"Do I stay or do I go?"--job change and labor market exit intentions of employees providing informal care to older adults

Does Publicly-Funded Adult Social Care Impact Informal and Unpaid Carers' Quality of Life in England?

Informal carers are important for their care recipients, but the burden of care may have a detrimental effect on the carer's well-being. Publicly-funded Adult Social Care (simply, ASC) in England may alleviate this burden. We therefore investigate whether ASC expenditure improves carers' quality of life and the channels through which this effect may exist. We analyze data on informal carers from the biennial Survey of Adult Carers in England in 2014/15, 2016/17, 2018/19 and 2021/22. We implement panel data instrumental variables methods that use conditionally exogenous variability in the local taxation to identify the causal effect of ASC expenditure. Our main finding suggests that a £1000-increase in ASC expenditure per client increases, on average, the carer-reported quality of life score by 0.3, which amounts to 4.2% of its average in 2021/22. Moreover, ASC expenditure has a beneficial impact on informal carers' care tasks, health, range of employment choices, and finances.

Employment Responses to a Partner's Disability Onset ("Care Shocks"): Do Working Conditions Matter?

OBJECTIVES

This study examines employment responses to a partner's disability onset and how this is moderated by working conditions: job satisfaction and psychosocial job demands.

METHODS

We use longitudinal nationally representative data from the English Longitudinal Study of Aging. Following the health shock literature, we identify individuals whose partners report the onset of difficulties in activities of daily living (ADL) or instrumental activities of daily living (IADL) between 2 waves (n = 1,020) as experiencing a "care shock." We combine coarsened exact matching and entropy balancing, and logistic modeling to estimate the impact of such a "care shock" on the probability of leaving paid work, working part-time, changing jobs, or looking for a new job. We also explore the moderating effect of gender and working conditions (i.e., job demands and job satisfaction) on the impact of a "care shock" on work transitions.

RESULTS

Our findings show that "care shocks" significantly increase individuals' likelihood of leaving paid work. This effect is moderated by job demands and job satisfaction. Individuals who report high job demands and job dissatisfaction before the care shock are significantly more likely to leave paid work. In contrast, those with low job demands or job satisfaction show no significant difference in their likelihood of leaving paid work.

DISCUSSION

Our study highlights the role of working conditions in moderating the impact of care shocks on paid work. It informs workplace policies, as our results suggest that adapting working conditions may facilitate participation in the labor market in late career stages.

Paid Leave to Meet the Health Needs of Aging Family Members in 193 Countries

Women and workers over 50 disproportionately provide care for aging family members worldwide, including the 101 million who are care-dependent. Paid leave for adult health needs, which temporarily replaces employment income for workers providing care, can critically support both caregivers' economic outcomes and care recipients' wellbeing. We created quantitatively comparable data on paid leave policies that can be used to meet adult family members' health needs in all United Nations member states. Globally, 112 countries fail to provide any paid leave that can be used to meet the serious health needs of an aging parent, spouse, or adult child. These gaps have profound consequences for older workers providing care as well as care access by aging, ill, and disabled adults.

[Care-related Termination of Employment among Informal Caregivers of Elderly Persons: Identification of a Risk Profile]

OBJECTIVE

Employed informal caregivers often experience role conflicts between caring for an elderly person in need of care at home and their employment. The goal of this paper was to identify a risk profile of care-related termination of employment.

METHODS

Analyses are based on the cross-sectional Benefits of Being a Caregiver Study (October 2019 - March 2020) with data from 481 informal caregivers of elderly persons in need of care. The data collected relate to characteristics of the care recipient, the informal caregiver, and the caregiving situation, as well as aspects of the employment situation. The risk profile of care-related cessation of employment is based on a binary logistic regression.

RESULTS

Approximately one in nine in the present sample (n=55) terminated employment because of having to offer informal care to an elderly person at home. Factors characterizing the risk profile of a care-related termination of employment were female gender of the caregivers, younger age of the care receiver, co-residence with the care receiver, and a higher care level of the care receiver.

CONCLUSIONS

In order to reduce care-related cessation of employment, support and relief services need to be adapted to the factors of the identified risk profile. In particular, the form and content of informal caregiver counselling should be modified in order to reach informal caregivers at an early stage. Adapted support programs should focus on and reach in particular female employed caregivers.

Impact of informal caregiving on caregivers' subjective well-being in China: a longitudinal study

BACKGROUND

While informal caregiving is crucial for improving and maintaining health of the elderly, there is limited evidence of its potential effect on caregivers' wellbeing. Understanding this effect is important for policy makers to design effective long-term care policies. This longitudinal study aims to investigate the impact of informal caregiving on caregivers' subjective wellbeing in China.

METHODS

Three waves (2016, 2018, 2020) of data from the China Family Panel Studies (CFPS) are constructed for empirical analysis. Ordered logit model is first used to estimate the effect. Fixed effects ordered logit model and mixed effects ordered logit model are further employed to control for the possible bias from unobserved individual heterogeneity.

RESULTS

Informal caregiving significantly reduces caregivers' subjective wellbeing and the negative effect is stronger for high-frequency caregivers. Subgroup analysis reveals that informal caregiving imposed greater negative impacts on women, those living in rural areas, being married, working, and living separately from parents. Further analysis of mechanism indicates that decrease in wage income, leisure and sleep time were channels through which informal caregiving affects caregivers' well-being.

CONCLUSION

When policy makers formulate sustainable long-term care policies and home support services, interventions to improve caregivers' stress-coping skills and ensure their engagement in leisure and social activities could be adopted to mitigate the negative effects on caregivers' subjective well-being.

Improving the Workplace Experience of Caregiver-Employees: A Time-Series Analysis of a Workplace Intervention

Background

Rapid population aging in developed countries has resulted in the working-age population increasingly being tasked with the provision of informal care.

Methods

An educational intervention was delivered to 21 carer-employees employed at a Canadian University. Work role function, job security, schedule control, work–family conflict, familywork conflict, and supervisor and coworker support were measured as part of an aggregated workplace experience score. This score was used to measure changes pre/post intervention and at a follow-up period approximately 12 months post intervention. Three random intercept models were created via linear mixed modeling to illustrate changes in participants' workplace experience across time.

Results

All three models reported statistically significant random and fixed effects intercepts, with a positive coefficient of change.

Conclusion

This suggests that the intervention demonstrated an improvement of the workplace experience score for participants over time, with the association particularly strong immediately after intervention.

What's important when caring for a loved one? Population-based preference weights for the Adult Social Care Outcomes Toolkit for informal carers (ASCOT-Carer) for Austria

Purpose

The Adult Social Care Outcomes Toolkit for informal carers (ASCOT-Carer) can be used to assess long-term care-related quality of life (LTC-QoL) of adult informal carers of persons using LTC services. The ASCOT-Carer instrument has been translated into several languages, but preference weights reflecting the relative importance of different outcome states are only available for England so far. In this paper, we estimated preference weights for the German version of the ASCOT-Carer for Austria and investigated the value people place on different QoL-outcome states.

Methods

We used data from a best–worst scaling (BWS) experiment and estimated a scale-adjusted multinomial logit (S-MNL) model to elicit preference weights for the ASCOT-Carer domain-levels. Data were collected using an online survey of the Austrian general population (n = 1001).

Results

Top levels in the domains of ‘Space and time to be yourself’, ‘Occupation’ and ‘Control over daily life’ were perceived as providing the highest utility, and states with high needs in the same domains seen as particularly undesirable. ‘Personal safety’ was the only domain where levels were roughly equidistant. In all other domains, the difference between the top two levels (‘ideal state’ and ‘no needs’) was very small.

Conclusion

The paper provides preference weights for the German version of ASCOT-Carer to be used in Austrian populations. Furthermore, the results give insight into which LTC-QoL-outcomes are seen as particularly (un)desirable, and may therefore help to better tailor services directed at informal carers and the persons they care for.

Employment adjustment and mental health of employed family caregivers in Canada

Family caregivers make employment adjustment to fulfill caregiving responsibility. However, the studies on the family caregivers' mental health outcomes associated with their employment adjustment are limited. This study utilized the role theory and stress process model of caregiving to examine the relationship between employment adjustment and mental health outcomes among family caregivers, and to test family-to-work role conflict as a mediator and workplace support as a moderator in this relationship. Data (n = 1,696) were drawn from the 2012 Canada General Social Survey: Caregiving and Care Receiving. Findings suggest that employment adjustment is significantly associated with negative mental health outcomes including worse self-rated mental health and higher life stress level. In addition, family-to-work role conflict mediates between employment adjustment and mental health outcomes, with the mediating effect as significant at all levels of workplace support and as weak with increasing workplace support. The findings highlight the role of family-to-work role conflict in understanding the influence of employment adjustment on family caregiver's mental health, and the implication of workplace support on promoting caregiver-friendly workplace culture to alleviate family-to-work role conflict thereby resulting in better mental health outcomes.

Transitions in Labour Force Participation over the Palliative Care Trajectory

BACKGROUND

Home-based palliative programs rely on family caregivers, who often miss time from employment. This article identified changes in caregivers' labour force participation over the palliative trajectory.

METHODS

Family caregivers (n = 262) were interviewed biweekly to measure transitions across four employment categories.

RESULTS

More than half of the caregivers had one employment transition and 29% had three or more. The highest proportion of transitions occurred for caregivers who were employed part-time.

INTERPRETATION

Understanding these transitions is critical to the development of strategies tailored to caregivers to contain labour force losses and to support caregivers during a time of high caregiving demands.

Challenges of combining work and unpaid care, and solutions: A scoping review

The number of people who combine work and unpaid care is increasing rapidly as more people need care, public and private care systems are progressively under pressure and more people are required to work for longer. Without adequate support, these working carers may experience detrimental effects on their well-being. To adequately support working carers, it is important to first understand the challenges they face. A scoping review was carried out, using Arksey and O'Malley's framework, to map the challenges of combining work and care and solutions described in the literature to address these challenges. The search included academic and grey literature between 2008 and 2018 and was conducted in April 2018, using electronic academic databases and reference list checks. Ninety-two publications were mapped, and the content analysed thematically. A conceptual framework was derived from the analysis which identified primary challenges (C1), directly resulting from combining work and care, primary solutions (S1) aiming to address these, secondary challenges (C2) resulting from solutions and secondary solutions (S2) aiming to address secondary challenges. Primary challenges were: (a) high and/or competing demands; (b) psychosocial/-emotional stressors; (c) distance; (d) carer's health; (e) returning to work; and (f) financial pressure. This framework serves to help those aiming to support working carers to better understand the challenges they face and those developing solutions for the challenges of combining work and care to consider potential consequences or barriers. Gaps in the literature have been identified and discussed.

The Effect of California's Paid Family Leave Program on Employment Among Middle-Aged Female Caregivers

BACKGROUND AND OBJECTIVES

This study examined the effect of a Paid Family Leave program in California (CA-PFL) on employment among middle-aged female caregivers. We also examined differences in the relationship between the availability of paid family leave (PFL) and employment in socioeconomic subgroups of midlife women.

RESEARCH DESIGN AND METHODS

Data came from multiple years (2000‒2014) of the Current Population Survey (CPS) (N = 68,773 individuals). Applying a Difference in Differences (DiD) approach to removing potential selection biases related to program participation, we used a logistic regression to estimate the effects of PFL.

RESULTS

There was a significant increase in the likelihood of working based on CA-PFL. This positive effect, however, was found only among the early middle-aged, the near-poor, and those had the highest level of education.

DISCUSSION AND IMPLICATIONS

Among the late middle-aged, caregiving burden may not affect decisions on whether to exit the labor market, and PFL may not significantly mitigate the well-known negative effects of intense and multiple caregiving roles (parents, spouse, and/or children with disabilities). Future studies should examine PFL effects and their correlates such as age-cohorts, caregiving intensity, and retirement patterns. The unexpected null findings of CA-PFL's effect on employment outcomes for the poor and those with low education levels suggests these vulnerable groups might not be able to fully benefit from the originally intended goal of the policy, instead being left more vulnerable compared to the near poor. Such a possibility increases the importance of focused research and policymaking attention for this group.

Dementia care-giving and employment: a mixed-studies review on a presumed conflict

Many persons with dementia live at home and are cared for by their relatives. If the relatives are still employed, this can lead to higher burden and losses in their work-life. The interplay between informal care-giving and working is complex. Different studies have explored this issue, but the results have not been yet synthesised. In this mixed-studies review, we elucidate the underlying complexity. Our objective is to identify the factors related to care-giving that influence employment, and to describe their impact on dementia care-givers’ employment. We performed a literature search of primary studies using four databases and one meta-database, and retrieved English- and German-language articles. We used the Mixed Methods Appraisal Tool to assess their methodological quality. Evidence identified was synthesised by a parallel-results convergent synthesis design. We included 55 qualitative, quantitative and mixed-method studies published up to January 2018. The emerging model identified factors linked to the care recipient with dementia, the informal care-giver and the care-giving context. The impacts of these factors on care-givers’ employment are mostly negative (e.g. stopped/reduced work, decreased job performance). Nevertheless, the results provide encouraging insights as working can counterbalance care-giving strain, and managing both roles can enhance care-givers’ wellbeing. Practical efforts should focus on enabling informal care-givers to better manage the balance between care-giving and work responsibilities.

A validation study of the ICECAP-O in informal carers of people with dementia from eight European Countries

PURPOSE

The pressure on healthcare budgets remains high, partially due to the ageing population. Economic evaluation can be a helpful tool to inform resource allocation in publicly financed systems. Such evaluations frequently use health-related outcome measures. However, in areas such as care of older people, improving health outcomes is not necessarily the main focus of care interventions and broader outcome measures, including outcomes for those providing informal care, may be preferred when evaluating such interventions. This paper validates a recently introduced well-being measure, the ICECAP-O, in a population of informal carers for people with dementia from eight European countries.

METHODS

Convergent and discriminant validity tests were performed to validate the ICECAP-O using data obtained in a sample of 451 respondents from Germany, Ireland, Italy, the Netherlands, Norway, Portugal, Sweden and the UK. These respondents completed a number of standardized questionnaires within the framework of the Actifcare project.

RESULTS

The ICECAP-O performed well among informal carers, in terms of both convergent and discriminant validity. In the multivariate analysis, it was found to be significantly associated with the age of the person with dementia, EQ-5D-5L health problem index of the person with dementia, carer-patient relationship, care recipient CDR, carer LSNS Score, the PAI score, and Perseverance Time.

CONCLUSION

The ICECAP-O appears to be a valid measure of well-being in informal carers for people with dementia. The ICECAP-O may therefore be useful as an outcome measure in economic evaluations of interventions aimed at such informal carers, when these aim to improve well-being beyond health.

Burden for Parents of Patients With Schizophrenia-A Nationwide Comparative Study of Parents of Offspring With Rheumatoid Arthritis, Multiple Sclerosis, Epilepsy, and Healthy Controls

BACKGROUND

The study aimed to (1) compare the risk of health care use, adverse health status, and work productivity loss of parents of patients with schizophrenia to parents of patients with multiple sclerosis (MS), rheumatoid arthritis (RA), epilepsy, and healthy controls; and (2) evaluate such outcome measures while considering disease severity of schizophrenia.

METHODS

Based on linkage of Swedish registers, at least one parent was included (n = 18215) of patients with schizophrenia (information 2006-2013, n = 10883). Similarly, parental information was linked to patients with MS, RA, epilepsy, and matched healthy controls, comprising 11292, 15516, 34715, and 18408 parents, respectively. Disease severity of schizophrenia was analyzed. Different regression models yielding odds ratios (OR), hazard ratios (HR), or relative risks (RR) with 95% confidence intervals (CI) were run.

RESULTS

Psychiatric health care use, mainly due to anxiety and affective disorders, showed a strongly increasing trend for parents of patients with schizophrenia throughout the observation period. During the follow-up, these parents had an up to 2.7 times higher risk of specialized psychiatric health care and receipt of social welfare benefits than other parents. Parents of the moderately severely ill patients with schizophrenia had higher risk estimates for psychiatric health care (RR: 1.12; 95% CI: 1.07-1.17) compared with parents of least severely ill patients.

CONCLUSIONS

Parents of patients with schizophrenia have a considerably higher risk of psychiatric health care and social welfare benefit receipt than other parents. Psychiatric health care use worsens over time and with increasing disease severity of the offspring.

Employment disadvantage and associated factors for informal carers of adults with mental illness: are they like other disability carers?

BACKGROUND

Providing unpaid support to family and friends with disabling health conditions can limit a carer's capacity to participate in employment. The emotional support needs and unpredictability of caring for people with mental illness may be particularly demanding. While previous research suggests variable employment rates across carers for different conditions, there are limited data on mental health carers specifically.

METHODS

This study analysed employment patterns for working-age, co-resident carers of adults with mental illness in an Australian cross-sectional household survey, the 2015 Survey of Disability, Ageing and Carers.

RESULTS

Significantly more mental health carers were not employed (42.3%, 95% CI: 36.6-48.1) compared to non-carers (24.0%, 95% CI: 23.5-24.6). Employed mental health carers were more likely to work fewer than 16 h per week (carers: 17.2%, 95% CI: 12.8-22.8, vs. non-carers: 11.7%, 95% CI: 11.3-12.1) and in lower skilled occupations (carers: 22.6, 95% CI: 17.5-28.7, vs. non-carers: 15.7, 95% CI: 15.1-16.2). Among the sub-group of primary mental health carers, 25.8% (95% CI: 15.6-39.5) had reduced their working hours to care and a further 26.4% (95% CI: 17.2-38.2) stopped working altogether. In corresponding comparisons between mental health carers and carers for people with other cognitive/behavioural conditions, and physical conditions with or without secondary mental illness, there were no differences except that mental health carers were more likely to be working in a lower skilled occupation than other cognitive/behavioural condition carers (14.8% of the latter, 95% CI 10.1-21.2). Multivariate logistic regression analyses revealed that female mental health carers were less likely to be employed if they were aged 35-54, had no post-secondary education, had a disability, or cared for someone with severe activity limitations. For male mental health carers, having a disability or caring for someone with severe limitations or who did not receive paid assistance were significantly associated with not being employed.

CONCLUSIONS

These results highlight the employment disadvantage experienced by mental health carers compared to non-carers, and similarities in employment patterns across carers for different conditions. Improving the availability of paid support services for people with mental illness may be an important target to assist carers to maintain their own employment.

The hidden cost of informal care: An empirical study on female caregivers' subjective well-being

Using data from the China Health and Nutrition Survey (CHNS), this study investigated the impact of informal care on female caregivers' subjective well-being in China. We found that informal care significantly reduced the subjective well-being of female caregivers using the instrumental variable (IV) ordered probit model. Our results revealed that the care effect on subjective well-being was more significant for rural caregivers than for urban caregivers. The more hours or more recipients care was provided for, the greater the negative impact on subjective well-being. Based on these findings, we further identified the two channels of 'wealth' and 'health' through which informal care lowered subjective well-being. These results have implications for policy makers in overcoming the challenges involved in constructing and developing a supportive system of informal care in China.

Job Strain, Time Strain, and Well-Being: A Longitudinal, Person-Centered Approach in Two Industries

The notion of constellations is central to many occupational health theories; empirical research is nevertheless dominated by variable-centered methodologies. Guided by the job demands-resources framework, we use a person-centered longitudinal approach to identify constellations of job demands and resources (task-based and time-based) over time that predict changes in well-being. We situate our research in two dissimilar, but growing, industries in the United States-information technology (IT) and long-term care. Drawing on data collected over 18 months, we identify five patterned, stable constellations of job demands/resources using group-based multi-trajectory modeling: (1) high strain/low hours, (2) high strain/low hours/shift work, (3) high strain/long hours, (4) active (high demands, high control) and (5) lower strain (lower demands, high control). IT workers are overrepresented in the lower-strain and active constellations, whereas long-term care providers are more often in high-strain constellations. Workers in the lower-strain constellation experience increased job satisfaction and decreased emotional exhaustion, work-family conflict and psychological distress over 18 months. In comparison, workers in high-strain job constellations fare worse on these outcomes, as do those in the active constellation. Industrial contexts matter, however: Compared with long-term care workers, IT workers' well-being is more at risk when working in the "high strain/long hours" constellation. As the labor market continues to experience structural changes, scholars and policy makers need to attend to redesigning the ecological contexts of work conditions to promote workers' well-being while taking into account industrial differences.

Estimating Long-Term Care Costs among Thai Elderly: A Phichit Province Case Study

Background

Rural-urban inequality in long-term care (LTC) services has been increasing alongside rapid socioeconomic development. This study estimates the average spending on LTC services and identifies the factors that influence the use and cost of LTC for the elderly living in urban and rural areas of Thailand.

Methods

The sample comprised 837 elderly aged 60 years drawn from rural and urban areas in Phichit Province. Costs were assessed over a 1-month period. Direct costs of caregiving and indirect costs (opportunity cost method) were analyzed. Binary logistic regression was performed to determine which factors affected LTC costs.

Results

The total annual LTC spending for rural and urban residents was on average USD 7,285 and USD 7,280.6, respectively. Formal care and informal care comprise the largest share of payments. There was a significant association between rural residents and costs for informal care, day/night care, and home renovation.

Conclusions

Even though total LTC expenditures do not seem to vary significantly across rural and urban areas, the fundamental differences between areas need to be recognized. Reorganizing country delivery systems and finding a balance between formal and informal care are alternative solutions.

Public expenditure costs of carers leaving employment in England, 2015/2016

In the context of global population ageing, the reconciliation of employment and unpaid caring is becoming an important social issue. The estimation of the public expenditure costs of carers leaving employment is a valuable measure that is of considerable interest to policy makers. In 2012, the Personal Social Services Research Unit estimated that the public expenditure costs of unpaid carers leaving employment in England were approximately £1.3 billion a year, based on the costs of Carer's Allowance and lost tax revenues on forgone incomes. However, this figure was known to be an underestimate partly because it did not include other key benefits that carers who have given up work to care may receive. This paper presents a new estimate of the public expenditure costs of carers leaving employment. Key sources of information are the 2009/2010 Survey of Carers in Households, 2011 Census and 2015/2016 costs data. As well as Carer's Allowance, the estimate also now includes the costs of other benefits that carers leaving work may receive, namely, Income Support and Housing Benefit. The results show that the estimated numbers of carers who have left employment because of caring have increased from approximately 315,000 to 345,000. Due mainly to the inclusion of a wider range of benefits, the public expenditure costs of carers leaving employment in England are now estimated at £2.9 billion a year. The new estimate comprises £1.7 billion in social security benefits paid to people who have left their jobs because of unpaid caring, plus another £1.2 billion in taxes forgone on this group's lost earnings. The paper concludes that, if there was greater public investment in social care, such as "replacement care" to support carers in employment, and fewer carers then left employment, public spending on benefits would be lower and revenues from taxation would be higher.

The legal implications of dementia in the workplace: establishing a cross-disciplinary research agenda

Dementia is a growing issue in the United Kingdom (UK) with over 800,000 people affected. Of these people, in excess of 40,000 are aged under 65 years. Thus, a significant number of individuals may be experiencing symptoms of dementia while in employment. In addition, as working lives extend, the potential impact of dementia on the workplace could be substantial. However, to date, there has been little research on experiences of dementia in the workplace. The research that exists highlights the lack of support for workers with dementia. Dementia may be considered to be a disability under the Equality Act 2010. Therefore, the legislation potentially provides a framework for individuals to request that their employer make reasonable adjustments to support their continued employment. International human rights law is potentially another tool that could be utilised to obtain necessary adjustments. This paper argues that in developing the evidence base on workplace experiences of dementia, it is important that the legal framework be considered. This paper reviews the existing literature on dementia in the workplace and embeds this in the legislative framework in order to establish a cross-disciplinary research agenda. While the paper focuses on the UK legal context, the argument presented in the paper is still relevant to other national contexts.

Caregiving and mental health among workers: Longitudinal evidence from a large cohort of adults in Thailand

BACKGROUND

As people in middle and lower income countries live longer, more people become sick, disabled, and frail and the demand for family caregiving grows. Thailand faces such challenges. This study investigates the relationship between caregiving and mental health among workers drawn from a large longitudinal cohort of Thai adults.

METHODS

Participants were drawn from the Thai Health-Risk Transition Study, a cohort study since 2005 of distance-learning adult Open University students residing nationwide. Caregiving status and binary psychological distress outcome (score 19-30 on Kessler 6) were recorded in 2009 and 2013 among cohort members who were paid workers at both years (n=33,972). Multivariate logistic regression was used to estimate the relationship between four-year longitudinal caregiving status and psychological distress in 2013, adjusting for potential covariates.

RESULTS

Longitudinal analyses revealed the transitional nature of care with 25% exiting and 10% entering the caring role during the four-year follow-up. Based on multivariate logistic regression, 2009-2013 caregiving status was significantly associated with psychological distress. Cohort members transitioning into caregiving and those who were caregivers in both 2009 and 2013 had a higher risk for psychological distress than non-caregivers (Adjusted Odds Ratios 1.40 [1.02-1.96] and 1.64 [1.16-2.33], respectively).

CONCLUSION

Our findings provide evidence on caregiving and associated risk for psychological distress among working Thais. This adds to the limited existing literature in middle-income countries and highlights the potential pressure among caregivers in balancing work and care while preserving their own mental health.

Economics of the Iceberg: Informal Care Provided to French Elderly with Dementia

OBJECTIVES

Dementia has a substantial effect on patients and their relatives, who have to cope with medical, social, and economic changes. In France, most elderly people with dementia live in the community and receive informal care, which has not been well characterized.

METHODS

Using a sample of 4680 people aged 75 years and older collected in 2008 through a national comprehensive survey on health and disability, we compared the economic value of the care received by 513 elderly people with dementia to that received by a propensity score- matched set of older people without dementia.

RESULTS

More than 85% of elderly people with dementia receive informal care; the estimation of its economic value ranges from €4.9 billion (proxy good method) to €6.7 billion (opportunity cost method) per year.

CONCLUSIONS

The informal care provided to people with dementia has substantial annual costs; further work should be done to examine the social and economic roles foregone as a result of this care.

Path toward economic resilience for family caregivers: mitigating household deprivation and the health care talent shortage at the same time

Rising costs and a workforce talent shortage are two of the health care industry's most pressing challenges. In particular, serious illnesses often impose significant costs on individuals and their families, which can place families at an increased risk for multigenerational economic deprivation or even an illness-poverty trap. At the same time, family caregivers often acquire a wide variety of health care skills that neither these caregivers nor the health care industry typically use. As these skills are marketable and could be paired with many existing medical certifications, this article describes a possible "path toward economic resilience" (PER) through a program whereby family caregivers could find meaningful employment using their new skills. The proposed program would identify ideal program candidates, assess and supplement their competencies, and connect them to the health care industry. We provide a set of practical steps and recommended tools for implementation, discuss pilot data on the program's appeal and feasibility, and raise several considerations for program development and future research. Our analysis suggests that this PER program could appeal to family caregivers and the health care industry alike, possibly helping to address two of our health care system's most pressing challenges with one solution.