The Benefits of Respite Time-Use

Abstract

This study uses data from semistructured interviews and time-log diaries to explore both desired and actual time-use among employed (n = 26) and nonemployed caregivers (n = 22). We found that employed caregivers were generally more satisfied with respite time-use than nonemployed caregivers. Employed caregivers were also more likely to do activities they had desired to do, suggesting they may have clearer expectations about what they could accomplish during respite. Although most employed caregivers considered employment to be a valuable and desired form of respite, lack of free time outside of work and caregiving was stressful. Similarly, nonemployed caregivers expressed a desire to do activities they wanted to do, rather than only those related to caregiving and household maintenance. These results suggest that both employed and nonemployed caregivers might benefit from better respite time-use. Practice and policy suggestions that might enhance caregivers’ use of respite time are provided.

Keywords

respite caregiving role enhancement/overload employment

Family members are the most common providers of direct care to older, sick, and disabled persons (Moen & Roehling, 2005). Research has long suggested that caregiving can be a stressful role that adversely affects physical health and mental well-being of those providing care (Pinquart & Sorensen, 2003, 2007). As a result, caregivers usually say that respite or “time away from caregiving responsibilities” is the number one most needed or desired service (Caserta, Lund, Wright, & Redburn, 1987; Shope, Holmes, Sharpe, Goodman, & Izenson, 1993). The majority of family caregivers are also employed outside of the home–nearly half (48%) on a full-time basis (National Alliance for Caregiving and AARP, 2004). Although employment may serve as a valuable source of respite from caregiving obligations, employed caregivers may be particularly subject to stress as they juggle the demands of full-time employment with the demands of caring for a loved one, while also attending to their own personal needs and desires (Bullock, Crawford, & Tennstedt, 2003; Kramer & Kipnis, 1995). The goal of this study was to compare what employed and nonemployed caregivers do during their respite time and to explore whether employed and nonemployed caregivers gain similar benefits from their respite time. While there has been considerable research on the outcomes and availability of respite (Pinquart & Sorenson, 2003, 2007; Zarit, Stephens, Townsend, & Greene, 1998), there is much less research on how caregivers’ choices—namely, employment obligations—might affect respite time-use and the benefits accrued from such services.

The Benefits of Respite

Respite may be provided informally by family members or friends who occasionally give the primary caregiver a break, or more formally through service providers such as home health agencies and adult day services. Formal respite is typically planned in advance and occurs on a routine schedule. The regularity of formal respite may be particularly important for employed caregivers, as it allows them to maintain a work schedule while having someone else look after the care recipient while they are at work (Redmond & Richardson, 2003).

Surprisingly, much of the research on the benefits of respite has concluded that respite is either not very or only moderately effective in reducing caregiving burden or in improving caregivers’ morale and satisfaction (Chappell, Reid, & Dow, 2001; Kirwin, 1991; Theis, Moss, & Pearson, 1994). One recent study found that caregivers were most satisfied with respite when they used the time to do things that they wanted or planned to do (Lund, Utz, Caserta, Wright, 2009). Furthermore, this same study mentioned that caregivers achieving a high consistency between desired and actual time-use were more likely to have better mental health, less burnout, and higher levels of satisfaction.

Because employed caregivers often use respite to go to work (rather than pursue other activities), we examined whether employed caregivers received the same types of benefits from respite as nonemployed caregivers. In other words, are employed caregivers able to do anything other than work during their respite time? Are they receiving the same benefits (or lack of benefit) from respite services as nonemployed caregivers? No research that we are aware of has examined differences between employed and nonemployed caregivers’ respite activities. Most of the existing research has focused on whether employment and caregiving are compatible roles.

Employment and Caregiving

There are competing assumptions about how well the caregiving and employment roles mix (Scharlach, 1994; Scharlach, Gustavson, & Dal Santo, 2007). The first explanation, often referred to as the competing demands hypothesis, suggests that combining the two roles produces an overload or strain for the caregiver, making him or her less efficient and effective in either role (Dunham & Dietz, 2003; Guberman, 2006; Lee, 1999). The second explanation, often referred to as the role enhancement hypothesis, suggests that employment may enhance the caregiver’s experience by providing time away from caregiving responsibilities, opportunities for personal growth, and much-needed benefits and financial resources (Center for Health Research & Coughlin, 2010; Chumbler, Pienta, & Dwyer, 2004; Marks, 1977).

In terms of the first hypothesis, it is assumed that combining the two roles adversely affects work performance, as well as the ability to be a good caregiver. Many employed caregivers report that they simply did not have enough hours in their day to attend to their personal needs, their employment obligations, and their caregiving duties (Fredricksen-Goldsen & Scharlach, 2006; Hill, Hawkins, Ferris, & Weitzman, 2001). As a result, employed caregivers may experience increased physical limitations, psychological distress, and caregiver burnout (Marks, Lambert, Jun, & Song, 2008; Pavalko & Woodbury, 2000).

On the contrary, not all employed caregivers experience the distress or detriments associated with role strain or role overload. Several studies suggest that employed caregivers perform significant amounts of direct care, despite their reduced time to do so (Bullock et al., 2003; Dautzenberg, Phillipsen, Stevens, Tan, & Vernooji-Dassen, 2000; MetLife, 2010). As well, less than half of employed caregivers report conflict in either their family or work roles (Stephens, Townsend, Martire, & Druly, 2001) and many report more favorable health outcomes (Cannuscio et al., 2004; Rosario, Morrow-Howell, & Hinterlong, 2004). The employment role may buffer the stress associated with occupying multiple roles–for example, by providing tangible resources such as health benefits, information, counseling, and referral services (Edwards, Zarit, Stephens, & Townsend, 2002) or intangible benefits such as allowing workers to feel like they are part of a larger community or purpose (Yantzi, Rosenberg, & McKeever 2006) or to develop an increased sense of personal accomplishment and productivity, enhanced interpersonal relationships, and greater self-esteem (Dunham & Dietz, 2003; Scharlach et al., 2007). Finally, and perhaps most important to the current analysis, employment provides caregivers with regular and significant doses of respite (Zarit et al., 1998). Although nonemployed caregivers may also receive regular doses of respite, they may not have an additional role, such as employment, that provides benefits or enhancements that offset the stress and strain associated with the caregiving role.

The literature has debated whether competing roles (i.e., caregiving & employment) can effectively be combined, but very little research has explored how respite may factor into the role-overload or role-enhancement perspective, or how employed and nonemployed caregivers juggle the demands of their competing roles through the use of respite services. Focusing on the patterns of actual and desired time-use among employed and nonemployed caregivers provides a qualitative understanding of the benefits associated with respite; this is an important contribution over existing research that mostly considers respite a quantitative measure of how much time away caregivers receive. For employed caregivers, the amount of respite may be high, but the ability to pursue activities outside of work may be limited. On the other hand, nonemployed caregivers may have less overall respite time, but more time to pursue activities during respite that are personally enjoyable and enriching. Accordingly, respite may provide different benefits to the employed and nonemployed caregivers.

The Current Study

The primary objective was to describe and compare how employed and nonemployed caregivers spend their respite time. We first compared differences and similarities across the employed and nonemployed caregivers, with a particular focus on their utilization of respite services and satisfaction with respite time-use. Second, we compared the specific time-use patterns of employed and nonemployed respite users, highlighting both the activities that they did and the activities they had desired to do during respite time. Third, we identified specific benefits that employed and nonemployed caregivers received from respite time-use, including an exploration of how they thought they might be able to use respite time more effectively. By combining both quantitative and qualitative data, we provide an exploratory answer to these three research objectives.

This study is important because it provides evidence to guide practice and policy that meets the specific needs and preferences of family caregivers, whether they are employed or not. More than a third of all U.S. workers are providing or have recently provided informal care to an older family member (Bond, Thompson, Galinsky, & Prottas, 2002), the economic value of which is estimated to be more than US$300 billion (Arno, 2006). Thus the health of the national economy depends, in part, on understanding how family caregivers manage the challenges associated with occupying multiple roles. Respite, and particularly caregivers’ time-use during respite, may be the critical factor that allows them to successfully maintain their role as informal caregivers.

Method

The data come from caregivers using adult day respite because this type of formal service provides relatively large blocks of time that are regularly scheduled, allowing a caregiver to pursue an extended activity such as employment. Although adult day respite is the most widely used form of formal respite services (Gottleib & Johnson, 2000), we acknowledge that these caregivers represent a selective group and may not represent the full range of diversity among caregivers and the variety of respite options available.

Procedure

We recruited participants from the client lists of three adult day centers in the western United States. These centers were all large (at least 50 clients), well-established facilities that had been in business for at least 5 years. They had fairly diverse client lists since each used a sliding-scale fee structure based on the caregivers’ financial status, and some clients used need-based waivers from the local Alzheimer’s Association to pay for services. Most important, the administrators at each facility were willing to collaborate in the research process.

The staff at each facility reviewed their client files and identified caregivers who spoke English, had used respite services regularly for at least one month, and were known to be the primary caregiver to an older adult at least age 50. Being a primary caregiver meant that they performed the majority of caregiving tasks and spent more time doing those tasks than anyone else (Lund, 1993). We limited the sample to older care recipients because the caregiving circumstances surrounding older and younger adults are quite different. Care recipients in this sample ranged in age from 58 to 90, with an average age of approximately 80.

Of the 91 eligible caregivers identified, 57% or 52 caregivers agreed to participate in the study. The most common reasons for refusal were too busy (n = 17) or not interested (n = 12); 6 caregivers cited health problems as a reason not to participate. After consenting to participate, each caregiver completed a 90-min semistructured in-home interview with a trained interviewer. Most caregivers (92%, n = 48) also completed a daily time-log, summarizing how they spent their respite time during the week prior to the scheduled interview. The 48 persons who completed both the interview and time-log comprise the primary analytic sample for this article.

Respondent Characteristics

On average, participants had been primary caregivers for an average of 3.6 years (SD = 2.9) and had been using adult day respite services for an average of 1.8 years at almost 33 hr per week. A little more than half of the analytic sample (54%, n = 26) had paid employment during the 2 months prior to the interview. The remaining caregivers (46%, n = 22) were nonemployed. On average, employed caregivers worked 32 hr per week, but employment activities ranged from 8 to 50 hr per week, with more than half (52%) working at least 40 hr a week and another two thirds working at least 25 hr per week. This analysis did not distinguish between part-time and full-time employees, given the small overall sample size and because exploratory analyses did not find differences between the groups.

Measures

Respite satisfaction

During the semistructured interview, both the employed and nonemployed caregivers answered three fixed-choice questions about the adequacy of respite services used and their satisfaction with how they spent their time during respite. First, they were asked whether the amount of respite time they had was adequate to meet their needs (yes, no). Second, they were asked “Overall, how satisfied are you with how you use your time during respite?” with response options including very satisfied, mostly satisfied, and not very satisfied. Third, they were asked whether they could improve the way they spent their respite time (yes, no).

Respite time-use

For a 7-day period, caregivers logged the amount of time, to the nearest 1/2 hour, they spent on a list of different activities (actual time-use), as well as how much time they would have liked to spend on each activity during their respite time (desired time-use). Altogether there were 19 activity categories that captured recreational and household activities such as sleeping, spending time with family, watching TV, shopping, cooking, eating, and exercising. We calculated the average reported time (in hours) for both actual and desired time-use and for each of the 19 activities, to provide a sense of what caregivers did and would have liked to do during their respite time.

Multitasking is common, meaning that some participants may have engaged in two activities at the same time, such as listening to the radio while commuting/traveling. To get an accurate assessment of time-use across activity areas and total amount of respite time, participants were asked in cases where multitasking occurred to record actual and desired times associated only with the primary activity, not the activity that was done passively (i.e., traveling/commuting in the example above). This allowed for the summation of actual time-use across the 19 activities to very closely approximate the total respite time for the week, as reported separately by each respondent.

The types of activities assessed in the daily time-logs were modeled after commonly used lists like the Yesterday Interview (Moss & Lawton, 1982), an instrument originally used to document time-use among elders in the community. This instrument did not contain separate domains related to activities such as internet browsing, interactive gaming, and emailing. We recommend that future research include computer-based activities as a separate activity domain on the time-log. Our respondents typically included such activities under recreational activities, hobbies, or the domain that included reading/writing/correspondence.

Furthermore, since respondents reported both desired and actual time-use at the same time, usually after they had already completed the day’s activities, it is possible that their report of desired time-use may reflect an after-the-fact evaluation of what they did or did not accomplish, rather than what they had intended to do. Reconstructing one’s desired time-use may be unavoidable in this type of data collection, but having the participants reflect on both actual and desired time-use forced them to evaluate whether they did what they had wanted to do, so we argue provides an important measure of intentions, accomplishments, and respite satisfaction. We found no discernable patterns across the week in participants’ desired or actual time-use, other than daily variations in the types of activities attempted. That is, caregivers seem to block out certain days for certain activities—like laundry and house cleaning on Mondays, exercise class on Tuesdays, and visiting with friends on another day.

Perceived benefits of respite

During open-ended interviews, both employed and nonemployed caregivers reflected on whether they could accomplish more during their respite time or whether they managed their time effectively. They were also asked to elaborate on what was the most positive, negative, or ideal use of respite time, and whether they spent their respite time doing activities they wanted to do or felt they had to do. Finally, employed caregivers discussed how they managed various work, family, and personal obligations—for example, what they did during their lunch hours and breaks during work. These narrative accounts provided an in-depth understanding about how employed and nonemployed caregivers used and benefited from their respite time.

Analytic Plan

The small sample size did not permit extensive statistical analyses, so we present a descriptive and exploratory analysis comparing the characteristics and time-use patterns of the employed and nonemployed subsamples (n = 26 & 22, respectively). When relevant and possible, we used independent samples t tests to show statistically significant differences across the two subsamples. In other cases, we used narrative accounts obtained from semistructured interviews to supplement statistical comparison of employed and nonemployed caregivers. Qualitative data were analyzed by reading through interview transcriptions with the aim of uncovering common themes and patterns, as well as specific examples associated with each concept. This process of coding was guided by the three research objectives outlined above. At least two researchers read through transcripts to establish interrater reliability and consensus (96% consistency). A third researcher verified the accuracy, completeness, and relevance of selected qualitative examples by going back to the original transcript and rereading the excerpted quote in its entirety and within its original context.

Results

As shown in Table 1, the employed and nonemployed caregivers had similar education and marital profiles, but differed in other ways. The employed caregivers were younger (50.5 vs. 65.2) and more likely to be male than nonemployed caregivers (67% vs. 88% female). Furthermore, employed caregivers were more likely to be adult children caring for mothers with probable Alzheimer’s disease or dementia, while the nonemployed caregivers were more likely to be wives providing care for aging and disabled husbands: nearly two thirds (63%) of employed caregivers were providing care to parents, while the majority (64%) of nonemployed caregivers were providing care to spouses. The care recipients of employed persons were 78% female, whereas the care recipients of nonemployed persons were only 28% female.

Table 1.

Description of Employed (n = 22) and Nonemployed Caregivers (n = 26)

	Employed			Nonemployed
	Mean or %	(SD)	Range	Mean or %	(SD)	Range
Characteristics of the caregiver
% Female^a	67%			88%
Average age^a	50.5	(11.9)	29-85	65.2	(15.1)	29-91
% Married	70%			80%
Education
Less than high school	4%			16%
High school graduate	59%			52%
College graduate or more	30%			32%
Relationship to care recipient^a
Son/daughter	63%			32%
Spouse	11%			64%
Other	26%			4%
Characteristics of the care recipient
Average age	80.7	(8.4)	60-90	77.0	(9.1)	58-90
% Female^a	78%			28%
Diagnosis^a
Probable AD or dementia	58%			42%
Physical impairment	15%			25%
Other	27%			33%
Characteristics of the caregiving relationship
Duration of caregiving (in months)^a	39.4	(37.0)	4-120	47.9	(31.9)	7-120
Amount of care provided (hours per day)^a	11.1	(7.5)	1-24	17.8	(6.2)	2-24
Characteristics of respite service use
Duration of respite use (in months)	18.1	(21.8)	3-84	15.2	(11.8)	2-48
Respite use (days per week)	4.2	(1.2)	2-5	4.1	(1.3)	1-5
Respite use (hours per week)^a	34.2	(10.6)	15-52	28.2	(12.2)	3-45
Perceived adequacy of respite time	71%			68%

Mean scores are significantly different between employed and nonemployed caregivers.

p < .05.

Nonemployed caregivers provided an average of 18 hr of direct care per day, which was significantly more than the 11 hr per day reported by employed caregivers. Nonemployed caregivers reported being the primary caregiver for significantly more months than the employed subsample had assumed this role: an average of 48 months (4 years) compared to 39 months (a little over 3 years). Although their caregiving circumstances were unique, employed and nonemployed caregivers reported similar levels of caregiver burden. This suggests that the level of burden, as perceived by the caregiver, may be more of a function of assuming the role of primary caregiver and not necessarily dependent on the number of competing roles a caregiver holds, how many hours of care are required, or how many hours of respite are used. Therefore, we argue that caregiver burden, although critically important in research looking at caregiver outcomes (George, 1994), will not confound the relationship between employment status and time-use patterns during respite.

Both employed and nonemployed caregivers had been using adult day services, on average, for about a year and a half (M = 15-18 months). Both groups used adult day respite services approximately 4 days a week. However, as expected, employed caregivers utilized respite for significantly longer durations each day. Nearly every employed caregiver (96%) used the service for at least 6 hr a day, whereas only 80% of nonemployed caregivers used it for 6 or more hours per day, resulting in utilization rates of 34 hr per week for employed caregivers and 28 hr for nonemployed caregivers (p < .05). Despite the differences in the amount of respite time used, we found no difference in the perceived adequacy of respite time: 71% of employed caregivers and 68% of nonemployed caregivers expressed that their utilization was adequate to meet their personal needs. As well, both groups very much looked forward to their respite time: on a scale from 1 (not at all) to 5 (very much), both the employed and nonemployed subsamples scored a 4.4 on whether they looked forward to their respite time. Nevertheless, when asked during the semistructured portion of the interview, 60% of employed caregivers, compared to only 47% of nonemployed caregivers, said they were “very satisfied” with how they used their respite time-use (p < .05).

Table 2 shows what types of activities the employed and nonemployed caregivers did during their respite time as well as what types of activities they had desired to do. The employed caregivers worked an average of 32 hr per week, leaving little additional respite time to pursue personal or leisure activities. Thus employed caregivers spent significantly less time than nonemployed caregivers doing the activities listed, with the exception of commuting/traveling. Their most common activities, other than employment, included spending time with family (M = 2.3 hr per week), doing housework (M = 1.7 hr per week), and watching TV (M = 1.7 per week). The most common activities for the nonemployed subsample included doing housework (M = 5.0 hr per week), reading or writing (M = 4.1 hr per week), and spending time with family (M = 4.0 hr per week).

Table 2.

Description of Desired and Actual Respite Time-Use Among Employed (n = 22) and Nonemployed Caregivers (n = 26)

	Employed caregivers					Nonemployed caregivers
	Desired time-use (in hours)		Actual time-use (in hours)		Discrepancy desired-actual^a (in hours)	Desired time-use (in hours)		Actual time-use (in hours)		Discrepancy desired-actual^a (in hours)
	M	(SD)	M	(SD)	Discrepancy desired-actual^a (in hours)	M	(SD)	M	(SD)	Discrepancy desired-actual^a (in hours)
Respite activities
1. Sleep or nap	2.3	(8.3)	0.4	(1.6)	1.9	0.6	(1.2)	1.0	(1.6)	−0.4
2. Time with family	2.2	(4.7)	2.2	(5.4)	0.0	4.0	(6.8)	4.0	(7.0)	0.0
3. Rest and relaxation	2.0	(5.4)	0.6	(1.8)	1.4	2.0	(4.1)	2.1	(4.2)	−0.1
4. Housework	1.9	(4.1)	1.7	(2.9)	0.2	3.1	(3.8)	5.0	(3.6)	−1.9	c
5. Watch TV	1.6	(4.1)	1.6	(4.9)	0.0	1.6	(2.5)	2.0	(2.9)	−0.4
6. Shop	1.4	(2.2)	0.9	(1.3)	0.5	1.4	(2.2)	2.3	(2.1)	−0.9	c
7. Help others	1.3	(3.3)	1.2	(3.5)	0.1	2.1	(3.2)	2.3	(3.5)	−0.2
8. Eat	1.2	(2.1)	1.2	(1.8)	0.0	1.6	(1.7)	2.4	(1.6)	−0.8	c
9. Cook	1.2	(2.0)	1.2	(2.0)	0.0	1.9	(2.3)	2.4	(2.2)	−0.5	c
10. Exercise	1.2	(2.5)	0.9	(2.5)	0.3	0.4	(0.9)	0.5	(1.1)	−0.1
11. Read or write	1.0	(1.8)	0.4	(1.0)	0.6	2.8	(2.9)	4.1	(5.9)	−1.3	b, c
12. Time with friends	0.8	(1.6)	0.2	(0.7)	0.6	1.7	(2.1)	1.3	(1.6)	0.4	c
13. Listen to radio	0.7	(1.3)	0.5	(1.0)	0.2	0.5	(1.2)	0.7	(1.0)	−0.2
14. Travel or commuting	0.7	(1.4)	0.9	(1.5)	−0.2	0.3	(0.7)	0.2	(0.6)	0.1	c
15. Personal/medical care	0.6	(1.2)	0.4	(0.9)	0.2	0.8	(1.4)	1.6	(2.0)	−0.8	c
16. Recreation	0.4	(1.2)	0.4	(0.4)	0.0	0.5	(1.1)	0.5	(1.4)	0.0
17. Hobby or craft	0.3	(0.9)	0.1	(0.4)	0.2	1.6	(3.3)	0.9	(2.0)	0.7	c
18. Religious activity	0.3	(1.0)	0.1	(0.4)	0.2	0.6	(1.5)	0.7	(1.6)	−0.1	c
19. Attend support group	0.2	(0.5)	0.1	(0.3)	0.1	0.2	(0.9)	0.1	(0.5)	0.1

Discrepancy was measured as (desired-actual), thus negative numbers indicate that caregivers wanted to do less of an activity than they actually did; positive numbers indicate that the caregiver wanted to do more of an activity than they actually did.

Desired time-use is significantly different between employed and nonemployed caregivers, p < .05.

Actual time-use is significantly different between employed and nonemployed caregivers, p < .05.

To explore whether actual time-use approximated desired time-use, we calculated average discrepancies [by subtracting actual time-use from desired time-use] for each activity domain across both the employed and nonemployed subsamples (see Table 2). On average, employed caregivers wanted to do more of almost every nonwork activity than they actually did, whereas nonemployed caregivers wanted to spend less time doing most activities than they actually did. For example, the employed caregivers desired an additional 2 hr of sleep each week, while the nonemployed caregivers did almost 2 hr of housework more than they had wanted to do. During the open-ended discussions, employed caregivers commonly expressed a desire to sleep or to do more personal activities like exercise. On the other hand, the nonemployed often commented on how they spent disproportionate amounts of respite time doing activities that were required to keep the household functioning. For example, one nonemployed caregiver said, “I would like to do something for me, not just the things I have to do, like grocery shopping, going to post office, bank.” Another commented, “I tend to waste my respite time and not get done the things I would really like to do for myself. I usually just have time to clean or vacuum the house.”

Four in 10 nonemployed caregivers (40%) thought they could improve on the way they spent their respite time, but only 6% of the employed caregivers felt there was room for improvement. This statistically and substantively significant difference is perhaps related to the discrepancies between the desired and actual time-use patterns across the two subsamples. The discrepancies suggest that nonemployed caregivers may be less likely than employed caregivers to do the amount or type of activities they desired to do during respite. That is, the discrepancy between desired and actual time-use was, on average, smaller for the employed caregivers than it was for nonemployed caregivers.

Although the employed did not spend as much time as the nonemployed doing personal, recreational, or social activities, employment itself appears to be an important source of respite for these caregivers. A majority of employed caregivers (73%) said they considered their time at work as “a break or respite from their caregiving obligations.” And, more than half (57%) “very much” enjoyed their time at work, with an average score of 4.4 (SD = 0.9) on a scale of 1 (not at all) to 5 (very much). Forty percent said they worry “not at all” about their loved one while at work, with an average of 1.9 (SD = 0.9) on a scale of 1 (not at all) to 5 (very much). One woman who cared for her mother commented, “It’s so nice not to be worrying about mom.” Another female caregiver, age 47, commented, “I really enjoy my job, having dad in daycare and knowing he was receiving good care is the only thing that makes it possible.”

When asked what the most helpful or anticipated respite activity was, the responses varied dramatically across the nonemployed caregivers (e.g., vacuuming, paying bills, grocery shopping, visiting with friends, resting), but almost all of the employed caregivers mentioned “employment” or “work” as the number one most helpful or anticipated way to spend respite time. A female caring for her father said, “I’m especially appreciative of my time at work. I enjoy it and enjoy the connections I have with people who are interested in the same things professionally as I am. It is interesting work, very satisfying, no distractions, and I–for once–have control over how I use my time. I can’t tell you how much I enjoy my time at work.” For some, work provided a “sense of accomplishment.” For others, work “gives me a lot of joy. It’s just good to have something to do.” And, still others mentioned the obvious financial benefits associated with paid employment: “I still need to support my family,” said a middle-aged male caring for his disabled grandmother. “I need the money,” commented a 58-year-old female caregiver. Finally, the workplace provided friendship and social interactions. One 60-year-old female spousal caregiver said, “I enjoy the people I work with.” A 58-year-old female who cares for her mother, remarked, “Just being with other people is so uplifting.”

Despite the noted benefits of employment, some of the employed caregivers also commented that they had very little time to do things for themselves, just as the nonemployed caregivers had revealed earlier. One middle-aged woman who was the primary caregiver for her mother revealed that she “will run home on my lunch hour to start fixing something for dinner. I always do something for the house during my breaks (shop, clean, cook).” Perhaps feeling that she does not have enough time in her day to accomplish everything, she later commented that the activity she most wished she had time to do was “take a nap.” Similarly, a male caregiver commented that although work was the most anticipated or helpful activity for him to pursue during respite, the activity he wished he could do was “take a day off–want to rest.” Another woman wished she could stay home alone instead of going into work so that she could “work on projects that I never have time for.” A younger man who was caring for his grandmother said he wished he had time for “physical fitness or rest. I never have time for either.”

While it was very common for employed caregivers to talk about needing and desiring even more respite time (i.e., beyond the hours they currently used for paid employment), several revealed they had found strategic ways to use their lunch hours and breaks during the workday to attend to personal matters. For example, many valued the social interactions and camaraderie they received through informal conversations and shared meals with colleagues during the workday. Others used their scheduled breaks and lunch hours to complete activities they did not have time for otherwise. “At break today, three of us walked to a nearby convenience store for a drink, some fresh air, and a little exercise. Sometimes, I use my breaks to talk to my wife by phone.” Others commented that break time was an opportunity to rest or “to take a quick cat nap.” Particularly impressing was the variety of activities pursued during lunchtime by a 61-year-old daughter caring for her mother, “One day I wrote a letter. Thursday I mailed letters and a package. One day I visited with my children by phone. One day I had lunch with some friends. One day I went to a fascinating lecture–All during my lunch hours.”

Table 3 provides a summary of the most important themes and differences identified across the employed and nonemployed subsamples. For example, employed caregivers were overall more satisfied with their respite time-use than nonemployed respite users. Furthermore, very few of the employed caregivers (6%) thought they could improve the way they spent their respite time, but 40% of the nonemployed group felt they could have used their respite time more effectively. Both employed and nonmployed caregivers expressed a desire to do more personally rewarding activities during respite time; however, the comments from employed caregivers suggested that they might need even more respite time to do such activities in addition to their employment and caregiving obligations, whereas the comments from the nonemployed caregivers alluded to needing better time-management and/or advanced planning so that their respite did not turn out to be a wasted opportunity to do such activities.

Table 3.

Summary of Respite Time-Use Satisfaction Among Employed (n = 22) and Nonemployed Caregivers (n = 26)

Employed caregivers	Nonemployed caregivers
Overall, how satisfied are you with how you spend your respite time?^a
60% very satisfied	47% very satisfied
Could you improve the way you spend your respite time?a
6% Yes	40% Yes
How might you improve your respite time-use?
Need more respite time for myself: I wish I had more respite time so I could “take a day off–want to rest” What I most want to do during my respite time is “take a nap” I wish I had time for “physical fitness or rest. I never have time for either” I wish I could “stay home alone and work on projects I never have time for” “There never seems to be enough time to do everything I need to do” “Ideally, I would be independently wealthy [and not have to work]. Then, I would have time to pursue health and recreation.”	Need to use respite time better: “Wasted time and wasted opportunity” I wish I could “do something for me, not just the things I do, like grocery shopping, going to the post office, bank” “I tend to waste my respite time and not get done things I would really like to do for myself. I usually just have time to clean or vacuum the house” “I’m somewhat annoyed with having to spend so much time on housework e.g., laundry–even though I enjoy actually doing it. But it would be nice to do something else. I just forget.” “I may be selfish, but I’d like to do a lot more than I do know. I feel so ‘tied down’–can’t do what I want. I am stuck in a rut. Don’t know how to get out”

Differences are statistically significant across employed and nonemployed subsamples as assessed by independent samples t tests, p < .05.

Discussion

This study focused exclusively on a small sample of primary caregivers who used adult day services; thus, our sample does not represent caregivers who used other forms of formal or informal respite. Caution is therefore warranted in making generalizations to family caregivers who have widely varied characteristics and circumstances. While recognizing these limitations, this study provides important insight regarding how employed and nonemployed caregivers use and benefit from formal respite services.

Overall, the employed caregivers were more satisfied with their respite time-use and less inclined to feel they needed to use their respite time more effectively than the nonemployed caregivers. Both employed and nonemployed caregivers expressed a desire to engage in more personally rewarding activities during respite time, but the means of achieving that may differ across the two types of caregivers: Employed caregivers might benefit from obtaining even more respite time since their available respite is mostly filled with employment-related activities. The nonemployed caregivers might benefit from better time management or advance planning to use their available respite time more effectively since they often felt that they missed an opportunity to do something personally meaningful during respite.

By comparing the discrepancy between desired and actual time-use, we found that employed caregivers were generally more likely than nonemployed caregivers to do the amount and type of activity they wanted to do or had planned to do during their respite time. Recent research has suggested that higher consistency between desired and actual time-use is associated with lower levels of depression and higher levels of caregiving satisfaction (Lund et al., 2009), implying that the employed caregivers may in turn receive greater personal benefit from being able to do what they wanted to do during respite than the nonemployed caregivers. Although they had very little time to pursue activities other than employment, they found both pleasure and purpose from their work-related activities, while also receiving a “worry-free” break from their caregiving obligations. Conversely, the nonemployed caregivers may have had lower overall satisfaction with their respite time-use because they were not as consistent in doing what they had wanted or intended to do during respite. According to our interview data, both employed and nonemployed caregivers seemed to agree that doing more of an activity that was undesirable (e.g., too much housework) was just as deleterious as doing less of an activity that was desired (e.g., not having enough time to spend with friends).

It is possible that employed caregivers have a clearer expectation about what can and cannot be accomplished during respite time, given the fact that most of their available respite is used for employment-related activities. That is, their lower levels of discrepancy between desired and actual time-use may be due more to how structured their work and free time is rather than them having more successful time management skills. In addition, demographic differences between the employed and nonemployed caregivers, in terms of age, gender, and social circumstances, may confound the relationship between well-being and time-use consistency. For example, it is possible that employed caregivers might appear to have less discrepancy in time-use patterns than nonemployed caregivers because that subsample has more males and younger persons than the nonemployed subsample. Future studies using a larger sample ought to explicate the relationship between time-use consistency and mental health, while controlling for the factors that may select caregivers into either the employed or nonemployed roles. Possible covariates that may confound the relationship between employment and time-use include variables that describe the nature of the caregiving relationship (e.g., relationship of caregiver & care recipient, duration of caregiving, perceived burden), personal characteristics of the caregiver (e.g., gender, age, health, financial circumstances), and the availability of respite services (e.g., amount and duration of service utilization). This analysis, given the small sample size, was unable to control for such factors that have selected one into the employed or nonemployed role; however, it is worth noting how the demographic profiles of the employed and nonemployed subsamples may be confounding the ability of each group to achieve consistency and satisfaction with respite time-use.

That being said, a noted strength of the current study is its qualitative and exploratory nature, which provided personalized accounts of one’s individual time-use patterns and perceived benefits associated with respite time-use. These qualitative insights revealed important insight regarding how informal caregivers spend their respite time as well as the specific benefits that employed caregivers received from paid employment, such as increased social integration, financial gain, and higher personal well-being. While many worked because of financial necessity, employed caregivers also commonly expressed personal satisfaction from the tasks they were able to accomplish at work. Thus, as shown in previous research, employment provides both tangible and intangible resources to caregivers, perhaps offsetting the strain or burden associated with caregiving and leading to increased levels of satisfaction and personal well-being among the employed caregivers (Center for Health Research & Coughlin, 2010).

Accordingly, these findings support the view that employment provides an overall net benefit (i.e., role enhancement), rather than increased strain (i.e., role overload) for caregivers who are faced with juggling the demands of these two competing roles (Scharlach, 1994). The employed caregivers in this study perceived their time at work as respite and found many opportunities to engage in valued social interactions and personally rewarding pursuits while at work. However, our intention is not to say that caregivers should be employed. Rather, they should be able and encouraged to maintain multiple roles if they so desire, instead of assuming that the two roles cannot be effectively combined.

Nevertheless, our data revealed that employed caregivers were more restricted in both the amount and type of activities they could pursue during respite than nonemployed caregivers were. Although some had found creative ways to use lunch hours and breaks to pursue nonwork related activities, employed caregivers typically spent less time than nonemployed caregivers engaging in activities that were related to social interaction or personal leisure during their formally scheduled respite time. Perhaps as a result, employed caregivers commonly expressed a desire for even more respite to pursue activities such as napping, finishing household projects, and exercising. They often discussed how they felt “squeezed” when trying to accomplish all the necessary and desired activities related to caregiving, employment, and personal leisure. Then again, nonemployed caregivers also expressed a desire to do more things for themselves, rather than just the things they felt they had to do to keep the household functioning. Thus, both employed and nonemployed caregivers provided evidence that the caregiving role impinges on the individuals’ ability to do the types of activities they might have done if they were not saddled with the responsibility of caring for a family member. This finding implies that both employed and nonemployed caregivers might benefit from better use of their respite time. Thus we end this discussion with practical advice that may help caregivers use their respite time more effectively.

Practice Considerations

The nonemployed caregivers appear to be in need of better assessment, planning, and monitoring of their respite activities–and most important, should be encouraged to pursue activities that are personally meaningful and not just household-related chores. These caregivers, like the employed caregivers, may benefit from an intervention that coaches them in how to set goals and to plan in advance how to best use their respite time (see Lund et al., 2009 for example). This type of intervention might reduce the feelings of “wasted time and wasted opportunity” that so many of the nonemployed caregivers expressed. Nonemployed caregivers may also consider using respite time to engage in formal volunteer activities. Many community nonprofit organizations are in need of mature, responsible volunteers to meet their organizational goals and objectives, while for caregivers, volunteer work may provide similar benefits to those identified by the employed caregivers.

Employed caregivers, on the other hand, may need assistance in (a) obtaining additional respite time that would allow them to engage in activities other than employment-related activities and/or (b) finding additional ways to use breaks and lunch hours during the work day to pursue nonwork activities. As well, and perhaps most important, an expansion of more family-friendly workplace policies might allow employed caregivers to better manage the competing demands of employment and caregiving roles, while also attending to personal needs and desires (Fredriksen-Goldsen & Scharlach, 2006; Koerin, Harrigan, & Secret, 2008; Pavalko & Henderson, 2006).

Although availability may differ across other contexts, only about half of U.S. workplaces offer any sort of formal eldercare benefits, such as long-term care insurance, flex time to accommodate long-term illnesses within the family, or referral/support services specific to family caregiving (Beauchamp, Irvine, Seeley, & Johnson, 2005). Policies such as the U.S. “Family and Medical Leave Act” (FMLA) are important but may not adequately address the needs of employed caregivers. This policy requires that public agencies and private companies with at least 50 employees offer employees up to 12 weeks of unpaid, job-protected leave per year to tend to family health-related matters such as birth of a child, personal illness, or caregiving responsibilities for a spouse, child, or parent. Although this type of policy helps employed caregivers manage work-family issues, it does not recognize that informal caregiving is often a long-term obligation and cannot be addressed during a short-term leave of absence. In our sample, caregivers had been primary caretakers, on average, for 3 to 4 years. Thus, work-place policies need to allow for longer term arrangements, rather than crisis-oriented leaves. Work-place policies also need to recognize that unpaid leaves may not be the most germane solution since many employed caregivers work because of the financial necessity to do so. Accordingly, workplace arrangements that allow caregivers to maintain income such as flex-time, job sharing, and telecommuting may be more effective in allowing employed caregivers meet the demands of their competing roles.

A report by Feinberg and Newman (2005) suggests that caregivers, above all else, want to retain control, choice, and flexibility over their lives. Thus the policy recommendations we have suggested (i.e., expanding the availability of respite services, maximizing the utility of family-friendly workplace policies, and designing interventions that help caregivers make better use of their respite time) may allow caregivers to be more effective and fulfilled in their caregiving role by giving them the control, choice, and flexibility to manage the demands of paid employment alongside the demands of caregiving and the pursuit of personal interests. Furthermore, by supporting families that take on the informal caregiving role, older adults will be more likely to “age in place” in the communities in which they have lived their lives (Bookman, 2008), while caregivers may feel less burden and be able to sustain the caregiving role for longer durations.

Footnotes

The author(s) declared that they had no conflicts of interest with respect to their authorship or the publication of this article.

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article:

This study was funded by a targeted research grant from the National Alzheimer’s Association.

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