Work-Life Conflict in Canada in the New Millennium

Chapter Six

Caregiver Strain: A Primer

This Chapter provides a primer for interested readers on the fourth of the four forms of work-life conflict examined in the 2001 Balancing Work, Family and Lifestyle National Study -caregiver strain. The structure of this chapter is identical to chapters 3, 4 and 5. The first section offers a definition of this construct and quantifies its prevalence in Canada at this time. The chapter then goes on to identify the demographic and organizational factors that place employees at risk with respect to caregiver strain, articulate the consequences of high levels of this form of work-life conflict on employers, employees, families and Canadian society and look at how this form of work-life conflict can best be reduced.

Definition

Caregiver strain is defined as the perceptual aspect of feeling overwhelmed, overloaded or stressed by the pressures associated with the role of employed elder caregiver. Three types of strains associated with the care of an elderly dependent are recognized: physical strain, financial strain and the sense of being overwhelmed emotionally.

Prevalence

The findings with respect to the prevalence of caregiver strain are very similar to those observed with respect to family interferes with work. While the majority of the respondents to this survey (74%) rarely experience caregiver strain, 9% find elder care to be a strain (physically, financially and mentally) several times a week or daily, while 17% experience such feelings approximately once a week. In other words, approximately one in four working Canadians experience what can be considered to be high levels of caregiver strain.

A more detailed analysis of the data determined that respondents with high caregiver strain were more likely to say that elder care was overwhelming and a financial strain. It is difficult from these data to determine if these types of elder care issues lead to high caregiver strain or if people who put family first are more likely to find it a strain to continue to work (because they need the money) when they would prefer to stay at home and care for an elderly family member. Future research is needed to clarify this association.

Caregiver strain likely to increase over time

We cannot determine if the prevalence of caregiver strain has increased over time because this construct was not measured in 1991. The fact that both family interferes with work and the proportion of Canadians with elder care responsibilities have increased over the past decade would suggest that high caregiver strain has also become more common. We can also expect that this form of work-life conflict will increase dramatically over the next several decades as more employees become 'at risk' (the aging of the Canadian population means that more employees will take on elder care responsibilities).

Who is at risk with respect to caregiver strain?

A number of very strong conclusions with respect to the prediction of caregiver strain can be drawn from the 2001 data. Key conclusions are summarized below.

Caregiver strain is associated with life cycle stage

Data from the 2001 study reveal three key determinants of caregiver strain which are shared by male and female employees: non-work demands, life cycle stage and adult roles. All these factors point to the same underlying cause of caregiver strain-elder care.

This form of work-life conflict can be predicted with a great deal of certainty if we know an employee's life cycle stage. Employees who are older and in a life cycle stage that involves elder care are more likely to report high levels of caregiver strain, regardless of where they live, where they work, their income, job type, etc. This finding is not a surprise given that caregiver strain is defined as a strain from caring for an elderly dependent. Who can be expected to have the most problems with respect to the caregiver role? The data identify three groups of employees who can be considered to be at higher risk: those with elder care responsibilities, those in the sandwich group (i.e multigenerational caregiving responsibilities) and single caregivers. In other words, older employees' life cycles are more susceptible to have this form of work-life conflict

Most employees will experience caregiver strain over time

Second, this form of work-life conflict has little to do with the other socio-economic or socio-demographic predictors examined in this analysis. From this we can conclude that factors such as place of residence, income and job type have little to do with the amount of caregiver strain an employee will experience. Rather, it would appear that it is a function of the passage of time-and that employees will face this challenge when they reach a certain point in their lives when their parents require care, regardless of their other life circumstances.

The higher the demands at home, the greater the strain

Caregiver strain is positively associated with the time demands associated with looking after an elderly dependent (first) and having this form of responsibility (second). Family demands are a substantive predictor of caregiver strain. The greater the responsibility (i.e. only child, parent lives in home, siblings do not assume their share, lack of community support), the higher the level of this form of conflict. Non-work demands are a more powerful predictor of caregiver strain for men than for women.

Women report higher levels of caregiver strain than men

The data reviewed in this study are unequivocal - women are more likely to report high levels of caregiver strain than men regardless of job type, dependent care status or sector of employment. This gender difference can be largely explained by the fact that women are more likely than men to find elder care mentally 'overwhelming' and a physical strain. These findings are not surprising given the higher levels of role overload reported by the women in the sample and data showing that the women in the sample are more likely than the men (regardless of their job type or sector of employment) to have primary responsibility for elder care and spend more time per week in elder care.

Age of children at home provides a useful indicator of life cycle stage for women

Women with older children at home are more likely to report high caregiver strain. This finding can be explained by the fact that for women, biological limitations provide an upper limit on the age at which a woman can have children.

If you know the age of a female employee you can make an informed guess about her risk of experiencing caregiver strain and family interferes with work

The data indicate that knowing the age of female employees will give us valuable information with respect to the incidence of two forms of work-life conflict: family interferes with work and caregiver strain. The following picture for female employees in Canada emerges from our research. As working women age, the amount of care required by their children declines (as does family to work interference) as their children get older. At the same time, the amount of care required by their parents and in-laws increases with the age of the female worker (as does caregiver strain). These data indicate that women experience lower levels of these two forms of work-life conflict when their children are adolescents and their parents are still young enough to be independent. These findings also indicate that employers and policy-makers need to consider both child care and elder care roles when looking at work-life conflict for women.

Caregiver strain is not associated with work demands or organizational culture

Caregiver strain has a very different cause than the other forms of work-life conflict examined in this study, in that it is the only form of work-life conflict that has little to no link with work. The data indicate no association between the sectors of employment, community, socio-economic circumstances, work demands and work characteristics, and caregiver strain for either gender. Also of interest is the fact that caregiver strain is the only form of work-life conflict examined in this study that was not substantively associated with organizational culture. These results support our earlier conclusion that this form of work-life conflict is largely a result of an employee's progress through the life cycle stage (i.e. it has little to do with work culture or demands).

Women with higher levels of caregiver strain shift work to home

Work demands are not an important predictor of caregiver strain for men. Work demands are, however, significantly associated with this form of work-life conflict for women. Analysis of the 2001 data shows that women with higher levels of caregiver strain spend fewer hours at work per week and more hours performing supplemental work at home These data suggest that women with high levels of this form of work-life conflict try to fit their work demands around their caregiving obligations by leaving the office early (fewer hours in work per week) and bringing work home to complete (higher supplemental work at home or SWAH).

What are the consequences of high levels of caregiver strain?

Over one in four of the respondents to the 2001 survey reported high levels of caregiver strain. What impact do these high levels of strain have on employers, employees, families and Canadian society? Answers to these questions are summarized below.

Caregiver strain has a minimal impact on the organizational attitudes examined in this study

Caregiver strain does not have the same type of association with work outcomes, as was observed with role overload and work interferes with family. The association between caregiver strain and organizational commitment, job stress, job satisfaction, intent to look for a new job and view of the organization as a place to work, while statistically significant, is not substantive.

Employees with high levels of caregiver strain are more likely to be absent from work

From the organization's perspective, the main consequence of high caregiver strain is higher absenteeism due to elder care problems and physical, mental and emotional fatigue. Compared to their counterparts with low levels of caregiver strain, employees with high levels of caregiver strain are:

• 13 times more likely to have missed three or more days of work in the past six months due to elder care problems,
• 1.8 times more likely to have missed three or more days of work in the past six months due to physical, mental or emotional fatigue,
• 1.4 times more likely to have missed three or more days of work in the past six months (all causes combined), and
• 1.4 times more likely to have missed three or more days of work in the past six months due to ill health.

Employees with high caregiver strain were more likely to take time off to deal with elder care problems and because they were mentally, emotionally or physically fatigued. Particularly noteworthy is the only dimension of work-life conflict that is associated with absenteeism due to elder care problems. The strong link between caregiver strain and absenteeism is similar to what was observed with respect to family interferes with work. The data show, however, that the root causes of the absenteeism does differ between these two forms of work-life conflict, as those with high family interferes with work are more likely to miss work due to issues with respect to child care, while those with higher levels of caregiver strain are more likely to miss work due to elder care issues.

Cost of absenteeism due to high caregiver strain just over $1 billion per year

The data collected in the 2001 survey provided us with the opportunity to estimate the potential financial cost of work-life conflict to Canadian organizations. Our calculations (see Report Two) indicate that, in 2001 the direct costs of absenteeism due to high levels of caregiver strain was just over $1 billion per year. Indirect costs were estimated at another $1 to $2 billion). Our calculations also determined that employers could reduce absenteeism in their organization by 8.6% if they could eliminate high levels of caregiver strain.

What is the impact of high levels of caregiver strain on Canadian employees?

The impact of caregiver strain on Canadian employees is virtually the same as what was observed with family interferes with work. Employees with high caregiver strain were 1.5 times more likely than those with low caregiver strain to report high levels of perceived stress and burnout, almost twice as likely to report high levels of depressed mood, 1.8 times less likely to indicate that they are satisfied with their lives, and 1.6 times more likely to perceive that their physical health was poor/fair.

Employees with high caregiver strain most likely to report high levels of stress and depressed mood

Caregiving responsibilities place employed Canadians at a higher risk with respect to physical and mental health problems. Respondents in this study with high caregiver strain reported the highest levels of perceived stress (80% with high caregiver strain reported high stress) and depressed mood (60% with high caregiver strain reported high depressed mood) of any group in the sample. They were also more likely to suffer from impaired physical health (28% with high caregiver strain reported their health as fair/poor). It would appear that strains of caring for elderly dependents, while employed, are exceeding Canadians' ability to cope.

What is the impact of high levels of caregiver strain on Canadian employees?

High caregiver strain impacts family life satisfaction, positive parenting and family well-being. Compared to their counterparts with high caregiver strain, those with low caregiver strain were:

• 1.3 times more likely to report high levels of family well-being, and
• 1.3 times more likely to be satisfied with their family life

Respondents with high caregiver strain were also the least likely to engage in behaviours associated with positive parenting. These phenomena can be explained by the fact that about one in three of the respondents in the high caregiver strain group are in the 'sandwich group'. It would appear that in these families the time and energy devoted to elder care activities is interfering with the time available for children.

What is the impact of high levels of caregiver strain on Canadian society?

To answer this question we looked at the impact of this form of interference on the use of Canada's health care system and the decision to have children.

Caregiver strain can be linked to poorer physical health

The data from this study support the idea that employed Canadians with higher levels of caregiver strain are in poorer physical health. Employees with high levels of caregiver strain make the greatest use of physician services and are the most likely to have spent time in hospital on both an inpatient and an outpatient basis. They also make the highest use of the emergency room and spent the greatest amount on prescription medication. Compared to their counterparts with low levels of caregiver strain, employees with high levels of caregiver strain are:

• 1.8 times more likely to have received care on an outpatient basis,
• 1.7 times more likely to say their health is fair/poor,
• 1.6 times more likely to have made eight or more visits per year to a health care professional,
• 1.6 times more likely to have spent $300 in the last year for prescription medicine for their personal use,
• 1.5 times more likely to have sought care from a mental health professional,
• 1.5 times more likely to have required inpatient hospital care,
• 1.5 times more likely to have visited a hospital emergency room,
• 1.4 times more likely to have made six or more visits per year to a physician.

It would appear from these data that caregiver strain is associated with an increased incidence of illness that requires treatment and prescription drugs.

The health care costs associated with high caregiver strain are substantial

Data on caregiver strain provide further support for our conclusion that work-life conflict is associated with increased health care demands and costs. For example, we calculated the direct costs of inpatient hospital stays due to high caregiver strain to be approximately $4 billion per year, of physician visits due to high caregiver strain to be approximately $1 billion per year, and of visits to the hospital emergency department due to high caregiver strain to be approximately $100 million per year. These costs can be expected to increase in the future as the proportion of the workforce with elder care responsibilities increases.

Support for elder care should reduce the demands on Canada's health care system

The 2001 data support the idea that demands on Canada's health care system can be reduced dramatically by providing more supports for employed Canadians who have to deal with elder care issues. Our calculations indicate that physician visits could be reduced by 8%, inpatient hospital stays lowered by 18% and use of Canada's emergency rooms cut by 14% if high levels of this form of work-life conflict could be eliminated.

It would appear that the need to provide elder care is overwhelming employees' ability to cope with both work and life demands. If nothing is done to alleviate the demands placed on these workers, ill health due to this form of work-life conflict is likely to increase dramatically in the next decade as more baby boomers assume responsibility for the care of their parents. These findings indicate that if business does not take strategic action with respect to this issue soon, the government should step in and take action to help employees deal with elder care issues. The country cannot afford to pay the health care costs incurred by organizational inaction in this area.

Employees with high levels of caregiver strain spend substantially more on prescription medicine

In 2001, the average employee with high caregiver strain spent approximately $118 in a six-month period or $236 per year on prescription medicine, as compared to $86 in the six months prior to the study being don, or $172 per year, for those with low caregiver strain. The higher drug expenditures reported by those suffering from this form of work-life conflict are not surprising, given the fact that they are more likely than respondents with other forms of work-life conflict to have sought care in a hospital setting (either as an inpatient, in the emergency department, or as an outpatient) in the six months prior to the study being done. It would appear that caregiver strain is associated with an increased incidence of illness that requires medical treatment and prescription drugs.

The decision to delay or not have children reduces caregiver strain for women

Women with high levels of caregiver strain were substantively more likely than their counterparts with lower levels of strain to decide to delay or not to have children. This implies that the solution to increasing Canada's birth rate is to help employees deal with caregiver strain, perhaps by providing elder care support mechanisms within the community.

What can we do to reduce caregiver strain?

What can employers, employees and their families do to help reduce the percentage of the population at risk of high caregiver strain? Answers to these questions are summarized below. Things that can be done by employees are addressed first. This is followed by strategies that can be used by employees and their families.

What can employers do to help employees cope with caregiver strain?

The data from this study suggest that there is very little that the employer can do to help employees deal with caregiver strain. That being said, this body of research does allow us to provide concrete advice to employers who are concerned with this issue. Key conclusions are summarized below.

Elder care referral key to coping with caregiver strain

There is only one high-impact strategy available to organizations that wish to reduce the levels of caregiver strain in their workforce: provide elder care referral services. The relationship between the use of this benefit and caregiver strain is very strong. The fact that the association is positive indicates that employees with higher strain are more likely to seek such assistance than those who have less caregiver strain. Again, while we cannot tell from this study the extent to which such a benefit helps employees cope with the demands associated with elder care, the data does tell us that employees themselves perceive that this benefit helps them cope.

Short-term personal leave helps employees cope with caregiver strain

The use of two other benefits, short-term personal leave, and family/personal days off work, were moderately associated with caregiver strain. The negative relationship between caregiver strain and short-term personal leave indicates that this benefit does help employees cope with the strains associated with the care of an elderly dependent. The positive relationship between personal days off work and caregiver strain, on the other hand, indicates that employees need to take time off work when caregiver strain gets high. This benefit makes it easier for employees to use this strategy.

Flextime arrangements associated with lower levels of caregiver strain

Employees who use flextime arrangements report substantially lower levels of caregiver strain. Employees who work a fixed schedule, on the other hand, report the highest levels of this form of work-life conflict. Unfortunately, when considered in the light of the findings obtained earlier with role interference, it appears that organizational actions that minimize caregiver strain will maximize family interferes with work.

Increasing perceived flexibility does provide some ability to cope with caregiver strain

By increasing perceived flexibility, organizations can give employees with dependent care responsibilities some small degree of protection against caregiver strain. Specifically, the ability to be home in time for dinner with the family, vary one's work hours, interrupt one's work day and return to work later, and arrange one's work day to meet family or personal needs, all seem to help employees cope with caregiver strain.

Employees who report to a non-supportive manager find it more difficult to cope with caregiver strain

One way employers can help their employees with dependent care responsibilities cope with caregiver strain is to reduce the number of non-supportive managers in their organizations. The following management behaviours were all found to be associated with higher levels of this form of work-life conflict: making employees feel guilty about time off for personal/family reasons, focusing on hours or work and not on output, and having unrealistic expectations around workloads. Again, it should be emphasized that the association between this form of work-life conflict and non-supportive management is only moderate in magnitude.

How can individuals cope with caregiver strain?

The relationships between the use of the various personal coping strategies and caregiver strain are very similar to those observed for family interferes with work. In both cases, individual coping strategies did little to help employed Canadians deal with the form of work-life conflict.

Analysis of the 2001 data lead to the identification of four coping strategies (reducing the quality of things one does, working harder, just trying to forget about things, use of prescription medicine) that were associated with caregiver strain when gender and dependent care status were taken into account. All but one of these strategies (use of prescription drugs) was also associated with family interferes with work.

With one exception (use of prescription medicine) the relationship between the use of the strategy and caregiver strain is straightforward - the greater the strain, the higher the use of the strategy.

Daily use of prescription drugs helps employees cope with caregiver strain

There is a moderate relationship between the use of prescription medicine to cope with stress and caregiver strain. The relationship between prescription drug use and caregiver strain is similar to that observed with both role overload and work interferes with family: prescription medicine helps employees cope with strain if used on a daily basis, but not if used occasionally. These findings suggest that employees resort to prescription drugs as a last resort (i.e. when their stress levels are higher).

Family coping strategies ineffective at reducing caregiver strain

The findings with respect to the ability of the various family coping strategies explored in this study to help employees cope with caregiver strain are, with one exception (employees hire help to care for elderly dependents rather than their children), virtually identical to those observed for family interferes with work. In both cases, only two strategies were substantively associated with caregiver strain: hire help to care for dependents and get by on less sleep.

While the relationship between caregiver strain and get by on less sleep is relatively straightforward (use of the strategy increases as strain increases) the relationship between hiring help to care for elderly dependents and caregiver strain is more complex and varies depending on both the gender and the job type of the individual. For the men in the sample, the greater the strain, the greater the tendency to procure assistance from outside the family. For women, on the other hand, moderate use of this coping strategy is associated with an increased ability to cope with caregiver strain. Daily use of hired help to care for elderly dependents, on the other hand, is associated with higher levels of caregiver strain. This suggests that when caregiver strain is acute, outside support does little to alleviate the strain.