"Domestic helpers provide support not just to frail
older adults, but also to family caregivers — in this case, it is
the spousal caregivers," Alice Chong told Reuters Health in an
Chong, who led the new study, is a researcher with the Department of
Applied Social Sciences of the City University of Hong Kong.
Caring for a frail elderly spouse can be time consuming and
emotionally exhausting. About half of spousal caregivers show signs
of distress, anger or depression, especially when their spouse is
older and frail, according to Chong and her coauthors.
They wanted to determine whether having a domestic helper might
reduce the spousal caregivers' distress to the extent that they were
better able to allow the frail elders to stay at home.
"Domestic helpers could be an alternate long-term care model, in
addition to in-home care, community services and institutional care,
and could help reduce premature institutionalization," Chong said.
The researchers used information collected on a large group of
Chinese elders who applied for publicly funded long-term care
services in Hong Kong from 2007 to 2009.
They reviewed the results of a survey used to determine the needs of
older adults with a physical or cognitive disability so they can be
matched with the best care. The survey also collected basic
information on family caregivers and domestic helpers.
Information for 6,442 care recipients aged 60 or older and their
care-giving spouses was used for the study. About three-quarters of
the care recipients were men with an average age of 77 years old,
and about 6 percent had live-in domestic helpers.
In Hong Kong, the researchers note, domestic helpers are often
foreign workers who perform cooking and cleaning services, and may
help with care of elder family members by escorting them to outdoor
activities or providing physical care as needed.
The minimum wage in 2013 for such workers was about $503 U.S.
dollars a month, "an affordable rate for most low- to middle-income
families," Chong's team writes in The Journals of Gerontology:
In general, the researchers found, 44 percent of all spousal
caregivers felt distressed.
Women and those whose care-receiving spouses were younger were the
most distressed. But those who had a domestic helper were
significantly less likely to be distressed.
The exception was when the care-receiving spouse had cognitive
impairment, such as dementia. Then the presence of a domestic helper
had little effect on the distress level of the care-giving spouse.
"I thought it was a really good use of this type of administrative
data," said Jill Cameron, a researcher in the Graduate Department of
Rehabilitation Science at the University of Toronto. Such data is
"really good at helping you learn something and also leading to new
research questions," she told Reuters Health.
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Cameron, who has studied the wellbeing of spousal caregivers,
noted that the new report did not look at the reasons why hiring a
domestic helper might reduce stress for the caregivers.
From her own research, she believes the additional help probably
freed up time for the caregivers so they could pursue activities
that are of value to them personally.
She added that further qualitative studies in which researchers
interview caregivers to get an in-depth understanding of the
interactions of caregiving spouses and domestic helpers would be
But Cameron wasn't surprised that there was less of an impact when
cognitive impairment was involved.
"Cognitive issues I think are the biggest challenge to caregivers
usually," she said. "I think it just comes down to them not being
prepared to manage somebody — the demands change and it's almost
like you don't know what you're going to expect from day to day with
the cognitive changes and it just makes it harder."
Cameron added that in those cases the domestic helpers were
probably more comfortable with providing physical care or helping
with the day-to-day things.
"It makes me wonder whether or not these domestic helpers, in the
same way that we are trying to educate, prepare and train family
caregivers to care for someone and also manage the cognitive issues,
are (also) going to ultimately need help in training to manage the
cognitive issues," she said.
Chong said she'd like to see more attention and discourse among
researchers and policymakers on the potential contributions and
challenges of having a paid domestic helper so that relevant social
policy and support services would be designed to strengthen their caregiving ability.
"Domestic helpers would suffer caregiving distress, just like family
caregivers," Chong said. "While there are policy and support
services to family caregivers, we also need to formulate appropriate
policy and support measures to the paid domestic helpers."
The Journals of Gerontology: Series B, online April 17, 2014.
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