Eldercare Responsibilities Research Articles

Intergenerational Support and Subjective Well-Being of Older Adults in China.

This study examines intergenerational support (IGS) and its impact on the subjective well-being of older adults in Chinese families, focusing on both upward and downward support. Data from the 2018 China Family Panel Studies show considerable mutual support between parents and children. Support from children to parents significantly improves the well-being of older adults, while support from parents to children has less impact. Contrary to expectations, the interaction between upward and downward support does not significantly affect the well-being of older adults. We categorized IGS into four family types and found that families with upward-IGS reported higher well-being than those with no IGS. Our findings underscore the central role of financial support and caregiving activities in enhancing the subjective well-being of older adults. These findings also suggest a policy recommendation for refining social eldercare systems in China to alleviate family pressures associated with eldercare responsibilities.

The transition of eldercare responsibility and traditional filial piety concepts and its urban-rural differences in China: an age-period-cohort analysis from 2006 to 2017

BackgroundWith rapid urbanization, massive migration, and non-family–based eldercare involvement, Chinese concepts of eldercare responsibility and filial piety are shifting. We performed age-period-cohort (APC) analyses to assess the transition of old-age pension coverage, eldercare responsibility, and filial piety concepts and its urban-rural differences among Chinese adults using data from the China General Social Survey (2006–2017).MethodsOld-age pension coverage (yes/no) and primary eldercare responsibility (government/offspring/self/sharing) were investigated in 2010, 2012, 2013, 2015, and 2017. Filial piety was evaluated using customized questionnaires in 2006 and 2017. The APC effects were estimated using mixed effects and generalized additive models.ResultsAmong 66,182 eligible participants (mean age: 48.8 years, females: 51.7%) in the six waves, APC analyses indicated that old-age pension coverage increased with aging and over time. Across cohort groups, it grew as the cohort was younger in urban residents but decreased in rural residents. The concept of offspring-based (> 50%) and government/self/offspring-shared eldercare (> 30%) predominated. APC analyses revealed that the offspring-based concept declined with aging (OR = 0.81, 95% CI: 0.79–0.84), whereas the government-based (OR = 1.37, 95% CI: 1.33–1.41) and self-based (OR = 1.55, 95% CI: 1.47–1.63) concepts increased with aging. People born around the 1940s have a comparatively higher possibility to perceive that the primary eldercare responsibility should be undertaken by the government and elder parents. In contrast, people born in the younger cohort were more likely to perceive that adult children are responsible for their parents’ primary eldercare. Filial piety score slightly increased with aging (β = 0.18, SD: 0.05) but decreased as the birth cohort was younger. In addition, rural participants were more likely to perceive offspring-based eldercare and maintain filial piety, and the related urban-rural difference was intensified by aging.ConclusionsThe traditional concept that eldercare solely relies on offspring has changed to relying on multiple entities, including the government and self-reliance. Diluted filial piety in people born in the young cohort requires reinforcement. Moreover, future healthy aging policies need to focus more on urban-rural disparities to promote equity in social well-being.

Formal long-term care, individualisation and filial responsibility: a multi-level analysis of 21 European countries

PurposeDue to the rapid ageing of the continent's population, a significant surge in long-term care expenses for the elderly is expected across Europe in the coming years. Could a potential solution to this challenge involve the increased informal care provided by adult children? In this context, we examined a general view or moral duty of European citizens regarding whether adult children should assume responsibility for providing long-term care to the elderly.Design/methodology/approachOur multilevel analysis draws on individual-level data from the 2017 European Value Study and country-level data from various European sources encompassing participants from 21 member countries of the European Union.FindingsThe findings reveal that in nations where public long-term care services are sufficiently available and of superior quality, there is a negative sentiment towards the notion that adult children should bear the responsibility for elderly care. In total, 71% of the country-level variance in our dependent variable was explained by the availability and quality of formal long-term care in a country. Furthermore, various individual-level attributes contribute to shaping attitudes towards care-giving responsibility. We observed that women, middle-aged individuals, those without religious affiliations, those with modern gender role attitudes and non-immigrants tended to hold unfavourable attitudes towards the responsibility of adult children in long-term care provision.Originality/valueThere are relatively many studies on the general attitude of the population towards filial obligation. However, so far there have been very few studies available that examine the population's attitude towards the obligation of adult children to commit to their parents' long-term care. Our research explains the variation of the phenomenon in Europe with both country-level and individual-level factors.

TRANSMISSION OF RELIGIOSITY BETWEEN GRANDPARENTS AND GRANDCHILDREN AS A BASIS FOR ELDERCARE RESPONSIBILITY

Abstract Different branches of research demonstrate that religiosity is effectively transmitted from grandparents to grandchildren and that religiosity strengthens norms of eldercare responsibility. This paper unites these two branches of inquiry by proposing that eldercare norms in emerging adulthood are directly and indirectly formed through an intergenerational religious pathway. Data derive from 149 grandparent-grandchild dyads from the 2021-22 wave of the Longitudinal Study of Generations. Religiosity is defined as a composite consisting of self-assessments of religious importance, religious intensity, and religious service attendance. Eldercare norms are assessed based on an evaluation of the obligation that adult children should have to provide support and care to older parents in six areas of assistance. Intermediate factors include grandchildren’s familistic values and emotional closeness to grandparents. Structural equation modelling was used to examine direct and indirect pathways linking these factors. Results indicate significant continuity in religiosity between grandparents and grandchildren. The impact of grandchildren’s religiosity on their eldercare norms is fully mediated by their familistic values and emotional closeness with grandparents. This analysis reveals that the transmission of religiosity to grandchildren begets eldercare norms through an ideational route of strengthening values of familism, and a personal route of promoting closer, and possibly more empathetic, relationships with grandparents who have or may soon have support needs. Results demonstrate the “hidden” impact of religious orientations of older grandparents on grandchildren and serve as a counterpoint to potentially specious reports about the adverse impact of declining religiosity and weakening intergenerational cohesion on aging families in American society.

Exploring the Causes of Gendered Elder Care Burden in South Korea

This paper investigates the reasons behind gender inequality in the responsibility for elder care in the case of South Korea. Specifically, to address this general research question, three sub-questions have been proposed: whether the differences in social resources by gender, or the different responses to similar resources by gender, are responsible for heavier elder care burdens for female members in the family. In addition, to what extent did the Korean welfare policies promote gender quality in elder care? Using quantitative data from Statistics Korea (KOSIS) and OECD, along with qualitative data from preceding research conducted by Sirin Sung in 2003, the study reveals that the results support the different resource argument to a great extent, whilst the data less support the different response argument. The study also finds that the current welfare policy implemented by the Korean government had alleviated the burden of providing elder care by family, but the effect of which on gender equality was limited.

“I Felt like I Was Losing Every Day”

The covid-19 pandemic severely disrupted the education system in Canada from March 2020 throughout the 2020–21 school year. It also had disproportionate secondary effects on women in terms of unpaid care, economic loss, and poor mental health. This article explores the lived experience of women educators in the province of Alberta, drawing on interviews and focus groups with 39 educators. Findings indicate that the pandemic not only exacerbated the triple burden that women educators, in particular, bear but added additional layers of responsibility related to public health management, educating children at home, elder care responsibilities, and emotional labour. The essential role women educators fulfilled within the covid-19 response, at work and at home, cost them time, professional development opportunities, mental wellness, and the positive rewards that had drawn them to the educational field. Current concerns around educator burnout and retention may be mitigated by acting on the recommendations of women educators regarding the development of more equitable education systems and social policy.

Time Use and Well-Being in Family and Other Unpaid Caregivers of Older Adults.

Caregivers report limited freedom to engage with others, participate in physical activities, pursue leisure activities, and sleep. Few studies have focused on caregivers' time use across different activities, particularly how different patterns of time use are associated with well-being. This study aimed to (a) identify time-use profiles of family caregivers of older adults and (b) examine associations between identified time-use profiles and caregiver well-being. We analyzed data from 1,640 family caregivers of community-dwelling older adults from Round 7 (2017) of the National Study of Caregiving and the National Health and Aging Trends Study. Latent profile analysis was used to estimate time-use profiles based on 4 indicators (i.e., regenerative time, discretionary time, eldercare-related committed time, non-eldercare committed time). We conducted regressions to examine the relationship between the latent profiles and well-being outcomes. Three profiles of caregivers emerged based on time-use patterns. The Overloaded profile (20%) spent the greatest time in non-eldercare committed activities, such as household activities and paid work. The Flexible profile (49%) spent the most amount of time in social activities and physical activities, and the least amount of non-eldercare committed time compared to the other 2 caregiver types. Lastly, the Occupied profile (31%) allocated time relatively evenly in all activities. When comparing well-being outcomes, caregivers in the Flexible profile had lower levels of anxiety than the Occupied profile. The profiles acknowledge the diverse experiences of caregivers, underscoring the significance of granting them greater latitude in balancing eldercare responsibilities and personal life for enhanced well-being.

Hearing Loss and Sociodemographic Barriers to Health Care Access Using the All of Us Research Program.

To explore how gender and low-income status independently influence general health care access in patients with hearing loss. Cross-sectional study. National database. Patients with a diagnosis of sensorineural hearing loss from the National Institutes of Health All of Us database were included. Data entered from May 2018 to November 2022 was analyzed. Patient demographicssuch as age, gender, educational level, and insurance status were assessed. Multivariate logistic regressions were performed for statistical evaluation. A subset of 8875 patients (48.3% male, mean age 69) were evaluated. After multivariate analysis, female participants were more likely than male participants to report difficulty affording prescribed medications (odds ratio [OR]: 1.7, p < .0005) and specialists (OR: 1.4, p < 0.005). Female patients were also more likely to delay care due to elder care responsibilities (OR: 2.6, p < .0005), employment obligations (OR: 1.7, p < .0005), and feelings of apprehension in seeing a provider (OR: 1.7, p < .0005). Finally, female participants reported feeling less likely to be involved in their own medical care compared to males (OR: 1.2, p < .005). Low-income (<$25,000) participants reported less likely to feel respected (OR: 3.2, p < .0005) and delivered understandable health information (OR: 2.3, p < .0005) by providers compared to participants of higher income. This work suggests that patients with hearing loss, female gender, and lower socioeconomic status independently introduce barriers to health care access and utilization. These factors should be considered in efforts to promote equity in the care of patients with hearing loss.

‘Everyone should have a wife’ – extreme work, eldercare, and the gendered academy in the context of the COVID-19 pandemic

This research explores the micro-level experiences of women with eldercare responsibilities in academia. We present academia as a site of extreme work and a gendered space. The ‘ideal academic’ is predicated on neoliberal logic, where long hours, uninterrupted career paths, and being care-less in terms of responsibilities are rewarded. Our study is set within the Irish Higher Education (HEI) sector where we undertook in-depth interviews with female academics who have eldercare responsibilities. Our findings reveal eldercare as an ‘invisible’ form of care, while research, arguably a substantive performance metric in academia was also experienced as an invisible pursuit taking place outside normal working hours. The interplay between these two invisible forces had disastrous consequences for women during the pandemic, as they attempted to respond to the intensification of elder care needs while extreme work in academia became normalised and research metrics continued to be a key measure of excellence, regardless of context. Our findings highlight the need to reshape the identity of the ‘ideal academic’ and dismantle the link between intense work patterns and success. Equally, the recalibration of HR policies, and performance metrics, to support staff with care responsibility emerged as vital in ensuring a sustainable academic workforce.

WEL Offers Leadership Development, Better Health for Women M.D.s

WEL Offers Leadership Development, Better Health for Women M.D.s

Keeping carers from the “precariat”: availability of carer-friendly workplace policies for employees with adult and elder care responsibilities in Quebec

PurposeAs employed carers tend to experience work interruptions and conflict between work and care, especially women, this paper aims to assess the availability and accessibility of carer-friendly workplace policies (CFWPs) in Quebec workplaces.Design/methodology/approachAn online survey was distributed to members of the Association of Human Resources Management Counsellors in Quebec. The authors used a validating quantitative data design. The data was collected between October 2019 and the end of February 2020 and the questionnaire yielded 122 valid responses.FindingsAdult/elder care responsibilities remain systematically perceived less important than childcare or general work-life balance needs. The current distribution of CFWPs within Quebec workplaces is unlikely to ensure carers sufficient support to prevent or significantly mitigate negative repercussions. Notable differences were found between organization type and size.Practical implicationsThere is a need for expanding CFWPs through increased support services, educational workshops, broader access to flexible work arrangements and manager training.Social implicationsThe results support recent research findings pointing that women with caring responsibilities face important opportunity costs and risk falling in precariousness. Carers should be able to maintain a social income from other sources to compensate a reduced activity on the labor market.Originality/valueBy investigating the availability of CFWPs in Quebec workplaces, this paper adds insights regarding the availability and access to CFWPs regionally and in small and medium size workplaces, rather than identifying best practice from workplaces across the globe. Workplace policies are analyzed for adult/elder care specifically.

Between Women of Color: The New Social Organization of Reproductive Labor

In this article, we examine citizenship inequalities in paid reproductive labor. Through an analysis of elder care in Los Angeles, California, based on interviews with Filipina home care agency workers and owners, we delineate citizen divisions made up of two interlocking dimensions. The longstanding U.S. welfare state abdication of responsibility for elder care for its citizens generates a racialized, gendered citizenship division that facilitates another citizenship division between women of color. The outsourcing of elder care by the government to the private sector including small business in the ethnic economy allows Filipina immigrants with legal citizenship to become middle-women minorities who hire undocumented Filipinas to provide care for white, middle-class, older adult women and their families. Through this new social organization of reproductive labor, responsibility is directed away from the state and generating tensions between women of color with different legal statuses. Our findings show how racialized, gendered inequalities are reinforced through this new social organization of reproductive labor but also demonstrate potential for undermining intersecting inequalities.

Investigating the Relationship Between Perception and Attitude With Responsibility for Elderly Care in Nurses of Emergency Wards of Ardabil Hospitals in 2020.

Nurses’ knowledge, attitudes, and their professional responsibility regarding elderly people are vital determinants in delivery of quality care for older people. Thus, this study aimed to identify the perception and attitude of nurses toward elderly care and their correlation with professional responsibility in nurses working in emergency departments. This descriptive-correlational study was conducted on 252 nurses working in the emergency departments of five general hospitals located in the province of Ardabil, Iran. Data was collected a demographic questionnaire and standard questionnaire of nursing care for the elderly of Persoon et al. The majority of nurses reported a positive knowledge and attitude towards elderly care. Only half of the nurses had a desirable professional responsibility towards elderly care. Based on the results of multivariate regression model, the variables of knowledge, attitude, age, work experience, and previous care of older client had a significant relationship with nurses ‘professional responsibility for elderly care (p < 0.01). Knowledge, attitude, age, and previous history of elderly care are significant determinants for professional responsibility towards elderly care; therefore, periodical evaluation of elderly care and its related factors can help the hospital managers to construct the basics of healthcare delivery for older people in emergency departments.

What’s Holding Back Employment in the Recovery from the COVID-19 Pandemic?

Bureau of Labor Statistics data indicate that five million jobs lost during the pandemic have not been recovered, but it is difficult to ascertain how many workers will return to available jobs. The Census Bureau’s Household Pulse Survey includes a detailed set of reasons for nonemployment, including households’ responses to the pandemic that provide a new perspective on reasons for not working. Among prime-age workers, reasons for nonemployment during the SARS-CoV-2 (COVID-19) pandemic have shifted substantially from mostly labor demand reasons to primarily labor supply inhibitors. At this point, most nonemployment is connected to three categories: sickness and concerns about COVID-19; child- and eldercare responsibilities; and the residual category “other reasons.” The persistence of these answers and the characteristics of individuals’ providing these answers point to barriers to fully recovering prior employment rates.

Eldercare Responsibilities and Physical Health Symptoms Among Manufacturing Workers

Working adults responsible for providing care to older relatives at home (eldercare) have reported greater psychological health problems such as depressive symptoms and stress than workers without eldercare responsibilities. Less is known about how eldercare is associated with physical health symptoms such as sleep-related problems and pain. Among manufacturing workers, such physical health symptoms have the capacity to diminish productivity. Therefore, we explored associations between eldercare responsibilities and physical health symptoms that could affect work performance in a sample of 357 adult employees from five manufacturing companies in a northeastern US state. Research questions were: are workers with eldercare responsibilities more likely than those without eldercare responsibilities to report sleep-related and pain-related symptoms, and are the number of eldercare tasks associated with these physical health symptoms? Among sample members, 52 (14.6%) provided eldercare, 62% were male, mean(standard deviation) age=49.8(12.7), and 77% were non-Hispanic White; no demographic differences were found between those with and without eldercare responsibilities. In bivariate analyses, we found that providing eldercare was associated with lower sleep quality (p=.05), fewer hours of sleep during the workweek (p=.04), more pain interference at home and at work (p=.02), and more pain on average in the past week (p=.01). Providing more types of eldercare tasks ranging from personal care to providing transportation was associated with more pain on average in the past week (p = .04). We conclude that eldercare is associated with physical health symptoms that could directly affect job performance among manufacturing workers. Workplace policy implications will be discussed.

Examining Mental and Physical Health Status Among Sandwich Generation Caregivers

With a sample of 54,076 caregivers, the Behavioral Risk Factor Surveillance System (BRFSS, 2015-2017) provides an opportunity to assess the impact of caregiving on U.S. adults varying in age, gender, and race. We focused on sandwich generation (SG) caregivers, aged 30-59, with childcare and eldercare responsibilities (n=8,805). In multivariate regression models of mental and physical health, we evaluated the association of age, gender, race and caregiving factors controlling for marital status, education, housing status, income, employment status, and self-rated health status. SG caregivers were predominantly female (65.6%), white (69.6%), black (13%) and were caring for a parent/parent-in-law (50%) or another relative (26.4%). Age, gender, and race were associated with mental health outcomes such that SG caregivers who were younger (aged 30-39), female, and white reported poorer mental health during the past month (p<.05). Older (aged 50-59), female, and white SG caregivers reported poorer physical health during the past month (p<.05). Caregiving factors were not associated with mental health, but SG caregivers who had been providing care for a longer period of time were more likely to report poor physical health in the past month. Finally, education, income, employment, housing status, and self-rated health status were statistically significant covariates in both models (p<.05). These findings demonstrate that young caregivers are at risk for poor mental health; older caregivers for poor physical health. Being female, white, with lower socioeconomic status is associated with poor mental and physical health. Future research should address the unique needs of SG caregivers with dual caregiving responsibilities.

Author's Response

Author's Response

“Cinderella Men”: Husband- and Son- Caregivers for Elders with Dementia in Shanghai

Traditionally, women had the day-to-day responsibility for eldercare. However, social changes have created alternatives for men to take on what is generally considered a “female duty.” Particularly, as the prevalence of dementia has increased in China, men are increasingly becoming the primary caregivers for their kin. Yet, we have limited understanding of male caregiving. Based on twenty months’ ethnographic study of 60 men taking care of a relative with dementia, this paper examines motivations, practices, struggles and strategies of male caregivers. While acknowledging the gendered nature of caregiving, I argue that eldercare goes beyond solely social construction of gender roles and power asymmetries between males and females. Men—both husbands and sons—who engage in caregiving are motivated by love, affection, moral obligation, reciprocity based on past assistance, and property inheritance. Male caregivers’ care practices and their responses toward challenges vary from case to case, yet, these differences have less association with gender identity but more with cohort variations. The expanding home roles of male caregivers call attention to the social transformation of gendered care practices in China and beyond.

Migrant domestic workers and the household division of intimate labour: reconfiguring eldercare relations in Singapore

As Singapore confronts escalating demands for eldercare labour in the face of rapid ageing, families are increasingly resorting to market-based, gender-normative options predicated on the care-chain migration of women to resolve familial care deficits. At the same time, given the prevalence of discourses of Asian familialism, the abdication of eldercare responsibilities to non-familial caregivers whose labour is purchased through market transactions often raises social anxieties decrying the decline of filial piety. This paper explores the way eldercare work is choreographed around gendered performances of intimate labour by different household members as families work through market solutions and moral dilemmas around eldercare. Following conceptualisation of the intimate that configure it along lines of mobility, emotion, materiality, belonging, alienation, we use the term intimate labour to refer to work involving embodied interactions that shape the social reproduction of everyday life. The paper is based on in-depth interviews with 34 elderly persons ‘cared for’ by foreign domestic workers and 35 foreign domestic workers employed to ‘care for’ the elderly. First, we examine the way families articulate the care logics behind the everyday division of intimate labour between live-in foreign domestic workers and spatially proximate family caregivers. Second, we show how the daily choreography of intimate labour and exchange among different household members folds into reshaping and relativizing affinal connections between ‘carer’ and ‘cared-for’ in the global household. Ultimately, we argue that home-based eldercare serve to rigidify the gendered contours of the ‘woman-carer model’ of care.

COVID-Apps: Misdirecting Public Health Attention in a Pandemic.

When there is no vaccine for a disease, ‘Test, Trace, Treat/Isolate’ is the public health go‐to directive. During the COVID‐19 pandemic, mobile phone apps are designed to improve on this. But COVID‐apps have not been effective as a public health tool. Countries spend millions to develop them, yet they have been shown to have terrible return on investment. This commentary explores why COVID‐apps are generally championed and provides three brief case studies (Germany, Sierra Leone, Canada) of non‐app public health success. In conclusion, I argue that we need to get our public health care priorities straight: Better and more testing; increased investment in manual contact tracing and treatments; hospitalization when necessary; and wrap‐around care – assistance with groceries, cleaning, child‐ or eldercare responsibilities, telehealth doctor appointment hookups – for sick people in home isolation.