Rural workers get fewer benefits to help with elderly care
Rural workers caring for older family members are less likely than urban workers to receive useful benefits such as flexible hours, paid time off, or the ability to telecommute.
While rural caregivers receive fewer workplace benefits that could help them fulfill their caregiving role, rural caregivers are also likely to face particular geographic challenges, says one of the authors of a study. on the workplace benefits for elderly care.
“All of the problems related to caregiving are heightened in rural areas,” said Carrie Henning-Smith, assistant professor in the Division of Health Policy and Management at the University’s School of Public Health. of Minnesota.
About 44 million Americans provide unpaid care for the elderly or their families. These volunteers provide up to 90% of all long-term care seniors receive in the United States.
Rural caregivers face particular barriers. Rural populations tend to be older. With a lower population density, there may be fewer volunteers ready. Transportation can be a problem.
Henning-Smith said she and co-author Megan Lahr, also a member of the Minnesota Health Policy Division, were curious to see if rural employees were more likely to receive benefits that could help them meet these challenges. Turns out they aren’t.
The study of people who worked and cared for an older person found that urban and rural caregivers provide comparable amounts of care (about 20 hours per week versus 16 hours, respectively. Rural and urban caregivers also provided similar amounts of care. stated that they were experiencing similar amounts of personal pressure as a result of their care activities.
Where the differences appeared was in employee benefits. Urban workers were more likely than rural workers to have an employee assistance program (which provides referrals for medical and other services). They were more likely to be able to telecommute and be able to use paid time off to care for a loved one.
We asked Henning-Smith about his study, the nature of elderly care in America, and his own interests in rural issues. (The conversation has been edited for clarity and length.)
Daily Yonder: How big is the elder care problem in the United States? Is it different in rural areas?
Henning Smith: I think this is a huge problem. It is estimated that around $ 500 billion [a year] unpaid care is provided by caregivers. This overshadows the amount we pay for nursing home care and formal home health services. We have tens of millions of caregivers providing care. I think this is a much bigger problem than we realize. I think there are a lot of people who provide care and don’t even realize they are caregivers. They would never use that term themselves. I think this will become more and more prevalent as our country ages.
In rural areas, we know that the population is on average older than in urban areas. The need for care is therefore greater. All of the problems associated with caregiving are exacerbated in rural areas.
Daily there: What are some examples of the type of elderly care you are talking about?
Henning Smith: There are all kinds of things. The poll [the study used data from the Caregiving in the US 2015 survey] asked people if they were helping someone take care of themselves, including help with personal needs like showering, bathing, dressing or running errands, accessing health care , something like that, all of which is somehow more than normal.
There are sometimes some gray areas there too, right? And I think that partly explains why caregivers have a hard time always recognizing that they are caregivers. If this is a relationship that you and your mom help each other out from time to time, it probably isn’t a caring relationship. If this is a case where she is relying on you to help her renew her medications, make an appointment with a doctor, or do the grocery shopping, all of those things would be care.
Daily there: You have found that urban and rural caregivers spend the same time providing care and experience similar pressures as a result. What differences did you find between rural and urban?
Henning Smith: Where we found a difference was in the support services that were available to caregivers in their workplace. … Overall, employed rural caregivers had fewer of these workplace supports than employed urban caregivers.
Workplaces are one avenue that can help alleviate some of that burden and some of that tension. There are all kinds of ways that can happen. This could happen by offering paid time off, paid sick leave, flexible working hours, the ability to work remotely. Then there are all kinds of support programs that some workplaces have put in place, like employee assistance programs, information, or referrals.
Daily Yonder: Do you have any idea why there is this difference?
Henning Smith: I think there are a bunch of reasons why there could be this difference. With the data we had for this study, we are not able to say exactly what is causing this, but we do know of other evidence of all kinds of differences in the professional landscapes of rural and urban caregivers. So that’s one thing. People can just do different types of jobs.
Rural areas have higher unemployment rates and lower median incomes. Caregivers in rural areas may have fewer jobs available and therefore to the extent that anyone is able to choose a job based on the benefits offered by the job, rural caregivers are less able to do so. .
Then we also know that there are broader structural issues involved. One of them is high speed internet access. It’s one thing to tell an employee that they can work remotely if you have very good internet access. If you don’t, it might be impossible for someone to work remotely.
Then there are discoveries regarding paid sick leave or flexible working hours, unpaid time off. Some of these policies are individual for the employer. Some of these policies are at the state level and some of these policies are at the federal level. But where we’ve seen a lot of movement recently is at the city and municipal level to extend paid sick leave or to raise the minimum wage. All of these kinds of efforts could really help caregivers who have a job, but they are [more likely to be] is happening in some of our major metropolitan cities. They don’t happen in individual rural communities where there is simply more economic pressure on people.
I am in Minnesota and Minneapolis raised the minimum wage and working to extend paid sick leave. Washington, DC, has exceeded paid sick leave. Duluth, Minnesota, [passed] paid sick leave, and then there are states that impose it, like California, New Jersey and Rhode Island. These are the states that allow paid family leave or require paid family leave. California, Massachusetts, Oregon, and Connecticut require paid sick leave, but these are states that aren’t as heavily rural. So we find that some rural communities and some rural states are being left behind.
I don’t mean to vilify individual employers. I think employers in rural communities are also in high demand. And so I think if somebody comes and says, “This community has to provide paid sick leave,” that’s going to be a burden on the employer as well. It’s just a really delicate and difficult balance.
But some of the policy solutions people are suggesting are using state-subsidized funds to help support paid sick leave so that burden doesn’t fall on individual employers. And it can help.
And then another big difference between rural and urban and why we might see some of that happening is simply the availability of health personnel and health services, and the availability of transportation for that matter.
So in rural areas you may be providing care not because of the most logical option, but because there is no official health service available to you or there is fewer options in place for you. So I think that’s another very important question about why people end up becoming caregivers.
Daily Yonder: What about the transport issue?
Transportation and distance are things that have been raised over and over again as a specific rural care challenge. And it is a challenge in many ways.
On the one hand, if someone has to drive someone to their appointments or if someone who does not live with the person they are caring for, just the time it takes to get to that appointment. person and come back, and if you live in a wintry climate where the weather is bad, it all gets worse when you are on the rural roads.
And then there are also issues where distance intersects with the availability of the health workforce. We’ve heard of homecare agencies in rural areas requiring a minimum of four hours to get to someone’s house because of the distance. It is not worth it for them to opt for less than that, but it ends up being prohibitive for some people to engage this kind of help when they can only afford an hour or so. ‘maybe only need an hour.
Daily there: What is your interest in rural health care? How did you get on the field? What motivates you to do this?
Henning Smith: Good questions. I think most people who are interested in rural affairs have rural roots, and they certainly are. I grew up in rural Southeastern Wisconsin and have farming roots in Illinois, Iowa, and Nebraska, which go back to my grandparents and great-grandparents. And so, in some ways, it’s part of my lived experience. But then all of the research I do, much of it related to rural health, focuses on issues of equity and where equity and policy intersect.
So rural health is sort of the perfect place where you see a lot of things happening and where there are policies that can help people and be helpful. And I’m also really interested in how context and place influence health. So how does where we live influence our quality of life and our health outcomes? So most of the work that I do is in rural settings and right now I’m in the study of caregiving. I work on rural social isolation and a lot on access to health care for rural residents.