"We Really Help, Taking Care of Each Other": Older Homeless Adults as Caregivers.

Objectives:Many older homeless adults maintain contact with family. We conducted a qualitative study examining the role of family caregiving for older homeless adults. Method:We conducted semi-structured qualitative interviews with a sample of 46 homeless participants who reported spending at least one night with a housed family member in the prior 6 months. Results:A total of 13 of 46 older adult participants provided caregiving. Themes included (a) the death of the care recipient led to the participant's homelessness; (b) feeling a duty to act as caregivers; (c) providing care in exchange for housing; (d) caregivers' ability to stay was tenuous; (e) providing care conflicted with the caregiver's needs; and (f) resentment when family was ungrateful. Discussion:In a sample of older homeless adults in contact with family, many provided caregiving for housed family. For some, caregiving precipitated homelessness; for others, caregiving provided temporary respite from homelessness, and for others, caregiving continued during homelessness

Psychometric Evaluation of the Shared Care Instrument in a Sample of Home Health Care Family Dyads

Researchers have studied negative effects of caregiving on a family caregiver; however, less is known about positive aspects of exchanging assistance for both members of a family caregiving dyad. In a previous naturalistic inquiry the author indentified a basis for studying caregiving interactions was a construct called shared care. The three components of shared care identified in the naturalistic inquiry were communication, decision making, and reciprocity. The Shared Care Instrument (SCI) was developed to measure the construct. The purpose of this study was to assess the psychometric properties of the SCI, and to assess its construct and criterion-related validity. A sample of home care family dyads (110 patients and 109 family members) returned usable survey questionnaires. Results indicated the Cronbach’s alphas for the patient group for the SCI subscales ranged from .78 to .84, and .77 to .79 for family members. Factor analysis supported the underlying theoretical basis and factor structure of the SCI. Criterion-related validity was also supported. Therefore, the results of this study provide initial evidence for the reliability and validity of the SCI for use with family caregiving dyads. The findings support the need for additional testing of the SCI

Family Caregiving to the Older Population: Background, Federal Programs, and Issues for Congress

[Excerpt] Family caregiving to older individuals in need of long-term care encompasses a wide range of activities, services, and supports. Caregiving can include assistance with personal care needs, such as bathing, dressing, and eating, as well as other activities necessary for independent living, such as shopping, medication management, and meal preparation. In addition, family caregivers may arrange, supervise, or pay for formal or paid care to be provided to the care recipient. Family caregivers fulfill the majority of the need for long-term care by older persons with chronic disabilities in the United States. As a result of increases in life expectancy, as well as the aging of the baby-boom generation, demand for family caregiving to the older population is likely to increase. However, demographic trends such as reduced fertility, increased divorce rates, and greater labor force participation among women may limit the number of available caregivers to older individuals, as well as the capacity for caregivers to provide needed care. Although many family caregivers find caregiving for an older family member a rewarding experience, other life circumstances, in addition to caregiving, may increase caregiver stress. For example, family members may not live in close proximity to the care recipient, they may face the competing demands of child care and elder care, and they may have to manage work with caregiving responsibilities. As a result, family caregiving can lead to emotional and physical strain and financial hardship. These effects are more likely to be felt among those caring for persons with high levels of disability or cognitive impairment. Caregiver stress has been linked to nursing home admission for the care recipient, thus interventions that can reduce stress may also reduce nursing home placement. Recognizing family caregivers as an important part of the nation\u27s long-term care delivery system, the federal government has established programs and initiatives that provide direct supports to caregivers, such as respite care, education and training, tax relief, and cash assistance. These benefits are targeted at family caregivers to reduce stress and financial hardship, and to improve caregiving skills, among other things. Other federal programs and initiatives provide home- and community-based long-term care services and supports to the care recipient. These programs can indirectly benefit caregivers in relieving caregiver burden by either supplementing the informal care they are providing or substituting with paid support. Three sets of policies that would provide direct assistance to family caregivers to older adults are briefly discussed in the last section of this report. These policy issues, which have been the subject of discussion among federal policymakers and other interested stakeholders, include the following: caregiver services and supports, flexible workplace accommodations and income security, and additional tax credits. This report will be updated as warranted

Shared Caregiving Responsibilities of Adult Siblings with Elderly Parents

This paper uses a nonstructural, ordered discrete choice model to measure the effects of various parent and child characteristics upon the independent caregiving decisions of the adult children of elderly parents sampled in the 1982 and 1984 National Long Term Care Survey (NLTCS). While significant effects are noted, emphasis is placed on test statistics constructed to measure the independence of caregiving decisions. The test statistic results are conclusive: the caregiving decisions of adult children are dependent across time and family members. Structural models taking dependencies among family members into account note effects similar to those in the nonstructural model.

The Experience of Family Caregiving Following Residential Aged Care Placement: An Exploratory Study

This thesis presents the findings of a study of 20 family caregivers of frail elderly residents of an Australian aged care facility. The participants were partners, adult children and nieces of the residents. The study used Interpretive Phenomenological methodology to explore the question, What is the experience of caregiving following placement? Semi-structured interviews with participants were used to gather data, which were analysed using Thematic Network analysis (Attride-Sterling, 2001). The participants were confronted by changes in their relationships with their relatives due to their relatives’ illnesses, frailty and placements in residential care. The participants adjusted their caregiving in the new setting by reconstructing their caregiving relationships. They used caregiving tasks and caregiving rituals to maintain a connection with their relatives which preserved their relatives’ well-being. When reconstructing their caregiving relationships, the participants aspired also to preserve their own health and well-being. The participants’ synthesis of preservative caregiving and self-preservation in a reconstructed caregiving relationship is interpreted in this thesis as caregiver intimacy. The participants experienced caregiver intimacy as a familial relation. They reconstructed their caregiving as reconstructed family caregiving following placement; when coordinating their own caregiving with care provided by residential care staff they reconstructed their caregiving as extended-family caregiving following placement. Reconstructed family caregiving and extended family caregiving are adaptations of the caregiving relationship which preserve caregiver intimacy following placement. The finding that most of the participants felt that they had preserved their relatives’ well-being whilst minimising the burdens of caregiving following placement represents a new contribution to the understanding of caregiving. Since caregiving following placement is expected to become increasingly prevalent as populations age worldwide, understanding the experience of caregiving following placement as an experience of intimacy has potential to transform our understanding of caregiving in an ageing society

Family Location and Caregiving Patterns from an International Perspective

This paper conducts a cross-national econometric analysis of intra-family location and caregiving patterns. First, we assess, from an international perspective, the relationship between family structure and the geographic proximity between adult children and their parents. We then examine whether differences in family structure affect the amount of informal care adult children provide to their elderly parents. Lastly, we look for cross-country differences in family location and caregiving patterns, and interpret observed differences in terms of heterogenous institutional solutions to the long-term care problem. Our results not only provide a new empirical perspective on the geography of the family, but also give interesting insights into how family-related and institutional factors shape patterns of time transfers from adult children to elderly parents.geography of the family, child-to-parent time transfers

Family Location and Caregiving Patterns from an International Perspective

This paper conducts a cross-national econometric analysis of intra-family location and caregiving patterns. First, we assess, from an international perspective, the relationship between family structure and the geographic proximity between adult children and their parents. We then examine whether differences in family structure affect the amount of informal care adult children provide to their elderly parents. Lastly, we look for cross-country differences in family location and caregiving patterns, and interpret observed differences in terms of heterogenous institutional solutions to the long-term care problem. Our results not only provide a new empirical perspective on the geography of the family, but also give interesting insights into how family-related and institutional factors shape patterns of time transfers from adult children to elderly parents.geography of the family, child-to-parent time transfers

Relationship of Preparedness and Burden among Family Caregivers of Cancer Patients in India

Introduction: Caregiving is a demanding physical and emotional journey, but most family caregivers assume the role with limited caregiving skills and few resources that may lead to increased levels of stress and feelings of inadequacy causing caregiver to view their role as burdensome. In an effort to understand the negative consequences of caregiving, the present study is aimed at finding the relationship of preparedness for caregiving and burden among family caregivers of cancer patients. Methods: An exploratory, co-relational, cross sectional survey assessed 225 eligible family caregivers of cancer patients undergoing chemotherapy and radiation therapy in selected hospital of Punjab. Measures involved Socio demographic Data Sheet, Caregiver Reaction Assessment (CRA), and Preparedness for Caregiving Scale. Data were analyzed using descriptive statistics and Independent t-test, ANOVA and Pearson’s correlation. Results: Preparedness for Caregiving had moderate negative correlation with burden at 0.01 level of significance (r= -0.531**). Female caregivers and those having sufficient unpaid help in caregiving responsibility had high level of perceived preparedness for caregiving. Burden was high in those caregivers who had no help in caregiving responsibility and belonged to other district (more distance from treatment center). Conclusion: Study concluded that low perceived Preparedness for Caregiving results in high burden. Oncology nurses should take the measures to increase the preparedness for caregiving among family caregiver of cancer patients. Study findings also warrant early assessments of caregiver preparedness so that supportive interventions may be targeted to the caregivers who are at risk of poor outcome. Keywords: Preparedness for Caregiving, burden, family caregiver, cancer

Impact of long-hours family caregiving on non-fatal coronary heart disease risk in middle-aged people: Results from a longitudinal nationwide survey in Japan

AimThe effects of family caregiving, especially long-hours caregiving, on coronary heart disease (CHD) are debatable. We examined the impact of family caregiving on incident non-fatal CHD.MethodsWe used data from the Longitudinal Survey of Middle-Aged and Elderly Persons from 2005 to 2010, a nationwide panel survey for Japanese people aged 50–59 years in 2005 (baseline). After we excluded non-respondents and people with missing key variables at baseline, 25 121 individuals without CHD, stroke or cancer were followed up for a mean of 4.6 years. The exposure was assessed at baseline by three indicators: (i) family caregiving; (ii) hours spent caregiving; and (iii) kinship type of care recipient. The non-fatal CHD incidence was identified according to questionnaire responses from 2006 to 2010.ResultsCox\u27s proportional hazards analysis did not show a statistically significant association between family caregiving and incident non-fatal CHD (hazard ratio [HR] 1.13, 95% confidence interval [CI] 0.92–1.40). Caregivers who spent 20–69 h per week on care showed a statistically significant increased risk for non-fatal CHD (HR 1.78, 95% CI 1.23–2.58) compared with non-caregivers; whereas this increased risk was statistically significant only among women (HR 1.98, 95% CI 1.27–3.08), but not among men (HR 1.35, 95% CI 0.67–2.71). Kinship type of care recipient did not make a significant difference to the effects of family caregiving on incident non-fatal CHD.ConclusionsLong-hours family caregiving could be an independent risk factor for incident non-fatal CHD among middle-aged women in Japan. Geriatr Gerontol Int 2017; 17: 2109–2115

Caregiving experiences predict changes in spiritual well-being among family caregivers of cancer patients

OBJECTIVE: Although enhanced spiritual well-being has been linked to positive mental health outcomes among family caregivers of cancer patients, little is known regarding predictors of spiritual well-being in this population. The current study aimed to examine caregiving experiences as predictors of change in family caregivers' spiritual well-being during the initial months following the patient's cancer diagnosis. METHODS: Seventy family caregivers of newly diagnosed cancer patients (74% female, mean age = 59 years) participated in this longitudinal survey. Caregivers completed baseline questionnaires shortly before staying with the patient at an American Cancer Society Hope Lodge. Baseline questionnaires assessed caregiving experiences (i.e., self-esteem related to caregiving, family support for providing care, impact of caregiving on finances, and impact of caregiving on one's schedule). In addition, caregivers' spiritual well-being (i.e., meaning in life, peace, and faith) was assessed at baseline and 4-month follow-up. RESULTS: In univariate analyses, all caregiving experiences studied were associated with one or more aspects of spiritual well-being at 4-month follow-up. However, in the multivariate analysis, the only caregiving experience associated with aspects of spiritual well-being at 4-month follow-up was caregivers' perceptions of family support. Specifically, lack of family support was associated with lower levels of meaning and peace. CONCLUSIONS: Findings point to the importance of family support in facilitating the search for meaning and peace shortly after a loved one's cancer diagnosis and suggest that interventions targeting caregivers' support system may enhance their spiritual well-being