‘Replacement Care’ for Working Carers? A Longitudinal Study in England, 2013–15

Abstract

In the context of rising need for long-term care, reconciling unpaid care and carers' employment is becoming an important social issue. In England, there is increasing policy emphasis on paid services for the person cared for, sometimes known as 'replacement care', to support working carers. Previous research has found an association between 'replacement care' and carers' employment. However, more information is needed on potential causal connections between services and carers' employment. This mixed methods study draws on new longitudinal data to examine service receipt and carers' employment in England. Data were collected from carers who were employed in the public sector, using selfcompletion questionnaires in 2013 and 2015, and qualitative interviews were conducted with a sub-sample of respondents to the 2015 questionnaire. We find that, where the person cared for did not receive at least one 'key service' (home care, personal assistant, day care, meals, short-term breaks), the carer was subsequently more likely to leave employment because of caring, suggesting that the absence of services contributed to the carer leaving work. In the interviews, carers identified specific ways in which services helped them to remain in employment. We conclude that, if a policy objective is to reduce the number of carers leaving employment because of caring, there needs to be greater access to publicly-funded services for disabled and older people who are looked after by unpaid carers.

Caring hours and possible need for employment support among primary carers for adults with mental illness: Results from an Australian household survey

“…Formal services never could or should completely replace the important and personalised support provided by mental health carers (Diminic et al, ). However, improving the effectiveness and accessibility of support services for both people with mental illness and their carers is likely to enable carers some respite and help them to sustain multiple roles of caring and paid work more easily (Lilly et al, ; Pickard, ; Pickard et al, ). Assisting carers with an intensive support role to better balance their employment and caring responsibilities is likely to have both economic benefits and significant benefits to carers’ own financial stability and quality of life (Carers Australia, ; Jacobs et al, ).…”

“…Since the 2015 SDAC was cross‐sectional, it was not possible to identify a causal association between caring hours and employment; carers who provide a high number of support hours may need to exit the workforce, but also carers who are not employed may be able to provide more support. Longitudinal studies have shown that intense caring hours for working carers do lead to a significant subsequent risk of leaving the workforce (King & Pickard, ; Leigh, ; Pickard et al, ). We did not explore whether characteristics of the carer's original employer or job role were related to their current employment status; this would be an interesting area for further research.…”

“…A number of variables were identified for inclusion in the analyses to control for potential covariates of the relationship between caring hours and not being employed, and group differences between primary carers for people with mental illness versus other conditions. Demographic and caring role characteristics selected based on previous research (Carr et al, ; King & Pickard, ; King et al, ; Lilly et al, ; Pickard et al, ; Pickard, King, Brimblecombe, & Knapp, ; Ruhm, ) included: carer sex, age group, marital status, rurality, country of birth, highest level of education, whether the carer has a disability, the number of people cared for, whether the main person supported is their partner or adult child, whether the main person cared for is profoundly limited in core activities, length of time caring, whether the main person supported receives formal assistance from organised services for their disability, receipt of formal assistance with cognitive or emotional tasks by any person cared for, receipt of other formal assistance by any person cared for (including with household chores, meal preparation, property maintenance, reading or writing, communication, transport, healthcare, mobility and self‐care), highest frequency of formal assistance received by any person being cared for (none, less than weekly, weekly or more), and whether any person being supported has an unmet need for assistance.…”

“…However, aspects of the caring role may be more amenable to intervention to help carers maintain employment. Intensive caring has been linked to lower employment rates among carers for people with any condition, where intensity is measured by the hours of support provided or related factors such as the care recipient's level of impairment or whether they receive paid assistance (Carmichael, Charles, & Hulme, ; Lilly et al, ; Pickard, Brimblecombe, King, & Knapp, ). In Australia, O’Loughlin, Loh, and Kendig () found that older adults caring for 10 or more hours per week had only half the full‐time employment rate of those caring for fewer than 10 hr.…”

“…Similarly, Leigh () identified a significant reduction in employment rates among carers providing more than 10, or more than 35 weekly hours of support. Previous studies suggest a non‐linear relationship between caring hours and employment, with a threshold of between 10–20 hr/week above which there is a significant drop‐off in employment (Carmichael & Charles, ; Carmichael et al, ; Carr et al, ; King & Pickard, ; Leigh, ; O'Loughlin et al, ; Pickard et al, ; Ruhm, ). There is a lack of consensus on the point beyond which caring hours are detrimental to employment (Nguyen & Connelly, ).…”