This study examined differences between paid and unpaid family/friend caregivers to better understand the consumer-driven caregiving workforce. We compared economic vulnerability, unhealthy behavior, and serious emotional distress for 475 paid and 10,500 unpaid family/friend informal caregivers from the 2009 California Health Interview Survey. We then estimated whether caregiver status moderated the relationship between economic vulnerability and health outcomes. Compared to unpaid family/friend caregivers, paid family/friend caregivers had a 27% greater risk (p = .002) of economic vulnerability. Among all family/friend caregivers, the probabilities of serious emotional distress and unhealthy behaviors increased by >100% and 28% for those with the greatest compared to the least economic vulnerability, and caregiver type did not moderate these relationships. To address economic and health vulnerabilities of paid informal caregivers, policy makers might increase wages in consumer-driven programs. These changes could prove beneficial to both paid informal caregivers and their care recipients, while reducing long-term inefficiencies in consumer-driven programs.
AinaY.SusmanJ. L. (2006). Understanding comorbidity with depression and anxiety disorders. Journal of the American Osteopathic Association, 106, S9–S14.
BenjaminA. E.MatthiasR. E. (2004). Work-life differences and outcomes for agency and consumer-directed home-care workers. The Gerontologist, 44, 479–488.
4.
BenjaminA. E.MatthiasR.FrankeT. M. (2000). Comparing consumer-directed and agency models for providing supportive services at home. Health Services Research, 35, 351–366.
5.
BenjaminA. E.MatthiasR. E.KietzmanK.FurmanW. (2008). Retention of paid related caregivers: Who stays and who leaves home care careers?The Gerontologist, 48, 104–113.
California Association of Public Authorities. (2012). CAPA Survey on IHSS Wages as of June 17, 2011. Retrieved fromhttps://capaihss.org/.
8.
CapistrantB. D.BerkmanL. F.GlymourM. M. (2014). Does duration of spousal caregiving affect risk of depression onset? Evidence from the Health and Retirement Study. American Journal of Geriatric Psychiatry, 22, 766–770. doi:10.1016/j.jagp.2013.01.073
9.
CatalanoR.Goldman-MellorS.SaxtonK.Margerison-ZilkoC.SubbaramanM.LeWinnK.AndersonE. (2011). The health effects of economic decline. Annual Review of Public Health, 32, 431–450. doi:10.1146/annurev-publhealth-031210-101146
10.
Direct Care Alliance. (2012). A stable, reliable direct care workforce for our future. New York, NY: Author.
11.
Dilworth-AndersonP.WilliamsI. C.GibsonB. E. (2002). Issues of race, ethnicity, and culture in caregiving research: A 20-year review (1980–2000). The Gerontologist, 42, 237–272.
12.
DoY. K.NortonE. C.StearnsS. C.Van HoutvenC. H. (2015). Informal care and caregiver’s health. Health Economics, 24, 224–237. doi:10.1002/hec.3012
FosterL.DaleS. B.BrownR. (2007). How caregivers and workers fared in cash and counseling. Health Services Research, 42, 510–532. doi:10.1111/j.1475-6773.2006.00672.x
16.
GarandL.DewM.EazorL.DeKoskyS.ReynoldsC. (2005). Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment. International Journal of Geriatric Psychiatry, 20, 512–522.
HoffmanG. J.LeeJ.Mendez-LuckC. A. (2012). Health behaviors among baby boomer informal caregivers. The Gerontologist, 52, 219–230. doi:10.1093/geront/gns003
19.
HoffmanG. J.Mendez-LuckC. A. (2011). Stressed and strapped: Caregivers in California. Los Angeles, CA: UCLA Center for Health Policy Research.
20.
HoffmanG. J.WallaceS. P. (2012). Hidden in plain sight: California’s paid Medi-Cal caregivers are vulnerable. Los Angeles, CA: UCLA Center for Health Policy Research.
21.
HowesC. (2004). Living wages and retention of homecare workers in San Francisco. Journal of Industrial Relations, 44(1), 139–163.
22.
Institute of Medicine. (2016). Families caring for an aging America (SchulzR.EdenJ., Eds.). Washington, DC: National Academies Press.
23.
KayeH. S. (2014). Toward a model long-term services and supports system: State policy elements. The Gerontologist. doi:10.1093/geront/gnu013
24.
KesslerR. C.AndrewsG.ColpeL. J.HiripiE.MroczekD. K.NormandS. L.…ZaslavskyA. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959–976. doi:10.1017S003329170200607
Mendez-LuckC. A.AmorimC.AnthonyK. P. (2016). Talk versus action: Comparing the narratives and behaviors of diabetes self-management in Latino caregiving dyads. Diabetes Educator, 42, 444–451. doi:10.1177/0145721716654007
28.
Mendez-LuckC. A.WalkerK. O.LuckJ. (2016). Preventive services use among African American and Latino adult caregivers in South Los Angeles. Medical Care, 54, 1098–1104. doi:10.1097/mlr.0000000000000584
29.
National Alliance for Caregiving. (2015). Caregiving in the U.S.: 2015 report. Washington, DC: National Alliance for Caregiving.
30.
PearlinL. I. (2010). The life course and the stress process: Some conceptual comparisons. The Journals of Gerontology. Series B: Psychological Sciences and Social Sciences, 65B, 207–215. doi:10.1093/geronb/gbp106
31.
PinquartM.SorensonS. (2011). Spouses, adult children, and children-in-law as caregivers of older adults: A meta-analytic comparison. Psychology and Aging, 26, 1–14. doi:10.1037/a002186
SchulzR.SherwoodP. (2008). Physical and mental health effects of family caregiving. American Journal of Nursing, 108, 23–27. doi:10.1097/01.NAJ.0000336406.45248.4
34.
Simon-RusinowitzL.GarciaG. M.MartinD.SadlerM. D.TillyJ.MarksL. N.…MahoneyK. J. (2010). Hiring relatives as caregivers in two states: Developing an education and research agenda for policy makers. Social Work in Public Health, 25, 17–41. doi:10.1080/19371910802678970
35.
Simon-RusinowitzL.SchwartzA. J.LoughlinD.SciegajM.MahoneyK. J.DonkohY. (2014). Where are they now? Cash and counseling successes and challenges over time. Care Management Journals, 15, 104–110. doi:10.1891/1521-0987.15.3.104
36.
Stata. (2013). Stata base reference manual: Release 13. College Station, TX: Stata Press.
UCLA Center for Health Policy Research CHPR. (2008). Designed for disease: The link between local food environments and obesity and diabetes. Los Angeles, CA: UCLA Center for Health Policy Research.
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