How Caregivers and Workers Fare in Cash and Counseling Leslie Foster Stacy Dale June 26, 2005 AcademyHealth Annual Research Meeting Boston MA

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

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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

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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

Primary Informal CaregiversPrimary Informal Caregivers

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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%)

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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)

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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


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


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


T T T TC C C C

AR FL NJ FL

***

*** ***

***

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Very Satisfied with Overall Care


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


5147

52

3740

3538

24

0

20

40

60

Percent Adults Children

T T T TC C C C

AR FL NJ FL

******

***

***

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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

Directly Hired WorkersDirectly Hired Workers

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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

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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

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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%

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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

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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

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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

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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

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Documents

How Caregivers and Workers Fare in Cash and Counseling Leslie Foster Stacy Dale June 26, 2005 AcademyHealth Annual Research Meeting Boston MA