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ORIGINALS

Care provided by immigrants to people older than 64 in households. An exploratory study*

Jesús Rogero-García,¹ Eva Martín-Coppola^1
1Instituto de Economía, Geografía y Demografía (IEGD). Centro de Ciencias Humanas y Sociales (CCHS). Consejo Superior de Investigaciones Científicas (CSIC). Madrid, Spain

Mail delivery: Jesús Rogero García. Instituto de Economía, Geografía y Demografía (IEGD, CSIC). C/ Albasanz, 26-28, Despacho 3E10. 28037, Madrid, España

Manuscrito received by 15.6.2009
Manuscrito accepted by 7.8.2009

Index de Enfermería [Index Enferm] 2010; 19(1): 29-33
*Work realized into the research project "Inmigration and Cares of elder people at Madrid" (CUIMAD). It's been financed by BBVA Foundation that managed by Vicente Rodríguez Rodríguez and his resarch team's been to consist of Silvia Marcu, Gloria Fernández-Mayoralas Fernández, Fermina Rojo Pérez, Raúl Lardiés Bosque, Santiago Ramos Espina, Eva Martín Coppola and Jesús Rogero García

How to cite this document

Abstract

Background: There has been a lack of research examining the type of care provided by immigrants to elderly people in Spain. Aim: To carry out an exploratory analysis of the type of care provided by immigrant caregivers to elderly people in their own homes. Methodology: A cross sectional study was developed based on 24 foreign-born women working in private households caring for dependent elderly people in the Autonomous Community of Madrid in 2008. Main results: All caregivers carried out housework, 87% of them accompanying duties, 79% personal help and 75% nursing care. Caregivers devoted 3.77 hours daily to housework, 2.27 to accompanying duties, 1.30 hours to personal help at home and 0.60 hours to nursing care. Those reporting less autonomy levels in mobility and care received more time in nursing care and personal help than the rest. Conclusion: Care provided to elderly people at home by their relatives, public institutions and employed immigrants responds to similar demands and could be potentially interchangeable. Immigrant caregivers act as connection of the dependent person with his/her social network and with the institution providing health and social services. Larger samples are required to deepen and better our insights.
Key-words: Immigrants/ Aged/ Dependency/ Caregivers/ Home care services.

Introduction

    During the last years, the aging of the population added to the recent incorporation of women to the labour market have derived into a size reduction in the contingent of family caretakers (generally women) in Spain. Such contraction has produced a consequent new demand of household care services. At present, the public formal services (home assistance, tele-assistance, day care centers and residences) present a limited coverage to satisfy the needs of elder dependent people and are mainly addressed to those with the highest level of dependency and the lowest incomes. On their side, the private formal services represent an excessively high cost for many families that can not assume the expenses derived from dependency.¹ As a consequence, many homes and families opt to hire, informally and at low cost, private services from foreign workers. Such workers are serving as relay for the Spanish women in part of the domestic tasks and care of dependent people at home.² In Spain, the estimated number of non-institutionalized elders having received private cares at home during 2003 is 191.293.³ From those, the 90% (172.164 elders) received such cares from immigrants.⁴
    The quick expansion of this phenomenon and its multiple derivations have recently generated a set of researches, mainly of qualitative nature.^5-9 These works have tackled in depth the situation of the foreign caretakers (socio-demographic characteristics, access to the market of cares, and work conditions), but have paid limited attention to the activities of care, and the health situation of the persons taken care of. None of the studies have offered precise data about the type of cares provided (activities done and time dedicated) and its relation to the health situation of the elders, which is a key element to know the role of immigrants in the satisfaction of their health needs.
    The analysis of the cares given by these workers and their effects on the quality of life of the elders faces two big difficulties: (1) usually the labor relation does not go through the market, and therefore there are no contracts, registers nor other accreditation documents; (2) the work is done in the family home, a private sphere with difficult access for researchers. These obstacles are the main responsible for the lack of quantitative analysis on the topic. This article intends to make an exploratory approximation to the type of attention provided by immigrant caretakers to elders in the homes of the Community of Madrid, based on the analysis of the activities which manifest such cares.

Methodology

    This research applies an ad hoc methodological instrument to know the structure of the cares provided by immigrant workers. The tool used, called "Pilot survey on the usage of time for foreign caretakers in the Community of Madrid 2008 (EPUTEC 2008)", has been developed within the framework of a wider research on immigration and elders care. 97 immigrant caretakers, families and implied institutions have been interviewed in depth, selecting 24 immigrant women working in particular homes taking care of only one elder. This criterion is essential to establish solid relations among the caretaker's usage of time and the characteristics of the person taken care of (dependency level, family situation, etc.).
    As there is no census nor directory of foreign people who take care of dependent individuals at their homes, it has not been possible to follow a conventional sampling. The snow ball sampling procedure has been applied instead, using contacts in parish churches, associations, and non-governmental organizations. The type of sampling added to the exploratory nature of the study, gives the samples only a limited capacity to represent statistically the population of immigrant caretakers providing cares to elders in the Community of Madrid. Nevertheless, the sampling design used has an intentional or qualitative representativity,¹⁰ that is, it intends to include a diversity of situations or standard practices manifested in former researches about the population under analysis. Three basic criteria have been considered to distribute the samples based on known facts from previous qualitative research: (a) the care regime: stay-in (N=13) or external (N=11); (b) the day of the week under analysis: week days (N=18) or weekend (N=6); and (c) the caretaker's geographic origin: Latin American (N=18) or non Latin American (N=6).
    The people interviewed had to indicate in the questionnaire the performing frequency and the time dedicated to a series of activities during their last work day, added to some other informations about their daily work. Information about the social situation and health of the person taken care of was also retrieved. The list of activities defined in advance is shown in table 1, where four main groups are specified: social-sanitary cares, personal help at home, domestic activities and company/support inside and outside the household.
    The state of health has been measured applying the questionnaire EQ-5D adapted to caretakers. This questionnaire is a simple and standardized measure widely applied in health research^11,12 which measures health regarding five dimensions: problems or absence of mobility problems, personal care, daily activities, pain or discomfort and anxiety or depression. The data obtained have been processed using contingency tables and comparison of measurements through the ANOVA statistical tests. The analysis was performed with the statistical tool SPSS 15.0.

Results

    Each and every caretaker interviewed performed some domestic activity, the 87,5% carried out company/support activities inside or outside the house, the 79,2% provided some kind of personal help and the 75,0% dispensed social-sanitary cares. The caretakers dedicated an average of 3,77 hours to domestic activities -which constitutes the 47,5% of their working day-, 2,27 hours to provide company/support -the 28,6% of their working day-, 1,30 hours to supply personal help at home -the 26,4%- and an average of 0,60 daily hours dedicated to social-sanitary cares -the 7,6% of the total care time-. Table 2 shows information about the specific activities performed: the percentage of caretakers who perform them, the percentage of those who do on daily basis and the average daily time spent on each. The whole of the caretakers performed on daily basis some domestic tasks like cooking and cleaning the house, and some other related to more compelling needs like helping to eat and drink, changing nappies, providing medication, helping to get up and go to bed, using the bathroom, moving inside the house, etc. In terms of dedicated time, cleaning is the leading activity with 2,07 daily hours as an average. Company and support inside the house, having a walk with the dependent person, helping to eat/drink, changing nappies and cooking consume more than one hour per day. For the rest of tasks less than one hour is employed.
    The activities performed by the caretakers are related to the difficulties of the dependent persons to develop his daily life routines. Table 3 shows the average time dedicated by the caretaker for each type of activity related to the functional limitations of the dependent individual. Those with lower autonomy levels for mobility and care received significantly longer time of social-sanitary care and personal help than those who had higher levels of autonomy.
    Analysis was also performed on the relation between another type of activities which are normally developed with lower regularity and the health of the persons taken care of [Table 4]. Three out of every four caretakers facilitated communication with the family during the last month, the 62,5% went to the doctor with the dependent person, the 37,5% provided information about social or sanitary services while a third part had to call health services (doctors, nurses, or an ambulance). Those who needed help to communicate with their families and to call the sanitary services had a health state significantly worse than the rest.

Discussion

    Despite its growing presence in the Spanish society added to its social and health repercussions, the care provided by immigrant women to dependent elders inside the Spanish households has not been analyzed with enough detail yet. This article offers novel information extracted from a pilot research about the composition of this type of attention within the Community of Madrid. No previous researches providing data about the amount of time dedicated to different activities related to the cares supplied by immigrants have been found.
    The results found on the caretakers' activities performance are similar to those reported by IMSERSO in the research done in 2005 with title "Cares provided to elders in the Spanish homes. The family environment". According to such work based on 78 interviews to immigrant caretakers, the 95% of them performed domestic works, an 85% helped in the daily tasks, and around the 80% gave assistance to the daily personal cares. In such way, results from both studies point at the multi-functionality as a characteristic of the work developed by the immigrant caretakers, always performed in the same physical space, the household, and the same time unit, one working day. The variety of tasks performed makes it difficult to characterize the work and identify the real needs of attention of those who hire it. The same lack of definition is also present in its legal regulation framework. The Basic Regulation for the Personnel providing Services in Family Homes labels all the activities performed inside the house under the category of "domestic tasks".¹³ This decree does not mention the social-sanitary cares nor the help in the housework given by these workers, even if such activities constitute the 24% of the total time in the case of attention provided to dependent elder people.
    The specificity of the work of caretaker does not lie so much in the intense dedication to direct physical help, but in the availability to provide diverse support when necessary. Most of the personal help at home and social-sanitary cares needed have an unpredictable nature which requires a constant personal supervision. In the same way, and despite the fact that the most of the care work is materialized in domestic tasks, the assistance in some daily life activities like having a walk together with the dependent individual or supporting the performance of physical and mental exercises, reflects the importance of the support labor of these caretakers in the maintenance of the autonomy in certain activities that elders can do.
    The existence of a connection between the amount of time dedicated to certain activities and the functional limitations of the person taken care underlines the correspondence between needs and type of attention. In the same way, the role of the immigrant caretakers as connectors between the dependent individual and its social network and the sanitary and social institutions has been observed.
    Cares provided by immigrants look similar to those supplied by caretakers from the family, not only in terms of monitoring and surveillance, but also in terms of the big diversity of tasks that they have to face.¹⁴ With regard to the attention provided by the public administrations, the service most similar to the work performed by the immigrant caretakers is the Home Attention Service, (SAD) which consists of personal and domestic attention given in the home of a person in situation of dependency. The comparison of the activities performed within the SAD and those performed by immigrant women reflects that both types of cares have a very similar composition: according to the data of Deloitte for the Community of Madrid in 2005, approximately the half of the time SAD was dedicated to domestic tasks and the other half to personal help and supervision (SAD does not provide social-sanitary cares which require the presence of nursing assistants);¹⁵ if the time dedicated to social-sanitary cares is not taken into account in the case of immigrant caretakers, the 51% of their working day is dedicated to domestic tasks and the 49% of it is dedicated to personal help and support/company. The comparative analysis of the cares provided to elders at home by family members, public institutions and remunerated immigrants suggests that these three types of cares answer similar attention demands and could be potentially exchangeable.
    These results should be carefully interpreted due to the limited number of cases in the sample and the exploratory nature of the study. Despite this fact, the representativity of the sample under analysis is intentional and the methodological tool has faced the topic of cares with a high level of detail, given the lack of other adequate instruments to achieve a precise measure of the cares provided to elders in their homes. In order to confirm these results and improve the knowledge about the effects that this type of attention has in the health and quality of life for the persons taken care of, it would be desirable that future researches would count on wider analysis samples taking into account the peculiarities of the caretakers (education, experience, work conditions, etc.), the health conditions of the persons taken care of (concrete pathologies, type of disability, etc) and the social environment (type of home/family, social network, geographic environment, etc). It is necessary to go in depth into the knowledge of the impact of the different caretaker agents (immigrants, family members, public institutions) on the health and quality of life of the elders. These steps forward will contribute to a better development of the System for the Autonomy and Attention to Dependency, currently in the middle of its implementation process.

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