Stage 1 Registered Report: A scoping review protocol to map the evidence on family carers who combine work with care

Introduction

As the population ages globally, the reliance on family carers to provide care in the community is expected to increase. A family carer can be defined as a person who ‘provides regular unpaid personal help for a friend or family member with a long-term illness, health problem or disability, regardless of whether or not they are in receipt of a Carer’s Allowance or Benefit’ (CSO, 2016; p.24). The 2016 Census revealed that 4.1% of the Irish population are family carers and provide more than 343 million hours per annum of unpaid care to a dependent person. Two thirds of carers are female and over half (52.7%) are in the 40 to 59 age group. The census data also reported that 57.4% of carers aged 15 years and older were in the labourforce (CSO, 2016a).

The number of family carers reported tends to be underestimated as family carers do not always recognise the care that they provide and can therefore sometimes struggle to self-identify as a ‘carer’ (Care Alliance Ireland, 2015; Care Alliance Ireland, 2017; Family Carers Ireland, 2017). The Irish Health Survey found a substantially higher percentage of people who reported that they provided care to a family relative. Based on a sample of 10,323 people aged 15 years and older, one in ten reported that they provided care to a person with a chronic condition or an infirmity due to old age (CSO, 2016b). This suggests that there are approximately 370,000 family carers in Ireland. This figure is consistent with statistics in other countries, most notably the UK (Office for National Statistics, 2011).

Caregiving can be a rewarding experience, but it is widely acknowledged that the demands associated with caregiving can negatively impact carers’ mental and physical health (Albert et al., 2010; NHS GP Patient Survey Oversight Group, 2019; Whittaker & Gallagher, 2019). It is also widely recognised that carers frequently experience relationship issues (Angermeyer et al., 2006) and social isolation (Greenwood et al., 2018).

Family carers who are in paid employment can face the additional challenge of trying to balance both the role of carer with that of an employee, and as a consequence may end up reducing their hours at work, taking a job with less responsibility or leaving their job entirely to provide care. This can result in financial loss (Carers UK, 2014) and impede careers (Carers UK, 2013). Women are more likely to reduce their hours due to caregiving obligations than men (Evandrou & Glaser, 2003; King & Pickard, 2013).

Recent research carried out by Carers UK (2019) showed that the number of people leaving the workforce to provide care for a relative or friend due to ageing, a disability or serious illness in the UK has increased from 2.3 million to 2.6 million between 2013 and 2018. Data from the English Longitudinal Study on Ageing (ELSA) indicated that providing just ten or more hours of care a week significantly increases the chances of a person aged between 50 and 65 leaving work within two years (King & Pickard, 2013). It was recently reported in the US that as many as 32% of all employees voluntarily left a job during the course of their career due to caregiving obligations (Fuller & Manjari, 2019).

The WHO recognises the importance of introducing ‘measures aimed at reconciling the conflicting pressures of paid work and care for carers, enabling them to engage with or retain paid employment' (Tarricone & Tsouros, 2008, p.26). In Ireland, the Health Service Executive (HSE) (2019) has committed to implementing the National Carer’s Strategy (2012) and its objectives to enable family carers to remain in employment and achieve a work-life balance. The Strategy states that carers should be enabled ‘to remain in touch with the labour market to the greatest extent possible’ and recognises the need to ‘encourage work-life balance provisions [which] are needed to ensure that working arrangements are carer friendly’ (Department of Health, 2012, p.25).

Recent figures released by Carers UK, estimate that as many as one in seven carers balance work with caregiving responsibilities for someone who is older, disabled or seriously ill (Carers UK, 2019). This statistic shows that the number of carers in paid employment has increased, when compared to available data from previous years (Carers UK, 2019; Office for National Statistics, 2011). Research suggests that enabling carers to maintain a working identity increases carers’ levels of happiness, financial security, and social inclusion (Eurofound, 2015; Stiell et al., 2006). Providing a supportive work environment for carers can bring many benefits for employers also, aiding the retention of their most talented and experienced staff, reducing absenteeism and presenteeism, and increasing productivity (Carers UK, 2013).

There is no single theoretical framework or model to explain the relationship between caregiving and employment. In a recent review of eldercare and work, Clancy et al. (2019) used four theories to construct their integrated model of eldercare and employment. These four theories comprised of role theory, social role theory, job demands/resources model, and bioecological systems theory. A scoping review would help to ascertain the theoretical frameworks currently used to understand caregiving and employment across all types of caregiving.

With an ageing population, a shift in dependency ratio, delayed retirement, more women participating in the labour market and smaller family sizes, an increasing number of people are going to find themselves juggling both caregiving responsibilities and employment. Reconciling work with family caregiving responsibilities is becoming a growing health, economic and social issue, along with a business issue in the context of the talent management challenges being faced by many organisations. According to Employers for Carers (2019), employers must act to avoid a workplace ‘crisis’ among carers. Governments across Europe are mandating for carer-friendly workplace policies to enforce a work-life balance for all parents and carers (EC, Employment, Social Affairs and Inclusion July, 2018).

The current body of literature relating to family carers tends to be fragmented (Larkin et al., 2019). There is a dearth of evidence on family carers who combine work with care. A systematic approach to examining the extant literature on ‘working family carers’ has not yet been conducted. The authors will undertake a scoping review to collate and synthesise the available literature to map the available evidence.

Study aim and objectives

The overall aim of this scoping review is to systematically and comprehensively scope the extent, range and nature of available evidence on ‘family carers who are in paid employment’.

The objectives of the review are to:

The review will map out and summarise the available body of evidence, which will help to identify research gaps in the literature and in doing so, will help to ascertain whether there is merit in pursuing a full systematic review (Arksey & O’Malley, 2005). The scope of the review has been kept deliberately broad. This review is the first step in a multi-phased research project which aims to develop an evidence-informed initiative to promote health and wellness among family carers in the workplace.

Protocol design

The scoping review will be guided by Arksey & O'Malley's (2005) and Levac et al.'s (2010) scoping review methodology. According to this framework, there are six different stages in undertaking a scoping review: (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; (5) collate, summarise and report the results and (6) consult with relevant stakeholders.

Study status

At the time of publication of this protocol, informal preliminary searches of the literature had been undertaken primarily to help to identity key search terms.

Discussion

The number of carers in paid employment is rising. Employers need to implement specific measures to support carers among their workforce to ensure they remain in the organisation and are not forced to exit the workforce due to a lack of support. While some research on family carers who combine work with care has been carried out internationally, the literature is somewhat fragmented, and seminal documents are often found in the grey literature and can therefore be difficult to locate. This scoping review will approach the available evidence systematically and will provide a mapped synthesis of the size and scope of the literature found through published and unpublished sources, as well as grey literature sources. This review will assist in determining whether a systematic literature review is warranted. It will also inform the next steps of a larger multi-phased research project which aims to support family carers and their wellness in the workplace.

Self-certification

The authors confirm that although preliminary searches have been conducted, no formal screening or data extraction has been performed.

Data availability

No data are associated with this article.