Caregiver

"Carer" redirects here. For Other meanings and uses, see Caregiver (disambiguation).

"Care provider" redirects here. For providers of health care, see Health care provider.

See also: Home care, Family caregivers, Elderly care, Carers rights movement, Caregiving and dementia, Long-term care, and Personal Care Assistant

Caregiver, (U.S., Canadian and Chinese usage) and carer (UK, NZ, Australian usage) are words normally used to refer to unpaid relatives or friends of a disabled individual who help that individual with his or her activities of daily living.

The words may be prefixed with "family" "spousal", "child", "parent", "young" or "adult" to distinguish between different care situations, and also to distinguish them definitively from the paid version of a caregiver, a Personal Care Assistant or Personal Care Attendant (PCA). Around half of all carers are effectively excluded from other, paid employment through the heavy demands and responsibilities of caring for a vulnerable relative or friend. The term "carer" may also be used to refer to a paid, employed, contracted PCA.

The general term dependant care (i.e., care of a dependant) is also used for the provided help. Terms such as "voluntary caregiver" and "informal carer" are also used occasionally, but these terms have been criticized by carers as misnomers because they are perceived as belittling the huge impact that caring may have on an individual's life, the lack of realistic alternatives, and the degree of perceived duty of care felt by many relatives.

More recently, Carers UK has defined carers as people who "provide unpaid care by looking after an ill, frail or disabled family member, friend or partner". Adults who act as carers for both their children and their parents are frequently called the Sandwich generation.

A general definition of a carer/caregiver is someone who is responsible for the care of someone who has poor mental health, physically disabled or whose health is impaired by sickness or old age. To help caregivers understand the role they have taken on, "Next Step in Care" outlines the following:

You are a caregiver if you:

• Take care of someone who has a chronic illness or disease.
• Manage medications or talk to doctors and nurses on someone’s behalf.
• Help bathe or dress someone who is frail or disabled.
• Take care of household chores, meals, or bills for someone who cannot do these things alone.

It's my Duty Isn't it?

—Baroness Pitkeathley (1989)

With an increasingly aging population in all developed societies, the role of carer has been increasingly recognized as an important one, both functionally and economically. Many organizations which provide support for persons with disabilities have developed various forms of support for carers as well.

Geographical variations and organizations

International organizations

See also: Carers rights movement and Caregiving and dementia

On February 27, 2004, the International Alliance of Carers Organizations (IACO) was launched by family caregiving organizations from Australia, the UK, Sweden, the Netherlands, and the U.S. The mission of the organization is threefold:

• to increase visibility of family caregiving across the lifespan as an international issue;
• to promote the sharing of best practices in caregiving programs between countries; and
• to encourage and provide assistance to countries interested in developing family carer organizations.

IACO is headquartered in London. Initial IACO projects included promotion of a United Nations Day for Carers and a presentation on the IACO as part of a half-day workshop at the International Federation on Aging conference in Singapore on August 4, 2004. National family carer organizations in all countries are encouraged to join the alliance.

Canada

Canadian Caregivers Association logo

Canadian Caregivers Association is a non-for-profit organization that was established to protect the rights of Canadian families and caregivers from all over Canada and warn them about malpractices in this business.

Europe

EUROFAMCARE aims to provide a European review of the situation of family carers of elderly people in relation to the existence, familiarity, availability,use and acceptability of supporting services. In 2003 six countries (Germany, Greece, Italy, Poland, Sweden, United Kingdom) formed a trans-European group, systematically representing the different types of welfare-states in Europe and started a comparative study. The Pan-European Group consists of 23 countries (including the six countries, which are represented by the members of the Consortium).

The last step is a feedback research action phase based both on the study results and on the pan-European expertise. A European Carers’ Charter in progress will be further developed by the new European network organization EUROCARERS in order to stimulate further activities both on national and European policy levels.

EUROCARERS was formally launched in June 2007 to provide a united voice at European level and influence policy both nationally and within the European Union. Eurocarers currently comprises representatives of 18 organisations and research bodies from nine countries. Members have come together to influence policy within the European Institutions to ensure that the invaluable contribution of carers is recognised across Europe.

EUFAMI - the European Federation of Families of People with Mental Illness - has been operating since 1992.

Ireland

The Carers Association was founded in 1987 to represent family carers and advocate for carers rights. The national census of 2006 shows that there are 160,917 people who stated that they are carers and almost 41,000 of these carers are providing 43 or more hours of care each week. They estimate that carers provide 194 million hours of care a year to the value of about 2.5 billion Euros to the economy. Approximately 33,000 fulltime carers qualify for the Carers Allowance from the government.

UK

According to Carers UK, and based on the 2001 census around six million people in the UK provide care on an unpaid basis for a relative, friend or neighbour in need of support due to old age, disability, frailty or illness. The population of carers is dynamic: at least a third of all people will fulfil a caring role at some point in their lives.

Research has shown that becoming a carer can have many impacts on a person's life. These include financial costs, exclusion and discrimination at work, social isolation and poor health through stress and physical injury.

At least half of all carers are in full or part time employment and some care for more than one person. Carers save the UK economy an estimated £87bn a year, and economic considerations form a key element in government policy to support carers.

The 2001 Census indicated that there are 175,000 young carers aged under 18 in the UK today. A poll commissioned by The Princess Royal Trust for Carers in 2004 indicates that the number of young carers could be much higher.

Scotland

Policy and legislation in relation to caregivers living in Scotland is somewhat different from that in England, Wales and Ireland. Carers are defined by the Scottish Census as being “individuals who look after, or give any help or support to family members, friends, neighbours and others because of long-term physical or mental ill health or disability or problems related to old age” (Scotland’s Census Results Online [SCROL]. Estimates from the 2001 census put the numbers of carers in Scotland at 481,579. Of these, 175,969 are reported to provide more than 20 hours of care a week, and 24% provide more than 50 hours of care.

Carers who provide care for 20 hours a week or more are regarded as being at the ‘heavy end’ of caring (Parker 1990). This assumes that they are the most involved carers, providing both personal and physical care, resulting in high levels of stress and most in need of support services. Many of these carers continue to provide care without support from social work or health services and because of this they remain hidden or invisible (Scottish Executive 2006, Cavaye 2006).

Carers are viewed by the government as an important resource and in recent years have been given increasing recognition in health and social care policy. Since devolution in 1999 legislation and policy for caregivers has been developed by the former Scottish Executive (now Scottish Government).

Carers in Scotland are regarded as ‘partners’ in the provision of care. As a result, support services provided to carers are regarded as part of the overall package of care to the person being looked after. This means that carers are not seen as service users and are therefore not responsible for the cost of any service provided. The exception to this is when a carer is looking after their partner; in that situation their income may be taken into account during a financial assessment.

This situation is different from that which exists in England where carers are viewed as services users in their own right and as such are liable for the cost of services provided. Yet, in many cases, it is not the carer who actually needs the service; it is the person being cared for who needs it because of their illness or disability.

Australia

According to the Australian Bureau of Statistics 2001 paper on the health and well being of Carers, Carers save the Australian Federal Government over $30 billion dollars a year, according to the same statistics there are over 300 000 Young Carers (CA states that a Young carer is any carer under the age of 25) with 1.5 million potential young carers, where potential is defined as a young person who lives in a household where there is at least one person who requires full time care (Is disabled etc.).

In Australia they also have The Australian National Young Carers Action Board (ANYCAT) whose goal is to advocate on behalf of young carers (Being young carers themselves) each board member is the sole representative of their state or territory and represent as few as 75 000 Young Carers. In Most states and Territories they have an ANYCAT equivalent team or Board in Queensland this is called Young Carers Action Board Queensland (YCABQ).

China

According to the National Bureau of Statistics of China 2011 report regarding China’s total population and structural changes, people belong to the age group of 60 years and above accounted for 184.99 million, which occupied 13.7 percent of the total national population at the end of 2011. The number has risen 0.47 percentage point comparing to the year of 2010. Of these, people age 65 years and above figured up 122.88 million that occupied 9.1 percent of the total and has increased 0.25 percentage points.

As a steadily increasing older population with a growing demand for long-term care, an issue of lacking of elderly care facilities as well as inadequate training for skilled caregivers has generated a social concern pertaining to elder care. According to the official Chinese media Xinhua, professionally qualified caregivers are in great request with approximately 10 million people needed to provide care for the Chinese aging population. However, the report also stated that only 300,000 people currently working as caregivers with less than 1/3 of them are trained properly.

There is no organized caregiver association in China. As a result, family members still construct the major source of caregiving in China especially in rural area where the quality of health services is a problem. A recent study aims to examine the effect of depression on family members of whom sons and daughter-in-laws carry out main responsibilities in caring for elderly parents have indicated several findings, including:

• The majority of caregivers choose to rely on medical resources (physicians and tranditional healers) during the caregiving for older people.
• The depression score varied significantly between caregivers of healthy and non-healthy older adults.
• The severity of depressive expression associated with background of caregiving, like caregiver’s income, age, and the time spent on caregiving.
• Social support plays an important role in impacting the status of depression among family caregivers.

Taiwan

Taiwan Today reports, "In Taiwan at present, only 72,000 seniors, or one third of those receiving long-term care, live in nursing institutes. The rest receive home care, provided by family members, along with some 170,000 foreign caregivers" (2011). Additionally, Taiwan Today also indicates, "According to the Taiwan Association of Family Caregivers (TAFC) survey, 80 percent of family caregivers are women, and 50 percent of them are over 50 years of age. They spent an average of 13.55 hours a day taking care of a relative, and more than half exhibit a tendency of depression" (2011). The Taiwan Association of Family Caregivers (TAFC) was built in 1996. It is the first non-profit organization to voice the rights for family caregivers in Taiwan.(AARP International) The association encourages each city to set up a chapter in order to provide service to family caregivers. The association is in Taipei and there are ten chapters around Taiwan. The services the TAFC provides are training courses, support groups, a consulting hotline and a counseling service for caregivers, and training programs for family caregivers. Additionally, the association has allied with the League of Welfare Improvement for Older People, the League of Welfare Organization for the Disabled, United Way and Parents Association for Persons with Intellectual Disabilities. In addition, Family Caregivers Day is on the fourth Sunday of November every year. It hopes to raise public awareness and concern for family caregivers and hopes to make policies to support and help them.

Ukraine

The Ukraine has an institute of Gerontology which was established in 1958, and it has four main centers or associations which include State Educational and Methodical Geriatric Center, Ukrainian Scientific Center of Osteoporosis, Ukrainian Association of Osteoporosis, and Ukrainian Association of Menopause, Andropuase, and Disease of Bone and Joint System ("History institute," ).This Institute has contributed research and publications which can be very helpful in assisting the older population of the country; however, there is no known or formal caregiver association established in the Ukraine. In the country there are different types of resources available to the older population, which requires care, and many factors which influence the availability of the care such as the population itself, government, economy and finances.

The average life expectancy in the Ukraine is 61 for men and 72 for women, and as of 2005 Ukraine’s population is about 48 million of whom 15% are 65 and older (Lipstiz, 2005). Older adults who cannot take care of themselves rely on family members, humanitarian organizations, government programs, or a combination of the three sources (Lipstiz, 2005). According to the United Nations the Ukrainian Institute of Gerontology completed a study in 1998 which included 8,574 adults of retirement age, and the results demonstrated that older adults rely on elderly spouses, relatives or others, and departments of community social centers for care (Bezrukov, & Foigt, 2002). In addition, 10 percent of the participants had an agreement with their caregiver(s) to trade inheritance of their property for the care that they were receiving (Bezrukov, & Foigt, 2002). The United Nations also describes the very underfunded and understaffed situations of the country to take care of its older population. For example, they mention that some 38,000 social workers provide care to about 500,000 older adults in need, and a total of 631 community centers and 131 social welfare units are available to provide support for the older population throughout the country (Bezrukov, & Foigt, 2002). In addition to limited government and local resources many of those who could be caregivers to family members or others in the community choose to migrate to Italy (Fedyuk, 2009).

The declining standards of living, economy, and production in the country of Ukraine could be contributing to the migration of Ukrainians to Italy and other countries abroad. It is estimated that there are close to 700,000 undocumented and approximately 195,000 legal working Ukrainian immigrants in Italy and a majority of them work as caregivers (Fedyuk, 2009). Fedyuk (2009) mentions that many of those who move to Italy do not speak the language, work unregulated hours, may be underpaid, and usually are not prepared for all the physical and psychological requirements of being a caregiver to older adults entails. For instance, Fedyuk (2009) describes the working requirements of a 51 year old caregiver who only had a 2 hour break during a single day and one day off a week. Also, there is mention of a 49 year old woman who arrived to her new job and was not told the “granny” she would be caring for had an amputated arm and leg, was blind and could not speak (Fedyuk, 2009). Those who migrate to Italy usually leave behind families and parents who require care themselves, and this puts further stress and pressure on the individual (Fedyuk, 2009). Further research should be done in order to examine the extent of the consequences that may result to the caregiver, receiver of care, and those who are left behind in the cases of migrant Ukrainian workers.

United States

According to a November, 2007 survey on family caregiving, most family caregivers feel more positive about their experiences than they did just before they took on the responsibility, with significant differences in expectation prior to becoming a caregiver and the actual experience.

The survey also found that caregivers are often burdened by high out-of-pocket costs in caring for a spouse or parent, but:

• Sixty percent of the caregivers called the experience "very or extremely rewarding," a 50% jump over the number of caregivers who thought in advance they would find the experience "very or extremely rewarding." Nearly 80% (78.8%) percent of the caregivers found the experience to be at least "rewarding," an increase of more than one-third from initial expectation.
• A majority of the caregivers-nearly 54%-formed a stronger bond with the patient during the time they were together.
• Almost 60% of the respondents reported an improvement in the quality of their relationship with the person for whom they cared. By contrast, fewer than 10% said that their relationship got worse during the time they were caregivers.
• Social activities of the caregiver tend to diminish. The diminished social activities are replaced with an increased quality of relationship with the care recipient.
• More than 2/3 of all caregivers (68.7%) said they enjoy the tasks associated with caregiving. Prior to assuming the role, fewer than half (45.5%) thought they would enjoy caregiving.
• The amount of satisfaction with caregiving is directly related to the type of disease from which the care recipient suffers. Caregivers of depression sufferers, cancer and cardiac disease have more difficulty than those caring for patients who suffer from diabetes, high blood pressure and arthritis.

More than ¾ of caregivers are female. Nearly ¾ range in age from 35 to 59.

Other information about US caregivers: More than 50 million people provide care for a chronically ill, disabled or aged family member or friend during any given year.

1.4 million children ages 8 to 18 provide care for an adult relative; 72% are caring for a parent or grandparent, although most are not the sole caregiver.

30% of family caregivers caring for seniors are themselves aged 65 or over; another 15% are between the ages of 45 to 54.

The value of the services family caregivers provide for "free" is estimated to be $306 billion a year. That is almost twice as much as is actually spent on homecare and nursing home services combined ($158 billion).

Caregiving respite

The stress associated with unsupported care for chronically ill family members may result in a condition commonly referred to as caregiver syndrome.

In the United States today there are approximately 50 million people who are caring at home for family members including elderly parents, and spouses and children with disabilities and/or chronic illnesses. Without this home-care, most of these cared for loved ones would require permanent placement in institutions or health care facilities at great cost to society.

Close to 80% of all long-term care is now provided at home by family caregivers to children and adults with serious conditions, including mental health issues, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), traumatic brain injury, cancer, paralysis, developmental and physical disabilities, cognitive impairments and Alzheimer's disease. Parents and family caregivers are the backbone of the long-term care system and save health-care insurers and governments billions of dollars annually.

The physical, emotional and financial consequences for the family caregiver can be overwhelming without some support, such as respite. Respite provides the much needed temporary break from the often exhausting challenges faced by the family caregiver.

Respite is the service most often requested by family caregivers, yet it is in critically short supply, inaccessible, or unaffordable regardless of the age or disability of the individual needing assistance. While the focus has been on making sure families have the option of providing care at home, little attention has been paid to the needs of the family caregivers who make this possible.

Without respite, not only can families suffer economically and emotionally, caregivers themselves may face serious health and social risks as a result of stress associated with continuous caregiving. Three fifths of family caregivers age 19-64 surveyed recently by the Commonwealth Fund reported fair or poor health, one or more chronic conditions, or a disability, compared with only one-third of non-caregivers.

See also

• Carers rights movement
• Direct Support Professional
• Elderly care
• Family Caregiver Alliance
• Family caregivers
• Patient care assistant

Further reading

• Mitnick, S.; Leffler, C.; Hood, V.; American College of Physicians Ethics, P. A. H. R. C. (2010). "Family Caregivers, Patients and Physicians: Ethical Guidance to Optimize Relationships". Journal of general internal medicine 25 (3): 255–260. doi:10.1007/s11606-009-1206-3. PMC 2839338. PMID 20063128. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2839338. Lay summary. 
• Carol Levine, ed. (2004) Always On Call: When Illness Turns Families into Caregivers (2nd ed.), Vanderbilt University Press for the United Hospital Fund. ISBN 0826514608
• Dr. Marion Somers Elder Care Made Easier: Doctor Marion's 10 Steps to Help You Care for an Aging Loved One, Addicus Books, 2006. ISBN 1886039801
• Joyce Cavaye (2006) Hidden Carers, Dunedin Press, Edinburgh, ISBN 1903765668
• Judith M. Ashley,(2007) Into The Silence: The Power of Stillness in Living and Dying. 194 pp. ISBN 9780595440856 A Memoir. iUniverse.
• National Council for the Single Woman and Her Dependants, Roxane Arnold, and Olive Chandler (1974) Feminine Singular: Triumphs and Tribulations of the Single Woman: An Anthology. London: Femina Books. ISBN 0850430151 OCLC 1230000
• John Norman Agate (1979) Taking Care of Old People at Home, Unwin Paperbacks, London, 61.50, 159 pp. ISBN 0049700049 OCLC 12468034
• Tim Dartington (1980) Family Care of Old People, Souvenir Press, London, 23.95, 159 pp. ISBN 0285648853 OCLC 59798959
• J.A. Muir Gray, Heather McKenzie (1980) Take Care of Your Elderly Relative, George Allen and Unwin, London, g5.95, 202 pp. ISBN 0046180168 OCLC 6943192
• Bonnie Campbell McGovern (2007) Taking Care of Barbara: A Journey Through Life and Alzheimer's and 29 Insights for Caregivers. ISBN 0595405363 OCLC 145511953
• Ann Burack-Weissi, "The Caregiver’s Tale: Loss and Renewal in Memoirs of Family Life", Journal of Marriage and Family, 69, no. 1 (2007): 271-272 ISSN 0022-2445
• Sylvia Barron Baca (2007) Caregiver Daily Journal Gardners Books ISBN 1430321024 OCLC 176917554
• Linda S. Thompson, A Caregivers Journey-You Are Not Alone
• Frank A. Fuerst, (2007) Alzheimer's Care with Dignity, Headline Books.
• Tim Cook (2007) The History of the Carers' Movement, Carers UK. ISBN 978873747360
• Scottish Executive (2006) The Future of Unpaid Care in Scotland, Edinburgh, Scottish Executive.
• G. Parker (1990) With This Body: Caring and Disability in Marriage, Buckingham, Open University Press.
• Wang, Huali., Xiong, Qian., Levokoff, E Sue., Yu, Xin. (2009). Social support, health service use and mental health among caregivers of the elderly in rural China. Aging International , 35 (1): 72-84.

References

Bezrukov, V., & Foigt, N. (2002). Political, social and economic crises and living arrangements of older persons: the case of Ukraine. New York: UN Population Division.

Fedyuk, O. (2009), Death in the Life of Ukrainian labor migrants in Italy. http://aa.ecn.cz/img_upload/6334c0c7298d6b396d213ccd19be5999/OFedyuk_DeathinthelifeofUkrainianlabormigrantsinItaly_1.pdf

History institute. (n.d.). Retrieved from http://geront.kiev.ua/history.htm

Lipsitz, L. A. (2005). The Elderly People of Post-Soviet Ukraine: Medical, Social, and Economic Challenges. Journal Of The American Geriatrics Society, 53(12), 2216-2220. doi:10.1111/j.1532-5415.2005.00488.x

External links

• Caregiver search at the Open Directory Project returns many organizations and pages of further advice, forums, etc.
• Caregiver Discussion and Journals provides a forum for caregivers to communicate, ask questions, and relieve stress.
• Caregiver Support Network | Community Caregiver Jobs, Forums, Answers, Polls, Blogs and many more FREE resources for Caregivers
• eCareDiary.com provides a care diary tool to track appointments, a search engine to find care facilities in your area and expert Q&A Webinars for caregivers.