Nurses Providing Care at Home and at Work:

Investigating the Impact of

Double Duty Caregiving

Janice Keefe, Ph.D.

Professor, Mount Saint Vincent University

Director, Nova Scotia Centre on Aging

Lena Isabel Jodrey Chair in Gerontology

Presentation to the College and Association of Registered Nurses of Alberta

May 15th, 2013

Acknowledgements

The Research Team:

Western: Dr. C. Ward-Griffin (PI), Dr. M. Kerr, & Dr. J. Belle-Brown

University of British Columbia; Dr. A. Martin-Matthews

Mount Saint Vincent University; Dr. J. Keefe

Our Partners:

Our Funders: Canadian Institutes of Health Research.

Provincial Collaborators:

BC: Ministry of Health, BC; ARNBC; Northern Health

ONT: RNAO; ONA; MHLTC, Ontario;

NS:CRNNS; Ministry of Health, NS; College of LPNNS

National Collaborators:

Federal: Health Canada; Human Resources & Skills

Development Canadian Nurses’ Association;

Canadian Federation of Nurses’ Unions; VON

Carers : Canadian Caregiving Coalition

Overview 1) Significance of FAMILY AND WORK BALANCE for

Double Duty Caregivers (DDC)

2) What We Know About DDC Introduction to DDC DDC Prototypes DDC Process: Striving For Balance Effects Of DDC

3) Policies to Support Caregivers – The Great Debate

4) 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 who

provide care both at work (e.g. nurses, physicians)

and at home (e.g. family caregivers of older

relatives).

Located at the intersection of two competing

domains, health care labour force and family care

work ., (DDC) often negatively affects the health

and 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*

Personal

Caregiving

Professional

Caregiving

Caregiving

Interface

Expectations

Supports

Ward Griffen, Keefe, et al, 2009, Journal of Nursing Research, 41(3) 108-28

DDC PROTOTYPES

Making it Work Working to Manage

Expectations Expectations

Expectations Supports Supports

Supports

Living on the Edge

The DDC Conceptual Model (2011)

Expectations

Resources

Setting Limits

Making

Connections

Striving for

Balance

Making It Work

Working To Manage

Living on the Edge

Reaping Benefits

Taking a Toll

Caregiving

Interface

Because I had to take time off, I mean for my mom, so I mean that’s basically impacting on my patient care because I’m not there. So I mean um…I think in one case they replaced me but I think in the other case they couldn’t find anybody, so its basically left them short staffed [and feeling guilty]. So yes that is impacting on my patient care. ..

Comparison of Study Sample with all Canadian Nurses

DOUBLE DUTY NURSES

CIHI NURSE DATA – 2008

Sex:

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%

Provincial and DDC Breakdown

Four Caregiving Groups Were Created

Registered Nurses

Male

269 – 47%

DDCs

117 – 44%

Making it Work

81- 30%

Working to Manage

71 – 26%

Living on the edge

299 53%

Non-DDCs

Female

214 -27%

DDCs

83 – 39%

Making it work

74 -35%

Working to Manage

57- 27%

Living on the edge

569 – 73%

Non DDCs

Measurement Tools

DDC Scale (33-items) (Used to develop groups)

– Measures five aspects of DDC: ‘expectations’, ‘supports’, ‘setting limits’, ‘making connections’ and ‘caregiving interface

Caregiver 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-being

Maslach 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 Caregiving

Activities by Four Caregiving Groups (CWS)

Well Being: Level of Satisfaction with Caregiving

Needs by Caregiving Groups (CWS)

Burnout (Exhaustion) by Caregiving Groups

(MBI)

0

0.5

1

1.5

2

2.5

3

3.5

4

Non-DDCsMaking It

Work Working to

Manage Living on

the Edge

2.6

2.2 2.5

3.3

Exhaustion

Burnout (Cynicism ) By Caregiving Groups (MBI)

0

0.5

1

1.5

2

2.5

3

Non-DDCsMaking It

Work Working to

Manage Living on the

Edge

1.7

1.3

1.9

2.4

Cynicism

Burnout (efficacy) by Caregiving Groups (MBI)

5.0 5.3

4.9 4.8

0

1

2

3

4

5

6

Non-DDCs Making It Work Working to

Manage

Living on the

Edge

Efficacy

Key Findings from the Survey

Sample is older than general population of Nurses in Canada

Male Nurses were oversampled and report more negative health outcomes than Female Nurses

Double Duty Caregivers comprised a higher proportion of NS nurse sample compared to Ontario and British Columbia

Making it Work, double duty caregivers were more healthy (physical and mental and had less burnout than Non – DDCs)

Those Working to Manage and Living on the Edge reported more negative health outcomes than Making it Work or non DDCs

Health Experiences of DDCs The 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 health

enhancing and health threatening caregiving experiences.

• DDCs in the ‘living on the edge’ typology described how their health deteriorated

Making It

Work

Working to

Manage Living on the

Edge

Health Enhancing

Health Threatening

Double Duty Caregiving:

NEXT STEPS

SUPPORTING DOUBLE DUTY CAREGIVERS: A POLICY BRIEF

http://www.uwo.ca/nursing/cwg/docs/PolicyBrieffinal.pdf

Where do I start? :Policies/programs to support caregivers

Federal

• Compassionate Care

Benefit

•Tax relief

Private

• Home support services

• Respite

Community

• Voluntary organizations

• Advocacy and support groups

Provincial • Home care, respite, allowance

• Tax relief

• Education, information

Should Policies be Directed at Caregivers

or Care Receivers or Both?

Caregiver Care Receiver

Income

Security:

Cash

Payment

Employment

Labour

Workplace

Income

Security:

- Pension

- Taxation

Information

and Education

Home Care

Support:

RESPITE

Income

Security:

Direct

Payments

Continuing Care

Services:

Home

Care/Support

Enhanced

Independence:

Assist. Devices;

Health Promo;

Pharma;

The Scope of Policies To Support Caregivers

Public OR Private *Federal *Workplace

*Provincial *Collective Agreements

*Municipal *Professional Regulations

But, How Do We

View 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 insurance

1. Health/Continuing Care Respite care/Home care

Recognize caregivers as a client

Assess caregiver needs

2. Employment/Labour Leave policy – Employment Insurance

Labour Standards policy

3. Health Human Resources Training and standards

Improve working conditions

4. Caregiver Recognition

5. Immigration

Recommendations for Enhancing Workplace Supports

1. Converse with double duty caregivers in their workforce.

2. Conduct a comprehensive review of the current

supports/strategies relevant to double duty caregivers.

3. Collaborate to identify the ways in which DDC impacts

productivity, and labour force participation.

4. Continue to work collectively with all levels of government to

retain older workers.

5. Enhance workplace supports and HR policies that recognize

and support double duty caregivers and create caregiver-

friendly workplaces.

Recommendations for Enhancing

Home/Community Supports for Caregivers

1. Achieve measurable outcomes in the improvements to

family/friend caregivers.

2. Adopt a Caregiver Recognition Act.

3. Continue the development of National Best Practices in

homecare.

4. Lobby government to institute caregiver rights that

recognize the value of caregivers’ unpaid labour.

Thank You for Your Interest

Contact Information:

E-mail: Janice.Keefe@msvu.ca

Telephone: (902) 457-6466

Website: www.msvu.ca/mdc

POLICY http://www.uwo.ca/nursing/cwg/docs/PolicyBrieffinal.pdf

Acknowledgements

The Research Team:

University of Western Ontario; Dr. Catherine Ward-Griffin (PI),

Dr. Mickey Kerr, & Dr. Judy Belle-Brown

University of British Columbia; Dr. Anne Martin-Matthews

Mount Saint Vincent University; Dr. Janice Keefe

Funding for this research was provided by the

Canadian Institutes of Health Research.