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The Many Faces of Paid Caregivers Article

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The Many Faces of Paid Caregivers Article

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The article above titled "The Many Faces of Caregivers" by the Transamerica Institute demonstrates the variety landscape of different caregivers in the U.S. This article highlights important stats and insights from a survey completed in 2017. It talks about the different demographics of caregivers, including that they come from various age groups, ethnicities, and socioeconomic backgrounds.The report really emphasizes the financial and emotional challenges caregivers face. This includes high levels of stress, health issues, and a significant impact on their personal and professional lives. The article also addresses the importance of support systems and resources to help caregivers manage their daily responsibilities.

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The YouTube video above is titled "The Many Faces of Caregivers." It explores the diverse roles and experiences of caregivers, complementing the themes discussed in the Transamerica Institute's Article.

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Feds OK state plan to expand KidsCare eligibility, pay parent caregivers.

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Feds OK state plan to expand KidsCare eligibility, pay parent caregivers.

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The article above is the approval of two significant healthcare initiatives in our state of Arizona! First is the KidsCare Expansion.KidsCare is Arizona’s version of the Children’s Health Insurance Program (CHIP), that provides low-cost health coverage to children in families that earn too much to qualify for Medicaid. This expansion is expected to have an additional 10,000 children to receive health coverage starting in April 2024 . Second is the Parents as Paid Caregivers Program. Initially this was a temporary COVID-19 measure, which allowed parents of children with disabilities to be paid for providing caregiving services. This is significant for families such as Brandi Coon’s, whose son has multiple disabilities. The program offers parents financial support while ensuring their children receive care from those they trust most: their parents. How exciting!

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Feds OK state plan to expand KidsCare eligibility, pay parent caregivers

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Arizona will expand income eligibility for the state’s KidsCare program, potentially adding10,000 children to the low-cost health care program, and will make permanent a pandemic-era program to pay parents who act as caregivers for their disabled children.

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What are you going to pay for your aged care? Here are all the details.

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What are you going to pay for your aged care? Here are all the details.

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This article above from Australia demonstrates a proposed government plan to change how much aged care recipients will pay. It tries to make the aged care system more financially sustainable by having recipients contribute more to the cost of their care. The government covers a big portion of aged care expenses, but the changes would move more of the cost difficulties to individuals, especially those with higher incomes or assets. The proposal seeks to balance fairness while helping the increasing demand for aged care services as the population ages.

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The government has released the details of its proposed fee structure for aged care.

A lot is changing. Self-funded retirees and some pensioners will be expected to pay more, saving the government $12.6 billion over the next 11 years.

Residential care and in-home care will both change.

The key principle is that the government will continue to pay for health-related costs, but people with financial means will pay more for other costs.

The changes apply to future recipients only, not to anybody currently receiving care.

They will take effect from July of next year, assuming the legislation is passed before then, which is likely because the opposition supports the new fee structure.

This is how the reform will affect you.

In-home care

Care in the home will continue to be assessed on the basis of need.

There will be eight levels of support (instead of four currently), each with a different level of government funding, up to a maximum of $78,000 a year (instead of $60,000 currently).

That money can be thought of as an annual budget, which can be used to purchase services from an approved list.

What your budget can be spent on, versus what you will have to pay out of pocket, depends on your financial means and on the category of service.

There are three categories:

Clinical care, such as nursing and occupational therapy

Independence supports, such as help with showering, dressing and medications

Everyday living supports, such as help with cleaning, gardening and meals

For clinical care, the government-funded budget can pay for the whole cost.

For independence supports and everyday living supports, you will be expected to pay some of the cost out of your own pocket, depending on your means (see table below).

For the first time, the maximum price of home care services will be set by a government regulator to prevent over-charging.

In examples provided by the government, a full pensioner approved for level five support would end up paying for 6 per cent of her care, whereas a self-funded retiree who has no Commonwealth Seniors Health Card would pay 42 per cent.

A $25,000 payment will also be available to help recipients spend their final three months at home, and there will be a new 12-week program for help when recovering from an illness or injury.

Existing home care recipients, and those who are approved before July 2025, will switch to the new system but have a guarantee that they will not pay any more than they would under the old system.

Residential care

The payment structure for residential care will stay the same, but the amounts will change.

Residents pay in three ways:

A basic daily fee paid by everyone

An additional daily fee paid by those with financial means

An accommodation charge, which can be paid daily or as a lump sum deposit

The basic daily fee, set at 85 per cent of the Age Pension, will not change.

The means-tested fee will be renamed the "non-clinical care" fee, reflecting the fact that the government covers clinical costs.

It will be paid by those with more than $500,000 in assets, or more than about $130,000 in income, or a combination.

It is a maximum of $101.16 a day and is paid for the first four years of care only.

The maximum accommodation charge will increase from $550,000 a room to $750,000 a room. As now, providers can seek government approval to charge more.

This can still be paid as a lump sum deposit, but providers will now be able to hold onto a portion of the deposit - 2 per cent of it each year for five years.

Finally, a $12.55 per day "hotelling" supplement, currently paid to providers by the government, will instead be paid by residents with more than $238,000 in assets, $95,400 in income, or a combination.

Just as today, the family home only counts towards the asset assessment up to the value of about $200,000.

In examples provided by the government, a full pensioner with few savings will continue to pay 17 per cent of the cost of his care, deducted from his pension. A self-funded retiree will pay 45 per cent.

Overall, three in ten full pensioners will contribute more, and three in four part pensioners.

This will only apply to those who enter aged care from July 2025.

Lifetime cap on fees

Nobody will be able to pay more than $130,000 in non-clinical care costs over their lifetime, covering both in-home care and residential care. That is higher than the current cap of about $80,000.

Why is the government doing this?

Aged care is one of the largest and fastest-growing areas of government spending, and the demand for aged care will keep increasing as the large baby boomer cohort gets older.

At the same time, both sides of politics and the aged care sector agree that existing levels of funding have not been sufficient to deliver the quality of care Australians expect.

In 2021, the royal commission into aged care recommended a taxpayer-funded levy to boost funding.

But the government rejected that idea and has argued that residents should pay more if they can afford to do so. The government currently pays about $4 for every $1 paid by aged care residents, and $19 for every $1 paid by in-home care recipients.

These reforms would see the government pay $3.30 for every $1 paid by residents and $7.80 for every $1 paid by in-home care recipients.

The government also hopes that by charging more for in-home care, it can afford to provide support to more people and reduce waiting times. According to the most recent figures, 68,000 people are currently on the wait list for an in-home care package.

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What will aged care fee changes mean for you? Here are all the details

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The government has released the details of a new fee structure for aged care, which has bipartisan support. Find out how they will affect you.

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The article here looks at the mental and physical health impacts on caregivers of older adults in Europe. It uses specific data from the Survey of Health, Aging and Retirement in Europe to analyze the relationship between caregiving and well-being. The study shows that caregiving often leads to large amounts of psychological stress and physical strain, especially for those providing intensive care. It shows the importance of support systems to decrease the negative effects of caregiving on health.

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BMC Public Health 18, Article number: 53 (2018) Cite this article

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An Erratum to this article was published on 22 September 2017

Abstract

Background

Caregiving burden and depression in family caregivers have been investigated, but little is known about how they affect paid caregivers. The aim of this study was to investigate caregiving burden and depression in paid caregivers of hospitalized patients.

Methods

A cross-sectional survey study was conducted in a tertiary referral hospital (Chengdu, China) that enrolled 108 paid caregivers who worked in the inpatient department. The Caregiver Burden Inventory (CBI) and the Center for Epidemiologic Studies Depression (CES-D) scale were incorporated into a self-developed questionnaire to gather demographic information on the following four aspects: general, work, income, and family.

Results

The mean total CBI score was 29.7 ± 12.5. The time-dependence burden had the highest score of 15.3 ± 4.0, which was followed by the physical burden score of 6.5 ± 4.6, developmental burden score of 3.7 ± 4.0, social burden score of 3.2 ± 4.0, and emotional burden score of 2.4 ± 3.1. Multiple linear regression analysis showed that a higher CBI was associated with a longer time as a paid caregiver [β=7.041, 95% Confidence Interval (CI):1.935 to 12.974, p = 0.009], lower income satisfaction (β= − 6.573, 95% CI: -11.248 to −3.020, p = 0.001), and higher frequency of meeting with their relatives (β=7.125, 95% CI: 2.019 to 12.456, p = 0.006). The mean CES-D score was 11.9 ± 8.7, and significant depression was found in 28 (25.9%) paid caregivers according to the CES-D score ≥ 16 cut-off. There was a moderate positive correlation between the CBI and CES-D scores (Pearson's r = 0.452, p < 0.001).

Conclusions

A high caregiving burden was commonly observed in paid caregivers of hospitalized patients in China, as was a high prevalence of depression symptoms. Several associated factors were identified that could be areas for future interventions.

Peer Review reports

Background

Caregivers have been shown to suffer from high caregiving burden and depression; therefore, they are a group of vulnerable people or "invisible patients" who need attention or interventions from medical staff and social workers. [ 7, 8] However, most previous studies [ 1, 7, 8] have focused on the caregiving burden of family caregivers for patients who stayed at home and not on the growing population of paid caregivers who work in hospitals. According to published studies in Chinese journals, most paid caregivers are middle-aged women who were previously farmers from a rural area or laid-off workers from a city. [ 9, 10] Although psychological health and work pressure were investigated in paid caregivers in China, which were related to sleep disturbances, unstable income, and a lack of social respect and support, [ 11, 12] data are very limited on the caregiving burden in this population, especially by the use of designated inventories. Therefore, to provide information for developing practical interventions, a survey study was conducted to identify the prevalence of caregiving burden and depression symptoms as well as their associated factors from four categories, including general, work, income, and family characteristics.

Methods

Study design

This was a cross-sectional survey study in a tertiary referral hospital (Chengdu, China) performed with a self-developed questionnaire that is described in the "Instruments" section. Nurses participated in the design, distribution and return of the questionnaire.

Participants

Considering that caregiving burden could be affected by the working environment and patients of paid caregivers, the subjects were all paid caregivers who worked in four medical and four surgical wards (i.e., cardiology vs. cardiac surgery, respiratory medicine vs. thoracic surgery, gastrointestinal medicine vs. gastrointestinal surgery, and neurology vs. neurosurgery). The subjects were enrolled if they met the following criteria: (1) agreed to participate and signed the informed consent form and (2) could read and complete the questionnaire. Consequently, 120 of the 124 (96.8%) registered paid caregivers from the aforementioned wards were enrolled; four people did not fulfil the inclusion criteria as they refused to participate.

Instruments

The questionnaire was written in Chinese and consisted of three parts. In the first part, the baseline characteristics of the study subjects were collected; this included proposed factors associated with the caregiving burden or depression that were categorized into general, work, income, and family information. General information included the age, gender, education, and marital status. Work information included the ward in which they worked, number of years as a paid caregiver, and number of vacation days per month. For the income information, "income satisfaction" was a required field, while "income per month before and after becoming a paid caregiver" was optional. The number of dependents, frequency of meeting his/her own family, and housing status in Chengdu (owned or rental) were categorized as family information.

Five CBI factors and their scores. CBI, Caregiving Burden Inventory. The bar chart represents the means ± standard deviation, and the adjusted physical burden is the original score multiplied by 1.25 to give an equivalent score out of 20 for comparison. † p < 0.001 vs. the time-dependence burden and § p < 0.001 vs. the physical burden

The third part of the questionnaire assessed the depression symptoms of paid caregivers with the Chinese version of the Center for Epidemiologic Studies Depression Scale (CES-D), which has been validated and showed good reliability in a Chinese population. [ 17, 18, 19] The CES-D includes 20 items that cover affective, cognitive, behavioural, and somatic symptoms associated with depression. The subjects were asked to indicate the frequency of symptoms on the following 4-point scale from 0 (rarely or none of the time) to 3 (most or all of the time). The 4 positively formulated items (items 4, 8, 12, and 16) were recorded in reverse. Therefore, the total score of the CES-D ranged from 0 to 60, and a score of 16 or higher indicates the likely presence of clinically significant depression. [ 18, 20].

According to the study design, the copies of the questionnaire with inadequate quality were not entered into the final analysis, including those with an incomplete CBI or CES-D section, and a consistent lowest score (i.e. "0" score) or highest score (i.e. "4" score in the CBI section and "3" score in the CES-D section) for each item in either section. This extreme and unchangeable scoring situation was considered to indicate that the participant had not understood the survey or had not seriously considered it.

Statistics

The statistical analysis was performed using SPSS software, version 20.0 (SPSS, Chicago, IL, USA). A Kolmogorov-Smirnov test was performed to determine whether continuous parameters were normally distributed. T-tests, chi-square tests and Fisher's exact tests were used for univariate analyses. One-way ANOVA was used to test differences among the 5 factors of the CBI. Multiple linear regression was performed to identify factors associated with the CBI and CES-D scores. A Pearson correlation coefficient was used to analyse the correlations between the CBI and CES-D scores. A p-value <0.05 was considered statistically significant.

Results

During the study period, 120 copies of the survey were sent out and returned (100% response rate) by assigned ward nurses. However, several surveys were unsuitable for analysis (12/120, 10%), including nine that had an incomplete CBI or CES-D section and another three that had a consistent "0" score for each item in the CBI section.

Baseline characteristics

Data for the 4 domains are presented in Table 1. All paid caregivers were middle-aged, and most were female. The majority of the subjects achieved an educational level below high school. The number of years that each participant worked as a paid caregiver was categorized into five groups in the questionnaire (i.e., less than 1 year, 1 ~ 3 years, 3 ~ 5 years, 5 ~ 10 years, and more than 10 years); however, 73 (66.7%) paid caregivers worked in this field for more than 10 years.

Table 1 Baseline characteristics of the paid caregivers

Caregiving burden and depression scores in paid caregivers

The total CBI score was normally distributed among the study population with a mean value of 29.7 ± 12.5. There were some differences among the 5 factors of the CBI that were detected by the ANOVA (F ₍₄₅₃₅₎ = 194.207, P < 0.001) and post hoc analysis. The time-dependence burden factor had the highest score of 15.3 among the 5 factors; it was significantly higher than those of the remaining factors (all P < 0.001). It was followed by the physical burden score of 6.5, which was significantly higher than the emotional, developmental, and social burden scores (all P < 0.001). The scores of the last 3 factors were similar. (Fig. 1).

The CES-D score of the study participants also had a normal distribution with a mean value of 11.9 ± 8.7. Using the CES-D score ≥ 16 cut-off, depression was found in 28 (25.9%) paid caregivers. Moreover, the CBI score of the depression group (CES-D score ≥ 16) was significantly higher than that of the non-depression group (36.3 ± 14.3 vs. 27.4 ± 11.0, P = 0.001). The CBI score was positively correlated with the CES-D score ( r = 0.452, P < 0.001). (Fig. 2).

Correlation between the CES-D and CBI scores. CES-D, Center for Epidemiologic Studies Depression Scale. CBI, Caregiving Burden Inventory. The Pearson correlation coefficient is 0.452 ( P value <0.001)

Factors associated with a higher caregiving burden and depression

A multiple linear regression analysis was used to identify the factors that were related to higher CBI (Table 2) and CES-D (Table 3) scores. The parameters in Table 1 were all included as covariates in the model, where either the CBI or CES-D score was the dependent variable. Three independent variables were associated with a higher CBI score, which included a longer time as a paid caregiver ( P = 0.009), lower income satisfaction ( P = 0.001), and more frequent meeting with his/her own family ( P = 0.006). (Table 2) Similarly, a lower income satisfaction was found to be associated with a higher CES-D score ( P = 0.008). (Table 3).

Table 2 Variables associated with the likelihood of a higher CBI score

Table 3 Variables associated with the likelihood of a higher CES-D score

Discussion

In this survey, the majority of paid caregivers were married, middle-aged women with a low educational level. They suffered from a high caregiving burden that was related to the amount of time as a caregiver, income satisfaction and frequency of meeting with their own family. The depression rate of this group was higher than that of the general population, but it was lower than that of family caregivers; it was also positively correlated with caregiving burden.

High caregiving burden in paid caregivers

Factors associated with a higher caregiving burden

Previous studies showed that the risk factors for caregiving burden included female gender, [ 30] a low education, [ 31, 32] sleep deprivation, financial stress, [ 33] depression, [ 34] social isolation, [ 35] and time restrictions [ 36]. Because the paid caregivers in the current study worked on a 24-h schedule, we gathered the number of years they spent as paid caregivers rather than the number of hours per day spent performing their job and found the former to be associated with the CBI score. This association might be attributed to the self-perceived long-term time restrictions and deteriorating physical health of the paid caregivers. As previously reported, financial stress was a risk factor for caregiving burden [ 33], and poor payment for paid caregivers was a common issue. [ 37, 38] In China, most tertiary referral hospitals (as the study site) provide high-quality, specialized medical health care services to a number of districts that are located in urban areas; however, these areas also have the largest demand for paid caregivers. [ 39] In contrast, most paid caregivers are from the countryside and have moved to a city for a better living. Not surprisingly, lower income satisfaction was significantly associated with a higher caregiving burden, indicating a conflict among their actual payment, self-expectations and financial circumstances. However, this conflict cannot be resolved only by raising their salaries. It is possible that organized lectures and regular meetings could identify what paid caregivers need and think. More interestingly, it was observed in the study that paid caregivers who met with their own families more frequently had a higher CBI score. This phenomenon has not been previously identified, and its cause remains unexplored in the current study.

Correlation between depression and caregiving burden

Study limitations

The major limitations of this study include its cross-sectional nature and the absence of health consequence data, i.e. the result of coupling between the caregiving burden and the physical/emotional health of paid caregivers. Although some practical interventions to reduce the caregiving burden could be developed based on the results of the current study, their impact on the professional health of paid caregivers remains unclear. The relatively small sample size is another limitation.

Conclusions

Caregiving burden is high in paid caregivers of hospitalized patients in China, most of whom are middle-aged women from rural areas. It is associated with a prolonged working time, low income satisfaction and unexplained impact from their own families. In addition, the caregiver burden and depression are correlated, which is more prevalent in paid caregivers than in the general population.

Change history

22 September 2017

An erratum to this article has been published.

Abbreviations

CBI:

Caregiver Burden Inventory

CES-D:

Center for Epidemiologic Studies Depression Scale

References

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Acknowledgements

We appreciate Professor Rui Zhang (Department of Medical Administration, National Health and Family Planning Commission, P.R.C.) for providing us with the validated Chinese version of the CBI.

Funding

No funding supported this study.

Availability of data and materials

Data will be available upon request from the corresponding author.

Author information

Authors and Affiliations

1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Yao-Dan Liang, Ya-Li Wang, Zhi Li, Li He, Ying Xu, Qing Zhang & Gui-Ying You

2. Department of Nephrology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China

Xu-Hua Mi

Contributions

MXH designed this study and wrote the study protocol. LYD conducted the study and drafted the manuscript. YGY designed the questionnaire. WYL and LZ helped to finalize the questionnaire and recruited the paid caregivers in each ward. HL and XY were responsible for giving out and receiving the questionnaires, organizing the data, and performing the literature review. ZQ was responsible for performing the statistical analysis and revising the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Xu-Hua Mi.

Ethics declarations

Ethics approval and consent to participate

The current study was an observational study that was approved by the ethics committee of the West China Hospital of Sichuan University. Written informed consent was obtained from each study participant.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional information

An erratum to this article is available at https://doi.org/10.1186/s12889-017-4709-6.

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Liang, YD., Wang, YL., Li, Z. et al. Caregiving burden and depression in paid caregivers of hospitalized patients: a pilot study in China. BMC Public Health 18, 53 (2018). https://doi.org/10.1186/s12889-017-4563-6
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Caregiving burden and depression in paid caregivers of hospitalized patients: a pilot study in China - BMC Public Health

# data[].attributes.attachment_link.description
Background Caregiving burden and depression in family caregivers have been investigated, but little is known about how they affect paid caregivers. The aim of this study was to investigate caregiving burden and depression in paid caregivers of hospitalized patients.

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"A theory of caregiver stress derived from Roy Adaptation Model was developed to examine the relationships among stimuli, coping mechanism and adaptive modes. The theory hypothesized that objective burden in caregiving would be the most important stimulus that leaded to perceived caregiver stress." (Tsai et al., 2015)

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More Than 1 in 4 Americans Over 50 Are Now Caregivers

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More Than 1 in 4 Americans Over 50 Are Now Caregivers

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