Journal of Social Issues, Vol. 59, No. 3, 2003, pp. 591--610
Focus on Home: What Time-Use Data Can Tell About Caregiving to Adults William Michelson∗ University of Toronto
Lorne Tepperman University of Toronto
Care by adults to other adults is being increasingly transferred from formal public institutions to the private home. To learn more about the nature and situation of Canadian adults providing care at home to other adults, we analyzed data from Statistics Canada’s 1998 social survey of 10,749 persons. Data included time-use and respondents’ sociodemographic, cultural, work, and leisure characteristics, as well as outcome factors. We found 212 respondents (about 2%) providing personal, medical, or other care to other household adults on the day studied. We compared them to those not found to provide these services. The article explores time-use trade-offs, feelings of stress, and the ramifications of gender, age, and paid work in this newly reemerging use of household space. Housing is an object. It has raw materials organized by design. It is a commodity to be bought, sold, and rented. But housing is far more than that. More of the time than any other single place, housing is a setting for behavior (Szalai, Converse, Feldheim, Scheuch, & Stone, 1972)—by people of all ages, religions, social classes, and political persuasions, at any hour of the day, any day of the week, and most, if not all, years of the life.
∗ Correspondence concerning this article should be addressed to William Michelson, Department of Sociology, University of Toronto, 725 Spadina Avenue, Toronto, Ontario M5S 2J4, Canada [e-mail: email@example.com]. A previous draft was written for the workshop on “The Residential Context of Health,” in the conference of the European Network for Housing Research, G¨avle, Sweden, June 26–30, 2000. We are grateful to Terry Hartig, Irene Frieze, Ingrid Olsson, David Crouse, and Glenn Stalker for helpful suggestions, as well as to five anonymous reviewers. 591 C
2003 The Society for the Psychological Study of Social Issues
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Housing is certainly not a Procrustean bed. One size or shape does not fit all. Housing, like other built environments, offers opportunities and constraints for the realization of different patterns of behavior (Michelson, 1970) through differences in size, shape, equipment, and technology. Over time, characteristic types of housing come to be built in specific cultures and localities, to accommodate the habitual behavior of modal segments of the population (Lawrence, 1987; Rapoport, 1969). That behavior reflects on the various functions that families and communities have located in the home. From a practical perspective, it follows that knowledge about how residents behave in their homes can inform housing provisions and policies that will ease the movement of functions into or out of them. The objective of this article is to extend knowledge of what people experience when their home becomes a place to provide care to another adult person. The source and type of the data that we examine are not conventional, but they offer the opportunity to assess the substantive issue from a more representative and contextually rich foundation. We therefore both examine the substance of caregiving to adults as an increasingly common modification to the use of homes and explore the fruitfulness of the methodological approach. We shall look at each of these before turning to the analyses.
When Care to Adults Comes Home: Issues Across Cultures The home has always been a place in which intimates take care of each other, as best they can. However, the waxing of the modern industrial city in the 20th century brought with it specializationâ€”in health as in other matters. There was a growing belief that large institutions employing professional specialists could do many jobs better. Suitably antiseptic hospitals contained staffs of highly trained nurses and physicians and maintained specialized equipment. It was a matter of progress that persons needing intensive or continuing medical care should get it in the protective hospital environment. In recent years, though, the pendulum has begun to swing back. A trend towards deinstitutionalization reflects beliefs that, for many problems, removal from the local community or home takes a person away from close personal relationships and supports and into a dehumanized setting subject more to institutional prerogatives. Regardless of the humane intentions underlying the deinstitutionalization concept, deinstitutionalization has gone far because political leaders have found that they can save money in the short term by downloading many functions from large institutions to private persons without paying for equivalent support systems (Pescosolido, Wright, & Lutfey, 1999; Wright, Avirappattu, & Lafuze, 1999). Care to adults has come back homeâ€”quickly after childbirth and surgery and for indefinite periods for those with chronic problems. Although deinstitutionalization has brought with it demands for a greater supply of supportive housing
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options and services (e.g., Gallagher, Alcock, Diem, Angus, & Medves, 2002), those options and services may not be quickly available or affordable for many households. What does this mean for adults who must use and maintain their homes once again for the provision of necessary personal care to others? When a caregiver is overburdened, the consequences can be devastating for an entire family. The caregiver’s mental and physical health suffers, the interaction between family members suffers, and the quality of care suffers. Caregiver burden then is the beginning of a vicious cycle for, as the quality of care decreases, care recipients experience a greater risk of incurring additional health problems (Gottlieb, Kelloway, & Fraboni, 1994; Gottlieb, Kelloway, & Martin-Matthews, 1996; McDaniel, 1998; Tennstedt & Gonyea, 1994). This is a growing concern as the number of people caring for ill family members in their own homes steadily increases. The family home is also a workplace (however informal in most cases), and each family has a characteristic and enduring division of labor. Families are consistent with society at large. Domestic labor, in short, is gendered labor (for a good Canadian overview of this, see Nakhaie, 1995). Adult women are expected to carry out most of the work, and daughters are expected to do more of the work than sons—a pattern that persists in caregiving; the primary caregiver is usually the wife, mother, or daughter. Women do more of this work even if they engage in paid employment outside the home, they are parenting infants, or they are taking care of sick or disabled family members. A study comparing detailed data from Canada, the United States, Sweden, Norway, and Australia (Baxter, 1997) finds that the factors determining men’s and women’s participation in housework do not vary markedly across countries, despite variations in ideology and gender-role attitudes. The past two decades have seen more women holding jobs outside the home. Throughout the industrial world, women’s labor force participation and family lives have changed dramatically (Chafetz & Hagan, 1996). For women, working outside the home has many benefits. It contributes to their satisfaction, increases the likelihood of equal treatment within the home, and provides security in case of marital dissolution. However, women continue to do most of the housework and child care. This results in overload, culturally induced stress, and spillover. By overload, we mean that women face an excessive amount of work; they are physically and emotionally unable to keep up with the demands (Jacobson et al., 1996; Walters et al., 1996). By culturally induced stress, we mean that the workload— and the failure to complete it all—carries guilt-inducing meanings in our culture. By spillover, we mean that the demands and stresses from one domain spill over into other domains of a woman’s life, affecting the functioning of the entire family (Gill & Hibbins, 1996; Moore, 1995). What women face is a 21st-century work pattern and a 1950s division of labor at home. Sociologist Arlie Hochschild (1998) has suggested that domestic labor is even less manageable and egalitarian than paid work, and this is why many women do not take advantage of corporate arrangements like job-sharing. If they spend
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less time at work, it simply means that they will be doing more at home. (See also Skrypnek & Fast, 1996; Wharton & Erickson, 1995). Informal caregivers have a distinctive profile. Most are women, aged 30 to 59, and are married (Stommel, Given, Given, & Collins, 1995). Most are the children, parent, or partner of the care recipient. Nearly half of caregivers report they have experienced major health problems of their own in the past year (Gerin, 1995). Two thirds say they feel exhausted at the end of each day. Half feel they have more to do than they can handle (Gottlieb et al., 1996; Schofield & Herman, 1993). Men may provide occasional assistance, but are much less likely to assist with daily chores, for example (Stoller, 1990). There has been much research on the stresses of the “double day,” or “dual burden,” phenomenon—the responsibility of particular family members to both earn an income and maintain a household. When caregiving responsibilities are added, the dangers of caregiver burnout and family breakdown increase dramatically. Although some research (for example, Loomis & Booth, 1995) finds no evidence that the additional burden of caregiving increases caregiver stress or reduces the quality of family functioning, most other research draws an opposite conclusion. It reports that the difficulty in balancing the demands of home and employment produces considerable stress that, taken to extremes, contributes to life-threatening health conditions (see, for example, Ginn & Sandell, 1997; Scharlach & Fredriksen, 1994). Working women experience significant increases in stress when they are forced to alter their work schedule to meet home care needs of an impaired, elderly family member (Orodenker, 1990). Women continue to be far more likely than men to provide care, and to suffer consequent caregiving strain, work interference, income loss, and role strain (Fredriksen, 1996). Therefore, when turning our focus to the use of the home for adult caregiving, the literature urges empirical attention to the family structure in which adult caregiving occurs; the interrelation of caregiving with external, paid employment; the outcomes of caregiving for caregivers themselves; and the presence of gender as a factor in both the selection and subsequent experiences of caregivers. Examining Home-Based Adult Care Through Time-Use Time-use analysis is a specific methodological approach (e.g., Michelson, 1990). As part of a time-use survey, people are asked to specify the activities they pursued during an actual period of time, usually one day or more. They can do this in response to an interviewer’s questions or on a written questionnaire. If the answers are oral, they typically refer to the previous day; if they take the form of a written diary, the answers are recorded at intervals on a specified day to follow. In either case, the procedure involves starting either at an arbitrary time in the early morning, such as 4 a.m., or else at such time as the respondent gets up. A matrix of information is constructed, piece by piece, in chronological order of the
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activities pursued, when they start and when they finish, who else is present for each activity, and where each activity takes place. In some studies, one or more subjective dimensions are added to the matrix, such as the respondent’s assessment of the degree of stress or of pleasure experienced during the episodes of activity reported (Michelson, 1999). This approach provides researchers with data about the detailed behavioral content and context of people’s everyday lives, the social contacts they have in the process, and the locational attributes of both of these previous considerations, as well as respondents’ subjective appreciation of their situation (when included). These are drawn from people’s concrete experiences in real time, not from hypothetical responses to more generalized questions. The accuracy of this datagathering approach concerning immediately tangible time periods has been validated (e.g., Ziegler & Michelson, 1981), though it cannot be expected to provide valid information on socially unacceptable or illegal forms of behavior (Michelson, 1990). Typical time-use studies involve complementary questioning through more conventional approaches, to enable the analysis of the time-related data with other information on people’s characteristics and on special topics of interest. Early studies in this genre varied between very applied social policy analyses and descriptive studies of how people in different milieus lead their daily lives. Over the years, time-use studies have addressed such questions as work, leisure, domestic division of labor, commuting and other aspects of everyday travel, aging, and much more (e.g., Szalai et al., 1972; Michelson, 1978; Staikov, 1982; Harvey, Szalai, Elliott, Stone, & Clark, 1984; Pentland, Harvey, Lawton, & McColl, 1999). Researchers have been enabled by the time-use method to examine a range of everyday behaviors and how they vary among population subgroups. Also, they can understand more fully the social and environmental contexts of activity, such as the home. As the value of documenting time-use became more widely recognized, many national census bureaus began to hold representative national studies of this phenomenon, as part of their gathering of important national information (e.g., Harvey, Marshall, & Frederick, 1991). The most recent Canadian time-use study has over 10,000 respondents, representing well the national population from the age of 15. The repeated application of time-use surveys of the population has enabled analyses of behavioral change over time (e.g., Robinson & Godbey, 1997). Such large national time-use studies now make possible an additional contribution. On some topics, it is difficult to find a representative sample for study because there is no obvious way of identifying a large number of people with particular characteristics objectively. In some cases, appropriate subgroups for further analysis can be determined by looking at certain aspects of people’s everyday behavior. This kind of contribution can be made to the greater understanding of what happens when care to adults occurs more frequently at home. We took Statistics
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Canada’s General Social Survey 12, gathered in 1998, as the basis for a search for adults providing care at home to other adults. We searched the 10,749 cases to identify people found to spend time providing “personal,” “medical,” or “other care” to another adult who lives in the same household. A subsample of 212 cases was identified. The total duration of time given across the selected adult care activities in the day had a mean of 70 minutes and a median of 30 minutes. The highest quartile devoted more than 79 minutes to caregiving. Consistent with the literature noted in the preceding section, our analyses focus on the characteristics of the caregiver, the extent that caregiving is associated with other differences in daily life compared to the rest of the population, and the degree of differential personal outcomes such as stress that accompany caregiving. Findings on these phenomena help us to understand what accompanies contemporary trends toward more use of the home for caregiving.
Results Who Cares? What are the characteristics of those found to care for other household adults on the day covered by their time-use report? Do they differ significantly from those not giving such care that day? As expected, the proportion of women to men among the caregivers is much greater than among the noncaregivers. Almost two thirds of the caregivers are women, compared to only 54.6% in the rest of the sample. This is a highly significant difference (χ 2 = 9.21, df = 1, p = .002). Caregivers are less likely to have worked at a job or business in the previous week. Only 45.1% did so, compared to 61.4% of noncaregivers. This difference is also statistically significant (χ 2 = 22.31, df = 1, p = .000). The caregivers are somewhat older. Though just over 50% lie between the ages of 35 and 54, another 37% are divided evenly in the 10-year age brackets of 55–64, 65–74, and 75 and above. Given that the time-use data sample only the caregiving shown on a single day, this is consistent with recent American studies suggesting that 35% of all caregivers are over 65 years of age (“Helping the Patient,” 2000). The noncaregivers are skewed towards younger ages. The mean age of caregivers is 51, compared to 45 for the noncaregivers, while the median ages for the two categories are 49 and 42. The difference between means is statistically significant, F(1, 10747) = 24.83, p = .000. Viewed from the perspective of age cohorts, the oldest category, of persons 75 and older, contains the highest percentage of caregivers, as might be expected; but this percentage is still only 3.3% of all respondents in that age bracket. The next highest age group for caregiving is within 45–54 years. So although the caregivers
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are clearly older, they are not overwhelmingly restricted to senior citizens or even prevalent among senior citizens. There are many other ways to describe the family situation of caregivers. They are much more likely to be married (72.6% to 47.3%; χ 2 = 60.64, df = 5, p = .000). Most don’t have children living at home, but if they do, the children are at least in their teens; children in noncaregiver families are typically younger (χ 2 = 72.83, df = 5, p = .000). Caregivers do not live alone, but 72.7% of them live either with their spouse alone or with a child under 25. Only 8% of caretaker families live in three-generation households, but this is still greater than 1.9% among the noncaregivers (χ 2 = 38.77, df = 1, p = .000). We searched within the days of individuals to select periods of time when they performed one or another caregiving activity involving a household adult and then sought out the information on which person or persons were present with the respondent. Typically, no more than one person was named. Excepting the few nonhousehold members named, it is most likely that this person was the recipient of the care. Spouses are more than half of the recipients (51.9%), and almost all the rest are members of the household. The next older generation is a small minority, at 13.2%. Only 8.6% of caregiving episodes at home are to nonhousehold members. There are no noticeable differences between caregivers and noncaregivers in their occupational rankings, according to the Pineo Socio-Economic Classification (e.g., Pineo & Porter, 1967). Both categories include a wide range of occupational levels in almost the exact same percentages (χ 2 = 5.73, df = 5, p = .334). To this point, our conclusions from time-use analyses are largely consistent with the literature discussed earlier in the article. In the next section, we shall turn to behavioral and subjective outcomes of caregiving, keeping in mind for the section thereafter the extent that explanation reflects caregiving at home or, instead, one or another of the significant characteristics of the caregivers themselves. Behavioral and Subjective Aspects of Adult Caregiving On caregiving. While the selection of persons categorized as caregivers was based on putting in some time during the day reflected by the time-use protocol, this is certainly only a platform from which to proceed. For example, these persons differ from each other and from noncaregivers in the sheer amount of time they devote to caregiving on the day in question. As noted earlier, there is a considerable range in the duration of caregiving activities in the day; this extends among the caregivers from 1 to 885 minutes. It is therefore no wonder that the mean total time devoted to caregiving exceeds the median by about 230%. The standard deviation among caregivers is 107 minutes; standard deviations for time devoted to specific activities are commonly high, as they reflect persons with zero participation in certain activities as well as persons with extensive participation.
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In addition to the total time devoted, caregiving differs in terms of how it is distributed throughout the day. One measure of this is the number of episodes of caregiving activities. The mean number of occurrences of caregiving per caretaker is 1.55, with a standard deviation of 1.25; this indicates that there is considerable variation in occurrences of caregiving during the day. The literature on education suggests that the intertwining of many activities during the day, with constant starts and stops, induces stress among teachers (Hargreaves, 1990, 1992); this is called intensification. With the data on total duration of caregiving activities and the number of occurrences of caregiving per person, we computed a measure of the mean duration of individual caregiving activities. The subsample mean of durations of caregiving activities is 44.13 minutes, with a standard deviation of 60.63 minutes. Again, this reflects great variability in the measure. The value of a measure lies in its fruitfulness in explanation. To what extent do these different measures relate to variation in aspects potentially reflecting the existence, duration, and distribution of caregiving activities? Behavioral aspects . There are many ways to categorize aspects of everyday behavior. The time-use tradition gives three general directions at the start: activities, persons present during activities, and the locations of these activities. Different research teams have come up with different categorical schemes. The pioneering work by Szalai et al. (1972) in a 12-nation multinational study came up with 99 categories of activity alone. The Statistics Canada data set used in this study uses three-digit codes for specific activities which amount to at least several hundred activity codes; at the same time, they code a much smaller number of clusters of activity such as household work at the level of the total duration for the day. Location and persons present have also been coded in many ways. In the present case, our focus is on those aspects of behavior for which logic and the literature hypothesize a relationship with caregiving at home. The data in Table 1 show that those categorized as caregivers spend significantly more time in the day, besides that given to the care of other adults within their household, on domestic work, care to children under 15 years of age, shopping and the procurement of services, and civic and/or volunteer work outside the home. The caregivers spend significantly less time in paid employment. There is no significant difference between caregivers and noncaregivers in the time they devote to personal care (i.e., for themselves, which includes sleep), attention to the media and other forms of communication, eating meals, and socializing in a residential setting. It is probably not surprising that those with caregiving responsibilities are less likely to spend time in paid employment but end up with greater amounts of domestic work and care to younger children. This is a familiar trade-off. But it is not necessarily intuitive that those giving care at home are also found to spend
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Table 1. Differences Between Caregivers and Noncaregivers in Mean Minutes in a Day in Selected Activities, in Certain Locations, and With Particular Persons (Standard Deviations in Parentheses) Activities: Paid employment Domestic work Care to under 15’s Shopping/services Personal care (sleep) Media/communication Civic/volunteer Meals Socializing in houses Locations: At home At work Someone else’s home Another place Persons present: None (alone) Spouse/partner Child under 15 Parents/in-laws Others living at home Friends Others n=
138 (243.88) 172 (141.74) 109 (128.68) 60 (77.65) 623 (140.78) 180 (147.95) 109 (138.00) 66 (43.11) 72 (100.42)
221 (289.52) 127 (137.92) 28 (74.13) 47 (80.78) 626 (146.71) 182 (158.58) 21 (70.03) 64 (45.13) 82 (127.31)
17.24∗∗∗ 22.51∗∗∗ 237.59∗∗∗ 5.81∗ 0.09 0.04 308.72∗∗∗ 0.40 1.14
1083 (290.76) 100 (201.11) 31 (93.96) 141 (163.29)
984 (321.55) 176 (255.99) 60 (162.54) 142 (191.05)
19.61∗∗∗ 18.30∗∗∗ 6.69∗∗ 0.02
332 (213.29) 285 (262.03) 78 (174.61) 32 (115.42) 87 (178.20) 58 (136.22) 128 (197.30)
376 (269.82) 168 (241.22) 91 (193.33) 11 (62.83) 27 (100.28) 105 (188.31) 183 (242.20)
5.59∗ 48.74∗∗∗ 0.89 21.37∗∗∗ 71.93∗∗∗ 12.71∗∗∗ 10.78∗∗∗
Note. The F tests had 1 df in the numerator and 10747 df in the denominator. ∗ p < .05. ∗∗ p < .01. ∗∗∗ p < .001.
considerable time in external civic and volunteer work. The lack of difference in personal care and sleep is surprising, given that caregivers are said to take the caregiving time away from the attention to their own personal needs time; in aggregate, at least, this trade-off is not evident. It follows from the activity data that caregivers spend more time at home and less at an external workplace than the noncaregivers do. Perhaps more significant is that caregivers spend only half as much time in other people’s homes. Given the responsibility of caregiving, people spend more of their socializing time (and other activities) at home and not out in somebody else’s home. Several of these results—greater time spent by caregivers at home, less time in both workplace locations and other people’s homes, and greater time devoted to domestic work—suggest a growing salience of the nature and efficiency of the home for this situation. There are a number of logical differences in time spent with particular persons and types of persons. Caregivers spend much more time than do noncaregivers with
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their own spouse, not least because this person is most likely to be the one for whom care is given. By the same logic, more time is spent with parents or in-laws who live in the same household and with other people who live there as well. The tradeoff in this case is far less time spent with friends and others (who would include work colleagues). Caregivers do not suffer from a lack of contact. They are alone significantly less in the day than noncaregivers. The difference may lie in the kind and variety of daily contacts people have (not to speak of the locus for contact). Caregivers have a greater number of episodes of activity during the day, suggesting the possibility of a more intensified existence, as noted earlier. The difference between 26 and 21 episodes is, at the least, statistically significant, F(1, 10747) = 149.07, p < .001. The above-cited findings reflect the nominal distinction between whether or not respondents evidence any sign of caregiving in their day. This distinction is significant because, for those categorized as caregivers, it suggests the presence of a certain amount of responsibility to one or more adults. Furthermore, there is a solid argument that the expenditure of greater or lesser amounts of time to caregiving is dynamically related to how much time is available for allocation to other kinds of activity. Therefore, we computed binary correlations of the total time devoted to household adult care with the same behavioral variables selected for Table 1. These are reported in Table 2. This latter table involves only the 212 caregivers, insofar as only this subsample, by definition, has positive values for caregiving, and it eliminates the large number of zeros from the noncaregivers, which would reduce the correlational analysis to meaninglessness. A comparison of Tables 1 and 2 shows that measuring caregiving in daily duration accounts for some limited increase in time-use variation compared to the nominal caregiver/noncaregiver distinction. Regarding activities, the two measures of caregiving are equally indicative of daily activity, with one exception. While caregivers in aggregate do more domestic work than noncaregivers, the amount they do declines with the duration of time devoted to caregiving. There is a change in the direction of the relationship when the duration of caregiving time is correlated to time spent in someone elseâ€™s home. While caregivers in aggregate spend less time in other peopleâ€™s homes, there is a positive relationship between the amount of time they spend in other peopleâ€™s homes and the amount of time they devote to caregiving to household members. In addition, the significant relationships between caregiving and time spent at home and (inversely) at work lose their statistical significance when duration of caregiving is introduced. The correlation is nearly zero for the relationship between duration of caregiving and time at home, which suggests that the responsibility for caregiving is more highly related to time spent at home than is the actual duration of caregiving. Finally, the relationships of caregiving to persons present lose their significance in the correlations between duration of caregiving and time spent alone
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Table 2. Binary Correlations (Pearson) Between Duration of Caregiving and Total Minutes in a Day in Selected Activities, in Certain Locations, and With Particular Persons, for Caregivers (N = 212) r Activities: Paid employment Domestic work Care to under 15’s Shopping/services Personal care (sleep) Media/communication Civic/volunteer Meals Socializing in houses Locations: At home At work Someone else’s home Another place Persons present: None (alone) Spouse/partner Child under 15 Parents/in-laws Others living at home Friends Others Mean # of episodes
−.165∗ −.176∗∗ .806∗∗∗ −.130 .032 −.071 .771∗∗∗ .051 −.083 .001 −.118 .148∗ .124 −.079 .145∗ −.132 .152∗ −.050 .027 −.186∗∗ −.333∗∗∗
∗ p < .05. ∗∗ p < .01. ∗∗∗ p < .001.
(i.e., no other people present), with other household members, and with friends. Although the relationships are not strong, the direction also shifts with respect to the latter two variables. Thus, measuring caregiving in terms of the total amount of time devoted to it during the day does extend the analysis of caregiving in certain cases. But the strength of the nominal caregiving/noncaregiving distinction, as a likely reflection of responsibilities that accompany caregiving, remains. The home becomes more significant in daily life, in terms of the time caregivers spend there and the activities they do there. This finding supports the assertions of Kane, Reinardy, Penrod, and Huck (1999) on this matter. In the next section, we will examine whether this domestic situation is related to subjective outcomes. Subjective aspects. Subjective outcomes were assessed via a number of questions, some self-standing and others forming scales. We focus in this analysis on questions assessing self-stated happiness, life satisfaction, stress, time pressure, and the day’s most enjoyable activity.
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The nominal distinction between caregivers and noncaregivers is not related in any way to respondents’ self-stated feelings of happiness and life satisfaction. In contrast, 35% of the caregivers said they felt “a lot” of stress in the previous 2 weeks, compared to only 20% of the noncaregivers. Caregivers differ significantly in this direction from noncaregivers on the 5-point stress scale (χ 2 = 29.04, df = 4, N = 10,162, p = .000). When asked their main source of stress, 46% of the caregivers cited family, compared to only 19% of the noncaregivers. The latter were more likely to cite work. The relationship of caregiving status to feelings of time pressure is also significant. We measured time pressure using Robinson’s Time Crunch Index (see Robinson & Godbey, 1997). The index is the number of positive answers to 10 questions, of which the following 3 are illustrative and highly pertinent:
• Do you feel that you just don’t have time for fun anymore? • Do you often feel under stress when you don’t have enough time? • Would you like to spend more time alone? A larger number of positive responses designates a greater feeling of time pressure. Caregivers show a mean Time Crunch Index value of 4.18, compared to 3.74 for the noncaregivers, a statistically significant difference, F(1, 10162) = 5.76, p = .016. However, time pressure is not related to the amount of time put into care to household adults (r = .029, p = .679, n = 207)—only to the nominal caretaker/noncaretaker dichotomy. In this regard, feelings of time crunch are inverse to the amount of time shared with the spouse/partner (r = −.227, p = .001, n = 207). But these feelings are positively related to the duration of contact with household children under 15 (r = .234, p = .001, n = 207)! Although there is no difference by caregiver status in time devoted to the media and other forms of communication, feelings of time crunch are significantly less among those spending more time on such specific activities as watching TV or reading the newspaper (r = −.284, p = .000, n = 207). On the positive side, the most enjoyable activity of those done on the day reported is typically found in the respondents’ homes, whether a caregiver or not. Caregivers are more likely to feel this way, 60.5% to 52.1%, though this relationship is not statistically significant (χ 2 = 12.51, df = 9, p = .186). Nonetheless, caregivers are significantly more likely to choose their spouse/partner as the person present during the most enjoyable activity (35.2% to 23.8%; χ 2 = 12.61, df = 1, p = .000); children under age 15 are seldom part of the most enjoyable activity in both caregiver and noncaregiver households (11.7% vs. 16.1%; χ 2 = 2.50, df = 1, p = .114). Thus, data on the most enjoyable activity complement and confirm stress and sources of stress data regarding the positive and negative implications of caregiving.
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In short, although feelings of stress and time pressure are greater among these caregivers, they are not unhappy or unsatisfied with their lives. While they wish to be alone somewhat more, the crunch appears to come more from their preadult children than from being with and taking care of other adults, particularly their spouses. Competing Explanations: Caregiving, Gender, Age, and Work Behavioral aspects. In the previous section, we documented a number of significant relationships between the dichotomous nominal conception of caregiving and the amount of time respondents are seen to spend during the day on specific activities, in particular locations, and in the company of specific kinds of persons. Caregivers were also shown to have significantly more discrete episodes of behavior than noncaregivers. Nevertheless, both the previously cited literature and our findings indicate that caregivers are disproportionately likely to be women, older, and less likely to have been in the paid labor force in the previous 2 weeks, factors that typically explain many differences in everyday behavior. Are the behavioral aspects of moving caregiving back into homes actually functions of these other, typically potent explanatory variables? To address this question, we ran an analysis of variance (ANOVA) for each of the time-use variables that we had found to vary significantly with caregiving, as described previously and indicated in Table 1. As fixed factors in these ANOVA, we used caregiving (caregiver, noncaregiver), work status (paid work in the past week, no paid work in the past week), gender (male, female), and age (15–24, 25– 34, 35–44, 45–54, 55–64, 65–74, 75 and over). In each of the analyses, we wanted to determine whether the association between the time-use variable and caregiving would be in the same direction and statistically significant even after including work status, gender, and age as explanatory factors. To indicate the impacts of these controls on the previously described associations between caregiving and uses of time, we report the F values for the main effects of caregiving and the other explanatory factors in Table 3. We noted earlier that Table 1 showed a number of significant differences between caregivers and noncaregivers in the time they spend on selected activities, in certain locations, and with particular persons—sometimes more time and sometimes less. We see in Table 3 that the caregiving variable retains its significant levels of relationship with many of these time-use measures, despite the explanatory values of gender, age, and work. Caregiving to adults remains significantly positively associated with time devoted to children under 15 and to civic and volunteer work. It remains significantly positively related to time spent at home and negatively related to time spent in the homes of others. Significantly more time is still found among caregivers with the spouse or partner, parents or in-laws, and others living at home; significantly less time remains with friends and being alone.
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Table 3. Independent Associations of Caregiving, Work Status Last Week, Gender, and Age With Mean Minutes in a Day in Selected Activities, in Certain Locations, and With Particular Persons (N = 10,069) Caregiving Activities Paid employment Domestic work Care to under 15’s Shopping/services Civic/volunteer Locations At home At work Someone else’s home Persons present None (alone) Spouse/partner Parents/in-laws Others living at home Friends Others Mean # episodes
0.26 1.62 110.26∗∗∗ 0.43 105.19∗∗∗
84.59∗∗∗ 0.90 9.46∗∗ 0.02 2.80
0.15 49.62∗∗∗ 3.20 0.61 1.87
5.93∗ 1.43 5.52∗
32.14∗∗∗ 53.05∗∗∗ 0.05
3.51 0.11 0.04
2.84∗∗ 2.02 0.44
0.00 0.68 35.31∗∗∗ 2.40 0.48 26.17∗∗∗
0.23 3.77 3.33 1.67 3.25 0.56
4.47∗∗∗ 6.84∗∗∗ 24.77∗∗∗ 4.98∗∗∗ 3.85∗∗∗ 2.00
8.01∗∗ 14.67∗∗∗ 25.94∗∗∗ 26.50∗∗∗ 4.34∗ 0.40 47.43∗∗∗
Age 2.12∗ 6.93∗∗∗ 6.87∗∗∗ 1.11 2.76∗
Note. Values are for the F tests of main effects from a multifactorial analysis of variance that used the given time-use variable as the dependent variable. The main effects of caregiving, work, and gender have 1 df in the numerator, whereas that for age has 6; all of the effects have 10018 df in the denominator. ∗ p < .05. ∗∗ p < .01. ∗∗∗ p < .001.
Exceptions are highly logical. For example, time spent in paid employment varies primarily with work status and, to a lesser extent, with age. Domestic work is much more a function of gender and age. But when it comes to locations and persons present, the caregiving variable keeps its significance regardless of the three controls in all cases except time spent at work and with (usually work-related) others, for which it is no surprise that the work variable is highly significant. This adds salience to our concern for the characteristics of housing in which caregivers spend so much time and center their social contacts. Whether a respondent had paid work in the previous week remains a potent explanation of some aspects of behavior independent of caregiving. Gender, on the other hand, remains significantly associated with domestic work and a higher mean number of episodes of behavior. However, it has an independent relationship with fewer of the selected behavioral variables than caregiving, age, or work status. Even with the controls, age shows significant independent relationships with most of these behavioral variables. While such retained strength of an important explanatory variable is not surprising, it does not vitiate the strength of the caregiver variable.
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Fig. 1. Mean scores on Robinsonâ€™s Time Crunch Index by caregiving and age. Note. Time crunch scores can range from zero (low time crunch) to 10 (high time crunch). Of the total sample, 585 respondents lacked data on one of the variables, leaving 207 caregivers and 9,957 noncaregivers.
Subjective aspects. The same form of multifactorial analysis of variance was applied to scores on the Robinson Time Crunch Index. Before such multivariate controls, caregiving, work status, gender, and age each explained a significant amount of variation in perceptions of time pressure. We mentioned earlier that caregiving is associated with greater time pressure. Greater time pressure is also associated with having a job [F(1, 10162) = 819.07, p = .000], being a woman [F(1, 10162) = 29.77, p = .000], and younger ages [F(1, 10162) = 306.77, p = .000]. However, in the multifactorial ANOVA only caregiving and age retain statistically significant main effects; F(1, 10015) = 7.71 and F(6, 10015) = 12.40, respectively, ps < .005. This raises a logical question in principle. If caregivers are older, and older people report less time pressure, how is it that caregivers show higher levels of time pressure? Figure 1 illustrates this matter. The caregivers report higher pressure than the noncaregivers within all age groups but the youngest. Although time pressure declines with later age cohorts, the decline appears more pronounced among the noncaregivers after age 55. The behavioral and subjective aspects of caregiving follow a similar pattern. The analyses show that the major relationships of the nominal dichotomous caregiving variable with dependent variables largely maintain their significance
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independent of three of the most powerful variables that pertain to everyday lifeâ€” work, age, and gender. These latter variables are not diminished very much in their explanatory value, given the number of relationships in which they maintain independent significance. But just because a variable is helpful in explaining some outcomes does not mean it is omnipotent. There are many situations in which caregiving status may be irrelevant. But the power of caregiving status on aspects of everyday life and feelings of time pressure/stress need be paid close attention when coming to grips with the increasing degree to which caregiving is delegated to members of the family (especially spouses) in their own homes. Concluding Remarks on Impacts and Policy All of this suggests that the home becomes more and more the center of the universe on an everyday basis when adults care for others in the home. Being a caregiver focuses more of the day and its activities on the home, to accommodate the needs of a loved one. Adaptation to the concerted focus on this one part of the universe is a challenge to an increasingly highly educated population, accustomed to a larger stage of daily activity, performance in both public and private places, and a sharp differentiation of work time and nonwork time, instrumental and expressive activities. This puts greater demands on the spatial and infrastructural adequacy of the dwelling unit, including its size and efficiency both for caregiving and for relating to others more and more from oneâ€™s own home base. Families made less able to undertake caregiving activities from a suitable environment by emerging governmental policies and market forces will be doubly challenged and potentially at greater risk for negative consequences of stress. The patterns of findings, as well as the specific points involved, indicate that time-use data provide some unique and useful insights into particular kinds of lives, such as lives that include regularized caregiving. What can time-use data tell about caregiving to adults? In the most elementary sense, time-use data tell us which people are using their homes for care to others, consistent with deinstitutionalization trends. These data make it possible to embed caregiving in the wider range of activities people pursue during a day, in and away from home, including considerations of location and social contact. Insofar as survey content includes subjective outcomes, this enables another dimension with which to understand what actually happens in a particular combination of time and place. Our analysis focused on a number of details that contribute to a larger picture. They show that when adults take care of other adults at home, this has a variety of potential implicationsâ€”through feelings of responsibility rooted in the home, through trade-offs of time within the daily ration of 24 hours, and through consequent feelings of time pressure and stress. Although caregivers differ in their characteristics from noncaregivers, with some of the clear differences coming from
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variables with a long history of strong and helpful explanation (gender and work status), the role of caregiving is significant and independent. This has an important message attached to it. Were the caregiving implications to have been explained away by these competing variables, the implications of moving adult care back into household space would be far less. But while our analyses show that caregiving entails differing behavioral demands and accompanying feelings of time crunch, there is no evidence that people’s feelings of general happiness and life satisfaction are thereby altered. Most caregiving in this sample of people and time is given to a spouse. Indeed, most households in which caregiving takes place are small, and other people are usually not present during explicit caregiving activities. While the family is a major source of stress in the lives of the caregivers, it is also a source of the most enjoyed activities, particularly time spent, often in passive ways, with the spouse. If these data indicate a potential source of friction, it involves contact with children under 15 when the caretaker also has to provide care to another adult. These data also show that it is more the responsibility for having to take care of another adult person that is central to the issue, not the absolute amount of time given. There are also some clear shortcomings, however, with the data we analyzed. Such a survey is only as good as the relevance of the data gathered. The Johns Hopkins group (“Helping the Patient,” 2000) also notes that depression is a common occurrence among caregivers. Time-use surveys are more likely than ever to include questions about stress from the perspective of time pressure, given the intellectual proximity of time use and time pressure. The Statistics Canada’s General Social Survey 12 (GSS12) also had questions that could enable a calculation of life stressors, should that be pertinent; but there are no questions eliciting signs of depression. While there is a rich variety of subjective material on the GSS12, the subjective valence of particular activities—and combinations at the episode level of activity, location, and persons present—is better served by a dedicated subjective dimension in the time-use matrix for each episode. This enables a grounding of both objective and subjective phenomena in the same, actual activity. It enables a finer tuning of satisfaction and/or stress than was possible here. In a survey of this size and complexity, some important facts are just not elicited. Therefore, we do not know to what kind of problems the caregivers are responding. And the coding of persons present does not give total confidence that an accurate interpretation has been made as to the characteristics of who is being cared for, compared to who happens to be there at the same time. Inferences on this can be made that reflect the numbers of people involved and who they are, but these inferences are not foolproof. In addition, we are sure that the several categories of care to other resident adults greatly underestimate the amount of caregiving occurring, because many
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acts of caregiving can be categorized as typical daily activities, such as cooking and shopping. The difficulties we describe are not inevitable. The advantages of time-use inquiry can be gained with improvements in survey design, content, and coding. But accomplishing this in a survey that serves many masters is a challenge. Nonetheless, our findings suggest that the challenge may be worth taking. The growth of caregiving at home at the same time that the proportion of the elderly is growing raises, once again (e.g., Nystr¨om, 1991), serious questions about the adequacy of the housing market—regarding both quantity and quality. Should it be surprising that changes in health policy contain major housing implications? We think not.
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WILLIAM MICHELSON is S.D. Clark Professor of Sociology, University of Toronto. His research interests center on the many contexts of everyday life and their impacts on behavior. Previous publications have dealt with housing, urban infrastructure including transportation, and home-based work. LORNE TEPPERMAN is Professor and Chair, Department of Sociology, University of Toronto. He received his Ph.D. from Harvard University. His research interests have focused on the family, health, and Canadian society. His many publications include texts on the field of sociology and on writing research papers, not to speak of his special research interests.