Live-in Caregivers Research Articles

Experiences of Migrant Live-in Caregivers in Caring for Patients With Advanced Cancer - A Qualitative Study.

Foreign domestic workers are increasingly hired in Singapore as live-in caregivers for patients with advanced cancer. Language barriers and different cultural backgrounds can make caregiving potentially challenging. This study aims to explore the experiences of migrant live-in caregivers caring for patients with advanced cancer. Semi-structured interviews were conducted to explore: the challenges and needs of migrant live-in caregivers caring for patients with advanced cancer, what enables their cancer caregiving work, and their motivations. Participants were recruited from inpatient oncology wards of an acute tertiary hospital. Inclusion criteria included: (i) migrant live-in caregiver caring for a patient with stage IV solid organ cancer; (ii) age ≥21 years; (iii) conversant in English, Mandarin or Burmese. Twelve female caregivers participated in the study. Their mean age was 35.4 years, 4 were from Indonesia, 3 from Myanmar and 5 from the Philippines. Four main themes emerged: (1) Wide-ranging work responsibilities that could be challenging, (2) Treating and being treated like family, (3) Having access to multiple sources of support and (4) Motivated by being able to provide for their own family of origin. Migrant live-in caregivers face various challenges in cancer caregiving. Having a good relationship with patients, adequate employer and peer support and being able to provide for their family helped to motivate them. Efforts to support them can include formal training, better delineation of job scope and hours, and resources to address psycho-emotional needs. Further research could focus on knowledge gaps for cancer caregiving, psychosocial and post-bereavement needs.

Training for migrant live-in care workers in Austria: results from an online survey

Abstract Background In Austria, almost 60.000 migrant “24-hour” live-in caregivers work in two- or four-week shifts, travelling between Austria and their countries of origin (mostly Romania, Slovakia, Croatia, Hungary and more) to care for frail older people at home. As opposed to other social and healthcare professions, live-in care workers do not require any formal training at all to be able to work in Austria. Methods With the aim of gaining an in-depth insight into the working conditions of live-in caregivers and with the aim of recording their problems and needs, an online survey including 40 questions was conducted from 15 July to 15 September 2023 in four languages (Slovak, Romanian, Bulgarian and German). The study is part of the MigraCare project which focuses on improving working and living conditions for migrant live in care workers. Results Results show that many live-in caregivers are not fully aware of their job profile: what are nursing and medical tasks they are only allowed to do when delegated by professional healthcare staff? Most respondents have to take on tasks that are outside their job profile. Many state that it is difficult to care for people with dementia. In addition, some caregivers report physical and psychological violence and sexual harassment. Most wish for training possibilities regarding topics like dementia, communication with client and family, legal framework regarding their job in the long-term care sector and others. Conclusions Live-in care workers wish for continuous education activities and for a better relationship with the family relatives and the care recipient. Based on the results of the survey short multilingual training videos have been developed easily accessible on a video platform for live-in care workers. Also, a connection to community nurses has been established in order to improve communication between care recipient, family members and live-in care workers. Key messages • Results from an online survey show that live-in care workers face challenges at work which are partly due to an unclear job profile as well as communication problems with the care recipient. • Results of an online survey show that live-in care workers wish for education and training opportunities (mother tongues) in the field of dementia care, communication with family or legal framework.

Fraught triads – treating older women in crisis living with a migrant live-in caregiver and frail husband

ABSTRACT Hiring migrant live-in caregivers to take care of older adults with dementia, chronic disease or frailty has become more common in Europe, North America, the Middle East, and Asia. When older couples hire a non-relative to provide live-in caregiver services for a family member, the attendant household transformation – from couple to triad – gives rise to social and psychological challenges. Although live-in caregivers can be indispensable, living together can be very stressful for older adults and live-in caregiver. This article describes the emotional distress of two older adult wives in their eighties, and the therapeutic methods used to reduce it, including empathic understanding, legitimation of emotions, promotion of open communication, and formulation of a household ‘management strategy,’ establishing specific expectations concerning the parties’ roles and a daily activity schedule. Involvement of older couples’ children was found helpful, and was aided through psychoeducation. Gerontologists, therapists, educators, and social workers who serve the needs of older adults can effectively assist this population in the evolution of their perceptions of their new situation, the regaining of a sense of equilibrium, mastery and control over their lives, and the development of greater tolerance and understanding of migrant live-in caregivers’ work burden, native culture, and individual practices. Professionals should actively screen for risks of burden, stress, depression, and anxiety in households in which live-in caregiver services may be considered. Psychoeducation and preparation of both the older adults and their live-in caregivers entering the new relationship may lessen the incidence of potential stressors.

Providing Health Care but Receiving None in Return: An Expanded Right to Health Analysis of the Live-In Caregiver Program of Canada (1992-2014)

Canada’s robust universal, single-payer healthcare system has long made socio-economic rights (SER) advocates in the United States envious of our neighbors to the north. Fundamental human rights tenants echo in the Canadian Charter of Rights and Freedoms, including non-discrimination and individual freedom, yet the “right to health” has not been constitutionalized at the moment this essay was written.1 While Canada has a strong track record of signing international human rights conventions and guaranteeing the right to health for permanent citizens, there remains a gap in the health rights of migrant workers, even in regular situations or formalized citizenship pathways. Ever-changing legal qualifications for permanent residency and arbitrary three-month waiting periods for healthcare coverage to come into effect make securing the right to health for even the most highly desirable workers—namely, healthcare workers in private households—a thorny task. The motto for Canada’s paradoxical commitment to the socio-economic rights of migrant workers might be, as Toronto doctors Ritika Goel and Michaela Beder aptly articulate in the title of their medical journal op-ed, “Welcome to Canada...but don’t get sick.”

Nawalang Ilaw ng Tahanan:

The Philippines belongs to Southeast Asia and is rich in natural resources. However, it remains a developing country, with globalization and neoliberal policies paralyzing its industries and damaging its environmental resources to prioritize foreign interests (Velasco 2002). With a lack of national industries, the Philippine government implemented a labor export policy favorable to developed countries such as Canada, whose demand for domestic work, childcare, and eldercare expanded. In the 1980s, Canada’s Foreign Domestic Movement (FDM) Program allowed migrant workers to gain permanent residency status (Velasco 2002; Cohen 2000). FDM was replaced by the Live-in Care Giver (LCP) Program by 1992, and during this period the Philippines became among the top sources of laborers to Canada (Bonifacio 2008). The seemingly mutually beneficial setup between the two countries inevitably treated these human beings as commodities, with the laborers also racialized, thereby devoid of rights typically afforded to other migrant workers of European descent. The migration process was also gendered since most caregivers were women, depicting care work as feminized. This paper entitled: Ang Nawalang Ilaw ng Tahanan: Examining the Lived Experiences of Filipino Women in the Live-In Caregiver Program (Trans: The Missing Light of the Home) attempts to shed light on the experiences of Filipino caregivers who worked under the Live-In Caregiver Program. Most importantly, it investigates the interlocking issues of race, ethnicity, and gender and how these became tools of oppression for these Filipino women.

“Honour thy father and thy mother”: the meaning of integrating migrant live-in caregivers for elderly in the Haredi society - challenges and barriers to culturally-sensitive interventions

ABSTRACT Background and Purpose This study seeks to examine the complexities of integrating migrant live-in caregivers for elderly in the Haredi society from the lens of elderly’s family members. The main research questions were – what is the meaning of integrating migrant live-in caregivers for elderly in the Haredi society, and what are the implications of these meanings for developing policies and interventions? Materials and Methods This phenomenological study included 15 adult family members of elderly people from the Haredi society who receive around-the-clock homecare from migrant caregivers. Data was collected through in-depth, semi-structured interviews. Results Three themes emerged from the interviews: The motives of family members to become the prime caregivers for their parents; The encounter between the values of the Haredi family and migrant live-in caregivers; The commandment to honour one’s parents, and whether the integration of a migrant caregiver is implementing this commandment. Conclusions and Implications Results shed light on family members’ attitudes, perceptions and interactions in a phenomenon not yet explored. The importance of these results is highlighted considering the potential conflict between the Haredi society as a faith-based community and migrant live-in caregivers. The results could help develop a culturally-sensitive social policy for faith-based societies.

Praca poza granicami kraju w doświadczeniach edukacyjno-zawodowych jednostki (na przykładzie polskich całodobowych opiekunek/opiekunów osób starszych w Niemczech). Wybrane wyniki badań sondażowych

As a response to social needs, the job of a round-the-clock live-in caregiver for the elderly is a type of employment that requires mobility in the demanding labour market. The cause for this has been a rapidly growing demand for senior care. In the German market, caregiver’s work is particularly often carried out by migrant workers, including Polish nationals. As a Poland’s close neighbour sharing broadly the same cultural background, Germany has become for many Poles a potential labour market. A bilateral survey was carried out to identify experiences, earlier educational and occupational paths, motivations, opinions, evaluations, and attitudes of respondents employed as migrant live-in caregivers in German households. The sample consisted of 119 individuals. The survey results demonstrate that the respondents view their occupation as caregivers as, on the one hand, a source of income and an escape from financial hardship and, on the other hand, a challenge that allowed them to prove their value and satisfy the need to be useful. Working as caregivers, they learn and develop their interpersonal skills (relations with other people, patience, humbleness) and intramental skills (reflections on the transience of human life, the old age, handling the death and loss).

Quality of Life and Anxiety Levels in Latin American Immigrants as Caregivers of Older Adults in Spain.

Increased life expectancy in Spain has highlighted the need for formal caregivers who care for older adults who live at home. In many cases, families choose to hire immigrants from Latin America who, on many occasions, have been forced to emigrate, which causes a considerable psychological impact on them. To this, other factors such as precarious working conditions, loneliness, or high workload are added, which leads to many caregivers becoming sick. The aim of this study was to assess the quality of life and the level of anxiety derived from the workload of Latin American immigrants who come to Spain to care for older adults. A descriptive cross-sectional study was carried out using two validated questionnaires to measure this relationship. A correlation was also established between quality of life and anxiety as expressed by the participants. The sample consisted of a total of 426 subjects. One of the main results showed that the lower the caregiver's quality of life, the higher their level of anxiety (OR = 1.06; 95% CI). Live-in caregivers had a lower quality of life than people who did not live in the same house as the cared-for person (OR = 2.22; 95% CI). Working long hours and having a high workload was associated with poorer quality of life and higher levels of anxiety. Assessing immigrants who are formal caregivers and providing them with the support that helps to improve their quality of life is suggested to reduce the occurrence of anxiety disorders.

“It was terrible, I didn’t sleep for two years”: A mixed methods exploration of sleep and its effects among family caregivers of in-home hospice patients at end-of-life

Background: Due to overnight caregiving demands; exacerbation of high rates of anxiety, depression, and distress; and inadequate support, millions of family caregivers of patients receiving in-home hospice are at risk of poor sleep and negative health effects. Aim: To describe sleep experiences of family caregivers of in-home hospice patients and perceptions of these experiences on caregivers’ wellbeing in the context of caregiver health and live-in status. Design: Developed using the Symptom Management Model, this mixed methods study featured a concurrent nested design prioritizing qualitative reflexive thematic analysis. Setting/participants: About 47 family caregivers of in-home hospice patients from two randomized clinical trials (NCT03712410, NCT02929108) were interviewed (United States, 2021). Anxiety (GAD-7), depression (PHQ-9), quality-of-life (QOL) (CQLI-R), and self-rated health and energy were reported prior to interviews. Results: Qualitative analysis revealed three themes: compromised sleep quality, factors influencing sleep, effects of sleep. 72.5% of hospice family caregivers described “fair” or “poor” sleep quality, with “interrupted” sleep and frequent night-waking due to “on-call” “vigilance” and anxiety. Negative effects included exhaustion, mental and physical health decline, and reduced caregiver function. Live-in caregivers reported higher mean depression scores (8.4 vs 4.3, p = 0.08), higher mean anxiety scores (7.7 vs 3.3, p = 0.06), and lower mean QOL scores (24.8 vs 33.6, p < 0.001) than live-out caregivers. Anxiety, depression, and QOL worsened as self-reported caregiver sleep quality decreased. Few caregivers had adequate support. Conclusion: End-of-life family caregivers experience disrupted sleep with negative effects and inadequate support. Clinicians must assess sleep, offer sleep interventions, and provide more supports to hospice family caregivers.

Predictors of Quality-of-Care Provided by Migrant Live-In Caregivers of Frail older Persons: A Cross-Sectional Study.

We examined the association between employment-related characteristics and the quality-of-care migrant live-in caregivers provide to older care-recipients. Structured interviews were conducted with 115 migrant live-in caregivers, 72 older care-recipients, and 117 relatives of care-recipients. We conducted correlations among dependent (quality-of-care), independent (quality of relationship between caregiver and informant, caregiver perception of work, and problematic employment conditions), and demographic variables, and performed a path analysis by conducting a series of multiple regressions. Quality-of-care was most highly correlated with quality of relationship between informant and caregiver. Quality of relationship was predicted by caregiver perceptions of work, which was negatively predicted by problematic employment conditions. In the relatives-based model, quality of relationship was significantly better when the care-receiver was female and the care-recipient needed more assistance with activities of daily living. The study clarifies the role of caregiver work characteristics for quality-of-care and highlights the crucial role of the relationship with the care-recipient.

COACH: Caring for Older Adults and Caregivers at Home

Dementia is a major cause of disability and dependency in older adults and it has a physical, psychological, social, and economic impact on the affected individual as well as their caregivers. Most Americans with dementia receive care from their family members, and friends2. Care giving is associated with an increased level of psychological distress and lower subjective well-being and physical health2; caregiver support groups have been found to reduce angry and depressive feelings, improve caregiver's skills, maintain favorable health behaviors and quality of life, and increase social support and satisfaction for caregivers3. There is often a strong preference to keep the affected individual at home for as long as possible; however, significant behavioral challenges and caregiver strain lead to placement in a long-term care facility4. COACH is an innovative, longitudinal, home-based dementia care program serving veterans with dementia and their caregivers. The program originated as a clinical demonstration project by the Geriatric, Research, Education and Clinical Center at the Durham VA Health Care System (DVAHCS) in 2010. It became a fully established, permanent program in 2012 and expanded to rural Eastern North Carolina in 2014. COACH is designed to improve quality of life for veterans with dementia and their caregivers, with the goal of helping veterans remain at home for as long as possible. The criteria for COACH include veterans enrolled in VAHCS who are 65 or more years of age with moderate to severe cognitive impairment and who have a live-in caregiver. Enrolled veterans cannot be in another home-based program and must live within 50 miles from the COACH team's home clinic. The process begins with a consult to the COACH program from any health care provider. Once the veteran and their care giver are screened and found eligible, a LCSW and a RN conduct a comprehensive assessment. This includes psychosocial assessment; home safety assessment; evaluation of patient's cognitive and functional abilities; evaluation of patient's behaviors; medication review; and evaluation of care giver stress, knowledge of dementia, coping abilities, screening for depression and family resources. RN and LCSW consult with an interdisciplinary team of a geriatrician, a geriatric psychiatrist, and a geriatric pharmacist weekly to develop a comprehensive treatment plan integrating best evidence-based practices. After the initial assessment, LCSW and RN conduct follow ups via home visits or video and telephone contact at one, three, and six months. Home visits continue every six months with quarterly follow-ups via video or telephone, and additional ad-hoc home visits as recommended by the interdisciplinary team or needed by the caregiver. The team provides ongoing support and education to caregivers in five major areas of care. 1. Behavioral symptoms management: focuses on non-pharmacological approaches like communication skills, reminiscence and validation techniques, behavioral activation 2. Safety: addresses any safety hazards that may affect the veteran like driving or falls. 3. Advance care planning: offers anticipatory guidance and education on advance directives and end of life care preferences. 4. Caregiver burden: offers ongoing support to caregivers, emphasizes self-care. 5. Dementia related medical concerns: Offers pharmacological recommendations for safety, appropriateness, and compliance; guidance on strategies to maintain functioning, assistance with activities of daily living, and cover needs for durable medical equipment in the home. To augment the educational interventions, the program offers weekly caregiver support groups and monthly educational series talks on dementia. In the last in the last ten years, the program has served nearly 1,200 veterans, with about 100 new veterans enrolled each year. It has demonstrated ability to improve dementia care at home, delay long-term care facility placement6, reduce caregiver burden, and improve safety at home5. COACH exceeds all national dementia performance measures5.

Effects of Acceptance and Commitment Therapy (ACT) on Mental Health and Resiliency of Migrant Live-in Caregivers in Canada: Pilot Randomized Wait List Controlled Trial.

BackgroundTemporary migrant live-in caregivers constitute a vulnerable stream of temporary foreign workers in Canada. This is because the majority are racialized women from the Global South, the gendered nature of caregiving work has historically been undervalued, and their working and living spheres are intertwined which makes application of labor laws and surveillance almost impossible. Their invisible position in the fabric of Canadian society along with their precarious employment and immigration status place their mental health at jeopardy. There is a paucity of research about psychological support for this population.ObjectiveOur pilot study Women Empowerment—Caregiver Acceptance and Resilience E-Learning (WE2CARE) aimed to assess the efficacy of a 6-week online delivery of a psychological intervention based on acceptance and commitment therapy (ACT) in reducing psychological distress and promoting resiliency among live-in care givers in the Greater Toronto Area.MethodsA pilot randomized wait list controlled design was used. Participants were recruited by two community peer champions working with community health organizations serving migrant live-in caregivers. A total of 36 participants were recruited and randomly assigned to the intervention and wait list control groups; 7 dropped out of the study due to competing life priorities. Standardized self-reported surveys were administered online pre-, post-, and 6-week postintervention to assess mental distress (DASS-21), psychological flexibility (AAQ-2), mindfulness (CAMS-R), and Multi-System Model of Resilience (MSMR-I). Independent and dependent t tests were used to compare study outcomes at pre, post, and 6-week follow-up across and within both arms of the study. Linear mixed effects models were created for each outcome of interest from baseline to postintervention among intervention and control participants. Self-reported impact of the WE2CARE intervention was examined using independent t tests across the study arms.ResultsAverage age of participants was 38 years. Many were born in the Philippines (23/29, 79%). The data on the impact of the psychological intervention showed a lower level of depression, anxiety, and stress among the intervention group compared with the control. However, the differences were not significant due to small sample size and COVID-19 crisis (6.94 vs 9.50, P=.54; 6.94 vs 10.83, P=.20; 7.76 vs 10.33, P=.44, respectively). There was a significant improvement in mindful qualities and external resilience, particularly in life satisfaction and accessible support among the intervention group (37.18 vs 32.92, t22=2.35, P=.03; 20.29 vs 16.5, t21=2.98, P=.007; 8.47 vs 6.75, t14=2.41, P=.03; 7.59 vs 5.33, t16=.008, respectively).ConclusionsWE2CARE is among the first studies exploring the efficacy of online delivery of ACT in addressing mental health challenges among live-in caregivers. While there are increased web-based ACT interventions, few use group videoconferencing to promote peer connection and mutual support. WE2CARE showed promising results in reducing psychological distress and promoting mindfulness and resiliency. The intervention highly motivated participants to engage collectively in building social support networks.International Registered Report Identifier (IRRID)RR2-10.2196/preprints.31211

The Qibla—a never-ending story of migration, runaway, and pilgrimage

ABSTRACT The Qibla, written by the female playwright Wan-Ting Shen, is the title of the Best Play of the 2015 Taiwan Literature Award. This play, directed by Dong-Ning Hsieh, Artistic Director of Voleur du Feu Theatre, had its premiere in 2017. In her play, Shen portrays the interaction between a live-in foreign caregiver called Nadie and a Granny who suffers from Alzheimer and lives in the countryside. The purpose of this paper is to examine the three major motifs ─ migration, runaway, and pilgrimage ─ that are central to the play’s textuality and theatricality. The script and performance analysis of The Qibla are highlighted while a socio-economic and political background regarding the foreign migrant workers is provided so as to give the play a proper context. Since the three main characters, Nadie, Granny, and V-Rod, are all female subalterns who live on the margin of a society called the ‘Ocean State,’ this paper attempts to employ an anti-essentialist viewpoint derived from subaltern studies to investigate the social and biopolitical issues exposed in the play. In conjunction with this viewpoint, this paper intends to adopt the Brechtian reading to interrogate Hsieh’s directing approach and Shen’s dramaturgy.

Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol.

BackgroundPsychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status.ObjectiveThe Women Empowerment - Caregiver Acceptance & Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants’ satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined.MethodsA total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale – Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program.ResultsWE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021.ConclusionsWE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations.International Registered Report Identifier (IRRID)DERR1-10.2196/31211

From Fragility to Empowerment through Philanthropy: The Filipino Labor Migrant Community in Israel During COVID-19

Lockdown in response to the spread of COVID-19 is a challenging period for migrant laborers. This study used a mixed-methods approach to explore how a community of Filipino migrants working as live-in caregivers in Israel coped with the lockdown. Philanthropy for Filipinos in need in Israel and back home was found to be an effective coping mechanism. While lockdown conditions increased the fragility of the marginalized migrant workers, their ability to donate funds empowered them at both individual and communal levels. Developing a donor identity reinforced their sense of belonging to the Filipino community in Israel and back home.

Does Care Count for Less? Tracing the Income Trajectories of Low Status Female Immigrant Workers in Canada, 1993–2015

Canada has long relied on women from poorer countries to fill gaps in its paid care market. Yet little is known about the upward or downward trajectories of immigrant women who arrive intending to work in lower status jobs in care. Using a unique administrative dataset (the Longitudinal Immigration Database), the author estimates a series of growth curve models of employment income for 220,265 non-professional, non-managerial immigrant women working in Canada between 1993 and 2015. Results reinforce prior suggestions of a “care [wage] penalty”, as all intended care workers, besides nurse aides, fare worse over two decades in the labour market than comparable intended non-care workers. Yet entry class is also found to play a role. Women who arrive to Canada though the Live-in Caregiver Program--which has the explicit goal of providing in-home care for children, the elderly, and people with disabilities--have higher employment income than comparable immigrant women reporting the intention to work in homecare who entered via the family reunification and economic immigration streams.

Inclusion and beauty pageants? The Filipino migrant worker community in Israel

Beauty pageants held by immigrant groups in their host country, or diasporic beauty contests, are a fascinating global phenomenon. While previous studies have mainly explored this practice within permanently settled immigrant communities, there is a dearth of research regarding beauty contests in communities of migrant workers. Based on a seven- year fieldwork in the Filipino community in Israel, this study asks why beauty pageants have become such a prominent event among migrant workers employed as live-in caregivers. Involving candidates from both genders, these events were found significant for migrant workers at the personal, communal and transnational level. The uniqueness of these pageants lies in their inclusive effect, as it is expressed on every level. Unlike the construction of a Western ideal of gendered beauty from which the majority is excluded, diasporic beauty contests offer every migrant worker the opportunity to participate. Thus, becoming a platform for social inclusion and allowing live-in migrant workers to become visible and respectable.

Mind the caretaker: ED referrals of community-dwelling older adult patients by their primary caregivers are accurate.

ED referral of older adults on the initiative of their family or paid live-in caregiver is common but not previously studied. ED-presenting community-dwelling patients ≥65 years were studied, emphasizing the referring agent, and correct (admitted or discharged +changed diagnosis/treatment) vs. incorrect referral (discharged, no change made). Of 448 consecutive patients (median age 83 years), 231 were referred by their primary physician (PCP) (73% admitted, 17% discharged +change). 117 ED referrals were initiated by their family (78% admitted, 6% discharged +change), and 100 by their paid caregiver (66% admitted, 21% discharged +change). Differences were non-significant, as was the distribution of main diagnoses. ED referral of older adults from the community by laymen who know the patient well (family or caregiver) is non-inferior to a referral by their PCP. ED physicians should regard non-physician ED presentations as seriously as a referral by a physician, pending confirmation in future studies.

Brief telephone intervention for caregivers of medically complex patients during COVID-19

The VA Home Based Primary Care (HBPC) program consists of an interdisciplinary team, including psychology, serving veterans with complex medical conditions who are supported by live-in caregiver(s). HBPC psychologists may work with caregivers to address caregiver stress. Some veterans enrolled in HBPC attend Adult Day Care (ADC) programs, allowing respite for caregivers. At the onset of COVID19 pandemic, ADC centers closed to minimize spread of the virus. The authors identified these caregivers to be at high risk for burnout and sought to develop a protocol to assist these caregivers via telephone and evaluate outcomes. PreCOVID-19 caregiver stress was known via a 4-item Zarit Caregiver Burden annual screening (Bédard et al., 2001). Following ADC closures, caregivers of veterans enrolled in ADC programs were contacted and re-administered the Zarit to determine impact of COVID-19 on caregiver stress. Caregivers of veterans not attending ADC were also contacted for comparison. Contacted caregivers were provided a brief CBT-based intervention via telephone, and post-intervention Zarit screening was administered after two weeks. Ultimately, 4 ADC caregivers and 4 non-ADC caregivers were contacted and provided with services before ADC centers reopened. Statistical analysis via mixed model ANOVA did not yield significant results, likely due to small sample size, although there was a large effect size (η_p^2 =.566). ADC caregivers generally reported increased stress from baseline following ADC closure and reduced stress following provision of intervention. The authors will present caregiver feedback about aspects of telephone intervention that were helpful, and not helpful, as well as authors impression.

Cuidar de idosos não autossuficientes na Itália: de um sistema famílístico ao modelo de trabalhador corresidente imigrante

The aim of the article is to describe the specificities of the aging phenomenon in Italy and the social policies for non/self-sufficient elderly people, highlighting both the change from a model that relied heavily on a family system to a model based on co-resident immigrant workers to care for the elderly, and the contradictions of this new model. While in Italy the percentage of older people and very older is the highest in Europe, social policies for them involve a limited offer of home and residential services and widespread allowances. At the same time, in Italy, the rise of the aging population has been intertwined with the transformation of family structures, the increase of female employment, the lower capacity of families to take care of their non-self-sufficient relatives, and the improvement of older people’s economic conditions. Due to these changes, a new care model has been established in the past two decades, based on the employment of live-in caregivers, usually immigrant women, so-called ‘badanti’, who are hired and paid by the caretakers and their family. This model has led both caregivers and caretakers to experience a double dependency and a double solitude, which question its sustainability and the familistic nature of the system. This paper presents both demographic and economic data from institutional sources, and the regulatory framework on social policies, and, finally, the data that emerge from various research on immigration.