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Archives for August 2015

And so sabbatical ends

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Next week, my sabbatical officially ends. As you can imagine, I reenter the academic fray with mixed feelings and a bit of trepidation. I really, really enjoyed my sabbatical. I mean, I really enjoyed it. So much that around March or April, I started worrying about having to come back. But now I’m looking forward to seeing my colleagues and teaching and getting back into various projects and meetings . . . well, okay maybe not meetings. Although I expect reentry will be a bit bumpy and it remains to be seen how long this renewed feeling will last, but I’ve regained the “hooray school is starting” feeling that I’d lost the last couple of years.

So how did it go and why did it work? Here are a few thoughts.

I let go of work. I deleted work emails or filed them away for future reference without reading them. With a few exceptions, I didn’t have contact with anyone from work, at least not about work. I saw some people socially. I liked their pictures on Facebook. But I didn’t ask them about work and was blissfully ignorant of academic goings-on.

While much of my time was spent working at home, I spent seven weeks in May and June in Tampere, Finland. I really loved it there. I mean I really, really loved it. Yes, I missed my husband and my quadrupeds, but I was sad to leave. And then I was happy to be home. I’d say that’s probably the best of all possible worlds – to be happy in two different places and to miss each of them when you are away.

It was wonderful to be in Finland for an extended time. I was really able to explore Tampere. My Finnish did improve – an itty, bitty, bit. I was forced out of my regular grooves.

This was true for the whole sabbatical. I’m a routine-oriented person. When life is going fast and furious, that’s how I get things done. I get up at pretty much the same time everyday thanks to my quadruped alarm clocks, I feed the quads, make the coffee, have some breakfast, sit down to work. I write in the mornings. I do teaching and admin stuff in the afternoon. I go to the gym at roughly the same time every day. I make pancakes for breakfast on Sunday mornings and eat them while working the New York Times Sunday crossword puzzle. I’m in bed by 9:30 most nights. I read for a while and turn the light out at 10.

I stuck to many of these routines at first. It was hard to let go. But, gradually my grip loosened. I went sledding down the hill at the back of the house. (The neighbors saw the tracks and wondered if we’d had some kids visiting). I stayed up later, sometimes even later than my husband, which confused everyone. I made waffles instead of pancakes (how daring!) – sometimes even on a weekday! (gasp!) I started agility classes with my dog. I watched movies in the middle of the day (and felt very guilty about it – some things you just can’t change).

I also worked on a book and read and thought about elder care issues and pondered where to go next with my research. I started this blog and some other non-academic writing aimed at getting research out into the broader world. I read research in areas that I don’t normally look at and thought about the many different ways to approach similar questions and issues.

And I think it was this last bit that really helped me re-energize. Most of the time we are pressed to produce, produce, produce. Publish journal articles. Submit grant proposals. Find new collaborators. You start to work to a formula just to meet demand and in the process you lose some of the freedom and creativity that drew me to academia in the first place. Sabbatical helped me regain some of that and rediscover why I do what I do. Who knows how long that will last, but I will enjoy the benefits while I can. And, I’ll start planning my next sabbatical.

 

More on caregiving Part 2: The pluses and the not-so-pluses

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In my last post, I shared some research that found similar patterns of burden among caregivers across 20 countries. The bottom line: caregiving is hard work no matter what the structure of the health care and social welfare systems.

Today I look at a slightly older study that uses data from over 5,000 caregivers in Germany, Greece, Italy, Poland, Sweden, and the UK. I found this study interesting because it gives a bit more fine-grained picture of the experience of caregivers under different social welfare structures. (Spoiler alert: It’s not always clear how systemic structures and caregiver experiences are related).

The authors identify groups of caregivers with common characteristics and look at how these groups are similar or different across countries. The groups are identified based on a wide variety of things including caregiver burden, caregiver demographics, and care recipient charateristics. Caregiver burden includes subjective burden – as reported by the caregiver – and objective burden – based on how impaired the care recipient is, and therefore how much care they need.

The authors identify seven categories of caregivers each of which is found in every country, although there are some differences in the prevalence of categories across countries.

And the categories are . . . [drum roll please]:

  1. Caregivers who are highly burdened and living with the care recipient. They are unemployed daughters (or daughters-in-law) and are caring for a parent who is highly impaired. This accounted for 19% of caregivers and is the most “traditional” model of family caregiver. These caregivers tend to have low levels of education and spend more than 10 hours a day on caregiving.
  2. Caregivers who were highly burdened, but not living with the care recipient. These also tend to be daughters. However, they are employed and caring for a parent who is slightly or moderately impaired. This accounts for 12% of caregivers.
  3. Burdened wives – I think the title speaks for itself – are about 15% of caregivers.
  4. Moderately burdened husbands – ditto – are about 8% of caregivers.
  5. Caregivers who are experiencing low to medium levels of burden and caring for a relative who is highly impaired (about 16% of caregivers). These caregivers tend to have a high level of education and good access to support. This probably accounts for the lower level of objective burden they report. Even though their relative needs a lot of care, their support network helps them maintain some independence from their caregiving role.
  6. Children (or children-in-law) who report low burden and are caring for a moderately impaired parent. This is 13% of caregivers.
  7. Caregivers with low burden who are caring for a slightly impaired relative (about 17% of caregivers).

Overall, 30% of caregivers used at least one support service in the last 6 months. Sweden, the UK, and Germany have more formal support services specifically for caregivers.

  • About a quarter of caregivers in the UK are in Category 7, the group with the lowest subjective and objective burden.
  • Caregivers in Germany fall into Categories 5 (25%) and 1 (22%). These are the categories where care recipients are the most impaired, although those in Category 5 report low subjective burden.
  • In Sweden, however, despite the availability of formal supports, almost half of caregivers were in the most burdened groups (categories 1, 2, and 3) and a smaller proportion of caregivers (22%) reported using services specifically targeted for them compared to other countries.

Support services specifically targeted toward caregivers were not available in Greece, Italy, or Poland.

  • In Greece and Italy, roughly 30% of caregivers were in the “traditional” caregiving model (Category 1).
  • In Poland, however, despite this lack of services, most caregivers were in groups with lower burden (26% in Category 6 and 23% in Category 7). One possible reason for this is that over half of caregivers in Poland received monetary care allowances paid directly to them. The UK is the only other country where this is the case. Also, a higher proportion of care recipients in Poland receive home-based health care which may indirectly relieve some of the subjective burden on the caregiver.

What to make of all this? A few thoughts come to mind (and, of course, I would like to hear your thoughts as well). First, with the exception of Poland, the countries in this study all do better than the U.S. on a variety of measures outcomes such as quality of care, efficiency, access to services, equity, and population health. (See, for example, the most recent World Health Statistics report or this report by The Commonwealth Fund. That can’t be a coincidence. They must be doing something better than we are.

Second, the availability and accessibility of services – as influenced by systemic structures – is probably part of that. Looking at the caregivers in this study, those in the UK and Germany, with some of the most structured formal services, seem to be doing well. But, it’s not the whole story because caregivers in Sweden have significantly amounts of subjective and objective burden (30% fall into the “burdened wives” category) and appear to use the wide range of services that are available less.

Third, the type of supports may be particularly important. Caregivers in Poland are doing well with few social supports, but with monetary compensation given to directly to caregivers and more home care for the recipient that may indirectly relieve some burden.