Caregiving is providing regular care and assistance with daily living for the physical and emotional needs of seniors or disabled family members or friends at home or to residents in a long-term care home by family members or professional caregivers. It may be paid or unpaid for devoting just a few hours weekly, or many hours each day. It includes assistance with meals, personal care and transportation, and helping with medical procedures and therapy.
Though often perceived to be a service provided by medical and other healthcare professionals “Formal Health care” cannot meet the needs of individuals with chronic illness or disability, who need constant care and assistance from others. This type of health care is often home-based and given voluntarily by co-resident family members.
This unpaid care is called “informal care” and is not a part of the formal health care system, even though it is the backbone of long-term care. Unfortunately, the contributions of such informal caregivers go unnoticed, except by the recipients of this care. However, this contribution is irreplaceable and its estimated monetary value was deemed to be $450 billion in 2009, though the true value of caregivers far exceeds any monetary worth and is one of the greatest assets of humanity.
No society however rich or developed, can afford to substitute all informal caregivers with professional caregivers. The caregiving practices vary from country to country. Given here are the regional differences of caregiving practices as they vary across countries.
Australia has over 300,000 Young carers below the age of 25, with about 1.5 million potential young carers who live in a household which has at least one senior or disabled person requiring full-time care. In 2015, caregivers provided around 1.9 billion hours of unpaid care. $13.2 billion worth of free mental health support is provided by these carers to their family members and friends.
Chinese people aged 60 years and more accounted for about 184.99 million or 13.7 percent of the total national population by the end of the year 2011. Of these, 122.88 million, which is 9.1 percent of the total, were people aged 65 years and above. This constantly rising aging population, growing demand for long-term care, lack of elderly care facilities, and inadequate training for skilled caregivers have given rise to social concerns about elder care.
With a requirement of about 10 million people to provide care for the Chinese aging population, professionally qualified caregivers are in great demand. However, there are only 300,000 caregivers, and less than one-third of whom are properly trained. With no organized caregiver association in China, family members are still the major source of caregiving, particularly in rural areas where quality health services are not available.
The concept of Confucianism emphasizing filial piety guides the traditional caregiving ideology in China. Moreover, the average age of adult children providing care is 46 years, and the majority of them still work to support the family. Hence, their own life activities and personal schedules are negatively impacted causing great mental and physical strain.
Coping with the increasing number of dementia patients is the most significant caregiving challenge in Israel. Dementia being Israel's second leading cause of disability among those aged 70 and above, it is causing the most distressing and difficult conditions for the patients and their families. It is a great challenge for the health and social service systems, having a significant economic impact on society.
With the highest percentage of residents aged 65 and more and the life expectancy for males being 76.7 and 82.9 for females which are predicted to reach 81 and 86 years respectively by 2050 there is a rapidly growing older population in Italy and a shortage of younger individuals.
With family being the primary care provider for the older population, the government also provides adequate assistance to the family caregiver by providing qualified assistance at home, service vouchers, support services, day-care centers to provide support for families by offering elders rehabilitation and recreation, stays in holiday resorts for non-self-sufficient elders including those staying in hospitals or homes.
Though the family plays a major role in providing care to its elders, the young are the breadwinners as well, so many caregivers are immigrant workers who come for the search of work from many parts of the world such as the Philippines, Moldavia, Peru but mostly from Ukraine. Leaving their own families behind, they work long hours and weeks to send the money they earn.
There are only 72,000 seniors in Taiwan, and about one-third of those receiving long-term care, live in nursing homes. The rest are taken care of by family members numbering 600,000 spending an average of 13.55 hours a day caregiving. While 80 percent of them encountered limitations in social activities, 70 percent of them needed to take care of patients despite feeling unwell. 80 percent of the family caregivers are women, and 50 percent of them are over 50 years old.
Because of gender expectations, women are regarded as natural caregivers taking care of children and spouses, with chronicle illnesses and disabilities out of filial piety, and to meet social norms. Some of them experience guilt, nervousness, depression, sleeplessness, injuries, and hopelessness. Thus, it is very essential to promote the capabilities of family caregivers and improve their life quality.
As of 2005, Ukraine's population was about 48 million, of whom 15% were 65 and older with the average life expectancy being 61 for men and 72 for women. Elders unable to take care of themselves rely on family members, government programs, humanitarian organizations, or all. They rely on younger spouses, relatives or others, and community social centers for care. Ten percent even have an agreement with their caregiver to trade the inheritance of their property, for the care they are receiving.
The quality of services available to elders is highly affected by the underfunded and understaffed situation of the country. The declining standards of living, economy, and production has contributed to the migration of Ukrainians to Italy and other countries. About 700,000 undocumented and 195,000 legally working Ukrainian immigrants are estimated to be in Italy with the majority working as caregivers leaving behind families and parents who require care themselves. This puts further stress and pressure on these immigrant caregivers.
About six million Britons provide care on an unpaid basis for a relative, friend, or neighbor in need of support due to old age, frailty, disability, or illness. In 2022 there were 10.58 million carers and about a third of this dynamic population will fulfil a caring role at some point in their lives.
Becoming a caregiver can impact a person's life in many ways including financial costs, social isolation, exclusion and discrimination at work, and poor health due to stress and physical injury. At least 50% of all carers are in full or part-time employment, with some caring for more than one person. According to Age UK, carers who are 30% of people aged 80 and over, provide almost 23 million hours of unpaid care a week.
Scottish Census defines carers as individuals who look after, or give any help or support to family members, neighbors, friends, and others, because of long-term physical or mental ill health, disability, or problems related to old age. Carers providing care for 20 hours a week or more are at the heavy end of caring being the most involved carers, providing both personal and physical care, resulting in high levels of stress, and are most in need of support services. Many of them provide care without support from social work, or health services, thus remaining invisible.
However, in recent years they have been given increasing recognition in health and social care policy and are regarded as partners in the provision of care. Thus, support services provided to carers are considered as part of the overall package of care, for the person being looked after.
Carers are not seen as service users, and therefore not considered responsible for the cost of any service provided unless a carer is looking after their partner. In this case, their income may be taken into account during a financial assessment. On the other hand, carers in England are viewed as service users and are liable for the cost of services provided. In several cases, it is not the caregiver who actually needs the service, but it is the care recipient who needs it, because of their illness or disability.
According to a November 2007 survey, most family caregivers felt more positive about their experiences than they did prior to taking on the responsibility, with significant differences in expectations before becoming a caregiver and the actual experience.
It was 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. Nearly 80% percent of the caregivers found the experience to be at least "rewarding," an increase of more than one-third from initial expectation. Nearly 54% of caregivers formed a stronger bond with the care recipient 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 lessen as they dedicate more and more of their time. But the decline in social activities is replaced with better quality of relationship with the care recipient.
More than 2/3 of all caregivers (68.7%) said they enjoy the tasks associated with caregiving. Before taking up the role, 45.5% thought they would enjoy caregiving. The amount of fulfilment and satisfaction with caregiving is influenced greatly by the type of disease, the care recipient suffers from. Caregivers of people suffering from depression, cancer, or cardiac disease find it more difficult than caregivers caring for patients having diabetes, high BP, and arthritis.
According to the Caregiver statistics fact sheet (2012) 43.5 million of adult family caregivers care for someone 50+ years of age and 14.9 million care for someone who has Alzheimer's disease or other dementia. Young adults are increasingly becoming caregivers to their elderly relatives because of economic factors.
A new population of caregivers to the elderly is children and grandchildren, aged 40 years and younger, serving as the major source of support to an older relative(s). 61.6 million people provided unpaid care for chronically ill, disabled, or aged family members or friends at an estimated value of $450 billion by the year 2009.1.4 million children aged between 8 and 18 provided care for an adult relative while 72% were caring for a parent or grandparent, although the majority are not the sole caregivers. 30% of family caregivers caring for older patients are aged 65 and above while another 15% are between the ages of 45 to 54.
In the past, caregiving was an integral part of the Indian joint family system where each generation took care of the previous, and work was appropriately divided among family members, both young and old. With the advent of job-related migrations and the nuclear family system, the burden of caregiving fell on individuals, especially women who had now to balance work and home besides elder care.
In India caregiving is not recognized as a skill or a vocation or a profession and is taken by the family in its stride. The person who ends up caregiving for an elder keeps dipping more and more into their time to perform the required chores, but this is not recognized or appreciated by anyone. It is taken for granted, even when careers are given up mostly by women to handle the work.
Instead of appreciation, the caregiver is often made to feel they are not doing enough. No one expects the caregiver to want a break, socialize, get tired, or even spend some “ME” time. Hence there is a great need for continuing care facilities offering a better quality of life of dignity with luxury amenities that the elderly have the option to move into, should they decide.
Thus, caregiving is an issue, which affects the quality of life of millions of people worldwide. Providing informal care, particularly for a person needing assistance for activities of daily living, is a demanding task, which requires time, dedication, and perseverance. Most caregivers derive personal satisfaction while caring for someone close to them and that enables them to cope with the stress and burden of care.
While this system does have elders living in and cared for by their families through their aging and dementia, there is also a great price paid by the young. Hence, the need for more continuing care facilities offering more dignity and a better quality of life to these elders through their golden years, while freeing the younger generations from any burden or guilt.
Thank you John Francis for contributing this article.