderly clients in the context of home as the site of care. It considers gender in the provision of home support services by a marginalized group of employed women; in the experiences of elderly clients receiving services in the private sphere of the ‘home’; in the relationships between old people, family member(s) and home support workers; and in the gendered use of space within the household in care work. Informed by a self-reflexive, autobiographical perspective, the researcher’s experiences as a daughter in a family receiving home care prompted the re-examination of qualitative panel data from 150 home care workers and 155 elderly clients. It examines issues of territory and boundary, control and cooperation, the symbolic significance of home and the negotiating of contingent relationships when public services are provided in the private sphere of home.

Valuing the Older Person in the Context of Delivery and Receipt of Home Support Client Perspectives

Client perspectives of home support (i.e., assistance with daily activities that help to maintain a safe and supportive home) have not been considered in relation to personhood: “a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being.” Personhood and positive person work interactions conceptually guided our secondary analysis of data from a generic qualitative study including 82 semi-structured interviews with older adult home support clients in British Columbia, Canada. Findings revealed clients value a “focus on the person,” “preservation of autonomy,” and interactions characterized by recognition, validation, collaboration, and negotiation. Individuals involved in the delivery of home support services are in a key position to support the personhood of older adult clients.

Key issues in human resource planning for home support workers in Canada

OBJECTIVE This paper is a synthesis of research on recruitment and retention challenges for home support workers (HSWs) in Canada. PARTICIPANTS Home support workers (HSWs) provide needed support with personal care and daily activities to older persons living in the community. METHODS Literature (peer reviewed, government, and non-government documents) published in the past decade was collected from systematic data base searches between January and September 2009, and yielded over 100 references relevant to home care human resources for older Canadians. RESULTS Four key human resource issues affecting HSWs were identified: compensation, education and training, quality assurance, and working conditions. To increase the workforce and retain skilled employees, employers can tailor their marketing strategies to specific groups, make improvements in work environment, and learn about what workers value and what attracts them to home support work. CONCLUSIONS Understanding these HR issues for HSWs will improve recruitment and retention strategies for this workforce by helping agencies to target their limited resources. Given the projected increase in demand for these workers, preparations need to begin now and consider long-term strategies involving multiple policy areas, such as health and social care, employment, education, and immigration.

Why I Became a Home Support Worker: Recruitment in the Home Health Sector

Home care is considered an essential pillar of the health care systems in many industrialized countries. With an increased demand for home health workers, there has been growing interest in examining recruitment and retention of these workers. With a focus on recruitment of home support workers, in this study we draw on data from interviews with 57 home support workers in three Canadian provinces, to examine the factors that attract individuals to employment in this sector. These factors include: previous experience, financial considerations, and enjoying working with people. Understanding these overlapping factors can aide in the recruitment of future workers.

Revisiting Widowhood in Later Life: Changes in Patterns and Profiles, Advances in Research and Understanding

Cette analyse examine les façons dont l’expérience du veuvage dans la vieillesse ainsi que la nature de la recherche sur le veuvage ont changé depuis la publication du livre Le Veuvage en fin de vie en 1991. Les modèles de la baisse du veuvage sont examinés, à la fois dans sa durée et de son incidence retardée dans la vie. La recherche sur le veuvage a connu des avancées conceptuelles au-delà de la compréhension de la perte de rôle. La perspective du cours de la vie, ainsi que les concepts de narratifs multiples et de résilience ont aussi contribué à ce domaine. De nouvelles méthodes, y compris des méthodologies prospectives et longitudinales portant sur de larges ensembles de données, ainsi que des études qualitatives détaillées, ont fait avancer notre compréhension de la complexité et des variances du veuvage. Celles-ci incluent des variantes telles que le genre, la diversité ethnoculturelle et la combinaison de facteurs tels que l’aisance matérielle, la santé et la classe sociale. L’article examine aussi l’influence de l’affiliation au marché du travail, de la politique sociale et de la nature changeante du mariage sur le façonnement du veuvage plus tard au cours de la vie. This analysis reviews the ways in which both the experience of widowhood in old age and the nature of research on widowhood have changed since the publication of the book Widowhood in Later Life in 1991. Patterns of decline in widowhood in both its duration and incidence in later life are examined. Widowhood research has advanced conceptually by moving beyond understanding widowhood solely in terms of role loss. Life course perspectives, and concepts of multiple narratives and of resilience, have also contributed to the field. New methodologies, including prospective and longitudinal designs involving larger data sets, and more in-depth qualitative studies, have advanced our understanding of complexities and variations in widowhood. These include issues of gender and ethnocultural diversity, as well as the intersection of wealth, health, and class. This article also examines how patterns of labour force affiliation, social policy, and the changing nature of marriage shape widowhood in later life.

Caring Sons: Exploring Men's Involvement in Filial Care

This paper investigates socio-demographic, family structure and other factors that predict mens filial care involvement. The concepts guiding this investigation are related to family obligations or motivations to provide care — commitment to care, legitimate excuses, and caring by default. Data for this research come the Work and Eldercare Research Group of CARNET: The Canadian Aging Research Network. This work is based on a sample of 772 men who provide assistance to older parents or parents-in-law. Overall, findings demonstrate the value of the conceptual framework for explaining variations in mens care. For example, distance constraints and the commitment of young children, appear to be legitimate reasons for less care involvement. Further, living nearby and being without siblings may “default” men into being more involved in care. This research recognizes mens filial care as a more complex issue than a ‘gender difference’ focus on caregiving has allowed.

“I'm Satisfied … But”: Clients' and Families' Contingent Responses About Home Care

Home care service organizations need a means of gaining useful feedback about satisfaction with care from clients and their families. Interviews were conducted with 82 older adult clients and 52 family members about their satisfaction with home care. A subgroup of participants (n = 39) provided “contingent” satisfaction responses. Contingent responses reflect the duality of perceptions that clients and families convey about services. Three themes emerged as critical to understanding these types of responses: adept versus inept staff, predictable versus precarious scheduling, and responsive versus restrictive care plans. Understanding the reasons for contingent responses could help home care agencies to target quality improvement initiatives for individual clients and families.

Nurses Negotiating Professional–Familial Care Boundaries Striving for Balance Within Double Duty Caregiving

The purpose of this sequential, two-phase mixed-methods study was to examine the health of male and female nurses who provided care to older relatives (i.e., double duty caregivers). We explored the experiences of 32 double duty caregivers, which led to the development of an emergent grounded theory, Negotiating Professional–Familial Care Boundaries with two broad dialectical processes: professionalizing familial care and striving for balance. This article examines striving for balance, which is the process that responds to familial care expectations in the midst of available resources and reflects the health experiences of double duty caregivers. Two subprocesses of striving for balance, reaping the benefits and taking a toll, are presented in three composite vignettes, each representing specific double duty caregiving (DDC) prototypes (making it work, working to manage, living on the edge). This emergent theory extends current thinking of family caregiving that will inform the development and refinement of practices and policies relevant to DDC.