KWDI Korean Women’s Development Institute

Due to ongoing rapid population aging, changes in functioning of the family and shifts in related values, and the rise in the rate of female labor participation, the numbers of female older adults serving as the principal caregivers for their dependent spouse or young grandchildren are increasing significantly. Still, the care provided by female older adults has been undervalued, and thus few studies have to date examined their caregiving work. The purpose of this study was to comprehensively examine female older adults’ family caregiving work. The pertinent research questions were as follows: 1) How many female older adults care for a dependent spouse or for one or more young grandchildren (under age seven) in South Korea? 2) Why and to what extent is family caregiving work provided by female older adults (e.g., reasons for caregiving, time spent in caregiving work, duration of caregiving, level of public and private service utilization for the reduction of the caregiving burden, overall caregiving burden)? 3) How does family caregiving work affect quality of life among female older adults? 4) What are the major challenges associated with family caregiving work and is there a need for policy intervention to reduce the caregiving burden?

Both quantitative and qualitative methods were utilized for this study. To address research questions one and three, six data sets (2004, 2008, 2011 National Survey and Welfare Needs of Elders and Needs for Elderly Welfare Service; 2006, 2008, 2010 Korean Longitudinal Study of Ageing) were analyzed. To address research questions two, three and four, data were collected from a purposive sample of 300 female older adults aged 60 and older who were the major care providers for their spouses and 300 female older adults aged 60 and older who were the major care providers for one or more grandchildren under age seven. All respondents were residing in the greater Seoul/Incheon/Gyeonggi metropolitan area. With respect to quantitative analysis, descriptive statistics and multivariate models were obtained using software from SAS and SPSS Statistics. The data collected for this study also entailed structured interviews (n=20) performed by our research team; informed consent was obtained from the participants. The structured interviews with female older adults lasted approximately 40-120 minutes and full recordings of the sessions were obtained and transcribed. For the qualitative analysis, a comprehensive content review of all data, including line-by-line analysis, was conducted.

Using the 2004, 2008, and 2011 National Survey and Welfare Needs of Elders and Needs for Elderly Welfare Service data, we analyzed the number of female older adults taking care of either a dependent spouse or one or more grandchildren under the age of seven, and compared socioeconomic and health characteristics and quality of life among three groups: female older adults who took care of a dependent spouse, female older adults who took care of one or more grandchildren under the age of seven, and female older adults who did not provide any family caregiving. The results show that the absolute number and proportion of female older adults aged 65 and older who care for a dependent spouse is steadily increasing. When comparing the socioeconomic characteristics of female older adults who took care of a dependent spouse, cared for one or more young grandchildren, and those who did not provide family caregiving work, female older adults who took care of young grandchildren were relatively younger, showed higher educational attainment, and reported higher levels of household income compared to those who took care of a dependent spouse. In terms of health, female older adults who cared for young grandchildren were healthier and experienced a lower level of depression compared to those who provided care to a dependent spouse. In addition, among the three groups, quality of life proved the lowest among those female older adults who took care of a dependent spouse.

Using the 2006, 2008, and 2010 Korean Longitudinal Study of Ageing data, we examined the long-term effect of family caregiving work on female adults’(age 50+) quality of life. Results showed that female adults who took care of one or more grandchildren in one of either the 2006 or 2008 data sets exhibited higher quality of life in 2008 compared to female adults who provided no family caregiving. On the other hand, female adults who took care of a dependent spouse in one of either the 2006 or 2008 data sets exhibited a lower quality of life in 2008 compared to the other two groups. In addition, among female adults who cared for of a dependent spouse in both 2008 and 2010, the experience of being a spousal caregiver had a negative impact on their quality of life in 2010.

Given the limited available information regarding the profile of the family caregiving provided by female older adults in the existing data sets, our research team conducted both a survey and in-depth interviews with female older adults aged 60 and older. With respect to spousal caregiving (n=300), the majority of respondents in our sample reported taking their spousal caregiving role for granted (66%), and the major reasons for caring for their dependent spouse were ‘not to burden our children’ (48.7%), ‘my spouse wanted me personally to take care of him’ (42.0%), and ‘I feel most comfortable taking care of my dependent spouse’ (38.7%) (multiple responses). In general, female older adults began to take care of their spouses as they developed limitations in activities of daily living due to disease or accident. In our sample, the spouses of female older adults reported on average 3.44 limitations upon their activities of daily living.

Most female older adults (82.0%) in our sample reported taking care of their dependent spouse almost every day (on average 9.6 hours/day, 65.0 hours/week). 33.0% of respondents reported having a secondary caregiver to provide caregiving assistance (on average 4.0 hours/day, 6.1 hours/week), most of whom were adult children. However, 16.3% of respondents reported having no one to assist them. In terms of utilization of public and private services to ease the caregiving burden, a significant number of respondents were aware of Korean Long-Term Care Insurance benefits, but a very limited number of respondent were making use of the service due to the nature of the current LICI system (e.g., strict eligibility criteria). The majority of female older adults who utilized such service did so because they perceived it to be too difficult to alone provide care for the care recipient. They also reported that their level of caregiving burden was significantly lowered after making use of the service. Those who did not utilize such service provided ‘the financial burden associated with the service use was too high’ or ‘they were not eligible for the service’ as the major reasons not using the service.

With respect to caregiving burden, respondents reported a high level of physical, psychological, and financial burden. In addition, caregiving burden increased as the caregiver experienced a deteriorated health condition, the care recipient showed a poor health condition, or the caregiver took care of the recipient for a lengthy period. According to the in-depth interviews, the quality of the spousal relationship and the attitude of the spouse affected their perceptions of their burden. Despite this burden, female older adults stated that taking care of a spouse is socially worthwhile work, and they reported that they believe they should receive at least 910,000 Korean won monthly (equivalent to 830 USD as of November 2012) if they were to be paid for their work. Thus, it appears necessary to develop measures to compensate for family caregiving work. In terms of policy measures, the bulk of respondents reported both financial assistance and in-home service to be highly necessary for easing their caregiving.

With respect to grand-parenting (n=300), most respondents in our sample reported taking care of grandchildren in order to allow their adult children to maintain outside employment (78.3%). In our sample, female older adults took care of 1.34 grandchildren on average, and 39.0% of them took care of grandchildren aged less than 36 months. About half of the respondents reported co-residing with grandchildren and took care of their grandchildren for about 8.9 hours per day and 47.2 hours per week. Approximately 32% of respondents reported having a secondary caregiver to help them take care of grandchildren, most of whom were a spouse. In terms of public or private service utilization, most respondents were aware of public services such as daycare centers and kindergartens, and many were in fact utilizing such services. The major reasons for contracting such services were ‘it would be beneficial to grandchildren’s social skills and education’ (54.9%), and ‘it is hard for me to take care of grandchildren all by myself’ (16.4%). A significant number of respondents who made use of such services showed a very high level of satisfaction, as their caregiving burden was reduced upon engaging the service.

With respect to the caregiving burden involved, more than half of the respondents reported grand-parenting to be physically and psychologically demanding. In addition, if female older adults suffered a poor health condition or if the level of family conflict associated with grandparenting was higher, the caregiving burden was increased. Although female older adults reported experiencing difficulties with grandparenting to some extent, they valued their role and reported on positive aspects of grand-parenting as well. In addition, they stated that they should receive at least 880,000 Korean won monthly (equivalent to USD 805 as of November 2012) if they were to be paid for this work.

In terms of policy measures, the majority of respondents insisted that existing work-life balance policy should be expanded in order to allow parents to take care of their own children. In addition, female older adults reported that the quality of childcare should be ensured to allow working parents to rely on it for child care. Lastly, female older adults also mentioned a need for developing services for older adults who take care of grandchildren, such as health service and educational programs.

Policy recommendations are as follows: With respect to spousal caregiving, current long-term care (LTC) service coverage and types of services (e.g., adult daycare centers, short-term care facilities, etc.) should be expanded based on a social consensus so that such services can ease family caregivers’ caregiving burden. In addition, post-acute care service should be developed in order to provide needed services to elderly patients and inform family caregivers as to how to better care for elderly patients. Secondly, more attention should be focused on striking a balance between collective and individual responsibility for user costs associated with LTC and elderly welfare service use, since a significant number of female older adults expressed concerns regarding the economic burden involved. Thirdly, measures to ensure the quality of LTC should be cultivated through accreditation, formulation of national standards and guidelines for delivering LTC services, and an improved monitoring system, as well as development of the formal LTC workforce. Fourth, attitudes toward using LTC services should be shifted in a positive direction among older adults and family caregivers to allow a greater number of people to make use of the service; quality assurance should take precedence. Fifth, there is a need for developing a legal foundation to support family caregivers. Sixth, measures to compensate and recognize informal family caregivers should be considered, such as pension credits and caregivers’ allowances, while ensuring that the level of compensation is socially appropriate. Seventh, a range of programs to support elderly caregivers (e.g., information and coordination services, counseling and training services, health services, respite services, etc.) should be devised and implemented. Lastly, effective programs designed to improve partner relationships in mid- and late-life should be established and disseminated, since spousal caregiving in later life is likely to be influenced by the related prior relationship history.

With respect to grand-parenting, current work-life balance policies such as maternity/parental leave and flexible working arrangements should be expanded. In addition, the current corporate culture that fosters extended working hours should evolve in order to allow working parents to strike a balance between work and family life. A variety of child care support programs such as home help service for newborns to three-year-olds, temporary child care service, community-based child service, children’s centers which provide information, rental toys, and a space for parent-led playgroups should all be designed and implemented so that female older adults can utilize them as necessary. Likewise, access to and the quality of child care should be improved by means of expanding public child care services and strengthening quality assurance and monitoring systems to allow both working parents and grandparents to rely upon such services. Lastly, education programs for both grandparents and adult children who request their parents to help raise their children should be developed regarding how to raise grandchildren, how to communicate about parenting issues and conflicts stemming from child-rearing, and how to maintain personal health. Outreach activities should be directed toward the needy population.

It is appropriate to acknowledge certain limitations of this study. First of all, the data collected in this investigation are not nationally representative and, therefore, these findings may not be fully applicable to the general population. In addition, the cross-sectional nature of this study fails to capture the ongoing effect of family caregiving throughout a female caregivers’ life course, leading to longitudinal studies being called for in order to detect how family caregiving experience earlier in life influences economic well-being in later life among female older adults. Lastly, research on male older adults who take care of family members should be explored in the near future. Despite these limitations, the current study is meaningful in that it explored caregiving burden and quality of life, as well as subjective perceptions regarding caregiving work among female older adults who took care of family members (i.e., spouse, grandchildren).