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Health Status Health Services Health Care Reform Diverse Communities of Women
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Coping as a Rural Caregiver: The Impact of Health Care Reforms on Rural Women Informal Caregivers Bonnie Blakley and JoAnn Jaffe, Department of Sociology and Social Studies, University of Regina
Health care in rural Saskatchewan is rapidly changing. Many rural communities are losing their hospitals, long-term care facilities and, in some cases, primary care services. Care of the chronically ill or disabled is being deinstitutionalized. Respite or physical therapy services are scarce or becoming centralized and more difficult to access. The numbers of rural informal caregivers are increasing, while insecurity regarding medicare and the restructuring of health services is intensifying. Policy-makers are introducing rapid changes to the health system, yet little is known about their impacts on rural informal caregivers. Policies appear to be based on myths and assumptions about rural women, families and communities. The Rural Women Informal Caregivers Study therefore asked four questions:
The North Valley Health District in east central Saskatchewan was chosen as the study site because of its proximity to Regina, it was a well-defined area and caregivers in the district had the potential to access the same number and type of health care services. The area includes smaller communities and can therefore be considered rural. The district has an estimated population of 14,992, having declined slightly in the late 1990s. Individual interviews using a structured questionnaire were conducted with 53 women between June and October 1998. Most interviews were conducted in the caregiver’s home. Six interviews were carried out in public restaurants chosen by the caregiver. The interviews lasted between 45 minutes and four hours. Key findings 1. Women report that their health has deteriorated since taking on the caregiver role. Two-thirds of the caregivers in this study consider themselves to be healthy. Close to half of all the caregivers interviewed reported that their health had deteriorated since taking on the caregiver role. It is interesting to note that some of the caregivers who identified themselves as healthy still feel that their health has deteriorated since they started caregiving. These caregivers reported suffering from more stress headaches, chronic back pain, depression and emotional and physical exhaustion since they began caregiving. As caregivers are compelled to care for more than one care-receiver over their lifetime and for longer periods of time, we can anticipate seeing greater numbers of stress related illnesses develop in caregivers. 2. Caregivers have variable experiences with using district health services and supports for caregiving. Caregivers identified a wide range of health district services as community supports but few were accessing more than one of these services. Caregivers felt that having more home care workers available, more knowledgeable home care workers, and not so many different home care workers would make home care more attractive to people. 25 caregivers believe that community support should focus on maintaining hospital and clinic services while 24 caregivers believe that community support should focus on expanding group and care homes. While some caregivers felt that home care services were ‘great just the way they are,” others felt that home care was “useless” and would not use it. 3. How a caregiver reports her health is directly correlated to her level of family support and employment outside the home. Caregivers who do not consider themselves healthy are very likely to feel their health has deteriorated since they started caregiving. Remarkably, age and income seem to have very little effect on whether caregivers say they have become less healthy – although young healthy caregivers are slightly more likely to report that they have experienced deteriorating health. People with higher levels of education are more likely to consider themselves healthy, yet are also slightly more likely to say their health has deteriorated since they began caregiving. The most significant variables to explain both whether the caregiver considers herself to be healthy and whether her health is staying the same or deteriorating are family help and outside employment. Caregivers who are employed outside the home are much more likely to consider themselves as healthy and are unlikely to report their health as deteriorating since they started caregiving for a family member. In contrast, caregivers who do not work outside the home are both more likely to evaluate their health as poor and to feel it has deteriorated. A large number of caregivers who do not consider themselves healthy receive no assistance from family members with their caregiving duties. Meanwhile, caregivers who do receive help are more likely to consider themselves as healthy, and are also less likely to feel that their health is deteriorating. 4. Caregivers need both formal and informal supports. Caregivers feel that having strong support from the community and family members would make their caregiving tasks easier. However, 30% of the caregivers believe there is nothing that can make their caregiving tasks less difficult. Although 26 caregivers reported receiving caregiving help from other family members, 27 did not. Older caregivers were more likely to report not receiving help from family. Caregivers not receiving help from family are often caring for very old people. Rural women informal caregivers find themselves in a difficult situation. These women have to cope not only with the restructuring of their health care system but also of their communities. This study reveals that these changes are affecting caregivers’ social lives, their work, and their health. Briefly, caregivers often found that the demands of caregiving in a rural community limited their social lives, interfered with their work lives, and was associated with a deterioration in their own health. Various policy implications arise from this work:
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