OBJECTIVES:

As more people are being sent home “quicker and sicker”, families are taking on more frequent and complex caregiving responsibilities than in the past. One in five employed Canadians has caregiver responsibilities. Furthermore, there is growing evidence that double duty caregiving (DDC) - where health professionals provide care at home and at work - often negatively affects the health and lives of Canadian health care professionals.

Based on the evidence from our previous qualitative and quantitative research investigations on double duty caregiving, the overall goals of this grant proposal were to:

1. identify refinements to DDC policies and practice;
   
   
2. engage in a collaborative, pan-Canadian development of these refinements; and
   
   
3. create collaborative opportunities for advocacy and implementation of practice and policies relevant to DDC and health human resources.

METHODS & MEASURES:

In order to meet these project goals, we hosted a Transformative Knowledge Translation (KT) Workshop for health care practitioners, researchers, policy decision-makers and knowledge users interested in health human resources. A number of conventional and innovative KT strategies and activities enabled us to successfully foster collaborations amongst provincial and national stakeholders at the professional, workplace and governmental levels in order for knowledge exchange and translation to occur. Such strategies included personalized and tailored correspondence, the development and workshop presentation of "The Double Duty Caregiving Monologues" - a dramatic re-presentation of the research evidence, critical reflection, a 'knowledge fair' to exchange insights while developing policy implications, and post-workshop correspondence and teleconferencing to refine the workshop products.

By way of these mechanisms, this KT initiative provided an opportunity to bring together practitioners, administrators and policy makers for dialogue, reflection and action on an important health human resources issue. Through a socially interactive, inclusive, and action-oriented dialogue, invited workshop participants used their deepened understanding of DDC to refine and tailor policy recommendations for various DDC stakeholders and to create successful research and community partnerships that integrate DDC evidence into policy and practice.

A workshop evaluation was conducted at its conclusion -- participants were asked to identify what they found beneficial and relevant as well as what they were left wanting; this evaluation took the form of an open-ended survey.

KEY FINDINGS:

The workshop was attended by 28 stakeholders from across Canada (Nova Scotia, PEI, Ontario, Saskatchewan, and British Columbia) representing nursing associations, unions, and workplaces.

The workshop commenced with "The Double Duty Caregiving Monologues," a dramatic re-presentation of the research evidence that served to immerse the workshop participants in the complexity of double duty caregiving and to ready the ground for policy development. Shared reflections on the monologues led to the articulation of policy 'arenas' in which participants' efforts could be focused. This was supported further by an overview of policy development and refinement. Thereafter, through an iterative process of small and large group interactions and exchange, the workshop participants generated myriad possibilities and directions for redressing policy related to double duty caregiving.

Workshop evaluations indicated that nearly all respondents found the workshop shop format and content to be ‘excellent’ or ‘very good’ – particularly the Double Duty Monologues’ – and respondents agreed that the workshop had a clear, relevant objectives that were met through active participation, networking, and capacity building. Most indicated too their intent to continue developing opportunities with the networking contacts made at this workshop.

In the weeks following the workshop, a policy brief comprised of specific recommendations was drafted and iteratively and collaboratively refined. The recommendations are geared toward (i) enhanced workplace supports (5 recommendations) and (ii) enhanced community care supports (4 recommendations), abbreviated as follows:
 
Re: Enhancing Workplace Supports:

1. Employers/Health care agencies should converse with double duty caregivers in their workforce about their health- and familial care expectations, the resources they are using/needing, as well as how their caregiving role is impacting their labour force participation and health status. 
   
   
2. Health care administrators, human resource managers, researchers, policy makers, health provider associations and/or union officials should conduct a comprehensive review of the current supports/strategies that are relevant to double duty caregivers.  Using a life course perspective, it would be useful to assess what supports (e.g. flex time/schedules, family leave) are available and used by double duty caregivers, and which supports are most needed among new grads, early-, mid-, and late-career health care providers.   A comparison of those supports from other agencies/provinces would be helpful to identify and evaluate those that could be adopted and/or adapted from other agencies/regions.
   
   
3. Employers/health care agencies and researchers should collaborate to identify the ways in which double duty caregiving impacts productivity, and labour force participation such as turn over/retention, as well as quality of care.  For instance, exit interviews could be conducted to determine if and to what extent double duty caregiving was a factor leading to resignation, early retirement, the transition from full to part-time, and/or sick leave. Professional associations could also ask this question on the annual registration forms. 
   
   
4. National, provincial and territorial professional health provider associations and unions must continue to work collectively with all levels of government to retain older workers.  Together, the identification and adoption of successful retainment strategies will ensure a healthier health care workforce and improve retention and recruitment to the professions.
   
   
5. Governmental officials, employers, union representatives and/or researchers should continue to work collaboratively to enhance workplace supports and HR policies that recognize and support double duty caregivers and create caregiver friendly workplaces.

Re: Enhancing Community Care Supports:

1. A specific amount of the Federal government’s transfer of health care dollars to the Provinces and Territories should be targeted to achieve measurable outcomes in the improvements to family/friend caregivers. For example, such targeted funding could support specific programs geared towards the assessment of family/friend caregivers’ needs, network of supports and health risks, including an assessment of the expectations placed on employees by their workplace.¹⁵
   
   
2. To acknowledge the social and economic contributions of family caregivers, provincial/territorial governments across Canada should adopt a caregiver recognition act similar to that of Manitoba’s. Provisions could include: proclaiming a caregiver recognition day;  creating general provincial principles relating to caregivers, outlining how caregivers should be treated and considered when interacting with the public, health staff and in the workplace;  instituting a progress report every two years, which would evaluate caregiver needs and supports; establishing a caregiver advisory committee to provide the minister with information, advice and recommendations; starting consultations with the minister and caregivers, organizations that provide care, appropriate government departments, the advisory committee and others; and generating awareness and recognition among health professional regulatory bodies and associations (including colleges) of the work of double duty caregivers.
   
   
3. National and, provincial / territorial associations and NGOs such as the Canadian Home Care Association and the Canadian Caregiver Coalition should continue the development of national best practices in homecare. By offering standards for health and safety, these best practices will identify successful and transferable systems and practices to facilitate government decisions regarding investment in homecare and will ensure the ongoing enhancement of home care procedures. Furthermore, these best practices should include provisions for health care providers who provide care to an older relative, including practice standards and guiding principles that acknowledge their active participation in providing care.
   
   
4. Provincial, territorial and national professional associations from across the country should lobby government to institute caregiver rights that remunerate caregivers’ unpaid labour. Suggested practices for enhancing double duty caregivers’ financial security include: the provision of tax credits for caregiving; top-ups from employers for employees forced to take a leave; revisions to the compassionate care benefit program and increased flexibility of the Canadian Pension Plan; and the creation of registered caregivers’ savings accounts.

IMPLICATIONS & IMPACT:

Our collaborative partners and workshop participants have expressed keen interest in using this policy brief in their own work advocating for caregivers (and especially 'double duty' caregivers). Most notably, the policy brief is being brought to the National Seniors Council for their consideration in achieving their 2012-13 mandate of engaging and fostering a strong seniors workforce. Other organizations who have committed to bringing this DDC Policy Brief to bear on caregiver issues in their own regions include:

• Canadian Nurses Association
• Family Caregivers Network Society in British Columbia
• Health Human Resource Planning – British Columbia Ministry of Health
• Nova Scotia Ministry of Health
• Office of Nursing Policy, Strategic Policy Branch, Health Canada
• Ontario Ministry of Health and Long Term Care
• Seniors and Pensions Policy Secretariat – Human Resources and Skills Development Canada
• University of British Columbia – School of Nursing