Using Mixed Methods to Advance Understanding of Paid Family Caregiver Motivation and Well-Being

Background and Purpose:

Given the increasing demand for long-term care services, a well-documented shortage of (paid) direct care providers, and a projected decrease in available informal (unpaid) caregivers, it is important to understand what attracts people to engage in personal care work. While there is a vast literature on the consequences of caregiving, less is known about what leads caregivers to assume paid caregiver roles. The purpose of this study is to illuminate how paid family and friend caregivers describe and make sense of their motives for caregiving, and to examine how their reasons for caregiving are related to caregiver well-being.

Methods:

Using a triangulation mixed method design, telephone survey data were collected from 383 family and friend caregivers formerly paid to care for Medi-Cal eligible disabled and elderly through California's In-Home Supportive Services. A modified version of Kramer's conceptual model of caregiver adaptation (1997) provides the theoretical framework for hierarchical regression analyses conducted to identify predictors of caregiver well-being (both dimensional and composite scales). In-depth interview data were collected from 42 respondents and analyzed using a constructivist grounded theory approach and an iterative and rigorous process of constant comparison to explore caregiver motivation. Finally, the quantitative and qualitative findings were conceptually integrated, i.e., results were compared and evaluated for congruence, divergence, contradiction, and/or extension of knowledge.

Results:

Hierarchical regression analyses indicate that those who report less choice experience more caregiver-related stress (.210, p < .001), less job fit (.124, p < .05), and less overall caregiver well-being (.149, p < .01). Caregivers stating they would definitely not provide care without pay are less likely to feel rewarded by (.285, p < .001) or attribute value to (.194, p < .001) the caregiving experience. The theory developed from the qualitative data illustrates the complexity of paid family caregiver motivation while also revealing some of its temporal components. Results indicate that caregiver motivation typically involves moral, cultural, and practical elements. While many caregivers disclose that the money is helpful, being paid does not appear to be the primary motivator – a finding corroborated by the quantitative data. Interestingly, where quantitative and qualitative findings do not converge, differences are often explained by the qualitative data.

Conclusions and Implications:

Within the realm of clinical intervention and social work practice, these findings suggest that assessing caregiver choice and expectations about payment may be important to the identification of those most likely – and perhaps most appropriate - to assume a paid caregiver role. In the context of policy and program development, these findings may inform caregiver recruitment and retention efforts. The mixed methods design offers a useful approach to answering research questions which seek to both explore and explain social phenomena. The explanations (or emerging theory) derived from the qualitative data in this study provide both context and a point of comparison that enhances the statistical explanation derived from quantitative data analysis and extends understanding of paid family and friend caregiver motivation.