Mirko Di Rosa

The impact of migrant work in the elder care sector: recent trends and empirical evidence in Italy

Italy is characterized by a very high and increasing demand for elder care but, paradoxically, also by a surprisingly low level of public service provision in this sector. Due to current demographic, economic and socio-cultural trends, the potential availability of informal family care has been decreasing while, on the other hand, still strong familistic attitudes have so far limited the emergence of formal—both home and residential—care services. The ‘cash-for-care’ orientation of the Italian welfare system, with direct payments prevailing over in-kind services, has thus gradually developed into a care regime where monetary transfers to dependent (older) people are often used to privately employ migrant care workers. This phenomenon is analyzed in the context of two different studies (EUROFAMCARE and DIPO), in order to understand how migrant care work has been affecting both family care and professional care work in Italy. The main findings suggest that the widespread employment of migrant care workers—propelled by public care allowances—has certainly relieved many families from most burdensome care tasks, but at the same time partly ‘crowded out’ formal care services. Care quality issues remain. however, largely under-investigated, as do care drain effects in sending countries.

Migrant care workers as protective factor against caregiver burden: results from a longitudinal analysis of the EUROFAMCARE study in Italy.

Objective: The aim of the analysis is to assess the impact of privately employed migrant care workers (MCWs) on the burden of Italian family members who care for a disabled older person. Methods: EUROFAMCARE is a one-year prospective survey carried out to provide evidence on the availability and use of support services by family carers of older people in Europe. In Italy, 990 family caregivers were enrolled and successful follow-ups were completed for 863 subjects. The survey also assessed the level of caregiver burden using the COPE index, which has three sub-sections: ‘Positive Value’ (PV), ‘Quality of Support’ (QS) and ‘Negative Impact’ (NI). We used the one-year change of the COPE-NI as dependent variable and we realised multilevel regression models to estimate the longitudinal predictors of caregivers’ burden increase. Results: At a cross-sectional level, most burdened caregivers are those caring for a demented relative (COPE-NI = 13.6), with no educational title (14.5) and looking after their own spouses (15.1). Longitudinally those employing an MCW are significantly protected against burden increase (regression coefficient: −1.52; p < 0.01) while those who cannot rely on the support of other family members are exposed to the risk of burden increase (0.991; p < 0.05). Other formal services do not have any protective effect. Conclusion: Our study suggests that employing an MCW, rather than using formal services, is associated with a reduction of caregiving burden. Further research should assess whether the shift in care responsibilities to the MCWs also implies a transfer of care burden, and understand how these workers can be better supported by existing formal services.

Abuse of Older Men in Seven European Countries: A Multilevel Approach in the Framework of an Ecological Model.

Background Several studies on elder abuse indicate that a large number of victims are women, but others report that men in later life are also significantly abused, especially when they show symptoms of disability and poor health, and require help for their daily activities as a result. This study focused on the prevalence of different types of abuse experienced by men and on a comparison of male victims and non-victims concerning demographic/socio-economic characteristics, lifestyle/health variables, social support and quality of life. Additionally, the study identified factors associated with different types of abuse experienced by men and characteristics associated with the victims. Methods The cross-sectional data concerning abuse in the past 12 months were collected by means of interviews and self-response during January-July 2009, from a sample of 4,467 not demented individuals aged between 60–84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden). We used a multilevel approach, within the framework of an Ecological Model, to explore the phenomenon of abuse against males as the complex result of factors from multiple levels: individual, relational, community and societal. Results Multivariate analyses showed that older men educated to higher levels, blue-collar workers and men living in a rented accommodation were more often victims than those educated to lower levels, low-rank white-collar workers and home owners, respectively. In addition, high scores for factors such as somatic and anxiety symptoms seemed linked with an increased probability of being abused. Conversely, factors such as increased age, worries about daily expenses (financial strain) and greater social support seemed linked with a decreased probability of being abused. Conclusions Male elder abuse is under-recognized, under-detected and under-reported, mainly due to the vulnerability of older men and to social/cultural norms supporting traditional male characteristics of stoicism and strength. Further specific research on the topic is necessary in the light of the present findings. Such research should focus, in particular, on societal/community aspects, as well as individual and family ones, as allowed by the framework of the Ecological Model, which in turn could represent a useful method also for developing prevention strategies for elder abuse.

The Role of Work Status on European Older Volunteers’ Motivation:

The article aims to identify differences in motivation between working and nonworking older volunteers, in order to contribute to knowledge on the relationship between work status and volunteering in later life. The study also contributes a cross-European view, given that most literature emanates from the United States. It was conducted utilizing a database of 955 working and nonworking older volunteers in three European countries: the Netherlands, Germany, and Italy. Results showed that work status has a significant impact on the motivation to volunteer, suggesting that voluntary organizations need to consider responding to different motivations between older volunteers still in paid employment and those who are retired. Specifically, those in paid work may be more driven by the desire to improve their career or knowledge, whereas older retired volunteers and those employed part time may consider volunteering as a response to challenges associated with retirement and later life or an unsatisfactory working situation.

Concurrent validation of an index to estimate fall risk in community dwelling seniors through a wireless sensor insole system: A pilot study

Falls are a major health problem for older adults with immediate effects, such as fractures and head injuries, and longer term effects including fear of falling, loss of independence, and disability. The goals of the WIISEL project were to develop an unobtrusive, self-learning and wearable system aimed at assessing gait impairments and fall risk of older adults in the home setting; assessing activity and mobility in daily living conditions; identifying decline in mobility performance and detecting falls in the home setting. The WIISEL system was based on a pair of electronic insoles, able to transfer data to a commercially available smartphone, which was used to wirelessly collect data in real time from the insoles and transfer it to a backend computer server via mobile internet connection and then onwards to a gait analysis tool. Risk of falls was calculated by the system using a novel Fall Risk Index (FRI) based on multiple gait parameters and gait pattern recognition. The system was tested by twenty-nine older users and data collected by the insoles were compared with standardized functional tests with a concurrent validity approach. The results showed that the FRI captures the risk of falls with accuracy that is similar to that of conventional performance-based tests of fall risk. These preliminary findings support the idea that theWIISEL system can be a useful research tool and may have clinical utility for long-term monitoring of fall risk at home and in the community setting.

The impact of incontinence management on informal caregivers’ quality of life

BackgroundThe presence of incontinence symptoms might affect the quality of life (QoL) of those providing informal care to people suffering from them, causing social isolation, financial problems, psychological and physical exhaustion.AimsThis study aimed at assessing whether urinary and/or fecal incontinence in people aged 60 and over affects the level of burden in their informal caregivers.MethodsQoL was assessed amongst 304 informal caregivers of older people suffering from urinary and/or fecal incontinence, and compared to that reported by 305 caregivers of non-incontinent older relatives, all living in Italy. All participants were administered a questionnaire focused on: characteristics and conditions of the cared for; details of the care activity; emotions experienced by caregivers; attitudes of caregivers; reasons for providing care; availability of information and support; demographics.ResultsFindings show that, when no incontinence was reported, the longer was the caregiving situation, the better was the caregivers’ QoL, which was instead negatively affected by the lack of a support network. As for caregivers’ feelings, neither positive nor negative emotions influenced their QoL in a significant way. In terms of caregiver’s role, those who felt overwhelmed or loaded with responsibility reported a lower QoL, while the opposite was found among those who felt rewarded and supported, even when incontinence—of any kind—was present.ConclusionsThe management of incontinence does have a negative impact on caregivers’ QoL, but subjective factors might play a mitigating role on such an impact.

Family Networks and Supports in Older Age

This chapter will focus on the role of family networks and other social support networks for well-being in older age, providing empirical data across European countries on different sources of support. The first section will illustrate how family care in this respect represents a relevant actor, not only in traditional familistic societies but also in more well-developed European welfare states. Comparative data will be presented in particular on the role played by the family in granting assistance in case of increased dependency in older age. A related issue will be represented by the availability of supports to reconcile paid work and (unpaid) care tasks, especially in the light of the Europe-wide trends to a prolonged working life and increasing female participation in the labour market. Recent empirical evidence will be furthermore provided of the growing importance of migrant care work in households with dependent older people across the Continent, in particular when the formal care system is unable to tackle the challenge of very heavy care needs. The chapter will finally describe the effects of lacking family and support networks, which might take the form of elder abuse and neglect, identifying the main risk factors and possible strategies to prevent it.

Toward a Connected Health System for Older Adults: Lessons Learned

This paper aims to provide some lessons learned during the development of the Wireless Insole for Independent and Safe Elderly Living (WIISEL) system that can be generalized for all connected health devices for older adults. The analysis of the different results confirms that there is a clear challenge for modern technologically driven healthcare systems to meet the complex needs of an ageing society. We observed three major themes which should be taken into considerations when tackling the barriers to the uptake of technology enabled care: 1. Face cultural resistance and concerns toward technology enabled care; 2. Improve engagement of users in design; 3. Built or Increase users trust in connected health by spreading awareness and knowledge among end users about technology’s benefit and utility.

Understanding the link between older volunteers’ resources and motivation to volunteer

ABSTRACT The purpose of this study was to investigate the impact of older volunteers’ available human, social, and cultural capital on their motivational forces to volunteer, measured through the Volunteer Function Inventory. A large European database of 955 older volunteers (i.e., aged 50+) was employed, and Seemingly Unrelated Regressions showed that older volunteers have different motivations according to different sets of individual resources. Furthermore, lower amounts of human and social capital (e.g., low educational level, poor health, being widowed, divorced or single) are associated with a higher propensity to volunteer to enhance one’s own self-esteem, to avoid thinking of personal problems, and for social reasons. These results have important implications for policy makers and voluntary organizations if they want to enhance volunteering among older people with less resources, i.e., that are more at risk of social exclusion. For example, according to the results of this study, policy makers could consider developing more tailored opportunities for involving older volunteers with low educational level, poor health, widowed, divorced, or single. They could do this by underlying that volunteering offers possibilities to satisfy motivational needs important to the, elderly, e.g., to increase self-esteem, to deal with personal problems in a better way, and to have satisfying social contacts.

For better or worse : Factors predicting outcomes of family care of older people over a one-year period. A six-country European study

Objectives Demographic change has led to an increase of older people in need of long-term care in nearly all European countries. Informal carers primarily provide the care and support needed by dependent people. The supply and willingness of individuals to act as carers are critical to sustain informal care resources as part of the home health care provision. This paper describes a longitudinal study of informal care in six European countries and reports analyses that determine those factors predicting the outcomes of family care over a one-year period. Methods Analyses are based on data from the EUROFAMCARE project, a longitudinal survey study of family carers of older people with baseline data collection in 2004 and follow-up data collection a year later in six European countries (Germany, Greece, Italy, Poland, Sweden, and the United Kingdom), N = 3,348. Descriptive statistics of the sample characteristics are reported. Binary logistic random-intercept regressions were computed, predicting the outcome of change of the care dyad’s status at follow-up. Results Where care is provided by a more distant family member or by a friend or neighbour, the care-recipient is significantly more likely to be cared for by someone else (OR 1.62) or to be in residential care (OR 3.37) after one year. The same holds true if the care-recipient has memory problems with a dementia diagnosis (OR 1.79/OR 1.84). Higher dependency (OR 1.22) and behavioural problems (OR 1.76) in the care-recipient also lead to a change of care dyad status. Country of residence explained a relatively small amount of variance (8%) in whether a care-recipient was cared for by someone else after one year, but explained a substantial amount of variance (52%) in whether a care-recipient was in residential care. Particularly in Sweden, care-recipients are much more likely to be cared for by another family or professional carer or to be in residential care, whereas in Greece the status of the care dyad is much less likely to change. Discussion The majority of family carers continued to provide care to their respective older relatives over a one-year period, despite often high levels of functional, cognitive and behavioural problems in the care-recipient. Those family carers could benefit most from appropriate support. The carer/care-recipient relationship plays an important role in whether or not a family care dyad remains intact over a one-year period. The support of health and social care services should be particularly targeted toward those care dyads where there is no partner or spouse acting as carer, or no extended family network that might absorb the caring role when required. Distant relatives, friends or acquaintances who are acting as carers might need substantial intervention if their caregiving role is to be maintained.