1. FOR LOVE AND MONEY: PAYING FAMILY CAREGIVERS Sample oral presentation

2. outline 1. key wordskey words 2. summary and introductionsummary 3. supporting details 4. conclusion 5. comments Questions and discussion

3. Part one: key words

4. Part One (1): key words and summary Caregiver Care receiver Obligation Accountability Economics Care work Compensate/ compensation Direct payment Tax credit Unpaid leave Cash allowances Consumer-direction Community-based Long-term care Client Ideological Ethical Professional Personal-interpersonal

5. Part One (2): key words and summary Beneficence Well-intentioned Paternalistic Homecare In-home service Agency-based workers State-contracted homecare agency Self-directed care Acid test Inherent problematic concept The sense of empowerment Responsibility Workforce participation Empirical anecdotal

6. Part Two: Summary and Introduction

7. Part Two (1): Summary The debate over the issues for compensating family caregivers involves diverse problems, including economics, public policy questions, family value and the nature of care work. To re-evaluate these issues more comprehensively, the author will compare and inspect the pros and cons under four categories: ideological, ethical, and personal- interpersonal concerns.

8. Part Two (2):Introduction very complicated problem 1. policy questions: the intrusion of public systems into family life 2. ethical and ideological issues about obligation and accountability 3. pragmatic concerns about health, safety, and quality of services 4. the definition and distinction of care and work  love and money?!

9. Part Two (3):Introduction two sides Proponents: compensating family caregivers is a way to strengthen, expand, and sustain the natural support system Critics: compensation for some of the work will erode family obligation, create a strain on the public system, and put older people at greater risk of abuse and poor care

10. Part Three: Supporting Details

11. Part Three (1-1): Ideological concerns and empirical realities The conflicting ideology in USA: the primacy versus a reluctance to legislate supports for family care Public dollars to support a private and obligatory activity?

12. Part Three (1-2): Ideological concerns Concerns 1. Undermine social values 2. A major shift from caring as part of normal family responsibility 3. Decrease the quality of the care-giving 4. Tremendous burdens on public expenditures 5. Increase in the number of homecare recipients

13. Part Three (1-3) To address these concerns The same dollar allocation: hire family member/ traditional service system All programs paid worker compensation, unemployment insurance, and Social Security taxes. 80 percent of whom hired family members, reported large and consistently rates of satisfaction compared to a randomized control group No negative effects on the overall relationship between the paid family caregiver and the consumer

14. Part Three (2-1): Supporting detail Ethical Concerns Concern (1): in-home service recipients would be at greater risk of receiving poor quality care Concern (2): worker fraud, abuse and neglect were expected to be a much greater problem in the home when compared to the nursing home setting

15. Part Three (2-2): Supporting detail Ethical Concerns and discussion safety: (1) safety: no significant differences in safety risks between clients receiving agency-based services and those using consumer-directed services. (2) quality: consumers hiring family members report better care. (3) fraud: using a social service professional in a support and monitoring role with consumers and a systematic book-keeping system to assist and review expenditures can minimize auditing concerns

16. Part Three (2-3): Supporting detail Ethical Concerns and summary Paid family workers did not abuse the system, exploit the consumer, or fail to provide good service. Paying family caregivers provide an “acid test” for the notion that beneficence and lack of harm can only be achieved in a formal, public system.

17. Part Three (3-1): Personal/ Interpersonal Issues an inherently problematic concept Care work? Care= from heart, not for money Paid care-giving : paradoxical

18. Part Three (3-1): Personal/ Interpersonal Issues for money and for love? Two issues: 1. how and whether payment changes the relationship between caregiver and receiver? 2. The difficulties old and frail consumers may have in taking on the role of employer of their own family members

19. Part Three (3-2): Personal/ Interpersonal Issues changed relationship? Yet, but not negative! The sense of empowerment Hiring their own worker—very often family members—makes them feel more secure and more in charge of their lives.

20. Part Three (3-3): Personal/ Interpersonal Issues difficulties? Learn the roles of employer and employee  roles and responsibilities Key concepts: service, exchange, money, paychecks Empowered consumers seem to be successful at managing their workers, giving feedback, and making sure their services are being provided in the best way possible.

21. Part Four: Conclusion

22. Conclusion the changing society Societal changes in such areas as longevity patterns, workforce participation, and family composition suggest that care-giving will grow in both importance and difficulties.

23. Conclusion (2) paid family care Anecdotal (not true): neglect, safety, and negative effects Empirical evidence: recipients of paid family care are more satisfied, as are the caregivers.

24. Part Five: Comments

25. My Comments (1): Strengths 1. The way to organize the complicated issues and problems 2. The experiments and journal articles to support the arguments 3. The objective standpoint

26. My Comments (2): Weaknesses Do not consider the poor families, who cannot pay for any care-givers, even they are family members. Do not consider the poor families, who cannot pay for any care-givers, even they are family members. Too many variables are mixed up. Too many variables are mixed up. The radThe comparative studies The radThe comparative studies

27. My Comments (3): Suggestions for Improvement Some illustrations and figures are necessary. e.g. the results of the comparative studies The focus of each part should be highlighted more. E.g. ideological  empirical

28. Questions for discussion

29. Questions for discussion (1) 1. (p. 230) In the broadest sense, financial supports for caregivers can include direct payment for services provided, tax credits, unpaid leave, and cash allowances to cover related to caregiving.  Is there any other method to support both the care givers and care receivers?

30. Questions for discussion (2) (p.233) “The care-giver recipient relationship can be emotional, intense, and challenging, whether the individual providing service is a family member or not.”  To hire the family members as caregivers can improve such an intensified relationship?

31. Questions for discussion (3) (p.234) “Compensating family workers, and having consumers hire and manage their own workers, can be good for consumers, family members, and the long-term-care system overall.”  What will happen if a consumer (care-recipient) fail to pay the family worker?