Janice Keefe

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.

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.

Social vulnerability from a social ecology perspective: a cohort study of older adults from the National Population Health Survey of Canada

BackgroundNumerous social factors, generally studied in isolation, have been associated with older adults’ health. Even so, older people’s social circumstances are complex and an approach which embraces this complexity is desirable. Here we investigate many social factors in relation to one another and to survival among older adults using a social ecology perspective to measure social vulnerability among older adults.Methods2740 adults aged 65 and older were followed for ten years in the Canadian National Population Health Survey (NPHS). Twenty-three individual-level social variables were drawn from the 1994 NPHS and five Enumeration Area (EA)-level variables were abstracted from the 1996 Canadian Census using postal code linkage. Principal Component Analysis (PCA) was used to identify dimensions of social vulnerability. All social variables were summed to create a social vulnerability index which was studied in relation to ten-year mortality.ResultsThe PCA was limited by low variance (47%) explained by emergent factors. Seven dimensions of social vulnerability emerged in the most robust, yet limited, model: social support, engagement, living situation, self-esteem, sense of control, relations with others and contextual socio-economic status. These dimensions showed complex inter-relationships and were situated within a social ecology framework, considering spheres of influence from the individual through to group, neighbourhood and broader societal levels. Adjusting for age, sex, and frailty, increasing social vulnerability measured using the cumulative social vulnerability index was associated with increased risk of mortality over ten years in a Cox regression model (HR 1.04, 95% CI:1.01-1.07, p = 0.01).ConclusionsSocial vulnerability has important independent influence on older adults’ health though relationships between contributing variables are complex and do not lend themselves well to fragmentation into a small number of discrete factors. A social ecology perspective provides a candidate framework for further study of social vulnerability among older adults.

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.

Developing New Strategies to Support Future Caregivers of Older Canadians with Disabilities: Projections of Need and their Policy Implications

This paper projects annual growth rates between 2001 and 2031 in the need for informal and formal support among elderly Canadians with disabilities. The paper also discusses the policy implications of the increasing demand for informal caregivers. Using Statistics Canadas LifePaths microsimulation model, these projections incorporate disability rates and the potential availability of family caregivers. The authors conclude that continued focus on family to meet the needs of elderly Canadians is not sustainable. New public policies involving financial support and respite for family caregivers are proposed and their economic feasibility is evaluated.

The effects and expense of augmenting usual cancer clinic care with telephone problem-solving counseling.

This study was done to assess the effectiveness and efficiency of individualized, problem-solving counseling provided by baccalaureate nurses over the telephone to prevent the onset of depression in persons with breast, lung, or prostate cancer. Of 175 persons randomized, 149 completed the 8-month follow-up. The primary outcome measures were changes in the Jalowiec Coping Scale, the Centre for Epidemiologic Studies in Depression Scale, and the Derogotis Psychosocial Adjustment to Illness Scale. In addition, expenditures for peoples use of all health and social services were computed at baseline and follow-up. Telephone counseling improved the use of more favorable coping behaviors, prevented a clinically important but not statistically significant decline into depression, and poor psychosocial adjustment in a group of people with mixed cancer. These results were associated with a greater total per person per annum expenditure for use of all other health and social services in the community compared with the control group. In a situation of limited resources and a service producing more effect for more costs, one needs either to examine what services to forgo to offer this service or to carefully target the new service to those most likely to benefit.

Prevalence, correlates, and costs of patients with poor adjustment to mixed cancers.

Approximately 2% to 3% of the Canadian society has experienced cancer. Literature indicates that there is poor adjustment to chronic illness. Individuals with poor adjustment to chronic illness have been found to disproportionately use more health services. The purpose of this study was to determine the prevalence, correlates, and costs associated with poor adjustment to mixed cancer. A consecutive sample (n = 171) of breast, lung, and prostate cancer patients at the Nova Scotia Regional Cancer Center were surveyed. Twenty-eight percent of the cancer group showed fair to poor adjustment to illness using the Psychological Adjustment to Illness Self-report Scale Psychological Adjustment to Illness Self-Report Scale raw score. Poor adjustment was moderately correlated with depression (r = 0.50, P < .0001) and evasive coping (r = 0.38, P < .0001) and unrelated to demographic variables. Depression explained 25% of the variance in poor adjustment to illness in regression analysis. Cancer patients with fair to poor adjustment to illness had statistically significantly higher annual healthcare expenditures (P < .002) than those with good adjustment to illness. Expenditure findings agree with previous literature on chronic illnesses. The prevalence of fair to poor adjustment in this cancer population using the Psychological Adjustment to Illness Self-Report Scale measure is similar to that reported for chronic illness to date, suggesting that only those with better adjustment consented to this study.

The Impact of Ethnicity on Helping Older Relatives: Findings From a Sample of Employed Canadians

This study examines the relationship between ethnicity and the provision of assistance to older relatives. A sample of employed Canadians ( N = 2,753), a subsample of the CARNET Work and Family Survey, is used to explore how ethnicity influences the amount of assistance provided to older relatives. Findings from our study suggest that Asians, East Indians, and Southern Europeans provide higher levels ofhelp than British respondents. Final obligation affects the amount of help provided but plays a similar role within each ethnic group. However, structural factors — in particular, living arrangement and age — are stronger predictors of the level of involvement in helping older relatives than are cultural factors of filial obligation and belonging to a particular ethnic group.

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.