how caregivers and workers fare in cash and counseling
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How Caregivers and Workers Fare in Cash and Counseling. Leslie Foster Stacy Dale. June 26, 2005 AcademyHealth Annual Research Meeting Boston MA. Why Study Caregivers and Workers?. Informal Caregivers Provide more care than paid sources Help care recipients avoid nursing homes - PowerPoint PPT PresentationTRANSCRIPT
How Caregivers and Workers Fare How Caregivers and Workers Fare in Cash and Counselingin Cash and Counseling
Leslie FosterLeslie FosterStacy DaleStacy Dale
June 26, 2005June 26, 2005AcademyHealth Annual Research Meeting AcademyHealth Annual Research Meeting
Boston MABoston MA
2
Why Study Caregivers and Workers?
Informal CaregiversInformal Caregivers
– Provide more care than paid sourcesProvide more care than paid sources
– Help care recipients avoid nursing homesHelp care recipients avoid nursing homes
Directly Hired WorkersDirectly Hired Workers
– Are an important but overlooked groupAre an important but overlooked group
3
Methods
Effects on Primary Informal Caregivers Effects on Primary Informal Caregivers
– Identified at baseline; interviewed at 10 months Identified at baseline; interviewed at 10 months
– Compared treatment and control group caregivers Compared treatment and control group caregivers
Experiences of Directly Hired WorkersExperiences of Directly Hired Workers
– Identified and interviewed 9 to 10 months after Identified and interviewed 9 to 10 months after baselinebaseline
– Benchmarked against agency workers Benchmarked against agency workers
5
Caregiver Characteristics: 3 States
N = 1,000 – 1,400 (for Adults); 829 (for Children)N = 1,000 – 1,400 (for Adults); 829 (for Children)
Female (Female (~80%)~80%)
Related to Care Recipient (Related to Care Recipient (~90%)~90%)
Married (50 to 60%)Married (50 to 60%)
Dependent Children (20 to 30%)Dependent Children (20 to 30%)
Employed (40 to 50%)Employed (40 to 50%)
6
Caregiver Payment
Some treatment group caregivers were paid Some treatment group caregivers were paid for caregiving during followupfor caregiving during followup
56% Arkansas 56% Arkansas
42% New Jersey 42% New Jersey
29% Florida ( for Adult Care Recipients)29% Florida ( for Adult Care Recipients)21% Florida (for Children)21% Florida (for Children)
7
Hours of Care Provided in 2 Weeks
*,**,*** Significantly different from control group at .10 (*), .05 (**), or .01 (***) level.
107
124 123
150
117
133
113
155
0
20
40
60
80
100
120
140
160
MeanAdult Care Recipients Child Care Recipients
T T T TC C C C
AR FL NJ FL
*
*
8
Experienced Great Emotional Strain
27
36
4239
3439
49
42
0
10
20
30
40
50
60Percent Adults Children
*,**,*** Significantly different from control group at .10 (*), .05 (**), or .01 (***) level.
T T T TC C C C
AR FL NJ FL
***
**
9
Experienced Great Physical Strain
2328
32 3432
3942 42
0
10
20
30
40
50
60Percent
Adults Children
*,**,*** Significantly different from control group at .10 (*), .05 (**), or .01 (***) level.
T T T TC C C C
AR FL NJ FL
***
****** ***
10
Experienced Great Financial Strain
22
30 30
44
3639 39
56
0
10
20
30
40
50
60Percent
Adults Children
*,**,*** Significantly different from control group at .10 (*), .05 (**), or .01 (***) level.
T T T TC C C C
AR FL NJ FL
***
*** ***
***
11
Very Satisfied with Overall Care
*,**,*** Significantly different from control group at .10 (*), .05 (**), or .01 (***) level.
61
4852
4243
30 32
22
0
20
40
60
PercentAdults Children
T T T TC C C C
AR FL NJ FL
***
******
***
12
Very Satisfied with Own Life
*,**,*** Significantly different from control group at .10 (*), .05 (**), or .01 (***) level.
5147
52
3740
3538
24
0
20
40
60
Percent Adults Children
T T T TC C C C
AR FL NJ FL
******
***
***
13
Conclusions
Positive effects stemmed from several factorsPositive effects stemmed from several factors
– Allowance, hours, other workers, paymentAllowance, hours, other workers, payment
Cash and Counseling could postpone burnoutCash and Counseling could postpone burnout
– Reduction in Arkansas nursing home useReduction in Arkansas nursing home use
15
Relationship of Consumer toDirectly Hired Worker
78
59
70
54
16
2619
26
5
1610
21
0
25
50
75
100
Related Knew Previously Did Not Know Previously
Percent
AR Adults FL Adults NJ Adults FL Children
16
Hours of Care Provided by Directly Hired Workers
Paid Hours per Week Paid Hours per Week
– 12 (Arkansas) to 20 (Florida, New Jersey)12 (Arkansas) to 20 (Florida, New Jersey)
Unpaid Hours per WeekUnpaid Hours per Week
– 59 to 74% provided some unpaid hours59 to 74% provided some unpaid hours– 25% provided more than 41 unpaid hours25% provided more than 41 unpaid hours
17
Working Conditions
Directly HiredDirectly Hired Agency Agency
Hourly WageHourly Wage ARAR FL and NJFL and NJ
$6.00$6.00$10.00$10.00
$6.30$6.30$9.00$9.00
Receives Fringe Receives Fringe BenefitsBenefits 2 to 5%2 to 5% 17 to 24%17 to 24%
Very Satisfied Very Satisfied with Wages and with Wages and BenefitsBenefits 41 to 50%41 to 50% 19 to 23%19 to 23%
Very Satisfied Very Satisfied OverallOverall 79 to 85%79 to 85% 69 to 83%69 to 83%
18
Training and Preparedness of Directly Hired Workers
Half trained in personal care or routine health careHalf trained in personal care or routine health care
On the other hand—On the other hand—
Felt well-informed about care recipient’s condition Felt well-informed about care recipient’s condition ((~~90%)90%)
Felt fully prepared for job (>90%)Felt fully prepared for job (>90%)
Injuries and physical strain similar to agency workers Injuries and physical strain similar to agency workers providing equal hours of care providing equal hours of care
19
Worker Well-Being
Directly Hired Workers More Likely to:Directly Hired Workers More Likely to:
– Experience emotional strainExperience emotional strain
– Want more respect from consumer’s familyWant more respect from consumer’s family
20
Worker Well-Being (cont’d)
53
35
43
19
43
19
0
10
20
30
40
50
60
Related Not Related Agency
PercentFeels Emotional Strain
Wants More Respect
21
Conclusions
More emotional involvement than professional detachmentMore emotional involvement than professional detachment
– Relationships with consumers were strongRelationships with consumers were strong
More hands-on experience than formal training More hands-on experience than formal training
– But training is a good ideaBut training is a good idea
More overall satisfaction than financial compensationMore overall satisfaction than financial compensation
– The work force is dependableThe work force is dependable