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2018 Conference Presentation

Informal care United States

10 September 2018

The effect of primary caregivers’ employment on older people’s care receipt from their care networks and unmet need

Alexander Janus, University of Edinburgh, United Kingdom
Doty Pamela, , United States


Objectives: Social gerontologists have predicted that increased female employment would adversely affect the ability of disabled older people to rely on unpaid family caregivers. This paper is one of only a few that focuses on not only whether disabled older people receive fewer hours of help from employed primary caregivers but also whether supplemental paid and/or unpaid helpers compensate for any reduction in primary caregiver hours.

Methods: We conduct a pooled cross-sectional analysis of data on 2,268 older Americans and their primary caregivers from the National Study of Caregiving I and II, which was administered as part of rounds 1 and 5 of the National Health and Aging Trends Study. Results. Consistent with a previously published analysis based on the 1989 National Long-Term Care Survey (NLTCS) and Informal Caregiver Supplement (ICS), we find that employed primary caregivers provide fewer hours of help per week compared to non-working primary caregivers (27 versus 40 hours, p < .01).

Results: Unlike the earlier study’s findings, secondary caregivers’ hours did not change in response to the employment status of primary caregivers. However, older people with an employed primary caregiver make greater use of paid help compared to older people with a non-working primary caregiver (8 versus 5 hours, p < .01). Overall, while older people partially compensate for the reduction in hours from employed primary caregivers through greater use of paid help, older people with an employed primary caregiver still receive fewer total hours of help overall (-10 hours, p < .01). We also find that the compensatory effect of paid help is greater among older people with 2+ ADLs, dementia, and higher incomes. Finally, we find that older people with an employed primary caregiver report higher unmet need with IADLs (i.e., household management tasks) but a similar level of unmet need with ADLs (i.e., mobility-related and personal care tasks) compared to older people with a non-working primary caregiver. Interestingly, the percentage of primary caregivers who are employed among 2011/2015 NHATS/NSOC respondents is nearly the same (about one third) as among 1989 NLTCS/ICS respondents.

Conclusions: The decline since the late 1980s in the ability of employed primary caregivers to obtain supplemental informal help has made the ability to access paid help more important to ensure that high need care recipients get all the help they need. We have no explanation to offer except that it is consistent with the overall decline in secondary helpers documented in the NLTCS/ICS (1989, 1999, 2004). Accordingly, reliance on an employed primary caregiver now disadvantages high need care recipients who cannot afford to pay privately but are not poor enough to qualify for publicly-funded services.

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