Nurses Providing Care at Home and at Work:Investigating the Impact ofDouble Duty CaregivingJanice Keefe, Ph.D.Professor, Mount Saint Vincent UniversityDirector, Nova Scotia Centre on AgingLena Isabel Jodrey Chair in GerontologyPresentation to the College and Association of Registered Nurses of AlbertaMay 15th, 2013
AcknowledgementsThe Research Team:Western: Dr. C. Ward-Griffin (PI), Dr. M. Kerr, & Dr. J. Belle-BrownUniversity of British Columbia; Dr. A. Martin-MatthewsMount Saint Vincent University; Dr. J. KeefeOur Partners:Our Funders: Canadian Institutes of Health Research.Provincial Collaborators:BC: Ministry of Health, BC; ARNBC; Northern HealthONT: RNAO; ONA; MHLTC, Ontario;NS:CRNNS; Ministry of Health, NS; College of LPNNSNational Collaborators:Federal: Health Canada; Human Resources & SkillsDevelopment Canadian Nurses’ Association;Canadian Federation of Nurses’ Unions; VONCarers : Canadian Caregiving Coalition
Overview1) Significance of FAMILY AND WORK BALANCE forDouble Duty Caregivers (DDC)2) What We Know About DDC Introduction to DDC DDC Prototypes DDC Process: Striving For Balance Effects Of DDC3) Policies to Support Caregivers – The Great Debate4) Recommendations for the Future
Caregiving in Canada• ~4M Canadians aged 45+ provided care for a senior in previous year .• 75-80% of care provided to older adults is provided by family/friend caregivers.The Future of Caregiving:• Long term - decreased number of children• Narrowing mortality gap= more older spouses caring• Short term - more adult children affected by:• Women’s participation in the paid labour force• Mobility patterns• In rural areas - Out-migration of youth;access to supportive services• In urban areas - Increased cultural diversity• Length of care & sustainability
Work and Caregiving - Double Duty Caregiving % of 45 + who combine work and care Double duty caregivers are individuals whoprovide care both at work (e.g. nurses, physicians)and at home (e.g. family caregivers of olderrelatives). Located at the intersection of two competingdomains, health care labour force and family carework ., (DDC) often negatively affects the healthand lives of double duty caregivers. Our research – multi- method approach of RNs –from Colleges in BC, Ontario and Nova Scotia
Double Duty Caregiving (DDC) Model*PersonalCaregivingProfessionalCaregivingCaregivingInterfaceExpectationsSupportsWard Griffen, Keefe, et al, 2009, Journal of Nursing Research, 41(3) 108-28
DDC PROTOTYPESMaking it Work Working to ManageExpectationsExpectationsExpectationsSupportsSupportsSupportsLiving on the Edge
The DDC Conceptual Model (2011)ExpectationsResourcesSetting LimitsMakingConnectionsStriving forBalanceMaking It WorkWorking To ManageLiving on the EdgeReaping BenefitsTaking a TollCaregivingInterface
Because I had to take time off, I mean for mymom, so I mean that’s basically impacting onmy patient care because I’m not there. So Imean um…I think in one case they replacedme but I think in the other case they couldn’tfind anybody, so its basically left them shortstaffed [and feeling guilty]. So yes that isimpacting on my patient care. ..
Comparison of Study Sample with all Canadian NursesDOUBLE DUTY NURSES CIHI NURSE DATA – 2008Sex:Females: 43.7%Males: 56.3%Sex:Females: 94.0%Males: 6.0%Work Status:Full Time: 83% (DDCs); 85% (non-DDCs)Part Time: 17% (DDCs); 15% (non-DDCs)Work Status:Full Time: 56.6%Part Time: 31.8%Casual:10.5% (1.1% unknown)Age:< 45: 19%45-54: 60%55+; 31%Age:< 45 : 45.5%45-54: 32 %55+: 22%
Four Caregiving Groups Were CreatedRegisteredNursesMale269 – 47%DDCs117 – 44%Making itWork81- 30%Working toManage71 – 26%Living on theedge299 53%Non-DDCsFemale214 -27%DDCs83 – 39%Making it work74 -35%Working toManage57- 27%Living on theedge569 – 73%Non DDCs
Measurement ToolsDDC Scale (33-items) (Used to develop groups)– Measures five aspects of DDC: ‘expectations’, ‘supports’, ‘setting limits’, ‘making connections’and ‘caregiving interfaceCaregiver Well-Being Scale (short version) (16-items)– Measures caregiver satisfaction of ‘needs’ and ‘activities’SF-12v2 (12-items)– Measures the perceptions and activities of (physical and mental) health and well-beingMaslach Burnout Inventory (22-items)– Measures burnout as it relates to ‘emotional exhaustion’, ‘cynicism’, and ‘professional efficacy’.
Mental Health of Four Caregiving Groups (SF-12)
Physical Health of Four Caregiving Groups (SF-12)
Well Being: Level of Satisfaction with CaregivingActivities by Four Caregiving Groups (CWS)
Well Being: Level of Satisfaction with CaregivingNeeds by Caregiving Groups (CWS)
Burnout (Exhaustion) by Caregiving Groups(MBI)00.511.522.533.54Non-DDCsMaking ItWork Working toManage Living onthe Edge126.96.36.199.3Exhaustion
Burnout (Cynicism ) By Caregiving Groups (MBI)00.511.522.53Non-DDCsMaking ItWork Working toManage Living on theEdge188.8.131.52.4Cynicism
Burnout (efficacy) by Caregiving Groups (MBI)5.05.34.9 4.80123456Non-DDCs Making It Work Working toManageLiving on theEdgeEfficacy
Key Findings from the SurveySample is older than general population of Nurses in CanadaMale Nurses were oversampled and report more negative healthoutcomes than Female NursesDouble Duty Caregivers comprised a higher proportion of NS nursesample compared to Ontario and British ColumbiaMaking it Work, double duty caregivers were more healthy (physical andmental and had less burnout than Non – DDCs)Those Working to Manage and Living on the Edge reported more negativehealth outcomes than Making it Work or non DDCs
Health Experiences of DDCsThe results from Phase I resonate with the preliminary findings from Phase II in the following ways:• DDCs in the ‘making it work’ prototype described health enhancing experiences of caregiving.• DDCs in the ‘working to manage’ prototype described the fine balance between healthenhancing and health threatening caregiving experiences.• DDCs in the ‘living on the edge’ typology described how their health deterioratedMaking ItWorkWorking toManageLiving on theEdgeHealth EnhancingHealth Threatening
Where do I start? :Policies/programs to support caregiversFederal• Compassionate CareBenefit•Tax reliefPrivate• Home support services• RespiteCommunity• Voluntary organizations• Advocacy and support groupsProvincial• Home care, respite, allowance• Tax relief• Education, information
Should Policies be Directed at Caregiversor Care Receivers or Both?Caregiver Care ReceiverIncomeSecurity:CashPaymentEmploymentLabourWorkplaceIncomeSecurity:- Pension- TaxationInformationand EducationHome CareSupport:RESPITEIncomeSecurity:DirectPaymentsContinuing CareServices:HomeCare/SupportEnhancedIndependence:Assist. Devices;Health Promo;Pharma;
The Scope of Policies To Support CaregiversPublic OR Private*Federal *Workplace*Provincial *Collective Agreements*Municipal *Professional RegulationsBut, How Do WeView Caregivers? As a resource? As a client? As a partner-in-care?
NOW WHAT ??Some fundamental questions to consider: Caregiver or Care Receiver ? All Caregivers or Nurse Caregivers ? Employment domain; professional ? Incrementalist Approach or Rationale ? Economic or Social Values ? Government or Private Workplace ?
A CALL TO ACTION:Policy Partners Enhancing Work Place Supports Enhancing Home/Community Based Supports
6. Income Security Direct Financial Support: Caregiver payment/allowance Pension Schemes Reduced penalty for dropout State pays pension credits Taxation System Inclusion of care expenses Expansion of Tax Credits Social Security State pays employment/sickness insurance1. Health/Continuing Care Respite care/Home care Recognize caregivers as a client Assess caregiver needs2. Employment/Labour Leave policy – Employment Insurance Labour Standards policy3. Health Human Resources Training and standards Improve working conditions4. Caregiver Recognition5. Immigration
Recommendations for Enhancing Workplace Supports1. Converse with double duty caregivers in their workforce.2. Conduct a comprehensive review of the currentsupports/strategies relevant to double duty caregivers.3. Collaborate to identify the ways in which DDC impactsproductivity, and labour force participation.4. Continue to work collectively with all levels of government toretain older workers.5. Enhance workplace supports and HR policies that recognizeand support double duty caregivers and create caregiver-friendly workplaces.
Recommendations for EnhancingHome/Community Supports for Caregivers1. Achieve measurable outcomes in the improvements tofamily/friend caregivers.2. Adopt a Caregiver Recognition Act.3. Continue the development of National Best Practices inhomecare.4. Lobby government to institute caregiver rights thatrecognize the value of caregivers’ unpaid labour.
Thank You for Your InterestContact Information:E-mail: Janice.Keefe@msvu.caTelephone: (902) 457-6466Website: www.msvu.ca/mdcPOLICY http://www.uwo.ca/nursing/cwg/docs/PolicyBrieffinal.pdf
AcknowledgementsThe Research Team:University of Western Ontario; Dr. Catherine Ward-Griffin (PI),Dr. Mickey Kerr, & Dr. Judy Belle-BrownUniversity of British Columbia; Dr. Anne Martin-MatthewsMount Saint Vincent University; Dr. Janice KeefeFunding for this research was provided by theCanadian Institutes of Health Research.