Janet Fast

The Hidden Costs of Informal Elder Care

Demographic, socio-economic, and political trends throughout the developed world have contrived to make elder care an issue of utmost policy importance. They also have led to sharp reductions in health and social program expenditures. Policymakers are looking to communities to help meet growing care needs because community care is believed to be better and cheaper than institutional care. However, these beliefs become untenable when costs beyond public sector costs are considered. In fact, informal care carries a number of hidden costs that seldom are considered in health and social policy discussions. This article introduces a taxonomy of the costs of informal elder care, which can be categorized as out-of-pocket expenditures, foregone employment opportunities, unpaid labor, and emotional, physical and social well-being costs. Then, an illustration is provided regarding how the taxonomy can be applied to understanding the incidence, magnitude, and distribution of these costs among stakeholder groups. This taxonomy can help inform ongoing debate about health and social policy reform.

Understanding the caring capacity of informal networks of frail seniors: a case for care networks

Population ageing and constraints on public sector spending for older people with long-term health problems have led policy makers to turn to the social networks of older people, or the ‘informal sector’, as a source of long-term care. An important question arising from this policy shift is whether these social networks have the resources to sustain the high levels of care that can be required by older people with chronic health problems. In the face of both dire warnings about the imminent demise of the informal sector, and concurrent expectations that it will be the pillar of community long-term care, it is timely to undertake a critical analysis of the caring capacity of older peoples social networks. In this paper we argue that the best way to understand the caring capacity of informal networks of frail older people is to establish their membership and caring capacity. It is useful to make conceptual distinctions between ‘social’, ‘support’, and ‘care-giving’ networks. We argue that transitions of networks from social through support to care roles are likely to show systematic patterns, and that at each transition the networks tend to contract as the more narrowly defined functions prevail. A focus on ‘care networks’, rather than the more usual ‘care dyads’, will move forward our understanding of the caring capacity of the informal sector, and also our ability to forge sound social and health policies to support those who provide care.

Bridging Policy and Research in Eldercare

A new paradigm for continuing care policy has emerged that is based on assumptions about the benefits of caring partnerships and client-centred care delivery. Such assumptions place the interface between formal and informal care squarely on the policy agenda. The authors describe how existing research can contribute to the debate stimulated by the new policy paradigm and suggest future research that is informed by the paradigm. They argue that theory is an important tool to make policy agendas more explicit and they use human ecology theory to illustrate how theory can frame the development of research to address policy. Finally, they describe barriers to be overcome in order for policy and research to inform one another. Coauthors are Janet E. Fast, Ingrid A. Connidis, Margaret Penning, and Janice Keefe.

Employment and Social Integration in Midlife Preferred and Actual Time Use Across Welfare Regime Types

Policy makers aim to raise the retirement age for economic reasons. For individuals, longer employment maintains income and social contacts. However, retirement allows more time for socially integrating activities with family and friends. There is therefore tension for midlife individuals between the perceived advantages of employment and retirement. Welfare states vary in policies toward older workers, in terms of incentives for working longer or “early exit,” which may influence individuals’ preferences concerning retirement timing. Data from 20 European countries were used to examine middle-aged women’s and men’s attitudes toward employment and other time uses. The analysis incorporated age, gender, socioeconomic circumstances, and type of welfare regime. Work-life conflict was evident, expressed as preferring more time for family, friends, and leisure, especially where employment rates were highest and more for women than men. Many full-timers preferred shorter hours. Differences between desired and actual employment status were greatest among working-class, female, and older individuals. Unmet demand for jobs was most common in transitional and Mediterranean welfare states. The likelihood of employment was related to the type of welfare regime.

Poverty Status, Health Behaviours, and Health: Implications for Social Assistance and Health Care Policy

This study investigated the relationships among poverty status, health behaviours, and the health of 130 Albertans living in poor families. For the purposes of this study, poverty status indicated whether poor families were receiving social assistance along with comprehensive health care benefits or whether they were working poor without comprehensive health care benefits. Findings from seven separate path analyses indicate that poverty status was differentially related to the health of participants. Specifically, working poor respondents were found to be generally healthier than their social assistance counterparts except in those instances in which the working poor were prevented from filling needed prescriptions because they lacked the economic resources to do so. The paper concludes with a discussion of the implications of these findings for social assistance and health care policies.

Determinants of Loneliness among Older Adults in Canada

L’objectif de cette étude était de découvrir les déterminants principaux de la solitude des Canadiens âgés. Nous avons tiré sur des hypothèses concernant l’importance de la concordance entre la personne et l’environnement pour tester l’importance relative des caractéristiques personnelles, des conditions de vie privées, du réseau social/engagement social, et de la plausibilité de l’explication de la solitude. Les données comprenaient un échantillon de 3 799 répondants âgés de plus de 65, tirées de l’Enquête sociale générale de Statistique Canada, Cycle 22. Les caractéristiques personnelles, la dimension et la composition des réseaux sociaux, et la satisfaction avec les contacts du réseau, tous sont révélés d’être liés à la solitude, de même que les indicateurs de vivre sous des conditions économiquement et socialement difficiles. Les personnes âgées qui ont connu un recul récente de leurs situations financières, et qui n’avaient pas l’aide nécessaire pour faire face à un défi personnel récente, ont déclaré des niveaux plus élevés de la solitude. Une caractéristique frappante de nos résultats, cependant, c’est les scores relativement faibles sur la solitude des Canadiens âgés par rapport aux personnes âgées dans d’autres pays. The purpose of this study was to determine the key determinants of loneliness of older Canadians. We drew on the assumptions concerning the importance of person-environment fit to test the relative importance of personal characteristics, deprived living conditions, social network/social engagement, and satisfaction in explaining loneliness. Data comprised a sample of 3,799 respondents over age 65 drawn from Statistics Canada’s General Social Survey, Cycle 22. Personal characteristics, social network size and composition, and satisfaction with network contact were found to be related to loneliness, as were indicators of living in economically and socially challenging conditions. Older adults who had experienced a recent downturn in their financial situation, and who lacked the help needed to cope with a recent personal challenge, reported higher levels of loneliness. A striking feature of our findings is the relatively low scores on loneliness of older Canadians compared to older adults in other countries.

Productive Activity in Later Life: Stability and Change Across Three Decades

The authors examined time spent on paid and unpaid work across the life course and historically to reflect on connections between activity patterns and macroeconomic events. The authors conducted quasi-cohort analysis on time-use data over 30 years to examine trends in paid and unpaid work. Women aged 40 years and older spent more time on paid work and less time on unpaid work between 1971 and 1998. Men’s paid work time decreased between 1971 and 1981 and between 1992 and 1998 but increased between 1981 and 1992, paralleling economic cycles. Paid work declined in later life, both in cross-sections and within birth cohorts, for men and women, and it declined more rapidly with each successive survey year. Unpaid work peaked around the usual retirement age for men and women in all birth cohorts. Retired seniors remained engaged in productive activities into later life, making a partial substitution of one form of productive engagement for another.

Translating Knowledge: Promoting Health Through Intergenerational Community Arts Programming.

Introduction. Intergenerational programs have been touted to address the generation gaps and isolation of older adults. Mutual contact alone has produced mixed results, but attention to the intergenerational program content demonstrates well-being benefits. This practice-based article examines the benefits of creating and performing ensemble-created plays to older adults’ and university students’ well-being and the key processes that promote well-being. Method. This community participatory research project involved older adults as researchers as well as research subjects. Individual semistructured interviews were conducted by two trained interviewers with older adults (n = 15) and university students (n = 17). Results. Professional dramaturgical processes of storytelling, reminiscence, and playfulness were key elements in participants’ generative learning. They augmented older adults’ and university students’ ability to understand their situations and try innovative solutions. Skills such as openness, flexibility, and adaptation transferred into students’ and older adults’ daily lives. Conclusion. Participating in this intergenerational theatre group reduced ageism and improved intergenerational relationships. It increased older adults’ and university students’ well-being by building social networks, confidence, and self-esteem and developed a sense of social justice, empathy, and support for others.

Evaluating Consumer Satisfaction in Residential Continuing Care Settings

Abstract The outcome of the project reported on here is a client-centered consumer satisfaction questionnaire designed to evaluate new models of residential continuing care in Alberta, Canada. Satisfaction is defined as a multi-dimensional construct that is grounded in the consumers experience. Consultation with the clients of the services during development of the instrument ensured that characteristics important to the clients were assessed. The result is an instrument with which to measure satisfaction that is fully client-centered and that, with appropriate modifications, can be used to monitor any client-centered program for cognitivelyable continuing care clients.

The Impact of Eldercare on Adult Children’s Health and Employment in Transitional China

This paper explores the content and extent of the burden of caregiving for Chinese families in transition. It sets out to understand how Chinese families manage to balance family caregiving responsibilities with employment, the impact of the existing social institutions on family caregiving practices, and the risks that caregivers have to face. Data were collected from a sample of 214 workers from 14 manufacturing companies in an industrialized city in central China in 2013. Analysis revealed that common types of eldercare were assisting with activities of daily living and medical related care; middle aged employed respondents were most likely to be the caregivers to older family members; financial and time demands of care were challenging for caregivers, but women with more education and a secure job responded to the pressure of care giving better than those with less education and insecure jobs. An absence of workplace policies to support family caregivers was reported to create insecure employment conditions among middle aged workers. The findings imply an urgent need for legislative action and workplace policy that support family caregiving in China.