1. Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode, University of Birmingham IAFFE, August 2013 Informal care: choice or constraint? Al-Janabi H., Carmichael F. and Oyebode J

2. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 2/17 Context  Ageing population. –Increase in degenerative diseases (e.g. dementia). –Emphasis on cost-containment and efficiency in healthcare.  More informal care needed? –But working lives extending and increased female employment participation –How will caring supply be affected? –“understanding what motivates the provision of caring labor is a crucial element for sustainability and equitably meeting the needs of contemporary societies” Adams and Sharp 2013:101

3. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 3/17 Choice or constraint?  Is informal care really a free choice? –Does this perception differ between groups? –Do attitudes towards gender roles determine caring- employment profiles over the life-course?  Is freely entering caring better for your wellbeing?  Structure: –Motives for caring –Data 1 (Bristol) and 2 (BHPS/US) –Care or constraint (Bristol data) –Care-employment life profiles and gender-roles (BHPS/US) –Choice in care and wellbeing (Bristol data) –Summary.

4. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 4/17 Why do people provide informal care?  Care as a free choice –Utility maximisation and the allocation of time to caring - non- relational –Altruism: affection, love (Folbre 1995) - relational  Reciprocity: care as part of a reciprocal net of relationships (Adams and Sharp 2013) –E.g. Gift giving (Himmelweit 1996, 1999) Intergenerational solidarity (Daatland and Lowenstein 2005) Orientation to the future (Knobloch, 2013)  Conditioned by gender and age norms (e.g. elder care)  Responsibility: Care as a duty or obligation –Reinforced/countered by social norms e.g. gender norms, work ethic  And …. Once a caring episode begins more constraints, less choice

5. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 5/17 Data 1 : 2009 Bristol City Council Quality of Life Survey  5771 individuals responded –1,100 (19%) indicated that they “provided some care for... a family member, friend, neighbour or other person because of...ill-health...” –“Thinking about your decision to provide care, please tick ‘yes’ or ‘no’ to the following questions”:  I had a free choice to provide care  I provide care because it is my duty  There was no-one else to provide care  There was no money to provide care  Acknowledgments: Phil Chan (Bristol City Council) and colleagues in the quality of life team at Bristol City Council. Survey respondents (especially the carers!)

6. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 6/17 Data 2: British Household Panel Survey/Understanding Society  1 889 caring/employment life histories/sequences of between 14 and 19 years – Not caring; Caring for someone sick/disabled/elderly outside the household; Caring for someone sick/disabled/elderly in the household » Interacted with employment status –Attitudes towards gender roles - agree or not with statements:  Family suffers if woman works full time: Family_suffers_WW  Pre-school child suffers if mother works: Child_suffers_MW  Children need father as much as mother: Childneeds_father  Woman and family happier if she works: Family_happier_WW  Full time job makes woman independent: Fulltime_woman_Ind

7. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 7/17 Methods and results: Bristol data  Is caring perceived to be a free choice? –Responses categorised into three groups:  Only reported that they had a free choice to provide care.  Free choice, but also constrained by ‘duty’, ‘no-one else’ and/or ‘no money’.  Not a free choice: duty’, ‘no-one else’ and/or ‘no money’.  Who perceives informal care to be free choice? Ordered logistic regression of ‘level’ of freedom on contextual characteristics.  Is a free choice to care associated with higher wellbeing? (Objective 3) –Examined happiness, satisfaction, capabilities and caring experience. –Compared within carer sample and to non-carers responding to survey.

8. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 8/17 Is caring a free choice? *Constrained by sense of duty, lack of alternative carer or money MotiveYesNoResponse to item Free choice649 (81.3%)149 (18.7%)798 (72.5%) Duty569 (69.0%)256 (31.0%)825 (75.0%) No one else297 (43.1%)392 (56.9%)689 (62.6%) No money219 (33.8%)428 (66.2%)647 (58.8%) Derived variable representing overall freedom in caring Level 1: Free choice (only)33% Level 2: Free, but constrained, choice*49% Level 3: Not a free choice19%

9. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 9/17 Does freedom of choice differ between groups?  Results:OddsP-value Age of carer (over 65)1.250.16 Age of recipient (over 65)1.160.29 Sex (female)1.050.73 Ethnicity (white British)1.340.20 Religion (yes)0.900.48 Qualifications (no)0.970.85 Means tested benefits (yes)0.720.06 Employed (yes)1.030.82 Home ownership (yes)1.010.97  No evidence for that perception of choice determined by membership of the above groups  Caveat – this is individuals that are already carers (and at a moment in time).  Suggests motivation determined at a more individual level e.g. by attitudes?

10. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 10/17 Methods and results: BHPS/US ElementFrequencypercent Not a carer82 87880.56 Caring outside the household and employed8 1897.95 Caring inside the household and employed2 5022.43 Caring outside the household and not employed5 5325.37 Caring inside the household and not employed3 8003.69 1 889 caring/employment life histories/sequences 14-19 years Frequency of sequence elements within the sample

11. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 11/17 Caring-employment life history clusters  OM procedure (transition frequency-based substitution cost matrix) plus cluster analysis using Ward’s method –5 cluster solution suggested by Calinski/Harabasz pseudo-F index and the Duda and Hart (1973) Je(2)/Je(1) index

12. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 12/17 The 5 clusters 1. Mainly not caring (90% of sequence elements) 2. More caring (51% of elements) with most outside the household while employed (44%) 3. More caring (53%) with most in the household while employed (39%) 4. More caring (57%) with majority outside the household and not working (47%) 5. A lot of caring (70%) with most in the household and not working (58%)

13. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 13/17

14. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 14/17 IndependentOdds ratiozCI Fulltime_woman_Ind 0.99-0.30.93-1.05 Family_suffers_WW 1.113.391.04-1.17 Family_happier_WW 0.87-3.060.81-0.95 Childneeds_father 0.87-3.510.80-0.94 Startage<30 0.44-21.140.41-0.48 Startage45-59 1.195.031.11-1.27 Startage60+ 1.538.691.39-1.69 FEMALE 1.257.941.19-1.33 Observations Chisq Pseudo R 2 31361 948.42*** 0.02 Ordered logit: dependent variable = 5cluster

15. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 15/17 Bristol data: Association between motivation and wellbeing

16. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 16/17 Bristol data: Association between motivation and wellbeing Life satisfaction ‘boost’ from freely entering caring: Freely enter caring (only) vs. free (and constrained): +0.37 Freely enter caring (only) vs. do not freely enter caring: +0.96 Life satisfaction ‘boost’ from employment: Employed vs. unemployed (under 65s): +0.79

17. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 17/17 Summary  For most people, informal care appears to be a free, but often constrained, choice.  Traditional gender roles are linked to higher intensity caring profiles as are female gender and age  Freely entering caring is associated with a positive impact on wellbeing (but we cannot predict who those people will be)  Limitations: –Measures for motives for caring not linked well with existing theories –Cross sectional design for the Bristol work.  Further work: –Tackle research limitations. –How are motives likely to change over time?

18. Informal care: choice or constraint? Hareth Al-Janabi, Fiona Carmichael, Jan Oyebode slide 18/17 Bristol data: Sample characteristics