Pandemic-related restrictions in nursing homes have undermined the critical role that family and friend caregivers play in enhancing resident quality of life. We examined how family caregiver access restrictions in nursing homes were implemented and how they impacted the mutual well-being of and relationships between residents and their caregivers over time. Between March 2021 and March 2022, 24 ‘designated caregivers’ in Atlantic Canada were interviewed three times. We identified changes in family relationships and activities over time, constricted support networks, the increasing need for advocacy and monitoring, and the generally negative cumulative impacts of restrictions, especially during residents’ end-of-life. Subsequent adaptations to access restrictions allowed caregivers to contribute to essential monitoring, care relationships, and advocacy roles. We argue that the role of designated caregivers in nursing homes must be maintained during public health emergencies to ensure resident’s supportive family relationships and general well-being.

A new paradigm for continuing care policy has emerged that is based on assumptions about the benefits of caring partnerships and client-centred care delivery. Such assumptions place the interface between formal and informal care squarely on the policy agenda. The authors describe how existing research can contribute to the debate stimulated by the new policy paradigm and suggest future research that is informed by the paradigm. They argue that theory is an important tool to make policy agendas more explicit and they use human ecology theory to illustrate how theory can frame the development of research to address policy. Finally, they describe barriers to be overcome in order for policy and research to inform one another.

Older adults who age at home independently are often celebrated as having anticipated and planned for their care needs in the later stages of life, whereas those who receive assistance from home support services are often stigmatised as dependent and characterised as a ‘drain on the system’. However, this thematic analysis of interview data from 12 home care clients in two Canadian provinces offers evidence that counters the assumption that home care clients are passive recipients of care. Extending Corbin and Strauss' theorisation of how individuals manage chronic conditions alongside Dorothy Smiths' conception of work, we explore how home care clients ‘work’ to receive care as they age in place. Specifically, home care clients not only engage in daily life work, illness work and biographical work, but also advocate for themselves and their workers, co-ordinate and negotiate with members of their caring convoys and networks, and adapt in various ways to navigate personal, relational, structural and policy-level challenges. We suggest that work done by older adults who are ageing in place be addressed, acknowledged and incorporated into care planning and operational policy development to challenge both the stigma of dependency and neoliberal narratives of self-sufficiency.

The COVID-19 pandemic has taken a devastating toll on long-term care (LTC) residents, families, and staff. In an effort to keep residents safe from COVID-19, public health measures were implemented early in the pandemic to restrict visitation with residents in many countries, with subsequent adjustments made over the course of the pandemic. It is critical to understand the implementation process and how restrictions on visitations have impacted residents, families, and staff. This research note shares a summary of research interviews conducted with key informants in British Columbia (Canada), England (United Kingdom), and The Netherlands on the implementation of visitation programs in the COVID-19 context. It highlights leading practices and key challenges from these jurisdictions.

Research has shown that long-term care (LTC) volunteers play important roles in enhancing the quality of life (QoL) of older LTC residents, often through providing unique forms of relational care. Guided by Kane’s QoL domains, we used a modified objective hermeneutics method to analyze how unique volunteer roles are represented and supported in provincial policies in Alberta, British Columbia, Ontario, and Nova Scotia. We found that policies define volunteer roles narrowly, which may limit residents’ QoL. This happens through (1) omitting volunteers from most regulatory policy, (2) likening volunteers to supplementary staff rather than to caregivers with unique roles, and (3) overemphasizing residents’ safety, security, and order. We offer insights into promising provincial policy directions for LTC volunteers, yet we argue that further regulating volunteers may be an inadequate or ill-suited approach to addressing the cultural, social, and structural changes required for volunteers to enhance LTC residents’ QoL effectively.

This article examines provincial policy influence on long-term care (LTC) professionals’ advice-seeking networks in Canada’s Maritime provinces. The effects of facility ownership, geography, and region-specific political landscapes on LTC best-practice dissemination are examined. We used sociometric statistics and network sociograms, calculated from surveys with 169 senior leaders in LTC facilities, to identify advice-seeking network structures and to select 11 follow-up interview participants. Network structures were distinguished by density, sub-group number, opinion leader, and boundary spanner distribution. Network structure was affected by ownership model in Nova Scotia and Prince Edward Island, and by regional geography in New Brunswick. Political instability within each province’s LTC system negatively affected network actors’ capabilities to enact innovation. Moreover, provincial policy variations influence advice-seeking network structures, facilitating and constraining relationship development and networking. Consequently, local policy context is essential to informing dissemination strategy design or implementation.

This article is based on a study that used a validated care-giver assessment instrument known as ‘The C.A.R.E. (Caregivers’ Aspirations, Realities, and Expectations) Tool’ to understand its usefulness in working with older adults caring for a spouse with cognitive impairment. It draws on data collected as part of a larger, quasi-experimental pre- and post-test study examining the impact of a care-giver assessment on older spousal care-givers of a partner with cognitive impairment. One hundred community-living individuals (average age of 74) participated in the study. Participants met with a third-year nursing student who administered The C.A.R.E. Tool. Within three to seven days following this, a research team member conducted a semi-structured interview by telephone. This interview provided participants with the opportunity to comment on their experience and the usefulness of The C.A.R.E. Tool. Transcriptions of the interviews were analysed using a thematic analysis. Results indicate that the assessment experience was evaluated positively by most participants. Two broad themes emerged: assessment encourages care-givers to take stock of their situation, and it provides a relationship with a caring professional. In particular, the assessment experience gave these care-givers to have the opportunity to reflect, while expressing emotions and developing awareness, and provided them with an appreciated relationship with a caring professional who helped to validate and normalise their situation. For care-givers, the results suggest that assessment may serve as a catalyst for taking action in their care-giving situation or turning to services for help. For practitioners, assessment may increase awareness of the experience of spousal care-givers, potentially leading to interventions to support them. This study found that the attitudes and knowledge of practitioners play a role in care-givers’ experience of the assessment as positive. However, the goal of assessment must be clarified, as outcomes of other tools will differ depending on the aims.

This mixed-methods study identified the personal and workplace characteristics that drive the job satisfaction of home support workers (HSWs) providing assistance to elderly clients. Data were based on a standardized measure of job satisfaction, along with in-depth qualitative interviews with 176 home support workers from three Canadian provincial jurisdictions (British Columbia, n = 108; Ontario, n = 28; Nova Scotia, n = 40). We anticipated that variability in demographic profiles between the three groups of workers and different job descriptions would be associated with differences in perceived job satisfaction. This was not the case. Results from the qualitative analysis highlight key areas that contributed to job satisfaction. These are job (scheduling, travel, and safety), economic (income security), and organizational (communication, support, and respect) factors. Given these findings, we recommend improvements to workplace communication, increased travel time allowance between clients, and wage parity with equivalent positions in long-term care facilities.

This study examines the relationship between ethnicity and the provision of assistance to older relatives. A sample of employed Canadians (N = 2,753), a subsample of the CARNET Work and Family Survey, is used to explore how ethnicity influences the amount of assistance provided to older relatives. Findings from our study suggest that Asians, East Indians, and Southern Europeans provide higher levels ofhelp than British respondents. Final obligation affects the amount of help provided but plays a similar role within each ethnic group. However, structural factors — in particular, living arrangement and age — are stronger predictors of the level of involvement in helping older relatives than are cultural factors of filial obligation and belonging to a particular ethnic group.

Financial compensation for family members who provide informal care to elderly kin has frequently been discussed but rarely implemented in Canada. One exception is the Nova Scotia Home Life Support Program, which financially compensates family members for the care of the elderly. This study explores differences among caregivers who receive formal services, specifically, financial compensation or home help services. Financially compensated caregivers tend to be younger females who live in non-urban areas and co-reside with the care receiver. In comparison to caregivers who receive home help services, these paid caregivers report a reduction in financial worry but have greater involvement in the care of the elderly and higher levels of time dependence burden. Before implementing financial compensation policies, research which specifically investigates the effect of these programs on caregivers is needed.

This research broadens the understanding of the relationship between paid work and caregiving by including the contribution of the older “care recipient”. Using selected aspects of social exchange theory and a life course perspective, the importance of giving and receiving for caregivers and care recipients is explored through analyses of focus groups with employed women and interviews with their older mothers. The mothers and daughters focus on the time when they are most indebted to each other. The daughter's employment affects the type and value of contributions from care recipients. The mother's past assistance with housework and caring for children is greatly valued by the daughters. For care recipients, however, being reliant on a busy employee for their care has negative consequences. The mothers emphasize the current situation and under-estimate their past helping. Further research should consider the care recipient's perspective to obtain a broader understanding of the impact of the caregiver's employment in caregiving relationships.

In many countries one approach to supporting family-and-friend caregivers is direct financial or monetary support. Debates about the benefits and consequences of such policies pervade the literature. Building on the premise that values underlie public policy, the paper examines four policy paradoxes in the literature and uses selected examples from an international policy analysis to illustrate the underlying objectives and values upon which many of the policies were developed. These include the responsibility to care, economic or social objectives, gender equity, and the autonomy of care receivers. The authors conclude that policy makers need to be cautious about the unintended effects of financial support policy and develop a menu of policies and services to support caregivers. Future policy development in Canada must enable legitimate choice across the life course and ensure that neither the caregiver nor the care receiver will experience short- or long-term financial consequences of his or her choice.

Western societies are experiencing a dramatic growth in the population aged 75 and older. Changes in family composition raise questions about who will care for those who need assistance. We compared population projections to the year 2030 of those families aged 75 and older in Canada and France. Over the next 25 years, the pool of potential family carers, (i.e., spouses and children), will broaden from the effect of the baby boom and increased proportion of women with spouses. The populations most dependent on formal care, with no potential support from a child or a spouse, will increase more sharply in Canada (123%) than in France (34%) but at a slower rate than the total population. Policy and programs in both countries will need to prepare for a greater number of elderly spouses providing care and in Canada, at least, a significant increase in the number that will need to rely on formal services.

This paper examines care management, or ‘managerial care’, a type of informal care for older adults that has been relatively neglected by researchers. While previous research has acknowledged that care-giving may involve tasks other than direct ‘hands-on’ care, the conceptualisation of managerial care has often been vague and inconsistent. This study is the first explicitly to investigate managerial care amongst a large sample of carers. In our conceptualisation, care management includes care-related discussions with other family members or the care recipient about the arrangements for formal services and financial matters, doing relevant paperwork, and seeking information. The study examines the prevalence of this type of care, the circumstances under which it occurs, its variations by care-giver characteristics, and its impact on the carers. We drew from the Canadian CARNET ‘Work and Family Survey’ a sub-sample of 1,847 full-time employed individuals who were assisting older relatives. The analysis shows that managerial care is common, distinct from other types of care, a meaningful construct, and that most care-givers provide both managerial and direct care. Care management includes both the orchestration of care and financial and bureaucratic management. Providing managerial care generates stress amongst women and interferes with work amongst men, and the aspect that generates the greatest personal and job costs amongst both men and women is the orchestration of care.