Long-term Care Assistance Research Articles

Long-term quality of survival after pediatric low-grade glioma.

Low-grade glioma is the most common brain tumor in children with different modes of treatment and a high overall survival. Low-grade glioma is considered a chronic disease, since residual tumor is present in many children. The tumor and its treatment lead to acquired brain injury with diverse consequences for later life based on factors like the diverse tumor locations, treatment(s) applied, neurofibromatosis type 1, and age at diagnosis. An overview of affected domains is provided based upon cohort studies from literature and partially based on clinical experience with a practical approach regarding each domain of functioning in order to provide insight in the requirements for long-term care assistance after childhood low-grade glioma. The diverse domains that can potentially be affected are described as follows: motor function, speech, eating and swallowing, sensory functions, seizures, neuropathy, organ function after systemic treatment, late effects due to cranial radiation (vascular changes and secondary tumors, endocrine and hypothalamic function, sleep and energy, neuro-cognition and education, psychosocial effects, and quality of life. Insight in affected domains guides advices for medical follow-up, diagnostics, supportive instructions, and assistive measures per domain of functioning and provide insight in the requirements for long-term care assistance after childhood low-grade glioma.

Clearing Up Misconceptions About Nurse Practitioners and Physician Assistants in Long-Term Care

Clearing Up Misconceptions About Nurse Practitioners and Physician Assistants in Long-Term Care

Naar een toekomstbestendige medische zorg voor ouderen met complexe multimorbiditeit door interprofessionele samenwerking: leren van ervaringen uit de langdurige zorg

delivering medical care of appropriate quality to older people with complex multimorbidity will be challenging in the next few decades and is already under pressure in the long term care setting. Interprofessional collaboration between elderly care physicians, nurse practitioners and physician assistants can contribute to the sustainability of this care. to describe the experience with interprofessional collaboration of physicians, nurse practitioners and physician assistants in long term care and get insight in facilitators and challenges for it. focus group interviews were conducted with elderly care physicians, nurse practitioners and physician assistants from several long term care organisations were conducted, who collaborated as professionals for some time. interprofessional collaboration was valued positively. Themes emerging from the interviews were: 'scarcity of physicians as reason employing nurse practitioners and physician assistants'; 'unfamiliarity with competencies of nurse practitioners and physician assistant among physicians'; 'trust'; 'added value'; 'absence of protocols/formats' and 'legal and regulation barriers'. the emerging themes fit within an existing theoretical model about development of interprofessional collaboration. The development of interprofessional collaboration in long term care fits in the first phases of this model. Important steps for realizing further interprofessional collaboration in daily practice is being aware of and valuing each other's competencies. Also formats that describe competencies and collaboration procedures are considered helpful. Positive for further development is the recent formal support of the three professional organisations together, offering perspective for sustainability of medical care for older people with complex multimorbidity in the coming decades.].

Characteristics of older people who have an intention to work as assistance personnel for long-term care or childcare

Objectives With the rapid progress of aging society and decreasing population, there is a shortage of workers in various areas, which has become a serious problem especially in the welfare field, for long-term care and childcare. As one of the countermeasures, some efforts are being made to hire people who are living independent daily lives, as auxiliary personnel, and have them take charge of non-specialized peripheral work of the facilities. The purpose of this study was to examine the characteristics of older adults who have an intention to work as auxiliary personnel in the welfare field.Methods A self-response questionnaire survey was conducted from October to November 2019 for 374 members of "REPRINTS" who are picture-book reading volunteers, aged 60 years or more, and are living in the capital area. There were 295 valid responses. We performed logistic regression analysis using the presence or absence of intention to work for long-term care assistance and for childcare assistance as the dependent variables. The missing values were supplemented by the multiple imputation method (10 files were created).Results The results of analysis revealed that 24.9% of the respondents had an intention to work for long-term care assistance, and 36.6% for childcare assistance. From the results of logistic regression analysis, it was found that among those intending to work in long-term care assistance, participants involved in lifelong learning activities had significantly higher intention to work (OR: 2.98, 95%CI: 1.40-6.34). Among those intending to work in childcare assistance, those with a high subjective sense of health had a significantly higher intention to work (OR: 2.41, 95%CI: 1.01-5.76).Conclusion The intention of work for childcare assistance was higher than that for long-term care assistance. A notable characteristic of older people willing to work as assistants in the welfare field is that those who participate in lifelong learning activities would be willing to actively work for long-term care assistance, and those with high subjective health would be willing to actively work for childcare assistance. By focusing on the older people with these characteristics, we may be able to contribute to identifying the those among them who want to work as assistant personnel.

An Online Mindfulness-based Intervention for Certified Nursing Assistants in Long-term Care.

Purpose: Certified nursing assistants (CNAs) make up the largest segment of the long-term care (LTC) setting workforce, however, they are at high risk of job dissatisfaction and burnout. Evidence suggests that mindfulness-based interventions (MBIs) might be particularly relevant and useful for CNAs in reducing psychological distress, improving job satisfaction, and reducing burnout, but little research has investigated this possibility. A feasibility study of an online MBI for CNAs in LTC settings was therefore conducted. Methods: CNAs completed assessments at baseline and posttest. Paired t-tests assessed changes in mindfulness, psychological distress (i.e., depressive and anxiety symptoms, and stress), and professional quality of life. Results: Of the 19 CNAs who started the intervention, N = 13 (68%) completed it and provided postintervention data. Depressive symptoms were significantly decreased postintervention (F = 6.26, p = .036, d = .47). Conclusions: MBIs may have beneficial effects for CNAs in LTC settings. Further research with a larger CNA population will increase the power and relevance of these findings, ultimately contributing to the improvement of patient outcomes in LTC.

Difference of Physical Restraint Knowledge, Attitudes and Practice Between Nurses and Nursing Assistants in Long-Term Care Facilities: A Cross-Sectional Study.

BackgroundPhysical restraint (PR) is widespread use among older adults in long-term care (LTC) facilities, which has negative effects on older adults’ health and quality of care. Considering that research on PR use in Chinese LTC facilities is rare, assessment of nursing staff’s knowledge, attitude, and practice (KAP) is a prerequisite before minimized PR program and staff training project development.PurposeThis study aimed at determining the differentiation of levels and factors of KAP toward PR use between nurses and nursing assistants in LTC facilities.MethodsA cross-sectional study was conducted in six Chinese LTC facilities from November to December in 2019 and May to June in 2020. A total of 316 nursing staff, comprising 69 nurses and 247 nursing assistants were investigated using the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR. One-way analysis of variance, chi-squared test, Welch test, the Mann–Whitney U-test, and multiple linear regression were performed for data analysis.ResultsMean scores of overall knowledge, attitude, and practice were 5.90±2.27, 31.97±3.01, 30.89±4.82, respectively. PR knowledge and practice of nurses were significantly higher than that of nursing assistants (all P<0.001), whereas PR attitude with no significant difference (P=0.084). In-school training, in-job training, and knowledge on PR significantly affected PR practice of nurses and nursing assistants. Further, nursing assistants’ practice was also significantly predicted by education (β=0.131, P=0.019), age (β=−0.140, P=0.034), monthly income (β=−0.184, P=0.002), and attitude (β=0.130, P=0.030). In-job training (β=0.283, P<0.001), age (β=−0.164, P=0.021), and knowledge (β=0.292, P<0.001) significantly affected nursing assistants’ attitude, while their knowledge was influenced by monthly income (β=0.153, P=0.019) and work years in LTC (β=0.343, P<0.001).ConclusionSpecific knowledge deficits, negative fields of attitude, and practice were dissimilar between nurses and nursing assistants. The targeted and stratified PR education approaches were suggested to prompt their KAP.

Burnout, Compassion Satisfaction, and Personality Among Nursing Assistants: Who is at Risk?

It is well established that the health professional workforce is not adequately prepared to meet the demands of an aging older population. Caregivers are often the backbone supplemental workforce for seniors, providing daily care with assistance with activities of daily living, with little training. Part of the mission of the South Florida Geriatric Workforce Enhancement Program (SFGWEP) is to support and empower caregivers through community based training programs. Between January 1 2020 to January 31, 2021 SFGWEP provided education to more than 340 caregivers on topics related to opioid use, effective communication with individuals with dementia and other topics. Attendees responded to a short evaluation survey, which included three multiple-choice questions on if attending was a good use of their time, if they gained knowledge and if they plan to apply material, and two open-ended questions to identify opportunities for improvement in future trainings. Responses were overwhelmingly positive (>98% for multiple-choice questions.) There were also three open-ended questions that were analyzed using a modified thematic approach. The three questions covered what attendees learned, what they wanted to learn more about and suggestions for improvement. Analysis suggests that attendees plan to be more mindful about communication (e.g. improve eye contact, listen more) and that they want more information on neurocognitive disorders and resent research, including psychological changes due to disease and medication side effects. In terms of improvement, attendees said the program should allow more time for questions and should use more engaging materials (polls, posters, flyers and case studies).

Above and beyond: A qualitative study of the work of nurses and care assistants in long term care.

As the Canadian population ages, there is a need to improve long-term care (LTC) services. An increased understanding of the positive work experiences of LTC staff may help attract more human health resources to LTC. To describe the perceptions of the roles and work of nurses and care assistants in LTC from interprofessional perspectives. This study used qualitative data collected from a larger mixed-methods study, Care by Design. The qualitative phase explored the lived experience of LTC staff from the perspectives of key stakeholders via focus groups and individual interviews. One central theme that emerged from the study was that of LTC staff going "above and beyond" their clinical duties to care for residents. This above and beyond theme was categorized into subthemes including: 1. familial bonds between residents and staff; 2. staff spending additional time with residents; 3. the ability to provide comfort to family members; and 4. staff dedication during end-of-life care. The findings show that staff develop a kinship with residents, demonstrate respect towards residents' families and provide comfort at the end-of-life. In emphasizing these themes of positive and fulfilling work, the present study provides insight into why staff work in LTC.

Differences in determinants of intention to stay and retention between younger and older nursing assistants in long‐term care facilities: A longitudinal perspective

This study examines differences in the determinants of intention to stay (Time 1) and actual retention behaviour at follow-up (Time 2) between younger and older nursing assistants in long-term care facilities. The shortage of nursing assistants in long-term care is increasing, and the nursing assistant workforce is also ageing. Data were obtained from a stratified equal probability sample of 595 nursing assistants from 137 institutions over a two-year period in Taiwan. Multilevel modelling was utilized for analyses. High organisational support and low burnout were associated with high intention to stay at Time 1 for both older and younger nursing assistants. However, the retention of older nursing assistants at Time 2 was more strongly influenced by high work latitude, the use of an optimization strategy and less burnout at Time 1, while the retention of younger nursing assistants at Time 2 was more likely to be affected by personal factors such as gender and marital status at Time 1. Organisational factors, the use of selection, optimization, compensation strategies, and burnout were more strongly associated with retention of older nursing assistants than of younger nursing assistants. Nursing assistant managers should recognize the needs of nursing assistants vary by age and stage of life. Retention programs that are designed to account for age differences will be more effective at retaining nursing assistants.

Intentional Rounding With Certified Nursing Assistants in Long-Term Care: A Pilot Project.

Intentional rounding (IR) is a strategy used by predominately acute care nursing staff to proactively address patients' needs at regular and consistent intervals. The current project piloted the use of IR with certified nursing assistants (CNAs) on a 60-bed unit of a 120-bed skilled nursing facility (SNF). Using a pre/post intervention design and the Plan-Do-Study-Act (PDSA) framework, the authors measured knowledge of IR's "4Ps" (potty, position, possessions, and pain) and the incidence of falls and lost possessions. Uptake of IR over 10 weeks of implementation and CNAs' perceptions of intervention were also assessed. The pilot showed positive outcomes for each of the five aims. Data suggest that IR was well received by CNAs and changed practice patterns regarding quality, safety, and satisfaction. Based on these findings, replication of this project in other SNFs is recommended, given the current small and underpowered study. [Journal of Gerontological Nursing, 45(6), 15-21.].

Education and Training in End-of-Life Care for Certified Nursing Assistants in Long-Term Care.

The growth in the number of older adults in the United States requires appropriately prepared health care providers at all levels who will be able to effectively care for this population. First-line caregivers such as certified nursing assistants (CNAs) need education and training in end-of-life care so they can provide high-quality care for residents and families in the long-term-care (LTC) setting. CNAs were recruited from an LTC facility in western New York to attend an educational intervention consisting of six 45-minute sessions on various topics selected by the researchers using the curriculum from the Core Curriculum for the Hospice and Palliative Nursing Assistant. Pretests and posttests were administered to assess changes in knowledge, and a satisfaction survey was used for the CNAs to identify additional learning needs. Nineteen CNAs completed the six education and training sessions. Data analysis revealed a significant increase in knowledge for the participants. CNAs were also able to identify additional learning needs. Significant improvement in knowledge was seen after the CNAs attended the educational intervention. CNAs working in LTC facilities need education and training in end-of-life care so they can provide appropriate and effective care to residents and their families. Education and training for CNAs led to increased knowledge of end-of-life care and desire for more educational opportunities. J Contin Educ Nurs. 2017;48(2):81-85.

Impact of serious mental illness online training for certified nursing assistants in long term care

ABSTRACTCertified nurse assistants (CNAs) spend the most staff time with nursing home residents, yet they receive little training in addressing the mental health needs of residents with serious mental illness (SMI). Forty CNAs from four long-term-care facilities took the online interactive CARES-® Serious Mental Illness™ training consisting of two modules guided by the Recovery Movement philosophy of care. Responses from pre–post testing, Likert-type items, and open-ended questions indicated that CNAs gained information, changed their perspectives, and had more confidence in dealing with SMI. Although there were minor concerns regarding length, clarity of content, and technical issues, CNAs found the online format acceptable and easy to use, and many said they would recommend the training. CARES Serious Mental Illness online training appears to be a viable way of helping CNAs address the mental health needs of long term care residents. Additional testing on CARES Serious Mental Illness is planned.

Facilitating Change Among Nursing Assistants in Long Term Care

In this article, the authors consider the implementation of change in long term care organizations (LTCOs) and present their study describing the process by which new nursing assistants are informally integrated into LTCOs in Quebec, Canada. The study method included 23 in-depth interviews with nursing assistants in two long term care centres. The findings enabled the authors to describe the informal process by which new nursing assistants are integrated into LTCOs and the manner in which informal work strategies enhance the work of nursing care, thus enabling the nursing assistants to manage heavy workloads. The authors discuss whether this teamwork is a deterrent to change or a lever for change and address issues regarding the collective structure of nursing assistant teams. Implications for practice include a Five-Step Innovation Plan. In conclusion, the authors propose that organizational change among nursing assistants in a LTCO is best accomplished when the leaders consider the nursing assistants' strong sense of community to be a change engine rather than a change obstacle.

Estimated energy expenditure of nursing assistants in long term care

Ergonomic research on nursing work has focused primarily on the biomechanical analysis of patient handling tasks. Few studies have addressed the intensity of a full day of nursing work as measured by changes in heart rate and energy expenditure. A pilot study was conducted between August 2009 and May 2010 to examine the intensity of performing nursing assistant work in long term care settings and to assess the usefulness of heart rate monitoring as a measure of work intensity. The residents of the facilities were physically dependent adults. The settings had floor-based mechanical lifting devices available and no-lift policies that restricted workers from lifting. Eight women between the ages of 19 and 54 from two facilities participated in this study. A wearable recorder allowed unobtrusive heart rate monitoring while nursing assistants worked their usual shift. Continuous heart rate monitoring for a full shift provided an estimation of energy expenditure. The data suggest that the nursing assistants worked at a moderate level yet were within the safe work intensity level recommended by NIOSH [32]. The information provides preliminary baseline data for nursing assistants who work with physically dependent adults using floor-based lifts in a no-lift environment.

Sharing the Financial Responsibility of Caring for Parents

THE EXPERIENCES OF THE “M” FAMILY DESCRIBED BY Ritchie et al in this issue of JAMA are the topic of conversations among many baby boomers coping with aging parents who can no longer manage to live on their own. Although assisted living facilities or continuing care retirement communities are attractive options for individuals who recognize that they are slowing down, such options are paid for out of pocket; those who cannot afford them can either receive unpaid help from family or friends, pay for in-home care of which only a portion may be covered by insurance, or enter a nursing home and spend down to Medicaid—at great cost to the government and taxpayers. Encouraging aging adults to remain in their homes or live with their families would seem desirable from an individual and societal perspective. However, as Ritchie et al explain, the emotional, physical, social, and financial costs of caring for older parents can be high. Many of these costs occur whether the aging parents move in with the adult children or the children supervise care provided elsewhere. The financial costs in particular can be staggering, adding to the emotional stresses of both the parent and the adult child. However, only a small share of elders have high costs. In the United States, for example, 69% of those who live to age 65 years are estimated to need some type of long-term care assistance before they die. Most use only informal, but often substantial, care provided by their relatives and friends. However, while average lifetime long-term care expenditures (excluding informal care) of the individuals who live to age 65 years are projected to be $47 000 (in 2005 dollars), 16% of these individuals will have more than $100 000 (in 2005 dollars) of lifetime expenditures. These individuals receiving high-cost care are especially likely to be in nursing homes for more than 2 years; the average annual cost of nursing home care in 2006 was $72 000. Medicaid pays for more than 40% of all longterm expenditures, but individuals pay for 22% directly, in many cases exhausting their savings and then qualifying for Medicaid. In England, roughly 10% of people at age 65 years are estimated to have lifetime care expenditures of more than £100 000 (equivalent to about $160 000 in July 2011). The wide variation in need for long-term care assistance and the skewed distribution of expenditures (with only a small share of people paying very high costs) show why the financial risk is small but nontrivial. A private insurance market might be expected to thrive in such a situation. Yet it does not—in the United States or any of the other industrialized countries. The primary explanation is that there is great uncertainty surrounding who exactly will need expensive assistance and what those costs will be 20 or 30 years from now. The US Community Living Assistance Services and Supports (CLASS) plan, a voluntary, publicly administered insurance program established by the Affordable Care Act of 2010, was expected to help address this issue, but it appears unlikely to survive US efforts to reduce the budget deficit. With more baby boomers becoming aware of the needs and potentially high costs of family elder care, how to care for the 19% of Americans who by 2030 will be 65 years old and older could be a major focus of the national health care debate. Other industrialized countries have been having such debates for the past 2 decades—in part because higher shares of their population were already aged 64 years or older. For instance, in 2010, more than 20% of the individuals in Japan, Germany, and Italy were aged 65 years and older, as were more than 15% in Sweden, England, Spain, France, and the Netherlands—in the United States that proportion was 13%. These countries are wrestling with the same issues as families in the United States—how to provide quality care to elderly individuals who need assistance with activities of daily living (ADLs) while not impoverishing them and their families. Many countries address the risk of costly longterm care with a social insurance program or a program funded through general revenues to pay for care assistance. The Scandinavian countries rely on taxes raised at the national and local levels; the Netherlands, Germany, and Japan have social insurance programs with mandatory participation. Although the Scandinavian countries have had long-term care assistance programs in place since the 1960s (Sweden since the late 1940s), the programs in the Netherlands, Germany, Spain, and other countries have been implemented only since 1994.

Work Autonomy of Certified Nursing Assistants in Long-Term Care Facilities: Discrepant Perceptions Between Nursing Supervisors and Certified Nursing Assistants

Despite increasing demand of certified nursing assistants (CNAs) in long-term care (LTC) facilities, their work autonomy delegated by nursing supervisors remains ambiguous and varied. This study investigates the CNAs' role in LTC facilities by examining the degrees of work autonomy of CNAs from the perspectives of nursing supervisors and CNAs. Whether the characteristics of institutions including ownership of facilities, bed size, staffing levels, and the occupancy rate affected the CNAs' work autonomy and delegations was also examined. A stratified random sampling method was used to sample LTC facilities in Taiwan. A self-administered structured questionnaire was answered by a senior nursing supervisor and CNA in each sampled institution for their perception of work autonomy in the 5 main aspects of CNAs' job contents: personal care, affiliated nursing care, auxiliary medical service, social care, and administration services. Student t test and general linear models (GLM) were used to test the mean differences of CNAs' work autonomy and their relationship with the institutions' characteristics. Nursing supervisors and CNAs both rated the highest scores of work autonomy in the aspect of personal care, and the lowest scores in the aspect of affiliated nursing care. However, the nursing supervisors expected higher work autonomy of CNAs on the work items particularly in affiliated nursing care and auxiliary medical services than did the CNAs (P < .05). The institutional-level factors were significantly associated with perceptions of nursing supervisors toward CNAs' work autonomy. The ownership (hospital-based or freestanding homes), sizes (capacity), occupancy rates, CNA staff numbers of the long-term care facilities, and resident numbers were related to the CNAs' work autonomy as perceived by their nursing supervisors. No difference between the aspects of administration activities and social care was seen. There are discordance views towards CNAs' work autonomy both in nursing supervisors and CNAs across different settings in LTC institutions. The characteristics of institutions influence perceptions of CNAs' work autonomy as perceived by nursing supervisors. Clear and mandated regulation of CNA job contents is needed for their work identity and autonomy to improve the quality of care in LTC facilities.

Perceived Barriers to Effective Job Performance Among Nursing Assistants in Long-Term Care

This research explored perceived barriers to job performance among a national sample of nursing assistants (NAs). Specific objectives were (1) to clarify which of the problems identified by previous research are most troublesome for NAs, (2) to develop a reliable quantitative measure of perceived barriers to job performance, and (3) to test construct validity of the measure vis-à-vis work-related psychological empowerment and job satisfaction. Nursing assistants attending the 2006 national conference of the National Association of Health Care Assistants completed a paper-and-pencil survey including 33 barriers to job performance and standardized measures of empowerment and job satisfaction. The barriers were also rated by a small sample of NAs at a single Georgia nursing home. Factor analysis of barriers items yielded a 30-item Nursing Assistants Barriers Scale (NABS) comprising 6 subscales: Teamwork, Exclusion, Respect, Workload, Work Stress, and New NAs. Lack of teamwork and exclusion from communication processes were rated as most problematic by both samples. The 6 NABS subscales were significantly and independently associated with empowerment and satisfaction; different barriers predicted the 2 constructs. This study is a first step toward quantitative assessment of NAs' perceptions of barriers to doing their jobs. Primary limitations are the select sample and use of a job satisfaction measure that may have artificially inflated correlations with the NABS. Nonetheless, results confirm the validity of the new scale as an operationalization of the barriers construct. The concept of barriers to job performance is a unique construct from work empowerment and satisfaction with one's job. Nursing assistants clearly differentiate various barriers, converging on workload and lack of teamwork as most problematic. Further work is needed to substantiate validity and reliability of the NABS, particularly with respect to NAs' actual job performance, intent to stay on the job versus leave, absenteeism, and turnover.

Creating a career ladder for nursing assistants in long-term care.

This article describes the development, implementation, and evaluation of a career ladder for certified nursing assistants in long-term care. A career ladder is an effective way to maximize the use of unlicensed workers without changing the skill mix (eg, no loss of licensed nursing positions) and allow the licensed nurse more time to perform higher-level clinical tasks, such as assessments, patient education, and documentation. Implementation of an unlicensed worker career ladder also can improve nursing assistant retention.

Restructuring Care for the Elderly in Germany

Health insurance typically falls short of meeting the needs of frail elderly and other disabled persons. In 1995, Germany began implementing new provisions in its national health insurance law to provide for long-term care assistance. Payments are available for family caregivers, community-based services and nursing homes and institutions for the disabled This article is based on interviews carried out in the autumn of 1996 with German citizens and health care, insurance company and government officials. The insurance program has created: (1) affordable access to long-term care services for frail and disabled persons; (2) a restructuring toward community-based care; (3) the emergence of hundreds of new agencies; (4) new issues concerning the quality of care by families and by home care agencies; and (5) a recognition that eligibility criteria and benefits are overly narrow for certain types of disabilities.

Employee Family Care Responsibilities

This study examined the full range of family care responsibilities, including care for children and for ill and disabled adults, among employees of a government-funded research center Utilizing a family care model drawn from stress and coping and role theory perspectives, caregiving strain and occupational impacts were modeled in terms of type of care provided, work and family demands, resources available at home and at work, and background characteristics. Significant contributors to both caregiving strain and occupational impacts included type of care provided, as well as employee age and ethnicity, care recipient disability, problems with care arrangements, work demands, and lack of assistance with family responsibilities. Employees with child care responsibilities were found to experience higher levels of caregiving strain and occupational impacts than were employees caring for adults only. The implications of these findings for practitioners and for the development of programs geared toward employees' differential family responsibilities are discussed. Key Words: caregiving, dependent care, family, work. Resulting from a variety of social and demographic factors, such as the increased numbers of women in the formal labor market (U.S. Department of Labor, 1994) and the growing number of adult persons in need of long-term care assistance (U.S. Bureau of the Census, 1993), more persons than ever before are combining family care and employment responsibilities. Today nearly 60% of mothers and 80% of fathers with children under the age of 6 are employed (U.S. Department of Labor, 1994). In addition, more than 80% of the long-term care assistance needed by older adults is provided by family members (U.S. Senate Special Committee on Aging, 1985-86), of whom approximately one-half are employed full-time (NAC/AARP, 1997). It is estimated that approximately 1.8 million women are caring for both children and an elderly relative, and that more than 50% of these women are employed (Older Women's League, 1989). Approximately 3% of working women have children under the age of 15 as well as care for a disabled parent (Stone & Kemper, 1989). Moreover, increased life expectancies (U.S. Bureau of the Census, 1993) combined with a tendency among many families to delay childbearing (Wetzel, 1990) may lead to an increase in the number of employees with multigenerational caregiving responsibilities. Existing research has documented personal strain and work disruptions experienced by persons combining family care and employment responsibilities (Meisenheimer, 1990; Neal, Chapman, Ingersoll-Dayton, & Emlen, 1993). Workplace and family accommodations which employees make in order to meet their multiple role responsibilities include missing time from work, missing work promotions, decreasing social activities, and giving up free time (Emlen & Koren, 1984; Fredriksen, 1993; Neal et al., 1993; Scharlach & Boyd, 1989). To date, the vast majority of research on employees with family care responsibilities has focused on only one type of family care, either the care of children or the care of elderly adults, with relatively few attempts to examine the full range of family care responsibilities. For example, only a few studies have incorporated disabled working age adults in the research on family caregiving and the workplace (Scharlach & Fredriksen, 1994). Yet, 4% of the noninstitutionalized U.S. population under the age of 55 have difficulty meeting their personal care needs due to health-related mobility or self-care limitations (U.S. Bureau of the Census, 1990). It has often been suggested that middle age adults who are juggling multiple responsibilities are likely to experience higher levels of caregiving stress (Brody, 1981; Hogan, 1990; Older Women's League, 1989; Schlesinger, 1989). Yet, in one study the assumption of multigenerational caregiving responsibilities was found to have no effect on the caregivers' well-being (Loomis & Booth, 1995). …