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Hiring domestic help may reduce caregiver stress

By Shreen Jegtiv

NEW YORK (Reuters Health) -

NEW YORK (Reuters Health) - Elderly spouses caring for a sick husband or wife were less stressed when they hired a domestic helper, suggests a new study from China.

"Domestic helpers provide support not just to frail older adults, but also to family caregivers - in this case, it is the spousal caregivers," Alice Chong told Reuters Health in an email.

Chong, who led the new study, is a researcher with the Department of Applied Social Sciences of the City University of Hong Kong.

Caring for a frail elderly spouse can be time consuming and emotionally exhausting. About half of spousal caregivers show signs of distress, anger or depression, especially when their spouse is older and frail, according to Chong and her coauthors.

They wanted to determine whether having a domestic helper might reduce the spousal caregivers' distress to the extent that they were better able to allow the frail elders to stay at home.

"Domestic helpers could be an alternate long-term care model, in addition to in-home care, community services and institutional care, and could help reduce premature institutionalization," Chong said.

The researchers used information collected on a large group of Chinese elders who applied for publicly funded long-term care services in Hong Kong from 2007 to 2009.

They reviewed the results of a survey used to determine the needs of older adults with a physical or cognitive disability so they can be matched with the best care. The survey also collected basic information on family caregivers and domestic helpers.

Information for 6,442 care recipients aged 60 or older and their care-giving spouses was used for the study. About three-quarters of the care recipients were men with an average age of 77 years old, and about 6 percent had live-in domestic helpers.

In Hong Kong, the researchers note, domestic helpers are often foreign workers who perform cooking and cleaning services, and may help with care of elder family members by escorting them to outdoor activities or providing physical care as needed.

The minimum wage in 2013 for such workers was about $503 U.S. dollars a month, "an affordable rate for most low- to middle-income families," Chong's team writes in The Journals of Gerontology: Series B.

In general, the researchers found, 44 percent of all spousal caregivers felt distressed.

Women and those whose care-receiving spouses were younger were the most distressed. But those who had a domestic helper were significantly less likely to be distressed.

The exception was when the care-receiving spouse had cognitive impairment, such as dementia. Then the presence of a domestic helper had little effect on the distress level of the care-giving spouse.

"I thought it was a really good use of this type of administrative data," said Jill Cameron, a researcher in the Graduate Department of Rehabilitation Science at the University of Toronto. Such data is "really good at helping you learn something and also leading to new research questions," she told Reuters Health.

Cameron, who has studied the wellbeing of spousal caregivers, noted that the new report did not look at the reasons why hiring a domestic helper might reduce stress for the caregivers.

From her own research, she believes the additional help probably freed up time for the caregivers so they could pursue activities that are of value to them personally.

She added that further qualitative studies in which researchers interview caregivers to get an in-depth understanding of the interactions of caregiving spouses and domestic helpers would be valuable.

But Cameron wasn't surprised that there was less of an impact when cognitive impairment was involved.

"Cognitive issues I think are the biggest challenge to caregivers usually," she said. "I think it just comes down to them not being prepared to manage somebody - the demands change and it's almost like you don't know what you're going to expect from day to day with the cognitive changes and it just makes it harder."

Cameron added that in those cases the domestic helpers were probably more comfortable with providing physical care or helping with the day-to-day things.

"It makes me wonder whether or not these domestic helpers, in the same way that we are trying to educate, prepare and train family caregivers to care for someone and also manage the cognitive issues, are (also) going to ultimately need help in training to manage the cognitive issues," she said.

Chong said she'd like to see more attention and discourse among researchers and policy makers on the potential contributions and challenges of having a paid domestic helper so that relevant social policy and support services would be designed to strengthen their caregiving ability.

"Domestic helpers would suffer caregiving distress, just like family caregivers," Chong said. "While there are policy and support services to family caregivers, we also need to formulate appropriate policy and support measures to the paid domestic helpers."

SOURCE: http://bit.ly/1hiOjhp The Journals of Gerontology: Series B, online April 17, 2014.

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