Historically, most persons aged 65 and older with Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) disabilities could count on receiving all or most of the personal assistance they needed from informal (i.e., unpaid) helpers--mostly female relatives. Over the past three decades, however, the involvement of American women aged 16 and older in paid work has increased dramatically--from 30% in 1961 to 58% in 1993. While the laborforce participation of women has remained below that of men, which averaged over 75% in 1993, the Bureau of Labor Statistics forecasts an additional gain of five percentage points for women by the year 2005 (MetLife, 1994).

It is widely assumed that trends in higher female laborforce participation decrease women's availability to provide informal eldercare, which in turn produces a need for replacement assistance from paid caregivers. However, 1982 and 1989 National Long-Term Care Survey (NLTCS) data indicate that only a minority of primary informal caregivers are employed. Among primary caregivers of the more severely disabled elderly (those with ADL impairments), only about 1 in 4 are employed--in large part because fully half are retirement age (65+).

The 1989 NLTCS was the first nationally representative survey to collect data on weekly hours of assistance provided to ADL and/or IADL disabled elders living in the community by individual caregivers, both formal and informal. Thus, it is now possible to investigate the effects of primary caregivers' employment status on the amount of help that disabled elders receive.

Findings

Under an ASPE task order contract, Mary Elizabeth Jackson of the MEDSTAT Group carried out analyses of the effect of primary caregivers' employment status on the weekly hours of help that disabled elders received in total and from various sources, both formal and informal. ADL and/or IADL impaired elders in the 1989 NLTCS received a mean of 38.3 hours of help weekly from all sources, including a mean of 28.7 hours of help weekly from their primary informal caregivers. Employed primary caregivers provided a mean of 18 hours of help per week, whereas primary caregivers not in the laborforce provided a mean of 33.7 hours of weekly assistance. Within the employed primary caregiver group, full-time workers provided a mean of 16.3 hours of help weekly as compared to a mean of 21.8 hours contributed by those employed part-time (see Table).

Regression analyses were then performed to measure the impact of primary caregivers' employment status on the amounts of help that disabled elders received, while simultaneously controlling for disability status and other potentially confounding variables. A series of regression models were developed, involving as dependent variables, four different measures of hours of care: hours provided by the primary caregiver, hours from all unpaid sources other than the primary caregiver, hours from paid caregivers, and total hours of care provided by all paid and unpaid caregivers. Independent variables in the regression equations included several care recipient characteristics (age, sex, race, ADL and IADL sources, cognition, and continence) and several primary caregiver characteristics (age, sex, relationship to the care recipient, and employment, including full-time/part-time work status).

The most consistently statistically significant and powerful predictors across the various measures of hours of care provided are variables unrelated to informal primary caregivers' employment status. These are: care recipients' ADL and IADL scores (which are the strongest predictors of hours of paid care) and living arrangements (when primary caregivers--mostly spouses--live with their care recipients, the care recipients receive substantially more hours of help, in terms of both hours of help from the primary caregiver and total weekly hours of help).

Primary caregivers who are employed--both those employed full and part-time--were found to provide significantly fewer hours of help personally (7.9) than primary caregivers not in the labor force. Care recipients of employed primary caregivers received significantly more hours of paid care (2.9) than did care recipients of nonemployed primary caregivers. No statistically significant differences were found in total hours of care received from all sources by care recipients whose primary caregivers were employed full-time as compared to other primary caregivers. The reason is that disabled elders whose primary caregivers were employed full-time received approximately five additional hours of help from other sources (both paid and unpaid).

Contrary to expectations, part-time employed caregivers did not personally provide more hours of help than full-time employed caregivers. Part-time workers provided 9.5 fewer hours than other caregivers whereas full-time workers provided 7.1 fewer hours. These differences in hours provided by full and part-time employed caregivers are statistically significant only when compared to hours provided by nonemployed caregivers. However, unlike disabled elders whose caregivers worked full-time, part-time employed primary caregivers had less supplemental help from other paid and unpaid sources. As a result, care recipients whose primary caregivers worked part-time received significantly fewer total hours of care (8.1) than other disabled elderly care recipients.

Conclusions and Policy Implications

Analyses of data from the 1989 NLTCS--including multivariate analyses of factors associated with weekly hours of care provided--indicate that the impact of female laborforce participation on the demand for formal home care services is modest, but statistically significant.

Female laborforce participation is having considerably less impact on availability of informal eldercare than many experts have predicted for two main reasons. First, high percentages of primary caregivers are retired. Second, employed primary caregivers contribute very substantial amounts of weekly hours of informal help, even though they do provide significantly fewer hours of help personally than nonemployed primary caregivers.

Part-time work is often advocated as a good compromise solution for women who want to combine traditional family roles with paid employment. However, in the multivariate analyses part-time employed caregivers did not devote any more time to eldercare than full-time employed caregivers. Moreover, disabled elders whose caregivers worked part-time received fewer total weekly hours of care.

How should we interpret these unexpected findings? Are informal caregivers' attitudes about and/or differential access to various paid and unpaid sources of supplemental help important factors that influence their decisions to work full-time versus part-time? Conversely, do decisions about whether to work full or part-time affect access to supplemental help (e.g., by making paid help more or less affordable or other family members more or less willing to help out)? Do part-time working caregivers organize their own and their supplemental helpers' time more efficiently--or are the elders' needs being less well met? These issues merit additional research.

References

*Doty, Pamela and Mary Elizabeth Jackson. 1995. The Impact of Primary Informal Caregivers' Employment Status on Patterns of Formal and Informal Eldercare. (Forthcoming)

*Jackson, Mary Elizabeth. October 15, 1992. Data presented at "The Changing Face of Informal Caregiving," a conference sponsored by the Office of the Assistant Secretary for Planning and Evaluation/DHHS. Berkeley Springs, WV.

MetLife. July-September 1994. "Women in Labor Force." Statistical Bulletin. 75(3):2-10.

CONTACT PERSON: Pamela Doty, Office of Disability, Aging and Long-Term Care Policy

ASPE Research Notes Circulated periodically by the Office of the Assistant Secretary for Planning and Evaluation. This paper reflects only the views of its author(s) and does not necessarily represent the position of the Department of Health and Human Services. For further information on Informal/Long-Term Care, contact Robyn I. Stone, Office of Disability, Aging and Long-Term Care Policy at 202-690-6443. To obtain asterisked reports referenced above, write Brenda Veazey, DHHS/OS/ASPE/DALTCP, Room 424E, HHH Building, 200 Independence Avenue, S.W., Washington, D.C. 20201 (FAX 202-401-7733).

INFORMAL CARE OF THE DISABLED ELDERLY: A RESEARCH AND POLICY INITIATIVE REPORTS AVAILABLE

The Changing Face of Informal Caregiving--A National Conference on Policy Directions for the 1990s: Conference Package

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Eldercare: The Impact of Family Caregivers' Employment on Formal and Informal Helper Hours (August 1995)

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The Impact of Female Caregivers' Employment Status on Patterns of Formal and Informal Eldercare

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Cost of Teenage Childbearing: Current Trends (August 1992)

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Counting Persons in Poverty on the Current Population Survey (August 1998)

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Disability Among Children (January 1995)

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Eldercare: The Impact of Family Caregivers' Employment on Formal and Informal Helper Hours (August 1995)

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Estimating Eligibility for Publicly-Financed Home Care: Not a Simple Task… (April 1992)

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Health Insurance in 1994 from the Current Population Survey: Measurement Difficulties (November 1996)

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Informal Caregiver "Burnout": Predictors and Prevention (April 1993)

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Licensed Board and Care Homes: Preliminary Findings from the 1991 National Health Provider Inventory (May 1993)

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March 1992 Current Population Survey Shows Health Insurance Coverage Up in 1991: Number of Medicaid Recipients Also Rises (February 1993)

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March 1993 Current Population Survey Re-Benchmarked on 1990 Census (March 1995)

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Number of Medicaid Recipients Up: CPS Shows the Number of Uninsured Also Rises (April 1992)

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Population Estimates of Disability and Long-Term Care (February 1995)

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Research and Other Developments of Interest in Employer Group Long-Term Care Insurance ( )

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The Elderly with Disabilities: At Risk for High Health Care Costs (February 1994)

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The Medicaid Personal Care Services Option Part I: Cross-State Variations and Trends Over Time (November 1993)

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The Medicaid Personal Care Services Option Part II: Consumer-Directed Models of Care (December 1994)

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Trends in AFDC and Food Stamp Benfits: 1972-1994 (May 1995)

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Understanding Estimates of Uninsured Children: Putting the Differences in Context (January 1999)

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