Caring for older parents in Norway - How does it affect labor market participation and absence from work?

As the population ages, younger generations will increasingly be called upon to provide informal care to their aging parents. To prepare for this development, it is essential to understand how employees combine the dual responsibilities of work and caring for aging parents. By analyzing data collected in Norway in 2022 from a nationally representative sample of 6049 respondents, aged 35 to 67, we investigated how caring for older parents affects labor market participation and work absence. We provide descriptive statistics and conduct analyses with structural equation modeling. These analyses indicated that caregiving had no substantial impact on overall participation in the workforce. However, employees did use work absences to assist their parents. We differentiate between using holidays, compensatory time, and three types of formal leave: paid, unpaid, and sick leave. More than a third of the formal leave was taken as sick leave. Women were moderately more likely to use work absence to care for their parents. We conclude that caregiving for older parents currently has little effect on work participation in Norway and attribute the favorable situation in Norway to its comprehensive public elderly care system. However, a contributing factor is Norway's generous sick leave policy. Although intended for use when employees are sick themselves, sick leave is used by employees to provide care to aging parents. Sick leave seems to act as a safety valve. To mitigate the effects of informal care on work participation, welfare states may create conditions that allow employees to combine work and informal care without resorting to unauthorized sick leave. A solution could be to extend the existing support scheme for employees with young children to those providing care for their aging parents.

Social inequality in navigating the healthcare maze: Care trajectories from hospital to home via intermediate care for older people in Norway.

Although health inequality is a growing concern, striking differences in health and life expectancy still exist across and within OECD countries. In Oslo, the largest city in Norway, life expectancy differs by up to 7 years between districts. Equal access to healthcare can help reduce social differences in health. However, research indicates that older people at the lower level of the social gradient have more difficulty accessing health services. Older people experience early hospital discharge and several transitions between and across care levels. In this study, using Bourdieu's theory of practice as a theoretical lens, we explore social inequality in access to universal healthcare within care trajectories for older people in Oslo. Through observation of family meetings in intermediate care (N = 14) and semi-structured interviews with older patients (N = 15), informal caregivers (N = 12) and healthcare professionals (N = 18), the study identifies 15 unique care trajectories from hospital to home via intermediate care. Informed by a critical realist perspective and moving from west to east via the urban areas, there is a prominent finding of climbing down the social gradient and, subsequently, reduced access to healthcare. An overarching theme, 'Navigating the healthcare maze', was identified along with two subthemes: 'Individuality meets system' and 'Having a feel for the game'. Navigating the healthcare maze depends on where you live, your level of education and health literacy and the ability to mobilize social networks. Furthermore, it is an advantage to fit into the professional habitus of the 'active patient' discourse. The findings will be relevant for politicians, managers, healthcare professionals and other stakeholders working in the field and in the development of services adapted to the needs of various socioeconomic groups.

After Hospital: Should Older Care-Needing Patients Be Transferred to Their Homes or to an Intermediate Care Institution?

BACKGROUND: In most European countries, communities need to provide health and social care services to an increasing number of severely ill patients discharged from hospitals. We investigated whether nurses in hospitals and in the communities' health and social care services experienced that the administration in the municipalities allocated older patients the right type of services after hospital discharge. METHODS: We used data from Norway, with a qualitative pilot study and quantitative analysis (structural equation modeling) of surveys involving 2431 nurses on inpatient wards in acute hospitals and 4312 nurses working in nursing homes or home nursing. RESULTS: Dissatisfaction was widespread with the use of patients' homes the first days after hospital discharge. Among nurses working in hospitals, 38% were commonly or very commonly disagreeing with the use of the patient's home after hospital discharge, 25% among home nurses, and 18% among nurses in nursing homes. Home nurses were more prone to oppose the use of patients' homes if they also experienced that their service had inadequate staffing or inadequate medical equipment. CONCLUSIONS: This research indicates conflicting priorities between the bureaucracy and nurses involved in actual work with older patients. From the nurses' perspective, the municipalities' administration was offering too few older patients short-term-stay in an intermediate care institution as part of the clinical pathway from hospital to home. However, providing more recourses to home nursing would improve their ability to provide sufficient care to older patients discharged from hospital.

Nurses' assessments of staffing adequacy in care services for older patients following hospital discharge.

AIMS: To explore community nurses' assessments of staffing adequacy in care provision for older patients following hospital discharge and analyse the extent to which their assessments are associated with characteristics of the system level of municipality and vertical coordination between hospital and community care services. DESIGN: Nation-wide cross-sectional survey. METHODS: Web-based survey conducted in 2017 among 3,461 nurses working with older persons (65+) in homecare services, residential care and nursing homes in Norway. Responses from individual homecare nurses were linked with municipal-level register data (age structure, economic flexibility, service profiles). Stratified multilevel analyses were used to analyse the association of staffing adequacy with municipal characteristics and perceived quality of vertical coordination. RESULTS: Almost half of the nurses experienced inadequate staffing in general, whereas a similar share indicated that staffing was adequate. Nursing home nurses showed the least positive ratings of staffing adequacy. Most nurses indicated that there were too many unqualified care workers at their workplace. More positive assessments of staffing adequacy were associated with better vertical coordination. Average ratings of staffing adequacy were lower in larger municipalities and municipalities with an older population. CONCLUSION: Healthcare providers, nurse managers and policy makers may benefit from a stronger focus on rebalancing skill-mix and on new models of vertical coordination in addressing current and future nurse staffing shortages in care services for older people following hospital discharge. IMPACT STATEMENT: This study adds to the scarce national and international research literature on nurse staffing in community care services, addressing the pressing challenges of staffing and skill- mix in long-term care provision. Findings support the development of nurse-led models of care coordination for older patients following hospital discharge and stimulate future research on the effects of recruitment and retainment strategies in different municipalities and different models of vertical coordination.

Nurses' experiences of transitions of older patients from hospitals to community care. A nation-wide survey in Norway'.

Moving older patients from hospitals to community services is a critical phase of integrated care. Yet there has been little large-scale research on the quality of these transitions. We investigated how Norwegian nurses working in community care services (N = 4312) and at in-patient wards at hospitals (N = 2421) experienced the quality of transitions of older patients from hospitals to community care. We tested hypotheses derived from qualitative research and consistent with predictions, we found that compared to hospital nurses, the nurses working in community care experienced lower quality of patient transitions and were less satisfied with information exchange on patients' condition and needs. Further, when comparing groups of community nurses, we confirmed the hypothesis that nurses in home nursing were more dissatisfied with the quality of transitions and information exchange than nurses in nursing homes. We conclude that hospital nurses should have more face-to-face or telephone contact with community nurses, and specifically with home nurses. Further, we suggest that means are implemented to promote a mutual understanding of the older patients' pathway from one service to the other, and to improve co-ordination across the services.

Digitalized Discharge Planning Between Hospitals and Municipal Health Care.

The use of digitalized collaboration between levels of care is expected to improve coordination in patients' transitions. The aim of this study was to investigate how safe and effective e-messages were regarding discharge planning between hospital nurses and the municipal level of administration. A nationwide survey was conducted among 2 431 Norwegian nurses working in inpatient wards in general hospitals. A majority (86%) of the nurses used e-messages as their main mode of communication with the administration when older patients were discharged. Most nurses (73%) found that e-messages were effective in their collaboration, and that e-messages ensured safe discharge for older patients (65%). More than half of the nurses reported being satisfied with the collaboration with the administration. E-messages supported hospital nurses in their discharge planning for older patients. However, they sometimes needed to use the telephone to exchange additional and more detailed information.

Should I stay or should I go? Nurses' wishes to leave nursing homes and home nursing.

AIMS: This study investigates the prevalence of nurses' wishes to leave work in elderly care services and aims to explain differences between younger and older nurses. BACKGROUND: Health-and-care services, and specifically elderly care services, experience problems recruiting and retaining nurses. METHOD: A nationwide survey among nurses in Norway with 4,945 nurses aged 20-73 (mean age = 41.8), 95% female. Structural equation modelling was used, analysing the whole sample as well as analysing younger and older nurses as separate groups. RESULTS: Of the nurses surveyed, 25% wanted to work outside elderly care services and 25% were uncertain. The wish to leave was much more frequent among younger nurses. Reported working conditions were a strong predictor of the wish to leave, and a much stronger predictor among younger nurses than older nurses in nursing homes. CONCLUSIONS: Working conditions are a major predictor of nurses' wishes to leave elderly care services, especially among younger nurses in nursing homes. IMPLICATIONS FOR NURSING MANAGEMENT: Attempts to reduce turnover in elderly care services need to address the working conditions for younger nurses, for instance by reducing the time young nurses work in isolation.

Caring too much? Lack of public services to older people reduces attendance at work among their children.

The need to provide care for older people can put a strain on their adult children, potentially interfering with their work attendance. We tested the hypothesis that public care for older people (nursing homes or home care services) would moderate the association between having an older parent in need of care and reduced work attendance among the adult children. The analysis used data from a survey of Norwegian employees aged 45-65 (N = 529). Institutional care for older people in need of care (i.e. nursing homes) was associated with improved work attendance among their children-their daughters in particular. Data also indicated a moderating effect: the link between the parents' reduced health and reduced work attendance among the children was weaker if the parent lived in a nursing home. However, the results were very different for home-based care: data indicated no positive effects on adult children's work attendance when parents received non-institutionalised care of this kind. Overall, the results suggest that extending public care service to older people can improve their children's ability to combine work with care for parents. However, this effect seems to require the high level of care commonly provided by nursing homes. Thus, the current trend towards de-institutionalising care in Europe (and Norway in particular) might hamper work attendance among care-giving adult children, women in particular. Home care services to older people probably need to be extended if they are intended as a real alternative to institutional care.

Care challenges for informal caregivers of chronically ill lung patients: results from a questionnaire survey.

AIMS: The article aims to answer who the informal caregivers of patients with chronic obstructive pulmonary disease (COPD) are, what kind of help they provide, and how they experience providing help to the patient. METHOD: Data from a questionnaire survey to next of kin of COPD patients carried through in Norway in December 2009 and January 2010 is explored. RESULT: About 70% of the patients have one or more informal caregivers, and a majority of the caregivers is the patient's spouse, most often a wife. The help provided is, to a large extent, practical help like housework, garden work, and shopping. Another important support is to accompany the patient to health care. About 45% of the caregivers are part of the work force. Rather few of the respondents experience the caregiving as so demanding that they have chosen to work part-time or quit working. The most demanding part of being an informal caregiver is an overall worrying for the patient. CONCLUSIONS: Paid sick leaves for caregivers that are employed, and hospital-at-home programmes that provide education and surveillance to the patient and his/her family through different phases of the illness, are policy means that both can help the informal caregivers to manage daily life and reduce the pressure on the formal healthcare and long-term care services in the future.