tag:theconversation.com,2011:/us/topics/caregiving-14093/articlesCaregiving – The Conversation2024-03-18T23:20:44Ztag:theconversation.com,2011:article/2257802024-03-18T23:20:44Z2024-03-18T23:20:44Z‘Care is in everything we do and everything we are’: the work of Indigenous women needs to be valued<p>It’s commonly accepted that women do the vast majority of caregiving in Australian society. But less appreciated is that Indigenous women do larger amounts of unpaid care than any other group.</p>
<p>Working with the Aboriginal and Torres Strait Islander Social Justice Commissioner’s office, we worked with <a href="https://caepr.cass.anu.edu.au/research/publications/caring-about-care">more than 100 Indigenous women across</a> Australia to talk about their interpretations and experiences of care. </p>
<p>“Mainstream” definitions and measures of care do not include the vast and complex ways care is defined by First Nations women. This includes care not only for people, but for communities, Country and culture. </p>
<p>It means important work goes unrecognised, uncompensated or misunderstood, leading to the marginalisation of this crucial work and the women who do it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/definitions-are-often-very-western-this-excludes-us-our-research-shows-how-to-boost-indigenous-participation-in-stem-223465">'Definitions are often very western. This excludes us.' Our research shows how to boost Indigenous participation in STEM</a>
</strong>
</em>
</p>
<hr>
<h2>Redefining the concept</h2>
<p>The Australian Human Rights Commission’s <a href="https://humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-justice/publications/wiyi-yani-u-thangani">Wiyi Yani U Thangani</a> report illuminates the crucial importance of the care provided by First Nations women. Our work follows and builds on this report.</p>
<p>An Indigenous woman from the East Kimberley told us:</p>
<blockquote>
<p>Well, care for me, as an Indigenous person, is not just caring for your family, it’s caring for your Country.</p>
</blockquote>
<p>Another woman from the ACT told us care is a disposition, and a means of respecting culture and heritage: </p>
<blockquote>
<p>[Care is] enveloped in everything we do and everything we are and everything about where we are going and paying homage again to our ancestors and who’s come before us. That’s what care is.</p>
</blockquote>
<p>This notion of care as a strength is an important insight from the women in this study. However, unpaid care is often unrecognised and undervalued in Australian policy, which while prioritising getting women into employment, has neglected funding and supporting the existing unpaid care work that women do. </p>
<p>What is evident from our study is that Indigenous women want more support for the care work they do, as well as better care services largely within Aboriginal community-controlled organisations to assist them in doing it.</p>
<h2>Care has consequences</h2>
<p>Women frequently linked their demanding care loads to ongoing colonisation, which continues to create damage to the lives of Aboriginal and Torres Strait Islander people. A woman from greater Sydney said:</p>
<blockquote>
<p>It’s colonial […] It’s just not being able to do things in the way we should be doing them […] because of the colonial structure and things like that. </p>
</blockquote>
<p>This includes the impacts of colonisation on gender roles, child removals, incarceration rates, poor health, poverty, racism and more. </p>
<p>It also includes the impacts of state institutions set up to “care”, but which are <a href="https://www.theguardian.com/australia-news/2017/sep/01/coalition-hails-success-of-cashless-welfare-card-and-says-kalgoorlie-will-be-next-site">often uncaring</a> and <a href="https://theconversation.com/first-nations-children-are-still-being-removed-at-disproportionate-rates-cultural-assumptions-about-parenting-need-to-change-169090">may be violent and harmful</a>.</p>
<p>Ultimately, this requires Indigenous people’s care to heal, adding extra demands on existing care loads. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-women-dont-always-access-health-care-after-head-injuries-from-family-violence-heres-why-206084">First Nations women don't always access health care after head injuries from family violence. Here's why</a>
</strong>
</em>
</p>
<hr>
<p>Many of the women interviewed in this study were also tired, and often carers needed care too. Some were in, or had been through, periods of utter exhaustion and illness due to trying to carry their stressful care load. A Central Australian woman told us:</p>
<blockquote>
<p>It’s hard. It’s draining. Every day just exhausted. Sometimes there’s days when I just can’t keep up with it. And I don’t want to listen, just go away. But those are days when they really need help. So yeah, it’s very exhausting.</p>
</blockquote>
<h2>Time is money, but no one gets paid</h2>
<p>Our research also included a time-use survey, which showed that all unpaid care activities accounted for, on average, 62% of our participant women’s time on a usual weekday (about 14.8 hours per day on average), with 48% of their time (around 11.5 hours) spent caring for others and/or caring for Country and culture specifically. </p>
<p>Because (lost) remuneration for this work was raised as a crucial point by Indigenous women during our interviews, we also calculated the approximate market value of this unpaid care work through using hourly award rates for corresponding care activities (sometimes called the replacement method, which understands the cost of this work in the paid market). </p>
<p>The estimated economic value of this work ranged between $223.01 and $457.39 per day (representing an estimated annual salary of between $81,175.64 and $118,921.40). This estimation is conservative as it does not include the multitasking of more than one care activity at the one time.</p>
<p>The estimation raises important questions as to what is owed to Indigenous women, not just because the economy free-rides on unpaid care, but also because much of this care work mops up the mess of colonisation. </p>
<p>Many of the women we spoke to also talked about how unpaid care and paid employment interact. </p>
<p>In addition to their unpaid care roles, most women in paid employment in this study had roles in the community sector which put them at the frontline of caring for community. They saw this work as part of their broader commitment to supporting their families, communities and advancing Indigenous peoples. It is therefore hard to draw a line for these women between paid and unpaid work, meaning it is rare to be able to “switch off”. </p>
<p>Often, employers didn’t realise the amount of unpaid care of this type women do in <a href="https://theconversation.com/during-naidoc-week-many-indigenous-women-are-assigned-unpaid-work-new-research-shows-how-prevalent-this-is-in-the-workplace-208454">their paid work roles</a>, even though this actually makes their paid employment successful. Women are also not paid adequately for these valuable skills.</p>
<h2>A new approach is needed</h2>
<p>Our research follows generations of Indigenous women who have long shown the strength of care, but also looks at how settler society makes this work harder. </p>
<p>This research underlines the importance of a new approach to supporting Indigenous women, in which their voices, ideas and needs are central, and where care is placed at the heart. This is different to just “fitting” Indigenous care into various settler models, policies and measures already in circulation.</p><img src="https://counter.theconversation.com/content/225780/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elise Klein receives funding from the Gender Institute at the Australian National University. She is a member of the Anti-Poverty Centre, the Accountable Income Management Network and a Co-Director of the Australian Basic Income Lab.</span></em></p><p class="fine-print"><em><span>Chay Brown receives funding from the Office of Gender Equity and Diversity at the Northern Territory Government. She is affiliated with ANU, Tangentyere Council, and Her Story Mparntwe. </span></em></p><p class="fine-print"><em><span>Kayla Glynn-Braun is a First Nation Wiradjuri Women whom is a project coordinator at The Equality Institute and Co-Foundered Her Story Consulting and lead on U Right Sis? project, Indigenous Knowledge</span></em></p><p class="fine-print"><em><span>Janet Hunt and Zoe Staines do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To First Nations women, ‘care’ is more broad and all-encompassing than traditional definitions. We need a new approach to capturing, and appreciating, their work, paid and unpaid.Elise Klein, Associate professor, Australian National UniversityChay Brown, Managing Director, Her Story Consulting & Postdoctoral fellow, Australian National UniversityJanet Hunt, Honorary Associate Professor, CAEPR, Australian National UniversityKayla Glynn-Braun, Director of Her Story, project coordinator at The Equality Institute, lead on U Right Sis? project, Indigenous KnowledgeZoe Staines, Senior Lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2229822024-03-05T21:56:12Z2024-03-05T21:56:12ZImmigrant women suffer financially for taking maternity leave: 4 ways Canada can improve<figure><img src="https://images.theconversation.com/files/575120/original/file-20240212-18-b6ebmj.jpg?ixlib=rb-1.1.0&rect=70%2C50%2C6639%2C3722&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Immigrant women disproportionately work caring for children, elderly adults and people living with disabilities. At the same time, immigrant care workers earn low incomes and experience precarious employment.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Canada is facing a critical <a href="https://canadiancaregiving.org/wp-content/uploads/2022/11/CCCE_Giving-Care.pdf">shortage of caregivers</a>, both paid and unpaid. And those who do this vital work face significant pressures that are impacting their lives. In particular, there are high costs to immigrant women for taking time off of paid work to care for their own babies. </p>
<p>Immigrant women <a href="https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00036-eng.htm">disproportionately work caring for children, elderly adults and people living with disabilities</a>. At the same time, immigrant care workers <a href="https://doi.org/10.1111/imig.12851">earn low incomes</a> and experience <a href="https://www.parklandinstitute.ca/more_than_just_a_health_care_aide">precarious employment</a>. The fact that these women experience further economic penalties for taking maternity or parental leave is a pressing social issue.</p>
<p><a href="https://doi.org/10.3138/cpp.2023-005">My recent paper</a> in <em>Canadian Public Policy</em> documents for the first time the financial implications immigrant women face for taking time out of the labour market to care for a child. I use Statistics Canada data from the <a href="https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5057">Longitudinal Immigration Database (IMDB)</a> and the <a href="https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=4502">2018 General Social Survey (GSS)</a>. </p>
<p>The data revealed a gendered, classed and racialized divide among women caring for their children in Canada today. It’s a divide that is having a negative financial impact on immigrant women doing this work. </p>
<h2>Disparities in who is caring for children</h2>
<p>The data revealed patterns of who is providing unpaid care for children. Women were more than eight times as likely as men to be caring for children or on parental leave.</p>
<p>Immigrants were 1.8 times as likely to report these as their main activities compared with non-immigrants. Racialized populations were 1.5 times more likely than non-racialized populations to be providing this care. </p>
<p>Further, my analysis finds that immigrant women who came to Canada via the <a href="https://www.canada.ca/en/immigration-refugees-citizenship/services/work-canada/hire-permanent-foreign/caregiver-program.html">Live-in Caregiver/Caregiver Program (LCP/CP)</a> had a substantively higher probability of having a birth-related career interruption than comparable immigrant women who entered Canada via the <a href="https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/operational-bulletins-manuals/permanent-residence/non-economic-classes/family-class-process.html">family</a> or <a href="https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/operational-bulletins-manuals/permanent-residence/economic-classes.html">economic</a> immigration programs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579264/original/file-20240301-26-kmlxo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman using laptop carries a baby." src="https://images.theconversation.com/files/579264/original/file-20240301-26-kmlxo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579264/original/file-20240301-26-kmlxo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579264/original/file-20240301-26-kmlxo2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579264/original/file-20240301-26-kmlxo2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579264/original/file-20240301-26-kmlxo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579264/original/file-20240301-26-kmlxo2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579264/original/file-20240301-26-kmlxo2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Data suggests that, in the vast majority of cases, income will be lower the year after a birth-related career interruption.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Financial disadvantages for providing essential unpaid care</h2>
<p>I looked at immigrant women who took time out of the labour market to care for their babies and compared their income the year before the career interruption with the year after.</p>
<p>I found that the probability of having income ten per cent lower the year after a birth-related career interruption is highest for women who immigrated through the family class program, followed closely by those in the caregiver program and those who immigrated through the economic class. </p>
<p>The differences were small. Instead, there is a large divide across scenarios rather than entry classes. Notably, all immigrant women have much lower probabilities of having either the same or higher income after a birth-related career interruption.</p>
<p>This suggests that for immigrant women in Canada, in the vast majority of cases, income will be lower the year after a birth-related career interruption than prior. There are financial penalties for caring for their own children. </p>
<h2>What can the federal government do?</h2>
<p>Most important legislation affecting the career earnings trajectories of immigrants operates at the provincial level. For example, policies tied to collective bargaining and unionization, education and training, minimum wage, employment standards and occupational health and safety are set by provincial governments. </p>
<p>These are of critical importance to immigrant women workers, but there is wide variation across Canada.</p>
<p>At the federal level, however, concrete changes to the caregiver program and to Employment Insurance (EI) could help to address the challenges highlighted above. The four changes proposed below would be important steps forward for immigrant women care workers. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579263/original/file-20240301-20-3uw0rq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman and baby play on a couch" src="https://images.theconversation.com/files/579263/original/file-20240301-20-3uw0rq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579263/original/file-20240301-20-3uw0rq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579263/original/file-20240301-20-3uw0rq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579263/original/file-20240301-20-3uw0rq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579263/original/file-20240301-20-3uw0rq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579263/original/file-20240301-20-3uw0rq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579263/original/file-20240301-20-3uw0rq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Changes to caregiver programs and to Employment Insurance could help to address the challenges caregivers face.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>First, immigrants who enter Canada via caregiver programs should be eligible to access maternity leave and workers compensation benefits regardless of whether their status in Canada is temporary or permanent. As well, encouraging better education regarding maternity and parental leave entitlements so immigrants know their rights might improve take-up rates. </p>
<p>Second, the government should increase and improve programs to support the labour market integration of immigrants coming to Canada via caregiver programs. This would include assisting with transfer and recognition of foreign credentials which has been widely identified as <a href="https://triec.ca/eliminating-the-barrier-of-credential-recognition-for-immigrant-professionals/">an area in need of support</a>. This would also help immigrant care workers find work that is commensurate with their training and skills, likely with higher pay and better maternity benefits. </p>
<p>Third, further increasing federal funding for paid child-care provision would assist in alleviating the shortage of workers. Improving the quality, accessibility and affordability of paid child care would assist immigrant women in transitioning back to the labour market after having a baby. It would also improve pay for child-care workers, <a href="https://doi.org/10.1080/02568543.2023.2232832">who are disproportionately immigrant and racialized women</a>. </p>
<p>Fourth, governments need to look at reforming EI and other related programs through a gender-based analysis. This could include implementing new or more tax credits for unpaid caregiving, increasing flexibility in the definition of allowable expenses, changes to the child benefits system, increasing short-term programs to <a href="https://doi.org/10.1108/EDI-09-2020-0255">address deskilling</a> from extended time outside of the labour market caring for children, and suggesting regulatory changes to the definition of self-employment for income tax purposes. </p>
<p>These changes would better ensure that career interruptions tied to childbirth and care do not unduly impact or disadvantage immigrant women over their working lives. The minimum we can and should do as a society is ensure that immigrant women who devote their working lives to caring for others are equally cared for themselves when they become mothers.</p><img src="https://counter.theconversation.com/content/222982/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naomi Lightman receives funding from the Social Sciences and Humanities Research Counsel (SSHRC), the Canadian Research Data Centre Network (CRDCN), and Women and Gender Equality (WAGE) Canada.</span></em></p>Research shows a classed and racialized divide among women caring for their children in Canada today. It’s a divide that is having a negative financial impact on immigrant women doing this work.Naomi Lightman, Associate Professor of Sociology, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2235212024-03-05T14:01:43Z2024-03-05T14:01:43ZMichigan Gov. Whitmer proposes a caregiver tax credit − an idea many Americans support<figure><img src="https://images.theconversation.com/files/578799/original/file-20240229-24-loeyq2.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C2302%2C1285&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As the population of older adults in the U.S. grows, more people need care.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/comforting-hand-on-shoulder-of-man-royalty-free-image/1576851402?phrase=elderly&adppopup=true">seb_ra/via Getty Images</a></span></figcaption></figure><p>People caring for elderly or disabled relatives need a break – and, in Michigan, Gov. Gretchen Whitmer has a proposal to give them one.</p>
<p>Whitmer’s <a href="https://www.bridgemi.com/michigan-government/whitmer-seeks-5000-tax-credit-michigan-caregivers-how-much-will-it-help">recently proposed US$5,000 tax credit</a>, the Caring for MI Family Tax Credit, is part of a growing trend of public subsidies for families shouldering the responsibilities of caring for family members. </p>
<p>Americans strongly endorse the idea that families, not the government or other organizations, are responsible for providing care for family members. They especially endorse <a href="https://www.pewresearch.org/social-trends/2023/09/14/family-responsibilities/">adult children</a> providing care for their aging parents. </p>
<p>That may help explain why family members are the main and sometimes only <a href="https://www.aei.org/wp-content/uploads/2020/11/Paid-Leave-for-Caregiving.pdf">caregivers for older adults</a> and others with <a href="https://www.aarp.org/caregiving/home-care/info-2023/caregiving-for-your-adult-disabled-child.html">long-term care needs</a> in the United States.</p>
<p>We are researchers who study <a href="https://scholar.google.com/citations?user=ytD3n0IAAAAJ&hl=en&oi=ao">families</a> and <a href="https://scholar.google.com/citations?user=ruC6veMAAAAJ&hl=en&oi=ao">caregiving</a>. Our <a href="https://doi.org/10.1177/23780231231225574">recent study</a> finds that when given a choice between family, government or other care providers, many Americans think family should provide care but the government should pay for it.</p>
<p>Caregiving costs can be substantial. On average, a caregiver in Michigan can expect to spend over <a href="https://states.aarp.org/michigan/supporting-family-caregivers-in-michigan">$7,000 out of pocket</a> per year. One study estimates the cost of care for a person with dementia are even higher, ranging <a href="https://doi.org/10.1111/j.1525-1497.2001.10123.x">from $3,000 to $17,000</a>, depending on the severity of the disease. Another estimate that accounts for the total impact of caregiving, including costs such as lost wages and the impact on caregiver’s health, puts the personal expense of caring for a loved one at roughly <a href="https://ldi.upenn.edu/our-work/research-updates/a-comprehensive-measure-of-the-costs-of-caring-for-a-parent-differences-according-to-functional-status/">$90,000 a year</a>. </p>
<p>Despite this steep price, <a href="https://doi.org/10.1111%2F1468-0009.12567">few federal governmental programs</a> address caregivers’ financial burdens. </p>
<p>In response, states have begun to pass their own policies, like <a href="https://www.ncsl.org/labor-and-employment/state-family-and-medical-leave-laws">paid leave</a> in states such as California, Washington and Massachusetts, and, increasingly, <a href="https://www.taxpolicycenter.org/taxvox/are-tax-credits-best-way-subsidize-long-term-care-costs">tax credit policies</a> like Whitmer’s proposal in Michigan.</p>
<h2>Helping to offset, reduce costs</h2>
<p>Currently, <a href="https://ltsschoices.aarp.org/scorecard-report/2023/dimensions-and-indicators/state-caregiver-tax-credits#:%7E:text=Six%20states%20(Georgia%2C%20Missouri%2C,one%20activity%20of%20daily%20living.">six states</a> – Montana, North Dakota, Missouri, Georgia, South Carolina and New Jersey – offer a tax credit to offset <a href="https://doi.org/10.1080/08959420.2022.2127599">the costs of caregiving</a>. </p>
<p>The credit can be used to cover home modifications such as ramps or bathroom grab bars, assistive devices such as a cane or walker, or to pay a professional care worker.</p>
<p>Whitmer’s proposal is generous compared with other states. For example, <a href="https://support.taxslayer.com/hc/en-us/articles/360015705352-Georgia-Qualified-Caregiving-Expense-Credit">Georgia’s caregiving tax credit</a> reimburses up to 10% of costs, with a cap of $150.</p>
<h2>A needed break</h2>
<p>The proposed Michigan tax credit would support counseling, transportation and nursing or respite services that pay a caregiver to come help so the family caregiver can have a break.</p>
<p>These types of services <a href="https://doi.org/10.1017/s1041610218000686">delay transitions into nursing homes</a>, which helps <a href="https://doi.org/10.1093/geroni/igz040">keep costs down for Medicaid</a> and individual <a href="https://doi.org/10.1016/j.jamda.2023.09.010">monthly out-of-pocket spending</a>.</p>
<p>Respite care use has become <a href="https://doi.org/10.1093/geront/gnx093">more common over the past two decades</a>, especially among families providing care for older adults with dementia. However, many caregivers are unable to access these services. One barrier is <a href="https://doi.org/10.1093/geront/gnz095">the cost</a>, which averages <a href="https://www.genworth.com/aging-and-you/finances/cost-of-care.html/">$29 per hour</a>. </p>
<h2>Public support for caregivers increasing</h2>
<p>Recent polls show that a majority of Americans want Medicare, the federal program that provides health care to people over 65, to help cover <a href="https://www.longtermcarepoll.org/visualizing-support-for-greater-government-role-in-health-care-for-older-adults/">the cost of long-term care</a>. </p>
<p>In terms of what supports should be made available to caregivers, <a href="https://doi.org/10.1177/0164027501233004">tax credits</a> receive the greatest public support relative to other programs, such as unpaid time off. </p>
<p>A recent AARP study of registered voters ages 50 and older found 8 in 10 people support a $5,000 annual <a href="https://www.aarp.org/research/topics/care/info-2021/caregiving-tax-credit-in-home-care-bipartisan-support.html">caregiver tax credit</a>. Another study of voters of all ages found similar support for expanding the <a href="https://economicsecurityproject.org/resource/polls-support-for-eitc-with-automatic-filing-caregiver-credit/">earned income tax credit</a> to include family caregivers.</p>
<p>Evidence suggests that tax credits implemented in Arizona and Idaho in a three-year test of the program in the early 1980s had the desired effect – <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195118/">more care by family members</a> and a reduced use of formal care. Paid leave in California is also associated with a reduction in <a href="https://doi.org/10.1002/pam.22038">nursing home usage</a>. </p>
<p>The benefit of the Caring for MI Family Tax Credit will depend in large part on the details and design of the policy. A refundable tax credit will provide greatest benefit to low-income households.</p>
<p>A similar federal bill, the <a href="https://www.congress.gov/bill/117th-congress/house-bill/3321">Credit for Caring Act</a>, has been introduced in Congress. If passed, the legislation would provide a federal tax credit for working family caregivers to cover 30% of expenses incurred above $2,000. </p>
<p>And other <a href="https://www.ftb.ca.gov/tax-pros/law/legislation/2019-2020/AB2136-021020.pdf">states such as California</a> are also considering introducing tax credits to help offset the cost of caregiving. </p>
<p>The population of <a href="https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html">Americans over 65 is increasing</a>, <a href="https://aspe.hhs.gov/reports/most-older-adults-are-likely-need-use-long-term-services-supports-issue-brief-0">meaning more people</a> will need caregiving in the near future.</p>
<p>The introduction of these bills reflects Americans’ growing support for new solutions to defray the costs associated with providing care to a loved one.</p><img src="https://counter.theconversation.com/content/223521/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah E. Patterson receives funding from the National Institute on Aging (NIA). She volunteers with the Alzheimer's Association in Michigan. </span></em></p><p class="fine-print"><em><span>Ariana Reyes receives funding from the National Institute on Aging (NIA). </span></em></p>Michigan Gov. Gretchen Whitmer’s proposed tax credit is part of a trend toward public support for family caregiving.Sarah E. Patterson, Research Investigator at the Survey Research Center at the Institute of Social Research, University of MichiganAdriana Reyes, Assistant Professor of Public Policy, Cornell UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2240572024-03-04T20:58:06Z2024-03-04T20:58:06ZMAID and mental health: Does ending the suffering of mental illness mean supporting death or supporting better lives?<p>Recent headlines have <a href="https://nationalpost.com/news/canada/psychiatrists-clash-deadline-maid-mental-illness">highlighted debates</a> among federal parties over the proposal to <a href="https://www.canada.ca/en/health-canada/news/2024/02/the-government-of-canada-introduces-legislation-to-delay-medical-assistance-in-dying-expansion-by-3-years.html">extend Medical Assistance in Dying</a> (MAID) to people suffering solely with mental illness. </p>
<p>Proponents of <a href="https://psychiatry.utoronto.ca/news/discussing-medical-assistance-dying-and-mental-illness-canada">expanding Bill C-7 to mental illness claim</a> that delays to do so are based on stigma and stereotypes promoting the belief that a mental disorder renders someone incapable of making a rational choice to die. Those that advocate for delaying an expansion suggest that more work is needed to <a href="https://doi.org/10.1097/yco.0000000000000298">ensure appropriate safeguards</a> are in place to distinguish requests for MAID from illness-induced suicidal ideation. </p>
<p>The recent announcement that including mental illness in MAID will be <a href="https://www.cbc.ca/news/politics/liberals-delay-expanding-maid-1.7101560">delayed until 2027</a> gives provincial and territorial health-care systems more time to prepare for implementation. </p>
<h2>Putting access to MAID in context</h2>
<p>People living with long-term mental illness should have the option to consider MAID, like others facing chronic, debilitating illnesses. However, access to MAID is a small part of a larger conversation we ought to be having about how the health-care system can provide supports and services that empower people with mental health disorders to navigate the long journey of mental illness with dignity and resilience. Extending support to the families that care for them should be considered key. </p>
<p><a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">As the Centre for Addiction and Mental Health (CAMH) reports</a>, mental illness is the leading cause of disability in Canada, and wait lists for services are far too long. For each person with a debilitating mental illness, there are family members — biological, legal or chosen — doing their best to provide support and care. But who supports these families as they navigate the challenges of persistent mental illness? </p>
<p>Despite decades of research demonstrating the <a href="https://doi.org/10.7870/cjcmh-2015-009">importance of family caregivers</a> for supporting people with severe mental illness, and the <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/Caregiving_MHCC_Family_Caregivers_Guidelines_ENG_0.pdf">beneficial outcomes</a> for all family members when families are supported, vital support services have <a href="https://www.fraserinstitute.org/sites/default/files/mental-health-care-how-is-canada-doing.pdf">declined throughout Canada</a>. Families that are racialized, poor or newcomers are <a href="https://doi.org/10.1177/0840470420933911">getting even less support</a> in a depleted family support service system. </p>
<p>Examples of evidence-based family-focused supports that would help include <a href="https://doi.org/10.1111/j.1752-0606.2011.00256.x">family psychoeducation</a>, <a href="https://doi.org/10.1111/hsc.12689">peer support</a>, and <a href="https://doi.org/10.1177/07067437231197263">community-based, culturally-acceptable services</a> that focus on whole families.</p>
<h2>Supporting patients and families</h2>
<p>In addition to asking health-care systems to prepare to end the suffering of mental illness by facilitating death, we should be asking legislators and policymakers to build a health-care system that supports better lives for people with mental disorders and their families. </p>
<p>Families manage mental illness <a href="https://www.ctvnews.ca/health/relatives-of-people-with-serious-mental-illness-often-bear-brunt-of-stigma-study-1.6374892">out of sight</a> of these leaders and society at large; their suffering is seen as a <a href="https://tspace.library.utoronto.ca/bitstream/1807/94700/1/Caregiving%20under%20siege_Williams.pdf">personal matter</a> that is no one else’s business. But the numbers tell us that ending suffering from mental illness is everyone’s business. It requires <a href="https://cmha.ca/brochure/social-support/">networks of support</a> for those who have been diagnosed and caregivers. Ignoring the families that support individuals with mental illness has <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/Caregiving_MHCC_Family_Caregivers_Guidelines_ENG_0.pdf">ramifications for everyone’s health</a>. </p>
<p>My research exploring the experiences of Ontario families affected by mental illness has shown there are <a href="http://familyguidetomentalhealth.com/port/harmful-practices/">gaps in the system</a> when it comes to family support. Conversations with families reveal that, whether one is a caregiver or someone who has been diagnosed, those living with mental illness often feel <a href="http://familyguidetomentalhealth.com/port/stigma-isolation/">isolated, alone and overwhelmed</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/bO_jmSo4VfA?wmode=transparent&start=8" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In a video from the Family Caregiving Project, family members describe difficult interactions with the health-care system.</span></figcaption>
</figure>
<p>Family members who <a href="https://tspace.library.utoronto.ca/bitstream/1807/94700/1/Caregiving%20under%20siege_Williams.pdf">don’t fall into the definition of “traditional family”</a> often report challenges throughout the care process. Families that are part of marginalized or lower-income groups face additional <a href="https://doi.org/10.1177/0840470420933911">challenges to getting help and support</a>, often due to financial barriers, language and cultural barriers, or other social determinants that correspond to inequities in access to health care. </p>
<p>The failure to build proper supports and services that meet the needs of families could worsen an already growing mental health crisis. If the family is stressed, that <a href="https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=c8ae98f27c37c9ca253832a6f7a479f3d322b502">stress will impact everyone within it</a>, caregivers and people struggling with a mental illness alike. This is suffering that can last for decades. The well-being of whole families affected by mental illness must be recognized as an issue of urgent concern.</p>
<h2>Caring for people with long-term mental illness</h2>
<p>Education and training are needed to ensure health professionals have the information they need to better support families. At the same time, more work must be done to promote the general public’s understanding of mental illness and reduce stigma, so people don’t feel ashamed about asking for help. </p>
<p>My work with the Family Caregiving Project to develop <a href="http://familyguidetomentalhealth.com/family-caregiving-project/">free online educational resources</a> is a start. These resources help health-care professionals, educators and community groups better understand and discuss the experiences of families struggling with mental health issues. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/medical-assistance-in-dying-for-mental-illness-ignores-safeguards-for-vulnerable-people-156012">Medical assistance in dying for mental illness ignores safeguards for vulnerable people</a>
</strong>
</em>
</p>
<hr>
<p>But Canada’s families require government support as well. We need to ensure that our health-care system provides necessary services for families. Last year, we called on the Ontario government to fund targeted support for families living with serious and persistent mental illnesses, <a href="https://www.change.org/p/family-day-includes-families-affected-by-mental-illness-they-need-your-help-0cc2c044-c4bf-4de2-a722-ef5eae4f2d05">collecting nearly 1,500 signatures from people who agree family support needs to be a priority</a>. </p>
<p>Living with a recurrent mental illness and having hopes rise and fall when treatments fail is a source of profound suffering for families all over Canada. People diagnosed with mental illness need to be part of the dialogue surrounding MAID eligibility because long-term mental illness can be devastating. At the same time, we have a health-care system that is focused on the short term of crisis and hospitalization, with little thought or investment for the months and years over which individuals and their families must find ways to carry on. </p>
<p>We need to offer more than assistance to death. We need to offer adequate resources and services that will get people help when needed, and support the mental health and well-being of all family members over the long term.</p><img src="https://counter.theconversation.com/content/224057/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charmaine C. Williams receives funding from the Social Sciences and Humanities Research Council (SSHRC). In the past she has received funding from the Canadian Institutes of Health Research (CIHR), the International Development Research Council (IDRC), the Ontario HIV Treatment Network, and the Ministry of Health and Long-Term Care.</span></em></p>In addition to asking health-care systems to prepare to end suffering of mental illness through Medical Assistance in Dying (MAID), we must ask policymakers to support better lives for families.Charmaine C. Williams, Dean and Professor of Social Work, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2199532024-02-12T13:26:57Z2024-02-12T13:26:57ZFamily caregivers face financial burdens, isolation and limited resources − a social worker explains how to improve quality of life for this growing population<figure><img src="https://images.theconversation.com/files/574183/original/file-20240207-27-pcczxx.jpg?ixlib=rb-1.1.0&rect=30%2C30%2C5061%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Family caregivers may be less likely to turn to others when they need their own support. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-woman-pushing-father-in-wheelchair-royalty-free-image/494327497?phrase=caring+for+the+elderly&adppopup=true">Terry Vine/DigitalVision via Getty Images</a></span></figcaption></figure><p>Millions of Americans have <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">become informal family caregivers</a>: people who provide family members or friends with unpaid assistance in accomplishing daily tasks such as bathing, eating, transportation and managing medications. </p>
<p>Driven in part by a <a href="https://www.aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html">preference for home-based care</a> rather than long-term care options such as assisted living facilities, and the <a href="https://doi.org/10.1155/2012/680265">limited availability and high cost</a> of formal care services, family caregivers play a pivotal role in the safety and well-being of their loved ones.</p>
<p>Approximately 34.2 million people in the United States <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">provide unpaid assistance</a> to adults age 50 or above, according to the Family Caregiver Alliance. Among them, about 15.7 million adult family caregivers care for someone with dementia.</p>
<p>I am a licensed clinical social worker and an assistant professor of social work <a href="https://scholar.google.com/citations?user=AikbrQ4AAAAJ&hl=en">studying disparities in health and health care systems</a>. I focus on underrepresented populations in the field of aging. </p>
<h2>Challenges for family caregivers</h2>
<p>In my research focusing on <a href="https://doi.org/10.1093/geront/gnad086">East Asian family caregivers</a> for people with Alzheimer’s and related dementia, I discovered that <a href="https://doi.org/10.1177/07334648221142600">Chinese American</a> and <a href="https://doi.org/10.1080/13607863.2022.2122932">Korean American caregivers</a> often encounter challenging situations. These include discrimination from health care facilities or providers, feelings of loneliness and financial issues. Some of these caregivers even find themselves <a href="https://doi.org/10.1080/13607863.2022.2122932">having to retire early</a> because they struggle to balance both work and caregiving responsibilities. </p>
<p>My findings join a growing body of research showing that <a href="https://doi.org/10.1111/scs.12463">family caregivers</a> commonly <a href="https://doi.org/10.1177/0733464818813466">encounter five specific challenges</a>: financial burdens, limited use of home- and community-based services, difficulties accessing resources, a lack of knowledge about existing educational programs, and physical and emotional challenges, such as feelings of helplessness and caregiver burnout. </p>
<p>However, researchers are also finding that family caregivers feel more capable of managing these challenges when they can tap into formal services that offer practical guidance and insights for their situations, as well as assistance with some unique challenges involved with family caregiving.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dskLxMc2MW0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How to find your way back if you feel that you’ve lost yourself in a caregiving role.</span></figcaption>
</figure>
<h2>The demographics of informal caregivers</h2>
<p>More than 6 in 10 family caregivers are women. </p>
<p>Society has always expected <a href="https://doi.org/10.1093/geront/32.5.607">women to take on caregiving responsibilities</a>. Women also usually earn less money or rely on other family members for financial support. This is because equal pay in the workplace <a href="https://iwpr.org/wp-content/uploads/2020/09/C455.pdf">has been slow to happen</a>, and women often take on roles like becoming the primary caregiver for their own children as well as their aging relatives, which can drastically affect their earnings. </p>
<p>While nearly half of care recipients live in their own homes, 1 in 3 live <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">with their caregivers</a>.</p>
<p>Sometimes termed “resident caregivers,” these individuals are less likely to turn to others outside the family for caregiving support, often because they feel that it’s important to keep caregiving within the family. These caregivers <a href="https://doi.org/10.1080/13607863.2021.1935460">are typically older, retired or unemployed</a> and have lower income than caregivers who live separately.</p>
<p>According to a 2020 report from the AARP Public Policy Institute, about 1 in 3 family caregivers <a href="https://www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html">provide more than 21 hours of care a week</a> to a loved one. </p>
<p><iframe id="4L0re" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/4L0re/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Juggling caregiving with everyday life</h2>
<p>Caregiving often creates financial burdens because it <a href="https://doi.org/10.1093/geronb/gbv095">makes it harder to hold a full-time or part-time job</a>, or to <a href="https://doi.org/10.1093/geronb/gbv095">return to work</a> after taking time off, particularly for spouses who are caregivers.</p>
<p>Often, community-based organizations such as nonprofits that serve older adults offer a variety of in-home services and educational programs. These can help family caregivers <a href="https://www.cdc.gov/aging/caregiving/caregiver-brief.html">manage or reduce</a> the physical and emotional strains of their responsibilities. However, these demands also can make it difficult for some caregivers to even learn that these resources exist, or take advantage of them, particularly as the care recipient’s condition progresses. </p>
<p>These challenges <a href="https://doi.org/10.23750/abm.v93iS2.12979">worsened at the height of the COVID-19 pandemic</a>. Many support programs were canceled, and it was hard to access health care, which made things even more stressful and tiring for caregivers. </p>
<p>Research shows that those who are new to family caregiving often take care of their loved ones <a href="https://www.ncbi.nlm.nih.gov/books/NBK2665/">without any formal support initially</a>. As a result, they may face increased emotional burdens. And caregivers age 70 and above face particular challenges, since they may be navigating their own health issues at the same time. These individuals are less likely to receive informal support, which can lead to social isolation and burnout.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=1000&fit=clip"><img alt="Mature woman places a cardigan on an elderly adult." src="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Caregivers age 70 and above may be navigating their own health challenges with little support.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-caring-for-her-elderly-mother-royalty-free-image/1390975112?phrase=family+caregivers&adppopup=true">Alistair Berg/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<h2>Support for family caregivers</h2>
<p>There are numerous programs and services available for family caregivers and their loved ones, whether they reside at home or in a residential facility. These resources include government health and disability programs, legal assistance and disease-specific organizations, some of which are <a href="https://www.caregiver.org/connecting-caregivers/services-by-state/">specific to certain states</a>.</p>
<p>In addition, research has found that providing appropriate <a href="https://doi.org/10.1046/j.1532-5415.2001.49090.x">education and training</a> to people in the early stages of caregiving enables them to better balance their own health and well-being with successfully fulfilling their responsibilities. Many community-based organizations, such as local nonprofits focused on aging, as well as government programs or senior centers, <a href="https://doi.org/10.1111/jgs.14259">may offer case management services</a> for older adults, which can be beneficial for learning about existing resources and services. </p>
<p>For family caregivers of people with dementia, formal support services are particularly crucial to their <a href="https://doi.org/10.1590/1809-98232016019.150117">ability to cope and navigate the challenges</a> they face.</p>
<h2>The role of Medicaid</h2>
<p>Formal support may also be helpful in finding affordable home-based and community resources that can help compensate for a lack of informal support. These include <a href="https://www.medicare.gov/coverage/home-health-services">home health services</a> funded by Medicare and <a href="https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html">Medicaid-funded providers</a> of medical and nonmedical services, including transportation.</p>
<p>Medicaid, which targets low-income Americans, seniors, people with disabilities and a few select other groups, has certain income requirements. Determine the eligibility requirements first to find out whether your loved one qualifies for Medicaid.</p>
<p>The <a href="http://www.thescanfoundation.org/sites/default/files/the-need-to-include-family-caregiver-assessment-medicaid-hcbs-waiver-programs-report-aarp-ppi-ltc.pdf">services and support covered by Medicaid may vary</a> <a href="https://www.payingforseniorcare.com/medicaid-waivers/home-care">based on a number of factors</a>, such as timing of care, the specific needs of caregivers and their loved ones, the care plan in place for the loved one and the location or state in which the caregiver and their loved one reside. </p>
<p>Each state also has its own Medicaid program with unique rules, regulations and eligibility criteria. This can result in variations in the types of services covered, the extent of coverage and the specific requirements for <a href="https://www.medicaidplanningassistance.org/getting-paid-as-caregiver/">accessing Medicaid-funded support</a>.</p>
<p>If so, <a href="https://www.medicaid.gov/about-us/contact-us/index.html">contact your state’s Medicaid office</a> to get more information about self-directed services and whether you can become a paid family caregiver.</p>
<h2>Medicare might help</h2>
<p>Medicare may <a href="https://www.medicare.gov/coverage/home-health-services">help pay for certain home health services</a> if an older adult needs skilled services part time and is considered homebound.</p>
<p>This assistance can alleviate some of the caregiving responsibilities and financial burdens on the family caregiver, allowing them to focus on providing care and support to their loved ones without worrying about the cost of essential medical services. </p>
<p>Peer-to-peer support is also crucial. Family caregivers who join support groups tend to <a href="https://doi.org/10.1080/13607863.2016.1231169">manage their stress more effectively</a> and <a href="https://doi.org/10.3389/fpubh.2019.00122">experience an overall better</a> <a href="https://doi.org/10.1111/j.1532-5415.1990.tb03544.x">quality of life</a>.</p><img src="https://counter.theconversation.com/content/219953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathy Lee has received funding from the Alzheimer's Association - New to the Field (AARG-NTF-20-678171). </span></em></p>Family caregivers who have stronger support networks and positive communication with loved ones tend to be more resilient.Kathy L. Lee, Assistant Professor of Gerontological Social Work, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2150092023-10-25T13:48:57Z2023-10-25T13:48:57ZMen say they are spending more time on household chores, and would like to do more – survey of 17 countries<p>Women perform between <a href="https://www.equimundo.org/wp-content/uploads/2023/07/State-of-the-Worlds-Fathers-2023.pdf#page=7">three and seven times more caregiving tasks</a> than men in the global south. These include household domestic work and largely focus on caring for children. </p>
<p>Hopefully this is changing. The <a href="https://www.equimundo.org/wp-content/uploads/2023/07/State-of-the-Worlds-Fathers-2023.pdf">2023 State of the World’s Fathers Report</a>, themed “Centering Care in a World in Crisis”, explored the experiences and involvement in caregiving among 12,000 men and women, many of whom are parents, across 17 countries. The survey looked at who does the caregiving, how they care, for whom, and what men and women think about care.</p>
<p>I am one of five co-authors of the report, which unveiled a remarkable appreciation for care among respondents. In an online survey they overwhelmingly associated care with positive terms. “Love” was the most frequently mentioned word across all countries. </p>
<p>Other frequently mentioned words included “help”, “protection”, “attention”, “responsibility”, “health”, “kindness” and “family”.</p>
<p>Most of the men involved in the survey said they were doing care work, and they were willing to do more. But many barriers stood in their way, including societal norms and financial constraints. While the findings of the research point to changes, it also found that the pace of change is far too slow. </p>
<h2>Growing pressure for greater equality</h2>
<p>Earlier this year, United Nations member states unanimously designated <a href="https://www.unwomen.org/en/news-stories/news/2023/08/member-states-agree-on-international-day-of-care-and-support-a-milestone-for-gender-equality-and-sustainable-societies#:%7E:text=This%20international%20day%20shows%20the,key%20lever%20to%20sustainable%20development.%E2%80%9D">29 October as the International Day of Care and Support</a>. This reflects a growing recognition of the value of care and care work, highlighting the urgent need to distribute caregiving responsibilities more equitably. </p>
<p>Providing care for another person can be a positive experience, fostering empathy and meaningful relationships. However the unequal allocation of <a href="https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_633115/lang--en/index.htm">caregiving</a> between men and women has long hindered women’s participation in paid work. </p>
<p>In 2018, the International Labour Oganization estimated 606 million working age women were not able to do so because of unpaid care work. And the heavy burden of care work has had <a href="https://www.researchgate.net/publication/354252144_Women's_wellbeing_and_the_burden_of_unpaid_work">adverse consequences </a>on the physical and mental wellbeing of women.</p>
<h2>Moving in the right direction</h2>
<p>The State of the World’s Fathers report found that mothers still bore a greater share of responsibilities in care work such as cleaning, physical and emotional childcare, cooking and partner care. Women reported performing 1.32 times more physical childcare and 1.36 times more house cleaning than men across all countries surveyed for the report. </p>
<p>But fathers in countries as diverse as Argentina, Ireland, China, Croatia and Rwanda also reported dedicating significant hours to various unpaid caregiving tasks within the household.</p>
<p>The State of the World’s Fathers study attributed this shift to several factors, including the impact of <a href="https://www.who.int/europe/emergencies/situations/covid-19#page=58">COVID-19</a>, evolving gender norms related to caregiving, and structural factors such as care systems and parental leave policies.</p>
<p>In 15 countries, between 70% and 90% of men agreed with the statement, “I feel as responsible for care work as my partner.” </p>
<p>Encouragingly, in some nations like <a href="https://www.equimundo.org/wp-content/uploads/2023/07/State-of-the-Worlds-Fathers-2023.pdf">South Africa (85%) and Rwanda (93%)</a>, men disagreed with the statement, “Boys should not be taught to sew, cook, clean, or take care of their siblings.”</p>
<p>Men who were more emotionally aware and open to seeking emotional support were <a href="https://www.equimundo.org/wp-content/uploads/2023/07/State-of-the-Worlds-Fathers-2023.pdf#page=22">two to eight times</a> more likely to provide care to a family member than those who were not emotionally aware. </p>
<p>Men who spent more time caring for others experienced greater well-being. Respondents who expressed satisfaction with their involvement in raising their children were <a href="https://www.equimundo.org/wp-content/uploads/2023/07/State-of-the-Worlds-Fathers-2023.pdf#page=8">1.5 times</a> more likely to agree with the statement, “I am the person I always wanted to be” and report a sense of gratitude in life than respondents who did not report satisfaction with childrearing. </p>
<h2>Everybody needs to chip in</h2>
<p>It’s important to recognise that caregiving cannot be dependent solely on individual efforts. Men and women alike require the support of communities, care systems and policies to provide care effectively. </p>
<p>More than half of both mothers and fathers considered<a href="https://www.equimundo.org/wp-content/uploads/2023/07/State-of-the-Worlds-Fathers-2023.pdf#page=8"> political activism </a>for care leave policies a priority. This sentiment varied: 57% of fathers and 66% of mothers in India, and 92% of fathers and 94% of mothers in Rwanda supported this cause.</p>
<p>Women were more likely than men to <a href="https://www.equimundo.org/wp-content/uploads/2023/07/State-of-the-Worlds-Fathers-2023.pdf#page=54">prioritise care policies</a> along with healthcare and gender equality policies. Concerns about the cost of living were prevalent among both genders, with slightly more women (58%) than men (53%) expressing this worry. </p>
<p>The study found a significant portion of individuals in all countries reported <a href="https://www.equimundo.org/wp-content/uploads/2023/07/State-of-the-Worlds-Fathers-2023.pdf#page=54">taking action </a>to improve care policies. The majority (74%) discussed the issue with friends and family, while 39% of women and 36% of men signed or shared online petitions. Additionally, 27% of women and 33% of men attended events calling for improved care policies.</p>
<p>Policymakers have an important role to play in reforms for improved parental leave. Better data enables better policies, so there also need to be more accurate statistics on, for example, how many fathers take parental leave, and how time spent on care work is distributed among men and women. </p>
<p>Making it easier for men to share duties in the house is essential if countries are to <a href="https://www.equimundo.org/wp-content/uploads/2023/07/State-of-the-Worlds-Fathers-2023.pdf#page=81">thrive</a>.</p><img src="https://counter.theconversation.com/content/215009/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wessel Van Den Berg works for Equimundo: Center for Masculinities and Social Justice.</span></em></p>The latest State of the World’s Fathers report found a shift in attitudes. In 15 countries, between 70% and 90% of men agreed with the statement, “I feel as responsible for care work as my partner.”Wessel Van Den Berg, Research fellow, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2101052023-09-17T12:07:27Z2023-09-17T12:07:27ZOlder Canadians’ savings are shaped by their long-term care preferences<figure><img src="https://images.theconversation.com/files/547630/original/file-20230911-8406-rbs70z.jpg?ixlib=rb-1.1.0&rect=15%2C38%2C5160%2C3406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A recent study has found that Canadians are highly motivated to save money in preparation of long-term care.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/older-canadians-savings-are-shaped-by-their-long-term-care-preferences" width="100%" height="400"></iframe>
<p>Canada’s aging population is growing. According to the Organization for Economic Co-operation and Development, the proportion of Canadians aged 80 and older <a href="https://www.oecd.org/health/health-at-a-glance/">will surpass nine per cent by 2050</a>, up from 4.3 per cent in 2021. </p>
<p>This demographic shift is happening in most developed nations, and will result in a greater demand for long-term care. Québec, for instance, anticipates that <a href="https://creei.ca/wp-content/uploads/2021/02/cahier_21_01_financement_soutien_autonomie_personnes_agees_croisee_chemins.pdf">600,000 people will need long-term care by 2050</a> — nearly double the current number.</p>
<p>Meanwhile, escalated care expenses in recent years, <a href="https://www.statcan.gc.ca/o1/en/plus/4165-nurses-working-harder-more-hours-amid-increased-labour-shortage">attributed to labour shortages and exacerbated by COVID-19</a>, are a pressing concern.</p>
<h2>The costs of long-term care</h2>
<p>In Québec, <a href="https://bonjourresidences.com/blogue/couts-hebergement-chsld/">the rates (before any income-based subsidy) for public nursing home accommodations are around $2,000 a month</a>. But since public nursing homes have such long waiting lists, some choose private nursing homes instead. The costs of private nursing homes are estimated to be between $5,000 and $8,000 a month.</p>
<p>Home care — <a href="https://theconversation.com/canadians-want-home-care-not-long-term-care-facilities-after-covid-19-170620">a preferred option for many</a> — costs around $5,550 a month, excluding additional expenses like maintenance and food. Consequently, long-term care expenses present a substantial financial risk in old age, potentially motivating people to save for it ahead of time.</p>
<p>While both nursing homes and home care impose financial burdens, their distinct cost structures can influence precautionary savings in different ways. </p>
<p>Nursing homes bundle accommodation and food, offering limited additional services. In contrast, home care recipients can allocate savings for quality-of-life improvements like better food, home maintenance, etc. Additionally, people may inherently value spending more while at home.</p>
<h2>Long-term care and savings</h2>
<p>Our <a href="https://economie.esg.uqam.ca/wp-content/uploads/sites/54/2023/05/2023_02_docdt_eco.pdf">recent research project</a> aimed to understand how preferences for home-based care versus nursing homes affect people’s savings, using both survey responses and a simulation study.</p>
<p>Our research is crucial for two reasons. First, even before the pandemic, a reluctance to be institutionalized — known as <a href="https://doi.org/10.1016/j.jhe.2017.10.001">institutionalization aversion</a> — was documented. Second, COVID-19 has further <a href="https://doi.org/10.1016/j.jebo.2022.06.034">discouraged nursing home entry</a>, possibly due to excess mortality in nursing homes, as has been <a href="https://doi.org/10.1002/hec.4613">documented in many countries</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/inquiry-into-coronavirus-nursing-home-deaths-needs-to-include-discussion-of-workers-and-race-139017">Inquiry into coronavirus nursing home deaths needs to include discussion of workers and race</a>
</strong>
</em>
</p>
<hr>
<p>To model savings in different care settings effectively, we needed to understand how individuals allocated their resources in those settings. To accomplish this, we developed a set of survey questions aimed at uncovering these preferences.</p>
<p>These survey questions were designed to prompt respondents to consider how they would allocate their resources depending on the long-term care setting in a well-defined, hypothetical scenario.</p>
<p>Survey respondents were randomly assigned to different long-term care settings (home care, semi-private room in a nursing home or a private room in a nursing home). Their resource allocation choices allowed us to examine how their preferences for savings varied based on the type of long-term care setting.</p>
<p>Our analysis of 3,000 survey responses shows that Canadians are highly motivated to save money to be better prepared for long-term care. This willingness to save was much larger when respondents expected to use home care; respondents anticipating home care allocated 38 per cent more resources to savings. This reflects the greater financial needs associated with home care.</p>
<h2>Long-term care insurance</h2>
<p>We used the results from our survey to calibrate a simulation study — a computer-based experiment using a combination of economic theories and survey evidence — to simulate how households and individuals make financial decisions.</p>
<p>Our simulation study examined two scenarios: one based on the Canadian system, which includes a universal subsidy that lowers nursing home costs, and one based on the U.S. Medicaid system, which features a purely means-tested subsidy that provides free long-term care and ensures a minimum standard of living for those without sufficient income.</p>
<p>Differences in individual preferences for various care settings largely explain the savings disparities. In the Canada-like system, the prospect of receiving long-term care at home substantially boosts savings. On average, individuals planning to use home care saved $25,000 (8.3 per cent) more by the age of 66, compared to those planning to use private nursing home rooms, and $29,000 (9.8 per cent) more compared to those opting for semi-private rooms. </p>
<p>Under the U.S.-like system, the impacts on savings of different care settings were much smaller. This is because, in the absence of public subsidies, the minimum costs of a room in a nursing home are much higher than those of home care. When comparing the savings of individuals opting for home care versus a private room in a nursing home, the difference in savings was almost null. </p>
<p>However, when comparing savings between those opting for home care versus a semi-private room in a nursing home, we found that the former saved 3.7 per cent more.</p>
<h2>Policy implications</h2>
<p>Assessing how individuals value additional public subsidies for each type of long-term care setting can provide policymakers with valuable insights about how to expand public long-term care insurance effectively. </p>
<p>Our research found that all subsidies are valued well beyond costs, with home care subsidies being more valued than nursing home subsidies. Under the Canada-like system, the average valuation for a home care subsidy was $2.98 per $1 spent, surpassing private ($2.72) and semi-private ($2.35) nursing home subsidies.</p>
<p>Middle-income individuals who aren’t eligible for means-tested programs, but who have limited savings, placed the highest value on these subsidies. This shows that expanding subsidies for home care can be an effective way to protect Canadians from long-term care risks.</p><img src="https://counter.theconversation.com/content/210105/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Louise Leroux receives funding from FRQSC and SSHRC-CRSH. She is affiliated with CIRANO (Montreal) and CESifo (Munich). </span></em></p><p class="fine-print"><em><span>Franca Glenzer receives funding from SSHRC-CRSH. </span></em></p><p class="fine-print"><em><span>Bertrand Achou, Minjoon Lee, and Philippe De Donder do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While both nursing homes and home care impose financial burdens, their differing structures can influence how older Canadians save money.Marie-Louise Leroux, Professeure titulaire en Sciences Economiques, Université du Québec à Montréal (UQAM)Bertrand Achou, Assistant Professor, Economics, University of GroningenFranca Glenzer, Assistant Professor, Department of Finance, HEC MontréalMinjoon Lee, Assistant Professor, Economics, Carleton UniversityPhilippe De Donder, Research director (CNRS), Toulouse School of Economics – École d'Économie de ToulouseLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2124262023-09-14T19:48:11Z2023-09-14T19:48:11ZNavigating the complexities of caregiving for dementia in South Asian communities<figure><img src="https://images.theconversation.com/files/547295/original/file-20230908-43950-v2nuih.jpg?ixlib=rb-1.1.0&rect=103%2C60%2C5647%2C3768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caregiving in South Asian communities is characterized by close family bonds that emphasize respect for elders.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/navigating-the-complexities-of-caregiving-for-dementia-in-south-asian-communities" width="100%" height="400"></iframe>
<p>In 2020, an estimated <a href="https://alzheimer.ca/en/research/reports-dementia/landmark-study-report-1-path-forward">597,000</a> individuals were living with dementia in Canada. By 2030, that number is expected to increase to almost one million, and by 2050, almost 1.7 million. </p>
<p>Dementia is a global struggle affecting many around the world. In South Asian communities, an intricate tapestry of cultures, languages and traditions engenders a caregiving dynamic for those living with dementia.
Dementia care in South Asian households is nuanced and complex and is shaped by cultural, familial and societal forces. </p>
<p>Strong familial bonds and respect for elders provide a foundation for support. However, stigma, language barriers and gendered caregiving roles can create formidable challenges.</p>
<p>By understanding these diverse dynamics, experts and medical practitioners can provide better and more tailored support to South Asians with dementia and the people who care for them.</p>
<h2>Caregiving in South Asian communities</h2>
<p><strong>Strong family bonds:</strong> The South Asian community is characterized by its close-knit family structures, where family members often share caregiving responsibilities. This communal caregiving approach fosters unity and support, allowing individuals with dementia to remain within their familial environment. </p>
<p><strong>Respect for elders</strong>: South Asian cultures traditionally hold elders in high regard. This fosters a sense of duty and responsibility toward caring for aging family members and can translate into a heightened commitment to caregiving for individuals with <a href="https://brill.com/display/title/37884">dementia</a>. </p>
<p>These values are also informed by religious beliefs and cultural practices. In Hinduism, the concept of <a href="https://timesofindia.indiatimes.com/astrology/kundali-dasha-remedies/lal-kitab-remedies-for-pitru-rin/articleshow/68206686.cms">Pitru Rin (debt to ancestors)</a> emphasizes the obligation of children to <a href="https://doi.org/10.1177/1084822312439466">repay their parents for their nurturing and care</a>. Similarly, Islam strongly emphasizes <a href="https://doi.org/10.1007/s11562-020-00458-8">respecting and caring for one’s parents</a> and elderly relatives, as prescribed in the Qur’an and Hadith. In Sikhism, the concept of <a href="https://www.bbc.co.uk/bitesize/guides/zmcf3k7/revision/3">seva (selfless service)</a> extends to caring for elders in the community. Cultural norms and expectations shape the roles and responsibilities of care partners.</p>
<p><strong>Multi-generational households:</strong> Many South Asian households often have multiple generations living under one roof. This arrangement can benefit dementia caregiving, allowing continuous care, emotional support and companionship. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young Indian women places her arms around an older woman wearing a sari and holding a book." src="https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Living in multi-generational households can provide people with dementia continuous care, emotional support and companionship.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Challenges to caregiving</h2>
<p><strong>Stigma and a lack of awareness</strong>: Stigma surrounding dementia is prevalent and can often mean people delay getting medical help and <a href="https://doi.org/10.1177/1471301212444806">lack awareness about available support</a>. This can lead to isolation and a lack of care for people with dementia.</p>
<p><strong>Collectivism:</strong> South Asian cultures emphasize collectivism, where the needs of the family or community take precedence over individual needs. This can influence the decision-making process regarding caregiving arrangements.</p>
<p>While collectivism can provide a robust support network, it can also lead to care partners neglecting their well-being in favour of the needs of the person living with dementia. </p>
<p><strong>Language and cultural barriers:</strong> Language and cultural differences can pose significant challenges in accessing appropriate care and information about dementia. People with dementia and their caregivers may not be fluent in the language of their host country. That can make it especially challenging to communicate effectively with doctors and navigate <a href="https://doi.org/10.1017/S1041610211000214">health-care systems</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/navigating-dementia-care-in-the-south-asian-community-overcoming-barriers-and-stigma-171788">Navigating dementia care in the South Asian community: Overcoming barriers and stigma</a>
</strong>
</em>
</p>
<hr>
<p><strong>Emotional and financial stress:</strong> Caregiving for a loved one with dementia can be emotional and stressful for anyone. The constant demands of caregiving, coupled with the progressive nature of dementia, can lead to caregiver burnout and mental health issues. </p>
<p>In South Asian communities, caregiving responsibilities often fall on daughters or other female relatives due to <a href="https://doi.org/10.1159/000506363">gendered expectations</a> of their role in the family. Women often have to juggle caregiving with their other household and family duties. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close up of an elderly woman's hands being held by a younger woman." src="https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Stigma surrounding dementia and language barriers can often lead to isolation or delayed treatment.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Living in multi-generational households can also bring additional stress for family members tasked with caregiving. Long-term care homes are often viewed negatively due to cultural values that prioritize family unity and the belief that it’s the responsibility of younger generations to care for their elders at home. That can be compounded by financial stress if caregivers have to quit jobs to provide care full-time. </p>
<h2>Supporting caregivers</h2>
<p>Acknowledging and supporting caregivers is crucial for a more equitable future. This support entails recognizing and valuing their unpaid care work.</p>
<p>Employers should promote flexibility and provide workplace resources to ease caregiving burdens. These could include offering flexible work arrangements, adjusted hours and remote working options. They can provide paid family leave to accommodate caregiving needs and consider providing childcare support. </p>
<p>Financial support and legal protections further empower caregivers. These concerted efforts from governments, employers and communities collectively contribute to a more equitable and inclusive society.</p>
<p>By acknowledging the positive aspects of caregiving and addressing the negatives, society can work toward enhancing the well-being of South Asian care partners and individuals with dementia. </p>
<p>It is imperative to address the unique challenges faced by South Asian care partners and individuals with dementia. This includes promoting awareness about dementia, overcoming language barriers in health care and fostering culturally sensitive support networks.</p><img src="https://counter.theconversation.com/content/212426/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Navjot Gill does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dementia care in South Asian households is shaped by cultural, familial and societal forces that bring benefits and challenges.Navjot Gill, Doctoral Candidate, Aging, Health and Well-being, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2061512023-09-01T14:24:12Z2023-09-01T14:24:12ZWomen are less happy than men – a psychologist on why and four things you can do about it<figure><img src="https://images.theconversation.com/files/544784/original/file-20230825-29-eolc04.jpg?ixlib=rb-1.1.0&rect=451%2C0%2C4335%2C3401&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Carve out time for yourself to avoid getting overwhelmed.</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/faceless-unhappy-woman-covering-face-6383282/">pexels/liza summer</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/women-are-less-happy-than-men-a-psychologist-on-why-and-four-things-you-can-do-about-it-206151&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p>Something strange is going on in women’s happiness research. Because despite having more freedom and employment opportunities than ever before, women have <a href="https://www.aeaweb.org/articles?id=10.1257/pol.1.2.190">higher levels of</a> <a href="https://www.nber.org/papers/w29893">anxiety and more mental health challenges</a>, such as depression, anger, loneliness and more restless sleep. And these results are seen across many countries and different age groups. </p>
<p>A recent survey conducted by the American Psychological Association may hold some clues as to why. The results found that most US women are <a href="https://www.apa.org/monitor/2022/03/numbers-women-society">unhappy with how society treats them</a>. </p>
<p>Many women are still the main caregivers for children and elderly relatives. Most also have the double burden of <a href="https://idl-bnc-idrc.dspacedirect.org/bitstream/handle/10625/56506/IDL-56506.pdf">managing the home and family arrangements</a> on top of paid work responsibilities. And within the workplace three in five women have experienced bullying, <a href="https://www.tuc.org.uk/news/new-tuc-poll-2-3-young-women-have-experienced-sexual-harassment-bullying-or-verbal-abuse-work#:%7E:text=Three%20in%20five%20(58%25),poll%20published%20today%20(Friday)">sexual harassment or verbal abuse</a>.</p>
<p>The gender gap in wellbeing was notably documented during the pandemic, as many women took on more domestic and caregiving responsibilities <a href="https://link.springer.com/article/10.1007/s00737-020-01092-2">on top of work</a>. But it was also noted that although women took a bigger hit to their wellbeing they were quicker to recover, <a href="https://www.nber.org/system/files/working_papers/w29893/w29893.pdf">which seems to indicate that</a><a href="https://www.nber.org/system/files/working_papers/w29893/w29893.pdf">women are more emotionally resilient</a> than men.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/spain-is-the-egg-donation-capital-of-europe-heres-what-its-like-to-be-a-donor-205780">Spain is the egg donation capital of Europe – here’s what it’s like to be a donor</a></em></p>
<p><em><a href="https://theconversation.com/dirty-red-how-periods-have-been-stigmatised-through-history-to-the-modern-day-206967">‘Dirty red’: how periods have been stigmatised through history to the modern day</a></em></p>
<p><em><a href="https://theconversation.com/how-tracking-menopause-symptoms-can-give-women-more-control-over-their-health-209004">How tracking menopause symptoms can give women more control over their health</a></em></p>
<hr>
<p>One of the factors that may contribute towards women’s resilience is social connection. In one 2019 study, researchers found that women scored higher than men for positive relationships with others as well as <a href="https://www.mdpi.com/1660-4601/16/19/3531">capacity for personal growth</a>. In essence, women tend to be better than men at getting support. They ask for help sooner and so are more likely to overcome adversity quicker.</p>
<p>Women have also been found to place greater value on social connections than men. Studies have found that <a href="https://link.springer.com/article/10.1007/s40750-020-00155-z">women’s friendships are more intimate</a> – women favour face-to-face interactions that enable more self-disclosure and emotional support. Whereas men’s friendships tend to be more <a href="https://link.springer.com/article/10.1007/s11199-011-0109-z">side by side, pursuing shared activities</a>. Think catching up watching a football match versus catching up over coffee. Again this may explain the buffer to women’s mental health. </p>
<h2>Happiness versus purpose</h2>
<p>Although women may not be as happy in the moment as men and face greater social inequality, <a href="https://journals.sagepub.com/doi/full/10.1177/0022167818777658?casa_token=OaqZQu3c9NQAAAAA%3AfQsOc1SccjHMqHDsTTpeDAT60kS2zgY_dXlSm5csM0g_zOOa0LVi7Kopxg7-weQiAhKT1uHp-jA9">a recent study suggests</a> that women report having more purpose in their lives. And having meaning and purpose in life is associated with better health and living longer.</p>
<figure class="align-center ">
<img alt="Two women, old and young spending time together." src="https://images.theconversation.com/files/544782/original/file-20230825-24-pzte95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544782/original/file-20230825-24-pzte95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544782/original/file-20230825-24-pzte95.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544782/original/file-20230825-24-pzte95.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544782/original/file-20230825-24-pzte95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544782/original/file-20230825-24-pzte95.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544782/original/file-20230825-24-pzte95.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women are more likely to take on caregiving roles as well as volunteer to help other people.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/joyful-adult-daughter-greeting-happy-surprised-senior-mother-in-garden-3768131/">pexels/andrea piacquadio</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The study found that women tend to engage in more altruistic endeavours, such as supporting others and charity volunteering which leads to a greater sense of meaning and purpose. </p>
<p>However, the researchers also point out that this is likely linked to cultural norms of women being encouraged to put the needs of others first. While putting others first does not necessarily make you happier, having a sense of meaning in life definitely contributes towards happiness.</p>
<p>Given all this, women need to make time for themselves to protect their wellbeing. Here are four evidence-based ways to help you do this:</p>
<h2>1. Try therapy</h2>
<p>Having a place just for you, where you can talk about how you feel and express your emotions is important for your psychological wellbeing. Art-based therapies are <a href="https://www.tandfonline.com/doi/full/10.1080/17454832.2017.1317004?casa_token=JZ3JZDeTtK4AAAAA%3A-RN84vcWUDDDHTuPsjWtTFafCiBbdRfYV6Y765r1lm2AubXRL4fBvGcrFoxuwM-pXv-aj9vobUUa2Q">particularly beneficial for women</a> as are <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.12168?casa_token=hhEGS5Y90tIAAAAA%3APZbZLIiFuYydiPbBDhgrfp5qnzDJCXXHZaLlF1ecZ4NcjlWPzdCs8X2J-0NeouCL5q7-oZ1kmVaCD1c">group-based interventions</a> that allow women to speak openly with other women – which can <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/jocn.12168?casa_token=A5uR9LrmsvEAAAAA:062vY0B6NXh1yoJ84C35T5_SHNcIrkuIWXbiKGAGaRCZX1zfsESoLBbeKJhlXQwOfL_q96gepabjook">reduce feelings of stigma and shame</a>.</p>
<h2>2. Connect with nature</h2>
<p>Spending time outdoors in natural settings can be very comforting. <a href="https://www.tandfonline.com/doi/full/10.1080/02508281.2021.1917892?casa_token=n1rYt4Je7RQAAAAA%3AkBm1mtyqLaL1AUoUUEgHhqs1n2CFFCDYRByd23CVTHa9tgffKEJLACsh7yGXdflZ1_rLj7lP0zMu">A recent study</a> found that nature-based interventions are particularly healing for women who have experienced trauma or illness . Indeed, as women, our biology and values often <a href="https://rupture.ie/articles/women-and-nature">align with the natural world</a>. The term “Mother Earth” reflects the feminine tendency to be life-giving and nurturing. </p>
<p>So make sure you factor some time outside in nature into your daily or weekly plans. A walk on the beach, a run through the woods or reading a book in the park, it all helps.</p>
<h2>3. Move yourself</h2>
<p>Studies show that when women engage in regular physical activity it increases <a href="https://www.sciencedirect.com/science/article/pii/S2211266923000142">self-acceptance and personal growth</a>. Aerobic exercise is particularly helpful for <a href="https://www.cambridge.org/core/journals/journal-of-the-international-neuropsychological-society/article/longterm-effects-of-resistance-exercise-training-on-cognition-and-brain-volume-in-older-women-results-from-a-randomized-controlled-trial/EE3CD46849DB34FAFCC6E00D8FC3E8F7">cognitive health as women age</a>. High impact, weight-bearing exercise such as jumping and running improve <a href="https://www.mdpi.com/2076-3417/11/2/846">bone health for women in middle age</a> and regular moderate exercise, such as walking has been shown to <a href="https://journals.lww.com/menopausejournal/abstract/2020/08000/can_walking_exercise_programs_improve_health_for.17.aspx">improve symptoms of the menopause</a>.</p>
<h2>4. Cut down on alcohol</h2>
<p>Women face gender-specific risks related to alcohol, including a greater risk of being a <a href="https://movendi.ngo/news/2019/05/28/who-alcohol-major-factor-in-violence-against-women/">victim of violence</a> and more health-related issues such as <a href="https://www.cdc.gov/alcohol/fact-sheets/womens-health.htm">heart disease and breast cancer</a>. Women also become intoxicated quicker than men which can make them <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502688/">more vulnerable</a>. </p>
<p>Given that women are twice as likely as men to experience anxiety, reducing or eliminating alcohol may be sensible. Indeed, research shows quitting alcohol can significantly <a href="https://www.psychiatry.org/news-room/apa-blogs/for-women-quitting-alcohol-can-improve-well-being">improve women’s health and happiness</a>.</p><img src="https://counter.theconversation.com/content/206151/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lowri Dowthwaite-Walsh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Women’s wellbeing paradox: unhappier than men but more social, with higher levels of emotional resilience.Lowri Dowthwaite-Walsh, Senior Lecturer in Psychological Interventions, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088142023-08-24T12:27:03Z2023-08-24T12:27:03ZLGBTQ+ caregivers of people with dementia face unique stresses that lead to poorer physical and mental health<figure><img src="https://images.theconversation.com/files/544371/original/file-20230823-21-jnisva.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2120%2C1414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">LGBTQ+ caregivers from racial minorities reported experiencing poorer family quality of life and higher depressive symptoms.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/nurse-or-home-caregiver-and-senior-woman-holding-royalty-free-image/1397344056">FG Trade/E+ via Getty Images</a></span></figcaption></figure><p>Caring for someone living with dementia can be a <a href="https://www.alz.org/alzheimers-dementia/facts-figures">stressful experience</a> that harms the physical and mental health of caregivers. Many caregivers experience <a href="https://doi.org/10.1377/hlthaff.2015.0536">depression and lower quality of life</a>. LGBTQ+ caregivers face unique challenges that can magnify these strains.</p>
<p><a href="https://www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html">Around 8%</a> of the estimated 50 million-plus caregivers of adults or children with special needs in the U.S. identify as LGBTQ+, with many caring for someone living with dementia. LGBTQ+ caregivers have experienced <a href="https://doi.org/10.1177/08982643211014767">discrimination, isolation, stigma and other stressors</a> related to their sexual orientation or gender identity and generally have <a href="https://doi.org/10.17226/25877">poorer physical and mental health</a> than non-LGBTQ+ caregivers. Yet existing programs and services, such as caregiver support groups and respite services, do not account for their unique needs.</p>
<p><a href="https://scholar.google.com/citations?user=w7nWmsMAAAAJ&hl=en">As a researcher</a> exploring the health effects of caring for someone living with dementia, I am interested in developing strategies to alleviate strain on caregivers and improve their quality of life. Because of limited research on LGBTQ+ caregivers of people living with dementia, my team and I have been collecting data to address the health disparities they experience. Understanding how sexual orientation and gender identity affect the lives of caregivers can help tailor services and programs to support their health. </p>
<h2>LGBTQ+ caregivers by the numbers</h2>
<p>In our study, we asked 415 caregivers – 286 of whom were LGBTQ+ – to complete an online survey consisting of questions about their health and caregiving experiences. Gay, lesbian, bisexual, queer and transgender caregivers were represented, with over 40% of LGBTQ+ respondents identifying as gay men.</p>
<p>The majority, nearly 80% of LGBTQ+ caregivers, were white, while over a third identified as Latino. The majority of the LGBTQ+ caregivers, ranging in age from 21 to 72, were millennials ages 38 or younger. Half of the LGBTQ+ caregivers were the spouse or partner of the person with dementia, and a tenth were caring for an unrelated friend.</p>
<p>Overall, LGBTQ+ caregivers were significantly <a href="https://doi.org/10.1177/07334648221079496">younger and more racially and ethnically diverse</a> than their non-LGBTQ+ counterparts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544372/original/file-20230823-21-1nwcs7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Caregiver helping older adult using cane walk in a room" src="https://images.theconversation.com/files/544372/original/file-20230823-21-1nwcs7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544372/original/file-20230823-21-1nwcs7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544372/original/file-20230823-21-1nwcs7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544372/original/file-20230823-21-1nwcs7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544372/original/file-20230823-21-1nwcs7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544372/original/file-20230823-21-1nwcs7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544372/original/file-20230823-21-1nwcs7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">LGBTQ+ caregivers may be less likely to seek out supportive services because of a potential risk of discrimination.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caregiver-helping-senior-woman-patient-walking-royalty-free-image/1440560116">Phynart Studio/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>LGBTQ+ caregivers were also more likely to be working full or part time, to have never married, and to be caring for their friends or “chosen” family. In contrast, non-LGBTQ+ caregivers were more likely to be retired and caring for their spouse.</p>
<p>Despite relatively high levels of income among LGBTQ+ caregivers overall, lesbian and bisexual caregivers experienced significantly higher levels of difficulty in paying for everyday basics, and queer caregivers more frequently reported incomes of less than US$30,000. </p>
<p>Caregivers who were lesbian or <a href="https://theconversation.com/reviled-reclaimed-and-respected-the-history-of-the-word-queer-197533">queer</a> – an umbrella term for people who are not heterosexual – more likely needed to travel to provide care, while bisexual caregivers more frequently resided with their care recipients.</p>
<h2>Higher stress</h2>
<p>LGBTQ+ caregivers may be experiencing higher levels of stress than non-LGBTQ+ caregivers because they <a href="https://doi.org/10.1093/swr/svu030">seek out supportive services less frequently</a>. The need to disclose their sexual orientation or gender identity to service providers and support groups <a href="https://doi.org/10.1080/01634372.2015.1072759">increases the potential risk</a> for discrimination, microaggressions, stigma and being outed. </p>
<p>We found that 75% of LGBTQ+ caregivers of people with dementia reported moderate to high levels of perceived stress, and 78% experienced depressive symptoms. These negative health effects were significantly associated with experiences of <a href="https://doi.org/10.1177/08982643211014767">microaggressions, discrimination and stigma</a> related to their gender identity or sexual orientation in their everyday lives. </p>
<p>Given the diversity of experiences among LGBTQ+ caregivers, different identities experienced <a href="https://doi.org/10.1177/08982643211014767">different types of caregiving strain</a>. For example, bisexual and queer caregivers experienced higher stress than those with other identities. Queer caregivers also experienced higher levels of depressive symptoms.</p>
<p>Importantly, caregivers of all LGBTQ+ identities <a href="https://doi.org/10.1177/08982643211014767">met the criteria for probable clinical depression</a> and had significantly higher mean depressive symptom scores than those of non-LGBTQ+ caregivers.</p>
<p>Queer caregivers and caregivers who experienced more microaggressions reported poorer <a href="https://doi.org/10.1093/geront/gnaa022">family quality of life</a>, defined as a sense of well-being of the family. Gay male caregivers reported the highest levels of caregiver stigma. Racial minority LGBTQ+ caregivers also reported poorer family quality of life and higher levels of depressive symptoms.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/fmUugr62gE8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Many LGBTQ+ older adults living in assisted living facilities hide their identity in fear for their safety.</span></figcaption>
</figure>
<p>We also asked caregivers for general feedback about their experiences overall and whether they found it difficult to answer any of our questions. Several caregivers found that questions about family lacked nuance. “Some of my family is very supportive, but many family members are actively hostile and unhelpful,” one participant shared. Many caregivers emphasized the distinction between biological and chosen family. </p>
<p>These comments <a href="https://doi.org/10.1186/s12877-023-03914-1">echo those from other studies</a> on LGBTQ+ caregivers of people with Alzheimer’s disease. Many shared that they often experience isolation, financial strain, lack of support and connection, and stigma and discrimination.</p>
<h2>An understudied problem</h2>
<p>Our findings suggest that there are statistically and clinically significant differences in the physical and mental health of LGBTQ+ caregivers as compared with non-LGBTQ+ caregivers. But further research is necessary to understand how the stress of being an LGBTQ+ person and the stress of being a caregiver interact with each other. In 2018, the National Institute on Aging funded <a href="https://dpcpsi.nih.gov/sites/default/files/SGMRO_2018_PortfolioAnalysis_RF508_FINAL.pdf">only seven studies focused on LGBTQ+ aging</a>.</p>
<p>To address the underrepresentation of LGBTQ+ caregivers in aging research, my colleagues and I started the <a href="https://www.theriseregistry.org">RISE Project</a>. Our goal is to recruit LGBTQ+ caregivers of people living with dementia and memory loss in communities around the nation to get them involved in research.</p>
<p>Bolstered by recognition from the <a href="https://dpcpsi.nih.gov/sites/default/files/SGMStrategicPlan_2021_2025.pdf">National Institutes of Health</a> and <a href="https://nap.nationalacademies.org/catalog/25877/understanding-the-well-being-of-lgbtqi-populations">National Academies of Science, Engineering, and Medicine</a> that further study is needed, more researchers are studying health inequities among LGBTQ+ people. </p>
<p>A better understanding of the experiences of LGBTQ+ caregivers is a key step toward programs, policies and services that support their well-being.</p><img src="https://counter.theconversation.com/content/208814/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joel G. Anderson receives funding from the National Institute on Aging of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. He is affiliated with Healing Beyond Borders.</span></em></p>Discrimination, isolation and stigma related to sexual orientation or gender identity likely contribute to the higher rates of depression and lower quality of life of LGBTQ+ caregivers.Joel G. Anderson, Associate Professor of Nursing, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2102292023-08-15T12:35:07Z2023-08-15T12:35:07ZDaily report cards can decrease disruptions for children with ADHD<figure><img src="https://images.theconversation.com/files/542161/original/file-20230810-23-1fhmc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Students with ADHD who get a daily report card had 4.5 fewer rule violations per 30-minute class than those without one, one study found.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/father-looking-very-happy-looking-at-his-daughters-royalty-free-image/1389796720">Hispanolistic/E+ Collection/Getty Images</a></span></figcaption></figure><p>As another school year approaches, some caregivers, students and teachers may be feeling something new needs to happen to promote success in the classroom. </p>
<p>Daily report cards can be a great starting point.</p>
<p>As a clinical psychologist who studies <a href="https://scholar.google.com/citations?user=BRXERkMAAAAJ&hl=en">how schools can help students with attention-deficit/hyperactivity disorder</a>, I know traditional report cards distributed three or four times per year don’t do enough to make a difference for children who are prone to outbursts or other challenging behaviors. </p>
<p>Studies <a href="https://doi.org/10.1177/0014402917706370">conducted by my team</a> <a href="https://doi.org/10.1177/1087054717734646">and others</a> support the idea that these students are better served by <a href="https://doi.org/10.1080/02796015.2010.12087748">daily report cards</a>. </p>
<h2>Track daily progress</h2>
<p>Daily report cards date back at least to the 1960s, when they were used in a study involving children attending a <a href="https://doi.org/10.1901/jaba.1970.3-223">special education summer school</a>. </p>
<p>Today they are commonly used for <a href="https://doi.org/10.1177/0014402917706370">children with ADHD</a> in both <a href="https://doi.org/10.1007/s12310-020-09375-w">general education</a> and <a href="https://doi.org/10.1080/02796015.2010.12087775">special education</a> classrooms. Daily report cards have also been used for <a href="https://files.eric.ed.gov/fulltext/ED607134.pdf">students with autism</a> without intellectual disability. And one study found that many teachers say they use <a href="https://doi.org/10.1177/10983007060080030601">versions of a daily report card</a> for brief periods to address behaviors across many different school situations.</p>
<p>A daily report card can be very <a href="https://ccf.fiu.edu/research/_assets/how_to_establish_a_school_drc.pdf">easy for teachers</a> to <a href="https://doi.org/10.1080/10474412.2013.785182">create and use</a>, either with <a href="https://mygoalpal.fiu.edu">an app</a> or by developing them on their own. First, the teacher along with others – who may include the parents, principal, school psychologist or counselor, and even the child if appropriate – should meet to establish goals. Goals should be positively phrased, such as: “Completed work within time given” or “Participated in class discussions without interruption.” </p>
<p>Once set up, the daily report card can take just 10 seconds to complete. The time savings are significant when one considers the alternatives typically used in schools, such as repeated redirection or reprimanding, or sending the student to the principal’s office to be monitored.</p>
<p>Daily report cards also work. </p>
<p>A 2010 study evaluated children with ADHD where half had a daily report card and half did not. Those with the daily report card had an average of <a href="https://doi.org/10.1080/02796015.2010.12087775">4.5 fewer rule violations</a> per 30-minute class than those without one. Extrapolating across a school day, that is 54 fewer daily rule violations on average, and over 10,000 per school year. </p>
<figure class="align-center ">
<img alt="Example of a daily report card used in schools" src="https://images.theconversation.com/files/542048/original/file-20230810-25-k9dewx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542048/original/file-20230810-25-k9dewx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542048/original/file-20230810-25-k9dewx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542048/original/file-20230810-25-k9dewx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542048/original/file-20230810-25-k9dewx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542048/original/file-20230810-25-k9dewx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542048/original/file-20230810-25-k9dewx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An example of a daily report card.</span>
<span class="attribution"><span class="source">Florida International University Center for Children and Families</span></span>
</figcaption>
</figure>
<h2>Realistic goals</h2>
<p>For many children with challenging behaviors, it is important to set goals that can be easily reached – at least at first. </p>
<p>Over time, the goals can be made more challenging as the child experiences success – a <a href="https://www.routledge.com/Behavior-Modification-What-It-Is-and-How-To-Do-It/Martin-Pear/p/book/9780815366546">process called shaping</a>. For example, if a child interrupts a lesson by calling out about five times per class, the initial goal may be set at “Participates in lesson with no more than four interruptions.” </p>
<p>This would represent an improvement, and it would also ensure the goal was reachable. Once the child met the goal for three to five days in a row, the goal could be changed to “Participates in lesson with no more than three interruptions.”</p>
<h2>Positive parent-teacher communications</h2>
<p>Teachers tend to <a href="https://doi.org/10.1037/spq0000442">communicate with caregivers more frequently</a> when a child is experiencing difficulties in the classroom. But these communications often focus on <a href="https://www.additudemag.com/mean-teacher-comments-adhd-students/">negative behaviors</a>. As a result, they can <a href="https://doi.org/10.1080/00131911.2019.1666794">strain relationships</a> between the caregiver and the teacher. Other times, it may result in the caregiver’s avoiding communication with the school. </p>
<p>Daily report cards can result in more positive and solution-focused communication instead of reports focusing only on what went wrong and can therefore enhance caregiver-teacher communication.</p>
<h2>Motivating rewards</h2>
<p>Importantly, the daily report card should be linked to home-based privileges and rewards so that children are motivated to meet daily goals.</p>
<p>At the end of the day, the child brings their daily report card home and, based on their behavior at school that day, home privileges such as an allotment of screen time or a slightly later bedtime can be used as rewards.</p>
<p>Importantly, this is not a punishment program in which a child loses privileges if goals are not met. It also is not bribing the child by providing a reward before an appropriate behavior is completed. Rather, the child starts the day without home privileges and earns them based on positive school behavior. The daily report card tells the child exactly what goals need to be met to earn the motivating privileges. This small difference can be quite powerful for the child because it puts them in charge of how they earn access to things they like to do at home based on how they behaved at school that day.</p>
<p>Evidence suggests this home-based reward system is <a href="https://doi.org/10.1080/02796015.2010.12087775">one of the biggest factors</a> in whether the daily report card is successful. It also provides a new opportunity for the child and caregiver to have a positive discussion about school each day.</p>
<h2>Better than medication?</h2>
<p>There is also evidence that the daily report card is a <a href="https://doi.org/10.1080/15374416.2015.1055859">cost-effective approach</a> for children with ADHD as an <a href="https://doi.org/10.1080/15374416.2015.1105138">alternative to medication treatment</a>. </p>
<p>My colleagues and I conducted a study in which children with ADHD were randomly assigned to start the school year with either medication or a daily report card. The parents of those assigned the daily report cards took part in classes that taught them how to provide home rewards for it. At the end of the year, the students who started with the daily report card had half as many discipline referrals and 33% fewer disruptive behaviors observed in the classroom than the students receiving medication. The daily report card approach also <a href="https://doi.org/10.1080/15374416.2015.1055859">cost less than daily medication</a>. The students who started the school year with the daily report card had overall treatment costs of US$708 less than the students starting with medication.</p>
<p>Teachers and caregivers who want to learn more about daily reports cards can check out the <a href="https://ccf.fiu.edu/research/_assets/how_to_establish_a_school_drc.pdf">downloadable workbook</a> or <a href="https://mygoalpal.fiu.edu">free app</a> designed by my colleagues at Florida International University’s <a href="https://ccf.fiu.edu/">Center for Children and Families</a>. Both resources allow caregivers and teachers to set goals and track a student’s progress. Starting the school year with a daily report card should help the child achieve the positive days needed to get a good grade on their report card at the end of the grading period.</p><img src="https://counter.theconversation.com/content/210229/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gregory Fabiano receives funding from the Department of Education and the National Institutes of Health to study positive behavioral supports like the Daily Report Card. Gregory Fabiano also receives royalties from Guilford Publications for a book written about Daily Report Cards.</span></em></p>Traditional report cards sent home every few months are fine for most students. But for kids with behavioral issues, a daily report card can be a better option.Gregory Fabiano, Professor of Psychology, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2101542023-08-08T12:29:52Z2023-08-08T12:29:52ZOlder ‘sandwich generation’ Californians spent more time with parents and less with grandkids after paid family leave law took effect<figure><img src="https://images.theconversation.com/files/541049/original/file-20230803-27-xpn12q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4535%2C2841&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nearly a dozen states have enacted these policies so far.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-taking-care-of-old-woman-in-wheelchair-royalty-free-image/970176900?adppopup=true">Westend61 via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>A California law that mandates paid family leave has led to adults in their 50s, 60s and 70s spending more time taking care of their parents and less time being their grandkids’ caregivers.</p>
<p>The law requires all employers to allow eligible workers to <a href="https://edd.ca.gov/en/disability/Am_I_Eligible_for_PFL_Benefits/">take up to six weeks of paid leave</a> to care for newborns, newly adopted children or seriously ill family members.</p>
<p>From 2006, two years after the law went into effect, to 2016, <a href="https://ca.db101.org/ca/situations/workandbenefits/rights/program2c.htm">this policy led to older adults’ spending 19 fewer hours</a> per year caring for their grandchildren, a 17% decrease. They spent 20 additional hours on average helping their own parents, a 50% increase. </p>
<p>The effect was most striking for people with newborn grandchildren and parents in need of help, but the law also benefited Californians with older grandchildren and those who don’t have parents requiring their assistance.</p>
<p><a href="https://doi.org/10.1080/08959420.2023.2226283">These findings</a> are from research I conducted with <a href="https://scholar.google.com/citations?user=yWNlAzcAAAAJ">Marcus Dillender</a>, a fellow economist. They suggest the law had effects through two channels. It enabled older adults to take paid leave to care for relatives with medical needs and it reduced the need for older adults to care for their grandchildren by granting paid parental leave to these children’s parents.</p>
<p>To assess how older adults spend their time, we analyzed data for people between the ages of 50 and 79 from the Health and Retirement Study, a <a href="https://hrs.isr.umich.edu/">longitudinal study of approximately 20,000 Americans</a>.</p>
<p>The survey asks respondents in that age group how much time they spend taking care of their grandchildren and helping their aging parents with basic personal activities like dressing, eating and bathing. We compared outcomes for people who lived in California with what happened to Americans in other states before and the law’s enactment.</p>
<p>We also looked into what happened for people who had different combinations of caregiving obligations – grandchildren less than 2 years old or older grandkids, or parents who need help or no parents requiring assistance.</p>
<h2>Why it matters</h2>
<p>The U.S. is the only wealthy country that <a href="https://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf">doesn’t require employers to provide paid family leave</a>. California was the first state to implement its own policies; <a href="https://www.ncsl.org/labor-and-employment/state-family-and-medical-leave-laws">10 others and the District of Columbia</a> have followed suit so far.</p>
<p>These policies can significantly affect older adults, who spend substantial time caring for their relatives.</p>
<p>Caregiving has become a more urgent policy issue because of the growing number of Americans who feel that they belong to a “<a href="https://www.michiganmedicine.org/health-lab/sandwich-generation-study-shows-challenges-caring-both-kids-and-aging-parents">sandwich generation</a>” of people who have to take care of their children or grandchildren and their parents at the same time. </p>
<h2>What other research is being done</h2>
<p>Other research has found that California’s paid family leave policy doubled the overall length of maternity leave by new mothers, <a href="https://doi.org/10.1002/pam.21676">increasing it from an average of three weeks to six weeks</a>. It also upped the likelihood that <a href="https://doi.org/10.1002/pam.22030">fathers take parental leave</a> following the birth or adoption of a child by 46% – although <a href="https://doi.org/10.1002/pam.21894">fathers take less leave on average than mothers</a>.</p>
<p>According to some of the many other studies conducted so far, California’s paid family leave law helped workers with caregiving responsibilities stay employed by allowing them to take time off with reduced financial risk and increased job continuity, <a href="https://doi.org/10.1093/workar/waab022">including for those ages 45 to 64 with a disabled spouse</a> and <a href="https://doi.org/10.1093/geront/gny105">middle-aged female caregivers</a>. The law has, in addition, reduced the share of elderly people using nursing homes by <a href="https://doi.org/10.1002/pam.22038">facilitating more informal care</a>.</p><img src="https://counter.theconversation.com/content/210154/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joelle Abramowitz receives funding from the National Institute on Aging, the Social Security Administration and the National Science Foundation. </span></em></p>The law changed older adults’ caregiving behavior because their children became more able to take paid time off work to care for their own newborns.Joelle Abramowitz, Assistant Research Scientist at the Survey Research Center, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2086502023-07-21T12:27:32Z2023-07-21T12:27:32ZBluey teaches children and parents alike about how play supports creativity – and other life lessons<figure><img src="https://images.theconversation.com/files/536621/original/file-20230710-16123-hbig7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The playful Heeler family has amassed fans of all ages.</span> <span class="attribution"><a class="source" href="https://bbcw.box.com/s/ji22tfwxhdjokpvkmqj1w8eefn8ucmdc">Ian Kitt/BBC Studios</a></span></figcaption></figure><p><a href="https://mashable.com/article/bluey-kids-show-for-adults">Adults and kids</a> love <a href="https://www.bluey.tv/">Bluey</a>. This Australian animated show – hugely <a href="https://www.newidea.com.au/bluey-streaming">popular in the U.S.</a> as well – focuses on a family of blue heeler dogs living in Brisbane. The seven-minute episodes feature 6-year-old Bluey; her 4-year-old sister, Bingo; her mom, Chilli; and her dad, Bandit. They depict the beauty of childhood and portray the realities of being a parent in our current age. </p>
<p>As <a href="https://scholar.google.com/citations?user=0TfM-kYAAAAJ&hl=en&oi=ao">developmental scientists</a> <a href="https://sdlab.fas.harvard.edu/people/aria-gast%C3%B3n-panthaki">who study children</a> and <a href="https://scholar.google.com/citations?user=beCz8i0AAAAJ&hl=en&oi=ao">how they interact with the world</a>, we sort of adore Bluey too. </p>
<p>The show exemplifies what years of child psychology research have made clear: that <a href="https://www.doi.org/10.13140/RG.2.2.16823.01447">children learn through play</a>. Bluey illustrates a variety of age-appropriate caregiving practices that parents and caregivers can use in the everyday life of a child. Below we highlight five lessons depicted in select episodes and explain how certain scenes can provide inspiration for playful learning opportunities for all families.</p>
<h2>1. Support children’s creativity</h2>
<p>In the “<a href="https://www.bluey.tv/watch/season-3/rain/">Rain</a>” episode, Chilli and Bluey get caught in a downpour. While Mom runs inside, Bluey is thrilled to be out in the rain and begins to build a dam against the water on a walkway. When her hands can’t contain the water, she tries a variety of household objects – blocks, an umbrella, a dollhouse – to do the job. Importantly, Bluey does not give up and continues to find creative solutions to reach her goal. </p>
<p>Researchers and leaders in a variety of industries point to <a href="https://learningthroughplay.com/explore-the-research/why-creativity-matters-and-how-we-can-nurture-it">creative innovation</a> as a top skill that children will need to be successful in <a href="https://www.brookings.edu/articles/a-new-path-to-education-reform-playful-learning-promotes-21st-century-skills-in-schools-and-beyond/">tackling the upcoming challenges</a> of the 21st century. </p>
<p>Instead of stopping Bluey, Chilli recognizes how driven her daughter is to meet her goal, so she braves the rain and helps her to successfully build the dam. Chilli represents how <a href="https://www.pbs.org/parents/thrive/creative-play-the-real-work-of-childhood">caregivers can foster children’s creativity</a> by asking open-ended questions and allowing children to explore various ways of solving a problem. </p>
<h2>2. Use everyday materials for play</h2>
<p>In “<a href="https://www.bluey.tv/watch/season-2/flatpack/">Flatpack</a>,” after returning from the ready-to-assemble furniture store, Chilli and Bandit toss extra packaging from their new porch swing into the backyard. Bluey and Bingo use these items to construct a fantasy world. The girls let their imaginations take them on a journey from swimming like fish in a foam pond to hopping like frogs on a cardboard island.</p>
<p>Play experts use the term “<a href="https://extension.psu.edu/programs/betterkidcare/early-care/tip-pages/all/loose-parts-what-does-this-mean">loose parts</a>” for items without a defined play purpose that can be used in many ways and encourage children’s creativity. This episode shows Bluey and Bingo engaged in <a href="https://learningthroughplay.com/explore-the-research/engaging-young-children-in-play">free play</a> with such objects and portrays how deeply children can play even if they don’t have conventional toys or guidance from a caregiver.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/MmuDI7lbJpk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Bluey’s seven-minute episodes often center on the importance of play.</span></figcaption>
</figure>
<h2>3. Help kids process emotions through play</h2>
<p>Play is a natural way that children <a href="https://doi.org/10.1093/acprof:oso/9780195304381.001.0001">emotionally process</a> a variety of difficult experiences. Childhood experts emphasize that <a href="https://howtoddlersthrive.com/book/">pretend play gives children the freedom</a> to work through their fears and feelings. </p>
<p>In “<a href="https://www.bluey.tv/watch/season-1/copycat/">Copycat</a>,” Bluey and Bandit find an injured parakeet on a morning walk and take it to the vet. We then see Bluey engaged in a play scene in which she casts Bingo in the role of the parakeet and reenacts the morning. When Chilli, playing the vet, tells Bluey that Bingo is all better, Bluey protests: “No, you have to pretend it’s bad news, that the [parakeet] is dead.” Chilli seems wary to proceed but, importantly, follows her daughter’s lead in the play. </p>
<p>Similarly, in the episode “<a href="https://www.bluey.tv/watch/season-1/early-baby/">Early Baby</a>,” Bluey’s friend Indy uses play to work through a difficult life experience: having a younger sibling in a neonatal intensive care unit. In their classroom, Indy and her friends play “early baby” where they have to wash their hands before holding the baby doll and keep her in “a fish tank with holes in it” – an incubator. </p>
<h2>4. Promote multigenerational relationships</h2>
<p>These episodes explore the relationship between the girls and their grandparents. In “<a href="https://www.bluey.tv/watch/season-1/grannies/">Grannies</a>,” Bluey and Bingo are dressed up as grannies in search of a can of beans. After raiding the cabinets, Bluey scolds a dancing Bingo because “grannies can’t floss!” The girls argue and settle the debate by video chatting with Nana, learning she indeed cannot do the <a href="https://www.youtube.com/watch?v=0Kj3wWKjMSQ">popular dance</a>. When Bingo gets upset, Bluey helps Nana learn to floss by guiding her through the dance moves over video chat. </p>
<p>In “<a href="https://www.bluey.tv/watch/season-3/phones/">Phones</a>,” the girls teach Grandad about growing up in a digital world by creating fake smartphones with cardboard and crayons. They show Grandad how to navigate various apps to order food. Armed with his own crayon and a stuffed crocodile, Grandad sneaks the croc into Bingo’s basket and creates a “Croc Catcher” app for the girls to call for his assistance.</p>
<p>Research shows that strong relationships <a href="https://doi.org/10.1093/geront/gnu056">between grandparents and children</a> <a href="https://doi.org/10.1016/j.evolhumbehav.2016.11.010">benefit both generations</a>. Grandparents teach children about their family’s history while children bring grandparents up to speed with the modern world. A recent study of grandparents found that <a href="https://doi.org/10.1002/hbe2.268">video chat enables this bonding between generations</a>, and the “Phones” episode shows this when Nana learns how to fit herself in the video chat frame and do a new dance. While Grandad is initially baffled by using apps for everything, the girls help him navigate this modern convenience through play. </p>
<h2>5. Foster self-regulation</h2>
<p>The episode “<a href="https://www.bluey.tv/watch/season-1/wagon-ride/">Wagon Ride</a>” shows a common parenting scenario. Bandit encounters a friend in public and begins chatting with the friend, moving his attention away from Bluey. Bluey cannot wait any longer and interrupts her dad. Soon after, Bandit works with his daughter to establish a way she can control her impulse to interrupt him while also feeling acknowledged by her father: Whenever Bluey wants to get her dad’s attention, she can place her hand on his arm, and he’ll place his hand over hers to acknowledge that he knows she’s waiting. </p>
<p>Helping a child develop <a href="https://developingchild.harvard.edu/science/key-concepts/executive-function/">self-regulation skills</a> like the ability to wait patiently is important, as such skills predict many <a href="https://doi.org/10.1073/pnas.1019725108">positive lifelong outcomes</a>. Higher levels of self-regulation ability are often tied to <a href="https://doi.org/10.1016/j.bpsc.2018.06.011">better mental health</a> and <a href="https://doi.org/10.1080/00220671.2014.979913">academic performance</a>. Bandit exemplifies how caregivers can help build their child’s self-regulation ability by <a href="https://developingchild.harvard.edu/resources/activities-guide-enhancing-and-practicing-executive-function-skills-with-children-from-infancy-to-adolescence/">trying to make it fun</a>.</p><img src="https://counter.theconversation.com/content/208650/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The seven-minute episodes show characters dealing with difficult emotions like fear and grief through play.Molly Scott, Research Scientist in Playful Learning, Temple UniversityAria Gastón-Panthaki, Research Coordinator for Children's Development, Harvard UniversityDouglas Piper, Ph.D. Student in Psychology, Georgetown UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2042312023-07-12T21:17:03Z2023-07-12T21:17:03ZHow to overcome repetitive negative thinking through meditation<figure><img src="https://images.theconversation.com/files/523916/original/file-20230502-16-vvb9ww.jpg?ixlib=rb-1.1.0&rect=20%2C5%2C1876%2C1267&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Repetitive negative thinking can impact sleep quality, reduce efficiency and impair decision-making abilities.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Do you ever find yourself caught in a cycle of negative thoughts? Maybe you ruminate on past mistakes, worry excessively about the future, or imagine worst-case scenarios?</p>
<p>Do you sometimes have a great day, everything goes well, and then your brain says, “Hey, remember that time you embarrassed yourself in front of everyone? Let’s relive that moment for the next 20 minutes.” And suddenly, your good day turns into a cringe-fest.</p>
<p>If so, know that you’re not alone. Many people struggle with repetitive negative thinking, and this can have a serious impact on mental health and well-being.</p>
<p>As the coordinator of expertise in caregiving at the <a href="https://www.creges.ca/en/">Centre for Research and Expertise in Social Gerontology</a> and an associate member of the <a href="https://cerias.uqam.ca">Centre for Study and Research on India, South Asia and its Diaspora</a>, I would like to shed light on the negative impact of repetitive negative thinking on the mental and physical health of caregivers.</p>
<h2>The devastating effects of repetitive negative thinking</h2>
<p><a href="https://www.researchgate.net/file.PostFileLoader.html?id=56492e8660614bd60f8b456a&assetKey=AS%3A296223585128448%401447636614233">Repetitive negative thinking (RNT)</a> is a cognitive process characterized by persistent and intrusive contemplation on past events, commonly known as rumination, and apprehensions about future possibilities, often referred to as worries.</p>
<p>RNT is a recurring, unwelcome, and difficult to dislodge pattern of thinking that has been implicated in the onset and perpetuation of diverse mental disorders, including depression, anxiety, and post-traumatic stress disorder. Furthermore, <a href="https://doi.org/10.1037/0033-2909.134.2.163">RNT has been found to be associated with physical health and has been linked to an increased likelihood of future health issues</a>. RNT may negatively <a href="https://www.researchgate.net/file.PostFileLoader.html?id=56492e8660614bd60f8b456a&assetKey=AS%3A296223585128448%401447636614233">impact one’s quality of sleep, decrease efficiency, and hinder decision-making abilities</a>.</p>
<p>Recent studies have revealed that the severity of RNT is connected with <a href="https://doi.org/10.1016/j.pscychresns.2021.111353">changes in brain morphology</a>, leading to a decline in general cognitive abilities and increasing the <a href="https://doi.org/10.1002/alz.12116">risk of developing Alzheimer’s disease</a>. Even at low levels, RNT can have <a href="https://doi.org/10.3389/fnhum.2016.00534">detrimental effects on the cardiovascular, autonomic nervous, and endocrine systems</a>.</p>
<p>So, what would be the most effective strategy for managing repetitive negative thinking? <a href="https://doi.org/10.1007/s12144-017-9665-x">Research has demonstrated a negative correlation between RNT and mindfulness</a>, implying that a low level of mindfulness can increase one’s susceptibility to RNT.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520847/original/file-20230413-20-oozz0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman thinking while sitting at her desk in front of her computer" src="https://images.theconversation.com/files/520847/original/file-20230413-20-oozz0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520847/original/file-20230413-20-oozz0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520847/original/file-20230413-20-oozz0x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520847/original/file-20230413-20-oozz0x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520847/original/file-20230413-20-oozz0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520847/original/file-20230413-20-oozz0x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520847/original/file-20230413-20-oozz0x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Repetitive negative thinking is a cognitive process characterized by persistent and intrusive contemplation on past events and worries about the future.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Journey to the present: The transformative power of mindfulness</h2>
<p>Mindfulness can be seen as a mental faculty or skill that can be developed through regular practice. It entails cultivating <a href="https://doi.org/10.1016/j.copsyc.2018.10.015">a non-judgmental and non-reactive awareness of the present moment</a>. The objective is to be fully engaged in what’s happening right now, rather than dwelling on the past or worrying about the future.</p>
<p>There are two main styles of mindfulness practice: <a href="https://doi.org/10.3389/fpsyg.2014.01083">focused attention meditation and open monitoring meditation</a>. Focused attention meditation involves choosing a specific object, such as the breath, and bringing your full attention to it. Whenever the mind wanders, it is simply brought back to the object of focus. In contrast, open monitoring meditation involves being aware of everything occurring in the present moment. Instead of trying to focus on a specific object, one simply observes whatever arises in the experience, including thoughts, emotions, and physical sensations.</p>
<p>But what’s happening in the brain during these practices? Recent studies have revealed that only during focused attention meditation, there is a <a href="https://doi.org/10.1016/j.neubiorev.2016.03.021">deactivation of the “default mode network”</a> — a network of brain areas that are typically active when we’re not focused on any particular task. This network is implicated in “resting-state” thinking, which involves repetitive negative thinking. By deactivating the “default mode network,” focused attention meditation can help reduce this harmful type of thinking.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520850/original/file-20230413-20-zmquvi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A calm and peaceful young woman resting in her office chair" src="https://images.theconversation.com/files/520850/original/file-20230413-20-zmquvi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520850/original/file-20230413-20-zmquvi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520850/original/file-20230413-20-zmquvi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520850/original/file-20230413-20-zmquvi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520850/original/file-20230413-20-zmquvi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520850/original/file-20230413-20-zmquvi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520850/original/file-20230413-20-zmquvi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Focused attention meditation involves choosing a specific object, such as the breath, and bringing your full attention to it. Whenever the mind wanders, it is simply brought back to the object of focus.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Reducing repetitive negative thinking: A breakthrough for caregivers</h2>
<p>As part of <a href="https://www.creges.ca/en/publication/explorer-limpact-de-la-pratique-de-la-presence-attentive-mindfulness/">our project</a>, we will develop and examine an intervention targeted at reducing RNT in family caregivers.</p>
<p>According to a <a href="https://www150.statcan.gc.ca/n1/en/pub/75-006-x/2020001/article/00007-eng.pdf?st=Ryqnxh65">recent report</a>, over eight million Canadians aged 15 and older, or 25 per cent of the population, provide care to a family member or friend with a long-term health condition, disability, or aging-related needs.</p>
<p>While caregiving can be rewarding, it can also be challenging and stressful, particularly for those who provide extensive or complex care. <a href="https://doi.org/10.1037/0033-2909.129.6.946">Chronic stress</a> is a common experience for family caregivers, and it can take a toll on their health and well-being. <a href="https://doi.org/10.1017/S1041610219000243">A survey of caregivers</a> found that the top areas of need for caregivers were emotional health (58 per cent) and physical health (32 per cent). <a href="https://www.creges.ca/wp-content/uploads/2022/09/CREGES_Revue-narrative-Presence-attentive-Mindfulness-2022-4.pdf">RNT is strongly associated with caregiver burden</a> and predicts negative impacts on the physical and mental health of caregivers.</p>
<p>We will recruit 100 caregivers with high levels of RNT. The intervention will be presented to participants in the form of interactive videos that guide them through the practice of focused attention meditation. We will measure changes in RNT, stress, anxiety, depression, and quality of life before and after the intervention, as well as at a six-month follow-up.</p>
<p>If the intervention is effective, it could serve as the basis for the development of an innovative tool for monitoring and reducing RNT. This tool could be deployed as a mobile app or on virtual reality platforms, providing caregivers with access to an intervention that they can use at their convenience. This could significantly expand the reach of the intervention, making it more accessible and convenient for caregivers who may not have the time or resources to participate in traditional face-to-face interventions.</p>
<p>Overall, the potential of the focused attention meditation intervention to improve the mental and physical health of caregivers, as well as the development of new innovative tools, represents a promising avenue in the field of caregiver support services. Further research and implementation of such interventions could significantly improve the quality of life for caregivers and the people they care for.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520852/original/file-20230413-26-dcab8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Girl feeding her elderly mother with soup" src="https://images.theconversation.com/files/520852/original/file-20230413-26-dcab8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520852/original/file-20230413-26-dcab8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520852/original/file-20230413-26-dcab8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520852/original/file-20230413-26-dcab8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520852/original/file-20230413-26-dcab8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520852/original/file-20230413-26-dcab8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520852/original/file-20230413-26-dcab8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chronic stress is a common experience for family caregivers, and it can take a toll on their health and well-being.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>After all, to echo the words of philosopher Marcus Aurelius, “the happiness of your life depends upon the quality of your thoughts.”</p><img src="https://counter.theconversation.com/content/204231/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Andrianova is a social worker and a member of Ordre professionnel des travailleurs sociaux et des thérapeutes conjugaux et familiaux du Québec. She has received research grants from Laval University (Nicolas-and-Suzanne-Zay Excellence Scholarship, François-and-Rachel-Routhier Doctoral Scholarship from the Faculty of Social Sciences) as well as from the VITAM Research Center – Center for Sustainable Health Research.</span></em></p>Mindfulness, through focused attention meditation, can help overcome repetitive negative thinking, thus improving mental and physical health.Anna Andrianova, Coordonnatrice, Domaine d'expertise en Proche aidance, Centre de recherche et d'expertise en gérontologie sociale (CREGÉS), Candidate au Ph.D. et chargée de cours, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2073932023-06-25T13:34:56Z2023-06-25T13:34:56ZWhat to do if your child is struggling: Steps caregivers can take to help kids and teens with their mental health<figure><img src="https://images.theconversation.com/files/533781/original/file-20230623-21-poqbou.jpg?ixlib=rb-1.1.0&rect=119%2C175%2C5345%2C3723&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caregivers are encouraged to have conversations about mental health early and often, whether their child or teen is struggling or not.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Emerging research suggests that child and adolescent mental health problems are on the rise. For example, <a href="https://doi.org/10.1001/jamapediatrics.2021.2482">one in four children</a> report that they have experienced clinically elevated rates of depression, and rates of emergency department visits for attempted suicide have <a href="https://doi.org/10.1016/S2215-0366(23)00036-6">increased by 22 per cent</a> in the past few years.</p>
<p>As clinicians and researchers, we have interacted with thousands of caregivers, many of whom have asked us how they can better understand and support their children’s mental health. </p>
<p>Below we offer a step-by-step guide for recognizing the signs of mental distress and responding with support and resources to help foster recovery and resilience in children and adolescents.</p>
<h2>Recognize signs of distress</h2>
<p>Children and adolescents have varying reactions to experiences and events, and signs of mental distress can look different across young people (and can look different compared to adults too).</p>
<figure class="align-center ">
<img alt="A woman with her arm around a teen, sitting on the edge of a bed, seen from behind" src="https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533787/original/file-20230623-15-ob8w6d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Talking about mental health helps to normalize the conversation and supports children and adolescents in knowing they can go to you when they are struggling.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Changes are normal in children and adolescents, but <a href="https://ontario.cmha.ca/documents/child-and-youth-mental-health-signs-and-symptoms/">dramatic and sustained changes are not</a>. Typically, caregivers should be on the lookout for a combination of: </p>
<ol>
<li><p>Increased distress, such as more <a href="https://ontario.cmha.ca/documents/children-youth-and-depression/">sadness</a>, irritability, <a href="https://www.anxietycanada.com/articles/abcs-of-anxiety/">worry</a>, or <a href="https://www.camh.ca/-/media/files/guides-and-publications/what-parents-teen-risk-taking-en.pdf">risk-taking</a>.</p></li>
<li><p>Changes in daily functioning, such as changes in sleep, eating, physical activity, energy levels and/or interests, which may be subsequently impacting their peer or family relationships, extracurriculars or academic performance.</p></li>
</ol>
<h2>Talk to your children about mental health</h2>
<p>We encourage caregivers to have conversations about mental health early and often, whether their child or teen is struggling or not. This helps to normalize the conversation and supports children and adolescents in knowing they can go to you when they are struggling.</p>
<p>Conversations are especially important when children or adolescents <a href="https://health.sunnybrook.ca/mental-health/talk-about-mental-illness-conversation-parents/">appear to be struggling</a>. You can start by letting them know you care, and then pointing out what you have observed in terms of changes in their distress and daily functioning, such as “I’ve noticed that you’ve been sleeping a lot more than usual. Have you noticed these changes too?” Then ask if you can talk about this further together to deepen the conversation.</p>
<p>If you feel that strategy won’t work for your child, or if you often get answers of “fine” to “how are you feeling?”, try the third person strategy, which can <a href="https://doi.org/10.3389%2Ffpsyg.2016.01715">reduce distress</a> during tense conversations. </p>
<p>In this scenario, make a statement about children’s mental health generally, such as “I hear there’s a lot of kids and teens struggling with their mental health right now” and then ask open-ended questions, such as: “what do you think about that?” or “what have you noticed about your own mental health lately”? </p>
<figure class="align-center ">
<img alt="A man and a teen outside, having a conversation." src="https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533782/original/file-20230623-31-7rmk4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If your child finds it hard to have face-to-face conversations about their mental health, ask them to go for a walk and start the conversation then.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>When you have conversations about mental health with your child or adolescent, try to minimize any potential discomfort. It’s best to find a time that works well for your child. For example, when they are rested, fed, and relaxed. </p>
<p>Also, some children find it hard to have face-to-face conversations about their mental health. If this is the case with your child or adolescent, you could ask them to go for a walk and start the conversation then or when you are doing something else, like loading the dishwasher or driving to an extracurricular activity. This can take the pressure off what might be perceived as stressful face-to-face conversations.</p>
<p>When children and adolescents do open up, express empathy for what they are going through, using phrases such as “that sounds really difficult” and/or “I understand how painful that can be.” Often as caregivers, we want to jump into problem-solving mode, but the most effective approach to supporting children and adolescents is often to listen and validate their feelings and/or distress. </p>
<p>Communicating and connecting with children and adolescents, and confirming they have our support, can foster resilience in times of adversity. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KZBTYViDPlQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Express empathy for what children and adolescents are going through. This video discusses empathy and sympathy.</span></figcaption>
</figure>
<h2>Talk with their teacher</h2>
<p>If you remain concerned about your child, and want to gather additional information, you could speak with their teacher or guidance counsellor. Up to <a href="https://doi.org/10.1542/peds.2020-1440">80 per cent of children</a> get their knowledge about mental health from schools. Guidance counsellors are specifically trained to <a href="https://doi.org/10.1080/03069885.2010.531384">address mental health concerns</a> and other school staff are used to having conversations about mental health with students. They typically welcome these conversations with caregivers.</p>
<p>Teachers can also provide a valuable perspective on how a child’s mental health may have changed, and what might be precipitating these changes. For example, children may be experiencing learning struggles or bullying, which they haven’t yet disclosed to you, but is causing them some distress. Guidance counsellors and teachers can also help brainstorm ideas for building up children’s coping strategies and supporting their success at school.</p>
<p>If possible, have your child join these conversations, so they feel involved in discussions about their own mental health and develop agency in addressing it.</p>
<h2>Talk with your health-care provider</h2>
<p>Health-care providers are trained in evaluating mental and physical health problems alike. They can formally <a href="https://cps.ca/en/mental-health-screening-tools">screen and assess for mental health problems</a> by asking the caregiver and child questions about changes in mood, behaviour and functioning and matching symptoms of distress and impairment with “diagnostic criteria” for various mental health disorders. </p>
<figure class="align-center ">
<img alt="A woman with a child on her lap talking to a doctor" src="https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533785/original/file-20230623-23-35uieg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health-care providers can offer strategies and resources to support children and caregivers.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>With this knowledge, health-care providers can offer strategies and resources to support children and caregivers. They will work with caregivers and children directly to decide on the best approaches to addressing the child’s mental health struggles.</p>
<p>It is also important to let children and adolescents know of other services they can access for support, such as <a href="https://kidshelpphone.ca/">Kids Help Phone</a>, which is available via text or phone 24/7.</p>
<h2>Immediately address urgent mental health problems</h2>
<p>The strategies above can occur when children and adolescents are not in immediate danger. But when your child shows warning signs of suicide, or is engaging in self-harm behaviour, <a href="https://www.camh.ca/en/professionals/treating-conditions-and-disorders/suicide-risk/suicide---detecting-and-assessing-suicidality">get them help as soon as possible</a>, including:</p>
<ul>
<li><p>Taking them to the nearest acute care hospital.</p></li>
<li><p>If your child will not go to the hospital or you’re unsure if this is the right thing to do, get help from a health-care provider as quickly as possible. You can call the health-care team or a crisis line.</p></li>
<li><p>If your child is attempting or about to attempt suicide, do not leave them alone, and call 911 immediately.</p></li>
</ul>
<p>Although supportive in nature, taking care of our children’s mental health can also be taxing and/or triggering for many caregivers. To best support children and adolescents, we also need to take care of ourselves. We encourage caregivers to prioritize their own mental health, so that they can feel energized and empowered to attend to their children’s mental health.</p>
<p>If caregivers have concerns about their own mental health, we recommend the following resources:</p>
<ul>
<li><a href="https://www.wellnesstogether.ca/en-CA">Wellness Together Canada</a> is a free and confidential service available to Canadian residents. They can give you information on mental health, offer free confidential sessions with health professionals, and provide peer support services.</li>
<li>Speak to your health-care provider.</li>
<li>If you are in crisis, contact <a href="https://talksuicide.ca/">Talk Suicide Canada</a>.</li>
</ul><img src="https://counter.theconversation.com/content/207393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, an anonymous donor, and the Canada Research Chairs program.</span></em></p><p class="fine-print"><em><span>Tracy Vaillancourt receives funding from the Canadian Institutes of Health Research, Social Sciences and Humanities Research Council and Canada First Research Excellence Fund. </span></em></p>With child and adolescent mental health problems on the rise, here is a step-by-step guide for caregivers for recognizing signs of mental distress and responding with support and resources.Sheri Madigan, Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryTracy Vaillancourt, Tier 1 Canada Research Chair in School-Based Mental Health and Violence Prevention, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2059602023-05-22T12:27:43Z2023-05-22T12:27:43ZGOP’s proposed expansion of SNAP work requirements targets many low-income people in their early 50s – but many of them already work<figure><img src="https://images.theconversation.com/files/527300/original/file-20230519-21-rnxqd4.jpg?ixlib=rb-1.1.0&rect=0%2C33%2C5488%2C3190&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many Americans in their early 50s take care of older loved ones.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caregiver-woman-helping-senior-man-with-shopping-royalty-free-image/587506108">FredFroese/E+ via Getty Imagres</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Roughly half of the people who would be affected by a proposed expansion of <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-199929">Supplemental Nutrition Assistance Program</a> work requirements already do what’s needed to meet those requirements. There’s also evidence suggesting that many of the rest have caregiving or health conditions that prevent them from working.</p>
<p>Formerly known as food stamps, SNAP helps low-income people buy groceries. </p>
<p>Republicans want the federal government to make SNAP benefits for <a href="https://www.cnn.com/2023/04/26/politics/work-requirements-food-stamps-medicaid-debt-ceiling/index.html">adults age 50 to 55</a> without dependents or disabilities contingent on spending <a href="https://www.fns.usda.gov/snap/work-requirements#:%7E:text=Work%20at%20least%2080%20hours,least%2080%20hours%20a%20month">80 hours per month on work activities</a>, which may include employment, short-term training and community service. This proposed change is in a package that the Republican-led <a href="https://www.cnn.com/2023/04/19/politics/mccarthy-debt-limit-bill/index.html">House of Representatives passed in April 2023</a> that seeks to cut spending on several social programs.</p>
<p>Currently, the requirements only apply to adults under 50 without dependents who aren’t disabled.</p>
<p>We’re basing these estimates on our analysis of nationally representative time-diary data from the Bureau of Labor Statistics’ <a href="https://www.bls.gov/tus/">American Time Use Survey</a>.</p>
<p>We analyzed the time that low-income Americans ages 50-55 who didn’t have a disability or child at home spent working, caring for others or dealing with their personal health and well-being from 2012 to 2021. </p>
<p>We found that in most years, more than half of them worked at least 20 hours per week. We estimated that, on average, those who met the work requirement actually worked about 41-51 hours per week – a full-time schedule. </p>
<p>We also determined that relative to their counterparts who met the work requirements, those who did not spent 10 times as much time managing their own health, five times as much time on child care, and more than five times as much time caring for an elderly or disabled adult.</p>
<p><iframe id="Lcj3Y" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Lcj3Y/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Why it matters</h2>
<p>The GOP bill is <a href="https://www.washingtonexaminer.com/restoring-america/faith-freedom-self-reliance/how-to-stop-the-lefts-dangerous-despicable-war-on-work">grounded in a belief</a> that people who get SNAP benefits and aid through other assistance programs are not employed but capable of working, and that enforcing work requirements can increase employment and earnings.</p>
<p>But <a href="https://www.census.gov/library/stories/2020/07/most-families-that-received-snap-benefits-in-2018-had-at-least-one-person-working.html">that’s a misconception</a>.</p>
<p>This measure and <a href="https://networklobby.org/devastating-debt-ceiling-bill/">several others like it</a> are part of a package that would raise the debt limit to avert a potential U.S. default and a global economic crisis.</p>
<p>Our findings <a href="https://www.cbpp.org/research/food-assistance/house-republicans-agriculture-appropriations-bill-would-cut-wic-benefits">support widespread concerns</a> that expanding SNAP work requirements would sever food assistance benefits for an estimated <a href="https://www.cbo.gov/publication/59102">275,000 low-income people</a> between the ages of 50 and 55, including many with health conditions and who care for others.</p>
<p>That’s troubling because the cost of <a href="https://blog.dol.gov/2023/01/24/new-childcare-data-shows-prices-are-untenable-for-families">professional child care</a> and <a href="https://www.cnn.com/2023/04/20/health/senior-care-cost/index.html">elder care</a>, as well as the <a href="https://www.nationaldisabilityinstitute.org/wp-content/uploads/2020/10/extra-costs-living-with-disability-brief.pdf">care for the disabled</a>, is very high in the U.S.</p>
<p>It’s reasonable to expect that the new work requirements would force many people to make hard choices between the caregiving arrangements for their loved ones and keeping their benefits. Also, since people who have poor health may not be able to work, they may find themselves unable to put food on the table if they lose SNAP benefits.</p>
<p><iframe id="Gpems" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Gpems/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>What other research is being done</h2>
<p>SNAP is associated with many positive trends beyond getting enough to eat. These include <a href="https://doi.org/10.1001/jamainternmed.2017.4841">spending less on health care</a>, having <a href="https://doi.org/10.1017/s1368980021003815">better health</a> and <a href="https://www.federalreserve.gov/econres/feds/financial-repercussions-of-snap-work-requirements.htm">becoming more financially secure</a>.</p>
<p>Further, when Americans use SNAP to buy groceries, studies have shown that it <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/supplemental-nutrition-assistance-program-snap/economic-linkages/">stimulates the economy where they live</a>, supporting low-income communities. </p>
<p>Additional research has found that work requirements tied to aid programs <a href="https://theconversation.com/snap-work-requirements-dont-actually-get-more-people-working-but-they-do-drastically-limit-the-availability-of-food-aid-204257">don’t get more low-income people to enter the labor force</a>. Studies also have found that these policies cause many people who are eligible for assistance to <a href="https://theconversation.com/medicaid-work-requirements-would-leave-more-low-income-people-without-health-insurance-but-this-policy-is-unlikely-to-pass-this-time-around-204731">lose their benefits</a> due to paperwork hassles and unclear guidelines.</p><img src="https://counter.theconversation.com/content/205960/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Engel receives funding from the U.S. Department of Agriculture.</span></em></p><p class="fine-print"><em><span>Taryn Morrissey has received funding from the U.S. Department of Agriculture, the U.S. Department of Health and Human Services, the Robert Wood Johnson Foundation, the Bainum Family Foundation, DC Action for Children, and the Peter G. Peterson and Ford Foundations. Morrissey is a non-resident Fellow at the Urban Institute and previously a Senior Fellow at the Center for American Progress.</span></em></p>Republicans are pressing for policy changes based on a misconception that hardly anyone who gets help buying groceries with Supplemental Nutrition Assistance Program benefits is employed.Katherine Engel, PhD Student in Public Administration and Policy, American University School of Public AffairsTaryn Morrissey, Professor of Public Administration and Policy, American University School of Public AffairsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048962023-05-16T20:42:11Z2023-05-16T20:42:11ZNew research discoveries are more likely to be put to use in pediatricians’ offices if patients and their caregivers get involved<figure><img src="https://images.theconversation.com/files/526563/original/file-20230516-19-vo0he0.jpg?ixlib=rb-1.1.0&rect=117%2C8%2C5405%2C3433&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Involving young patients and their parents or caregivers can help bring new research evidence into clinics.
</span> <span class="attribution"><span class="source">(Pexels/Christina Morillo)</span></span></figcaption></figure><p>Thousands of health research articles are published every year. With new evidence constantly being made available, you might assume health practices are also constantly evolving. </p>
<p>The reality is, however, <a href="https://doi.org/10.1055/s-0038-1637943">less than 15 per cent</a> of clinical research will ever make it into practice. Even when evidence is adopted into practice, this process can take <a href="https://doi.org/10.1258/jrsm.2011.110180">as long as 17 years</a>.</p>
<p>The field of children’s health is not exempt from this slow uptake. Considering that 17 years is nearly the length of an entire childhood, the speed with which evidence is adopted into practice must increase. </p>
<p>As a PhD candidate in clinical psychology, my research is focused on implementation science and pediatric pain, and specifically seeks to understand how to best support the uptake of evidence to improve children’s health and well-being.</p>
<p>Research evidence that impacts practice must be three things: </p>
<ul>
<li>relevant to those who may benefit from it, </li>
<li>tailored to the context where it will be used, and </li>
<li>easy to adopt into practice. </li>
</ul>
<p>How can these principles be addressed so evidence is better implemented? The group that holds the key to answering this question is young patients and their parents or caregivers. </p>
<h2>Patient partnerships</h2>
<figure class="align-center ">
<img alt="A woman with a child on her lap in a doctor's office, with the doctor holding a stethoscope to the child's chest" src="https://images.theconversation.com/files/526589/original/file-20230516-19-6pwo5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526589/original/file-20230516-19-6pwo5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526589/original/file-20230516-19-6pwo5m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526589/original/file-20230516-19-6pwo5m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526589/original/file-20230516-19-6pwo5m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526589/original/file-20230516-19-6pwo5m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526589/original/file-20230516-19-6pwo5m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Engaging people with lived experience means integrating the perspectives of people who have not only lived with a given health condition, but have navigated the health-care system for treatment.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Traditionally seen as just the recipients of health care, young patients and their parents or caregivers bring with them something that cannot be taught in graduate programs or medical school: lived experience.</p>
<p>Engaging people with lived experience means integrating the perspectives of people who have not only lived with a given health condition, but have navigated the health-care system for treatment. These perspectives can be integrated into research in several ways, from developing research questions to sharing evidence. </p>
<p>When researchers work with patients and parents or caregivers to guide research and share evidence (called “patient partnership”), <a href="https://doi.org/10.1186/1472-6963-14-89">research shows positive outcomes</a> for the quality of evidence, and how easily it can be integrated into clinical practice.</p>
<p>By contributing their lived experience, patients and parents or caregivers can increase the impact of evidence. How does experience impact how evidence is used in practice, however? Engaging patients and caregivers can improve the way evidence is shared with potential users. These include understanding context, tailoring resources and increasing the efficiency of information sharing.</p>
<h2>Understanding context</h2>
<p>Context is the setting or situation in which research evidence can be used. </p>
<p>Context is important for understanding what information is needed, how it will be used and who will use it. It also ensures that relevant evidence is shared to support identified needs in the clinical environment. Patients and caregivers who have engaged with services within the health-care system can point out details in the environment that should be considered based on their experiences.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fear-of-needles-5-simple-ways-to-ease-vaccination-pain-for-your-child-and-yourself-134328">Fear of needles: 5 simple ways to ease vaccination pain for your child (and yourself)</a>
</strong>
</em>
</p>
<hr>
<p>Consider an example that most parents or caregivers are familiar with: managing children’s needle pain during a vaccination. Young patients and their caregivers can offer insight into important elements of the physical environment. </p>
<p>Aspects of the environment include things like having a chair so the parent can use <a href="https://assets.aboutkidshealth.ca/AKHAssets/CARD_Comfort_Positions.pdf">comfort positioning</a>, and an electrical outlet and charger so parents can distract their child with a tablet, as well as other considerations such as accommodating breastfeeding. </p>
<p><a href="https://doi.org/10.2217/cer-2019-0175">Engaging patients</a> and caregivers helps anticipate needs in the environment when it comes time to put research evidence into practice.</p>
<h2>Tailoring resources</h2>
<figure class="align-center ">
<img alt="A child in a face mask pointing to a blue bandage on his arm" src="https://images.theconversation.com/files/526592/original/file-20230516-30763-qp70wy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526592/original/file-20230516-30763-qp70wy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526592/original/file-20230516-30763-qp70wy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526592/original/file-20230516-30763-qp70wy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526592/original/file-20230516-30763-qp70wy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526592/original/file-20230516-30763-qp70wy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526592/original/file-20230516-30763-qp70wy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young patients and their caregivers can offer insight into important elements of the physical environment for things like managing pain during procedures such as vaccinations.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1080/24740527.2022.2045192">Research shows</a> that patients and caregivers, researchers and health professionals all experience challenges accessing evidence related to children’s health. Each of these groups also need information to be presented in a way they can understand it and put it to use. </p>
<p>Tailoring information ensures that it is relevant to, and understood by, the target audience.</p>
<p>Consider the needle pain management example again. Patients and caregivers can help shape the type of information they need to manage pain (in this example, pain management for needle pokes as well as post-vaccination soreness, etc.), and the best language to use when sharing information. For example, patients or their caregivers can review language to ensure it is understandable. </p>
<p>Engaging the people whom information will be tailored to is the <a href="https://doi.org/10.1186/1472-6963-14-89">most meaningful approach</a> to ensuring information is understandable.</p>
<h2>Increasing efficiency of information sharing</h2>
<p>Patients and caregivers are unlikely to read the academic journals that researchers and health professionals review. <a href="https://doi.org/10.1186/s12961-018-0282-4">For valuable insight</a> into where they are likely to seek information, and how best to present it, patients and parents or caregivers themselves are the best source. This can inform where resources are physically made available, the best way to present that information, and when it is best presented. </p>
<p>For example, are needle pain management resources best made available in waiting rooms? Online? In parenting groups? Is the best format to present the information a social media post? A brochure? A website? What time of day, or day or week, or season is it best to release that information? Can it be linked to medical checkups, the start of school or the holidays? </p>
<h2>Getting involved</h2>
<p>Opportunities are growing for patients and caregivers to take part in sharing knowledge and evidence about children’s health. </p>
<p>Groups for supporting patient-oriented research (SPOR) exist in many provinces. Patients and caregivers, researchers and health professionals can contact SPOR groups to learn more about patient engagement opportunities. There are also several knowledge-sharing organizations in Canada that support patient engagement in specific health areas (for example, <a href="https://kidsinpain.ca/">Solutions for Kids in Pain</a>).</p>
<p>Generating evidence is critical, but equally so is ensuring that evidence is used. Patients and caregivers play an essential role in making sure that evidence impacts practice.</p>
<p><em>This story is part of a series produced by <a href="https://www.kidsinpain.ca/">SKIP (Solutions for Kids in Pain)</a>, a national knowledge mobilization network whose mission is to improve children’s pain management by mobilizing evidence-based solutions through co-ordination and collaboration.</em></p><img src="https://counter.theconversation.com/content/204896/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole MacKenzie receives support for graduate funding from a Research Nova Scotia Scotia Scholars Award, a Maritime SPOR Support Unit doctoral award, and a Nova Scotia Graduate Scholarship doctoral award. She is also a Killam Scholar. She is also collaborating with Solutions for Kids in Pain (SKIP) as a research trainee.</span></em></p>Three factors that can speed up adoption of clinical research discoveries are context, tailoring resources and efficient knowledge sharing.Nicole MacKenzie, PhD Candidate in Clinical Psychology, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2015412023-03-15T20:55:38Z2023-03-15T20:55:38ZOlder adults with dementia but without close family: Who are they? And who cares for them?<figure><img src="https://images.theconversation.com/files/515611/original/file-20230315-2738-i6ezz2.jpg?ixlib=rb-1.1.0&rect=372%2C128%2C3451%2C2456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than eight per cent of study subjects were 'kinless' at the time of their dementia diagnosis.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>What happens to <a href="https://www.nytimes.com/2022/12/03/health/elderly-living-alone.html">older adults who do not have close family</a> when they develop <a href="https://alzheimer.ca/sites/default/files/documents/ASC_What-is-dementia-info-sheet_en.pdf">dementia</a>? The truth is, we hardly know. </p>
<p><a href="https://census.gc.ca/census-recensement/2021/as-sa/98-200-X/2021003/98-200-X2021003-eng.cfm">Population aging</a> together with changing patterns of marriage and childrearing mean that growing numbers of people in North America <a href="https://doi.org/10.1093/geronb/gbab222">reach advanced ages without a living spouse or children</a>. This matters because the incidence of dementia increases with age, and considerable support and care are needed to live well as the condition progresses. The vast majority of this care is <a href="https://alzheimer.ca/sites/default/files/documents/Landmark-Study-Report-1-Path_Alzheimer-Society-Canada_0.pdf">provided by spouses and children</a>. </p>
<p>There is reason to worry that older adults who lack family in these two relationship categories may be <a href="https://www.nytimes.com/2015/09/29/health/near-the-end-its-best-to-be-friended.html">particularly vulnerable</a> if they develop dementia. Until now, however, very little research has examined the topic. </p>
<h2>Older adults with dementia without close kin</h2>
<p>I am a <a href="https://medanthro.net/about/about-medical-anthropology/">medical anthropologist</a> and I research social and cultural dimensions of illness and health care. (I am also the <a href="https://doi.org/10.1111/j.1548-1387.2008.00036.x">daughter of a mother who lived with dementia</a> for a very long time). </p>
<p>For the past several years, I have been working with a team of fifteen other researchers — in fields that range from social work to public health, public policy, demography, nursing and several different medical specialties — to find out what happens to older adults who are “kinless” (i.e., they do not have a living spouse or children) at the time they develop dementia. </p>
<figure class="align-center ">
<img alt="A woman with gray hair sitting beside a man with gray hair in a bed" src="https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515605/original/file-20230315-2703-baa7d7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A person’s role as caregiver (at the time they developed dementia, or previous to that) could have important consequences for their own ability to access care.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Our team has worked with information collected as part of a long-running medical research study of dementia called <a href="https://actagingresearch.org/">the Adult Changes in Thought (ACT) study</a>. Since the early 1990s, this study has been following participants recruited from the membership of an integrated health-delivery organization in Seattle to identify those who develop dementia. </p>
<p>Our team has been examining the research data and administrative documents generated by the ACT study, with an eye to what they can tell us about the circumstances and needs of older adults who were kinless when they developed dementia. </p>
<p>Qualitative analysis of ACT administrative documents, some of which contained clinical chart notes from participants’ medical records, proved to be an especially rich and informative source of data. </p>
<h2>Surprising findings</h2>
<figure class="align-center ">
<img alt="A older man looking into a kitchen cupboard and scratching his head" src="https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515606/original/file-20230315-28-yxumbx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some kinless adults with dementia received support from neighbours and friends, however, in some cases community members appeared to have gotten involved only at moments of crisis.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>We <a href="https://doi.org/10.1093/geronb/gbad030">recently published</a> what we believe is the first article on kinless older adults with dementia, and some of the findings might surprise you:</p>
<ul>
<li><p>This circumstance is not rare. In our sample of community-dwelling older adults, we found that 8.4 per cent were kinless at the time they developed dementia. (This is probably a conservative estimate, because more would likely become kinless after the onset of dementia, upon the death of a spouse and/or child).</p></li>
<li><p>This is a predicament to which anyone may be susceptible. The life trajectories that led people in our sample to be kinless at the time they developed dementia were quite varied. Some had never married or had children, but others had outlived both spouses and children. </p></li>
<li><p>The average age of the kinless older adults in our sample at the time they developed dementia was 87. Half were living alone at that point, and one-third were living with unrelated persons such as hired caregivers. Most were women who became kinless late in life and unexpectedly.</p></li>
<li><p>A person’s role as caregiver (at the time they developed dementia, or previous to that) could have important consequences for their own ability to access care. For example, some in our sample had previously moved to a residential setting to meet the needs of a spouse, which could mean that they were well situated to access care later. On the other hand, at least one of the 64 kinless older adults with dementia in our sample was serving as caregiver for a roommate (who also had dementia), which triggered an intervention when it led to a situation that was dangerous for both parties.</p></li>
<li><p>Some of the kinless older adults in our sample seemed to have little support, but others received considerable support from relatives such as nieces, nephews, sisters, grandchildren and others. </p></li>
<li><p>Some received support from neighbours and friends that could in some cases involve quite extensive hands-on care. In many instances, however, neighbours and other community members appeared to have gotten involved only at moments of crisis, as a form of rescue. </p></li>
</ul>
<p>This research affords a rare window into the circumstances and needs of a potentially very vulnerable group that up to now has remained largely invisible. Our findings have implications for clinicians and health systems, but also for society more broadly. </p>
<p>“Who cares?” is, on one level, an informational question about caregiving networks — one that our team, through this research, has begun to answer. On another level, however, “who cares?” is a provocation. The predicament of kinless older adults with dementia should provoke all of us to work to better support people facing <a href="https://doi.org/10.1016/j.jaging.2017.08.002">a form of precarity that anyone may be susceptible to in late life</a>.</p><img src="https://counter.theconversation.com/content/201541/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work was supported by grant R21AG058056 from the National Institute on Aging at the National Institutes of Health. The Adult Changes in Thought study was supported by U01AG006781 (Larson and Crane, multiple PIs). Partial support for this research came from a Eunice Kennedy Shriver National Institute of Child Health and Human Development research infrastructure
grant, P2C HD042828, to the Center for Studies in Demography and Ecology (CSDE) at the University of Washington.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent
the official views of the National Institutes of Health</span></em></p>New research affords a rare window into the circumstances and needs of a potentially very vulnerable group that until now has remained largely invisible: people with dementia who have no close kin.Janelle S. Taylor, Professor, Medical Anthropology, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1980742023-01-18T15:55:17Z2023-01-18T15:55:17ZMy child isn’t happy with their final exam results. How can I support them?<figure><img src="https://images.theconversation.com/files/505086/original/file-20230118-22-x6e3z0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Teens look to their parents for love and support in hard times.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Every January, the day arrives that South Africans know can decide their fates: the “matric” exam results are announced. In 2023, <a href="https://sundayworld.co.za/news/education/umalusi-gives-the-release-of-matric-results-the-green-light/">a total of 919 532 pupils</a> wrote these all-important exams from October to November. They’ll receive their individual results on 19 January.</p>
<p>Many probably feel ambivalent about this massive moment in their educational journey. On the one hand, there is the feeling of completeness because the school years are done. On the other, there is a basket of emotions: stress, anxiety and excitement at the prospect of the unknown. Matrics (or Grade 12s) and their parents know that the <a href="https://www.education.gov.za/Curriculum/NationalSeniorCertificate(NSC)Examinations.aspx">National Senior Certificate</a>, issued when matric is successfully completed, is a ticket to the future. </p>
<p>The results dictate whether you qualify to apply to a tertiary institution or not; this a big deal in a society that sees university qualifications as the ideal (or only) <a href="http://www.sajournalofeducation.co.za/index.php/saje/article/view/760/363">path to wealth, image and fame</a>. University qualifications are <a href="https://theconversation.com/history-explains-why-black-south-africans-still-mistrust-vocational-training-46998">also viewed as superior</a> to vocational training.</p>
<p>So, those who don’t achieve the required matric marks will not be able to attend university. It can shatter dreams and cause huge disappointment, along with feelings of failure, hopelessness and helplessness. The way a parent or caregiver responds in this situation is extremely important.</p>
<p>As a researcher specialising in parent-child relationships, here’s my advice for guiding children through what can be a tough, scary and disappointing time.</p>
<h2>Positive support</h2>
<p>There are four key things your children need to hear if they are disappointed and feeling like a failure:</p>
<ul>
<li><p>Getting up after a fall is important</p></li>
<li><p>Success is relative: everyone is different and has different abilities</p></li>
<li><p>There are many ways to achieve success other than getting a university degree</p></li>
<li><p>As a parent you believe your child is capable of doing anything.</p></li>
</ul>
<p>This kind of positive, loving support is critical. The research I’ve conducted with various colleagues shows that parents are important in adolescents’ <a href="https://link.springer.com/article/10.1007/s40894-015-0003-y">decision-making</a>, <a href="http://www.sajournalofeducation.co.za/index.php/saje/article/view/760/363">life goals and aspirations</a>. They also play a key role in shaping teens’ <a href="https://journals.sagepub.com/doi/10.1177/0081246316653744">psychological wellbeing</a>, as well as modelling both <a href="https://repository.uwc.ac.za/xmlui/handle/10566/2843">healthy</a> and risky behaviours.</p>
<p>Negative parenting practices like rejection, neglect, psychological control, pressure to perform, overprotectiveness and indulgent parenting are associated with difficulty in making good decisions. Children may panic about making decisions, become indecisive – especially about career choices – or make risky decisions.</p>
<p>It is normal for parents to be disappointed that their child’s results were not as expected. However, as a start, take a deep breath and realise that your child is struggling to come to terms with their results, too, and may believe they are a failure. This is not the time to scold and berate them about not achieving. </p>
<p>Remember, the Grade 12 year that’s just passed has, by and large, been about achieving success and feeling the pressure to perform. This situation just amplifies their stress and anxiety.</p>
<p>Taking a deep breath allows for calmness in your approach to supporting your child. A more positive approach, which includes being responsive, supportive, approachable, encouraging and understanding, would be very helpful as a start to diffusing a very emotional situation for your child. </p>
<h2>Room to talk and plan</h2>
<p>Allow your child to talk about how they’re feeling about the outcome, without interrupting. It would be a good idea to find out if your child has thoughts about the way forward. This could be the first of a few paced conversations over a few weeks. This will allow for some perspective and give your child the chance to think things through. That helps them to develop feelings of ownership in decision-making as well as boosting their confidence and competence. This is important for the satisfaction of psychological needs to achieve psychological wellbeing.</p>
<p>If they haven’t thought about what comes next, you could consider exploring the options together, building a plan B and C since plan A was not achieved. For instance, your child could request re-marks for subjects where they expected to perform better. Or they could enrol for the Department of Basic Education’s <a href="https://www.education.gov.za/programmes/secondchanceprogramme.aspx">Second Chance Programme</a>.</p>
<p>Monitor your child and their wellbeing in this time. You may feel that you need to draw in others, such as a counsellor, psychologist or social worker, or a teacher or friend your child is close to, to help map out the next steps, providing options or just as an additional support for you and your child.</p><img src="https://counter.theconversation.com/content/198074/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicolette V Roman receives funding from the National Research Foundation for her SARChI: Developing Human Capabilities and Social Cohesion through the Family. She is also a member of the Family Strengthening Steering Committee for the Western Cape Government.</span></em></p>The way a parent or caregiver responds in this situation is extremely important.Nicolette V Roman, SARChI: Human Capabilities, Social Cohesion and the Family, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952762023-01-12T13:22:40Z2023-01-12T13:22:40ZMeditation and mindfulness offer an abundance of health benefits and may be as effective as medication for treating certain conditions<figure><img src="https://images.theconversation.com/files/503183/original/file-20230105-12-ywtjr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People of any age or walk of life can access and benefit from meditation.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-multiracial-latina-woman-meditating-at-home-royalty-free-image/1394449576?phrase=mindfulness%20meditation&adppopup=true">Daniel de la Hoz/iStock via Getty Images Plus</a></span></figcaption></figure><p>Many people look to diet trends or new exercise regimens – often with questionable benefit – to get a healthier start on the new year. But there is one strategy that’s been shown time and again to boost both mood and health: meditation.</p>
<p>In late 2022, a <a href="http://doi.org/10.1001/jamapsychiatry.2022.3679">high-profile study</a> made a splash when it claimed that meditation may work as well as a common drug named Lexapro for the treatment of anxiety. Over the past couple of decades, similar evidence has emerged about mindfulness and meditation’s broad array of health benefits, for purposes ranging from stress and <a href="https://doi.org/10.1007/s12160-016-9844-2">pain reduction</a> to <a href="https://doi.org/https://doi.org/10.1016/j.psc.2017.08.008">depression treatments</a> to <a href="https://doi.org/10.1016/j.cpr.2011.04.006">boosting brain health</a> and helping to manage excessive <a href="https://doi.org/10.1155/2022/3523432">inflammation and long COVID-19</a>. </p>
<p>Despite the mounting body of evidence showing the health benefits of meditation, it can be hard to weigh the science and to know how robust it is.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=S9ykvZUAAAAJ&hl=en">neuroscientist studying the effects of stress and trauma</a> on <a href="https://theconversation.com/meditation-holds-the-potential-to-help-treat-children-suffering-from-traumas-difficult-diagnoses-or-other-stressors-a-behavioral-neuroscientist-explains-189037">brain development in children and adolescents</a>. I also study how mindfulness, meditation and <a href="https://theconversation.com/the-runners-high-may-result-from-molecules-called-cannabinoids-the-bodys-own-version-of-thc-and-cbd-170796">exercise</a> can positively affect brain development and mental health in youth. </p>
<p>I am very excited about how meditation can be used as a tool to provide powerful new insights into the ways the mind and brain work, and to fundamentally change a person’s outlook on life. And as a mental health researcher, I see the promise of meditation as a low- or no-cost, evidence-based tool to improve health that can be relatively easily integrated into daily life. </p>
<p>Meditation requires some training, discipline and practice – which are not always easy to come by. But with some specific tools and strategies, it can be accessible to everyone.</p>
<h2>What are mindfulness and meditation?</h2>
<p>There are many different types of meditation, and mindfulness is one of the most common. Fundamentally, mindfulness is a <a href="https://theconversation.com/why-you-should-give-the-gift-of-mindfulness-this-new-year-195711">mental state</a> that, according to <a href="https://doi.org/10.1176/ajp.149.7.936">Jon Kabat-Zinn</a> a renowned expert in mindfulness-based practices, involves “awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.” </p>
<p>This means not ruminating about something that happened in the past or worrying about that to-do list. Being focused on the present, or living in the moment, has been shown to have a broad array of benefits, including <a href="https://doi.org/10.7205/MILMED-D-14-00677">elevating mood, reducing anxiety</a>, <a href="https://doi.org/10.1016/0163-8343(82)90026-3">lessening pain</a> and potentially improving <a href="https://doi.org/10.1007/s11065-021-09519-y">cognitive performance</a>. </p>
<p>Mindfulness is a skill that can be practiced and cultivated over time. The goal is that, with repetition, the benefits of practicing mindfulness carry over into everyday life – when you aren’t actively meditating. For example, if you learn that you aren’t defined by an emotion that arises transiently, like anger, then it may be harder to stay angry for long. </p>
<p>The health benefits of meditation and other strategies aimed at stress reduction are thought to stem from increasing levels of <a href="https://doi.org/10.1038/nrn.2015.7">overall mindfulness</a> through practice. Elements of mindfulness are also present in practices like yoga, martial arts and dance that require focusing attention and discipline.</p>
<p>The vast body of evidence supporting the health benefits of meditation is too expansive to cover exhaustively. But the studies I reference below represent some of the top tier, or the <a href="https://doi.org/10.1007/978-0-387-88555-1_2">highest-quality and most rigorous summaries</a> of scientific data on the topic to date. Many of these include systematic reviews and meta-analyses, which synthesize many studies on a given topic. </p>
<h2>Stress and mental health</h2>
<p>Mindfulness-based programs have been shown to significantly reduce stress in a variety of populations, ranging from <a href="https://doi.org/10.1177/01640275211043486">caregivers of people living with dementia</a> to <a href="https://doi.org/10.1111/mbe.12307">children during the COVID-19 pandemic</a>. </p>
<p>Meta-analyses published during the pandemic show that mindfulness programs are effective for reducing <a href="https://doi.org/10.1002/smi.3138">symptoms of post-traumatic stress disorder</a>, <a href="https://doi.org/10.1016/j.jocrd.2022.100712">obsessive-compulsive disorder</a>, <a href="https://doi.org/10.1016/j.jpsychires.2020.12.048">attention-deficit/hyperactivity disorder</a> and <a href="https://doi.org/10.1089/jicm.2021.0036">depression</a> – including the <a href="https://theconversation.com/more-than-4-in-5-pregnancy-related-deaths-are-preventable-in-the-us-and-mental-health-is-the-leading-cause-193909">particularly vulnerable time</a> during <a href="https://doi.org/10.1111/papt.12441">pregnancy and the postnatal period</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/24W0vCqc0QE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In addition to improving mood and lowering stress, mindfulness has been shown to elevate cognitive performance, cut down on mind wandering and distractibility and increase emotional intelligence.</span></figcaption>
</figure>
<p>Mindfulness-based programs also show promise as a treatment option for anxiety disorders, which are the most common mental disorders, affecting an estimated <a href="https://doi.org/10.1016/S2215-0366(21)00395-3">301 million people globally</a>. While effective treatments for anxiety exist, many patients do not have access to them because they lack insurance coverage or transportation to providers, for instance, or they may experience only limited relief.</p>
<p>It’s important to note, however, that for those affected by mental or substance use disorders, mindfulness-based approaches should not replace first-line treatments like medicine and psychotherapy such as cognitive behavioral therapy. Mindfulness strategies should be seen as a supplement to these evidence-based treatments and a complement to healthy lifestyle interventions like physical activity and healthy eating. </p>
<h2>How does meditation work? A look into the brain</h2>
<p>Studies show that regular meditators experience better attention control and improved control of heart rate, breathing and <a href="https://doi.org/10.1073%2Fpnas.0707678104">autonomic nervous system functioning</a>, which regulates involuntary responses in the body, such as blood pressure. Research also shows that people who meditate have
<a href="https://doi.org/10.1073/pnas.0707678104">lower levels of cortisol</a> – a hormone involved in the stress response – than those who don’t. </p>
<p>A recent systematic review of neuroimaging studies showed that focused attention meditation is associated with <a href="https://doi.org/10.1016/j.neubiorev.2022.104846">functional changes in several brain regions</a> involved in cognitive control and emotion-related processing. The review also found that more experienced meditators had stronger activation of the brain regions involved in those cognitive and emotional processes, suggesting that the brain benefits improve with more practice. </p>
<p>A regular meditation practice may also <a href="https://doi.org/10.1097/01.wnr.0000186598.66243.19">stave off age-related thinning of the cerebral cortex</a>, which may help to protect against age-related disease and cognitive impairment. </p>
<h2>Limitations of meditation research</h2>
<p>This research <a href="https://doi.org/10.1016/j.jaim.2022.100620">does have limits</a>. These include a lack of a consistent definition for the types of programs used, and a lack of rigorously controlled studies. In gold-standard randomized controlled trials with medications, study participants don’t know whether they are getting the active drug or a placebo. </p>
<p>In contrast, in trials of mindfulness-based interventions, participants know what condition they are assigned to and are not “blinded,” so they may expect that some of the health benefits may happen to them. This creates a sense of expectancy, which can be a confounding variable in studies. Many meditation studies also don’t frequently include a control group, which is needed to assess how it compares with other treatments.</p>
<h2>Benefits and wider applications</h2>
<p>Compared with medications, mindfulness-based programs may be more easily accessible and have fewer negative side effects. However, medication and psychotherapy – <a href="https://theconversation.com/cbt-dbt-psychodynamic-what-type-of-therapy-is-right-for-me-171101">particularly cognitive behavioral therapy</a> – work well for many, and a combination approach may be best. Mindfulness-based interventions are also cost-effective and have better health outcomes than usual care, particularly among <a href="https://doi.org/10.1007/s12671-022-01960-1">high-risk patient populations</a> – so there are economic benefits as well.</p>
<p>Researchers are studying ways to deliver mindfulness tools on a computer or smartphone app, or with virtual reality, which may be <a href="https://doi.org/10.1016/j.explore.2022.08.001">more effective</a> than conventional in-person meditation training. </p>
<p>Importantly, mindfulness is not just for those with physical or mental health diagnoses. Anyone can use these strategies to reduce the risk of disease and to take advantage of the health benefits in everyday life, such as improved sleep and cognitive performance, elevated mood and lowered stress and anxiety. </p>
<h2>Where to get started?</h2>
<p>Many recreation centers, fitness studios and even universities offer in-person meditation classes. For those looking to see if meditation can help with the treatment of a physical or mental condition, there are over 600 <a href="https://clinicaltrials.gov/ct2/results?term=mindfulness+OR+meditation&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=">clinical trials</a> currently recruiting participants for various conditions, such as pain, cancer and depression. </p>
<p>If you want to try meditation from the comfort of your home, there are many free online videos on how to practice, including meditations for sleep, stress reduction, mindful eating and more. Several apps, such as Headspace, appear promising, with randomized controlled trials <a href="https://doi.org/10.2196/40924">showing benefits for users</a>. </p>
<p>The hardest part is, of course, getting started. However, if you set an alarm to practice every day, it will become a habit and may even translate into everyday life – which is the ultimate goal. For some, this may take some time and practice, and for others, this may start to happen pretty quickly. Even a <a href="https://doi.org/10.1007/s12671-019-01163-1">single five-minute session</a> can have positive health effects.</p><img src="https://counter.theconversation.com/content/195276/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hilary A. Marusak does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mindfulness, one of the most common forms of meditation, is a skill that must be cultivated and practiced. With some training and discipline, it can help anyone live more fully in the moment.Hilary A. Marusak, Assistant Professor of Psychiatry and Behavioral Neurosciences, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1896142022-11-15T13:22:55Z2022-11-15T13:22:55ZHey, new parents – go ahead and ‘spoil’ that baby!<figure><img src="https://images.theconversation.com/files/492648/original/file-20221031-19-qf207o.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C5200%2C3448&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">How to soothe a crying baby? Try everything.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-handing-crying-baby-boy-bottle-royalty-free-image/100955175?phrase=crying baby parent&adppopup=true">Tripod/Getty Images</a></span></figcaption></figure><p>When an infant cries, parents frequently wonder whether they should soothe the baby or let the baby calm itself down. If they respond to every sob, won’t the baby cry more? Isn’t that spoiling the baby?</p>
<p>I hear these questions a lot as <a href="https://scholar.google.com/citations?user=vtfvXqMAAAAJ&hl=en">a professor of child development and family science</a>. The notion of spoiling a baby remains common in the U.S., <a href="https://www.zerotothree.org/resource/help-your-child-develop-self-control/">despite evidence</a> that infants who have parents who respond to their needs are better at <a href="https://doi.org/10.1037/0893-3200.16.4.447">calming themselves down later in life</a>.</p>
<p>Many of the students I teach say that their parents resisted calming their cries and that they turned out just fine. Of course, there are <a href="http://doi.org/10.1016/j.infbeh.2008.10.007">individual differences in early childhood development</a>. There is no “<a href="http://doi.org/10.1111/cdep.12446">one size fits all</a>” for parenting. </p>
<p>That said, for decades now, developmental scientists have studied emotional regulation in children and the caregiver-infant bond. There is an answer to the common question of whether it’s better to comfort a crying baby or let them learn to calm themselves down. Let me explain …</p>
<h2>Emotional regulation during infancy</h2>
<p>Infants are born with a remarkable number of capabilities. Indeed, <a href="http://doi.org/10.1177/1745691619895071">research shows</a> that babies seem to <a href="https://doi.org/10.1038/s41598-019-39511-9">“know” a lot more about the world we live and grow in</a> than previously believed. For instance, infants <a href="https://www.nature.com/articles/358749a0">possess an understanding of numbers</a>, <a href="https://doi.org/10.1037/0012-1649.23.5.655">object permanence</a> and even <a href="https://www.nytimes.com/2010/05/09/magazine/09babies-t.html">morality</a>.</p>
<p>However, infants’ abilities are still immature. They rely on their caregivers to fine-tune those skills, <a href="http://doi.org/10.1126/science.1128727">much like other young mammals</a>. </p>
<p>And one thing newborns cannot do is <a href="https://www.ncbi.nlm.nih.gov/books/NBK225568/">regulate their own distress</a> – whether that distress comes from feeling <a href="http://doi.org/10.1016/j.copsyc.2017.02.009">cold, hunger, pain or any other discomfort</a>. That ability does not develop until approximately 4 months of age. So infants need their parents’ help to calm down. </p>
<p>Since crying is one of the first ways infants communicate <a href="https://doi.org/10.1016/0031-9384(94)00345-6">their needs to caregivers and others</a>, <a href="http://doi.org/10.1016/j.infbeh.2010.01.001">it is imperative</a> for the infant-parent bond that caregivers <a href="https://doi.org/10.1037/0012-1649.40.6.1123">respond to their infant cries</a>.</p>
<p>Moreover, <a href="http://doi.org/10.1093/cercor/bhv306">research shows</a> that infant cries elicit an apparent psychological need in others to <a href="https://doi.org/10.1016/S0163-6383(80)80020-8">ease their distress</a>. As such, infant cries serve a fundamental purpose for both infant and caregiver.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/492649/original/file-20221031-19-p24klo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Gay fathers trying to calm a crying newborn. The group is lying on bed with large window and sunlight in the background." src="https://images.theconversation.com/files/492649/original/file-20221031-19-p24klo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492649/original/file-20221031-19-p24klo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492649/original/file-20221031-19-p24klo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492649/original/file-20221031-19-p24klo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492649/original/file-20221031-19-p24klo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492649/original/file-20221031-19-p24klo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492649/original/file-20221031-19-p24klo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Caregivers who respond to infant needs show babies that they are worthy of love and care.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/calming-newborn-royalty-free-image/1160661226?phrase=crying%20baby%20parent&adppopup=true">Willie B. Thomas/Getty Images</a></span>
</figcaption>
</figure>
<p>Critically, infants also learn from the responsiveness of their caregivers <a href="https://doi.org/10.1037/0012-1649.40.6.1068">what it feels like to calm down</a>. This feeling is similar to the internal changes that adults and older children feel when they regulate their emotions – that is, their heart rate slows and they feel at ease. This repeated experience gives <a href="https://doi.org/10.1111/j.1467-8624.2008.01255.x">infants new life skills</a>: Longitudinal research indicates that infants whose caregivers respond to their distress are better able to <a href="http://doi.org/10.1017/S0954579408000023">regulate emotion and behavior as they get older</a>.</p>
<p>For babies, self-soothing likely means sucking on a pacifier or a fist. Later in life, those foundational infant calming skills learned in response to parental care develop into more adultlike habits for <a href="https://doi.org/10.1111/j.1469-7610.2008.02050.x">regulating distress</a>, like counting to 10 or taking deep breaths.</p>
<h2>Caregiver-infant bonding</h2>
<p>Parental responsiveness to infant cries also affects the infant-caregiver relationship. Caregivers provide the first information for infants about the predictability of the social world, the trustworthiness of others and about their own self-worth. </p>
<p>This lays the foundation for the quality of the <a href="https://doi.org/10.1037/fam0000794">lifelong relationship</a> between a caregiver and child. When infants are soothed in times of distress, they learn that their caregiver is trustworthy and reliable. They also learn that they are <a href="http://www.jstor.org/stable/23093743">worthy</a> of caring, loving relationships, which positively influences their <a href="http://doi.org/10.1111/j.1551-6709.2010.01112.x">future relationships</a>. </p>
<p>Caregiver responsiveness is also associated with a cascade of <a href="https://doi.org/10.1037/dev0000862">well-documented outcomes</a> in infants, children and adolescents, including <a href="http://doi.org/10.1542/peds.2005-1284">cognitive functioning</a>, <a href="http://doi.org/10.1016/j.ecresq.2020.01.002">language development</a>, <a href="https://doi.org/10.3389/fpsyg.2022.870669">self-esteem</a> and <a href="http://doi.org/10.1037/dev0000579">future sensitivity to infant needs</a>. </p>
<p>The absence of caregiver responsiveness, on the other hand, is <a href="https://doi.org/10.1037/0012-1649.35.2.569">linked to later behavioral difficulties</a> and <a href="https://doi.org/10.1111/j.1469-7610.2009.02202.x">developmental challenges</a>. Studies show that neglected children can struggle to bond with their peers and to cope with rejection.</p>
<p>Though one study recently reported that these <a href="https://doi.org/10.1111/jcpp.13223">ill effects might not apply</a> at night – as in, when parents let babies “cry it out” to teach them to sleep – the major consensus in the literature is that before 4 months of age babies should not be left to cry. I recommend no earlier than 6 months because of the formation of the attachment bond, and highly encourage caregivers to consider the individual abilities of their child. Indeed, some children are able to self-regulate better than others. In addition, there are <a href="https://www.npr.org/sections/health-shots/2019/07/15/730339536/sleep-training-truths-what-science-can-and-cant-tell-us-about-crying-it-out">alternative ways</a> to help babies learn to self-soothe at night that include responding to infant distress.</p>
<p>Fortunately, caregivers are biologically <a href="https://psycnet.apa.org/record/2002-02628-003">primed to care for their infants</a>. Research with animals and humans demonstrates that there are <a href="https://doi.org/10.1016/j.copsyc.2017.02.011">hormones that drive caregiving</a>. </p>
<h2>Go ahead, ‘spoil’ that baby</h2>
<p>My best advice, based on the scientific literature, is that parents should respond promptly and consistently to infant cries through at least 6 months of age. </p>
<p>But take a pragmatic approach. </p>
<p>Caregivers know the idiosyncrasies of their infants: Some may be more placid, while others are more excitable. Likewise, culture drives the goals caregivers set for themselves and their children. So, responsiveness and adaptive caregiver-infant relationships will look different for different families. Parents should act accordingly, <a href="https://doi.org/10.1111/cdep.12446">fitting their responsiveness</a> to their infant’s needs and their <a href="https://doi.org/10.1080/14616734.2022.2030132">cultural context</a>. </p>
<p>However you look at it, responding to an infant’s every cry is not “spoiling” the baby. Instead, the act of soothing a crying infant provides the baby with the tools they will use to soothe themselves in the future.</p><img src="https://counter.theconversation.com/content/189614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Root receives funding from National Institute of Child Health and Human Development.</span></em></p>A professor of child development explains why it’s OK – recommended, in fact – to respond to an infant’s every cry, sob and whimper.Amy Root, Professor of Applied Human Sciences, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1912452022-10-24T20:00:49Z2022-10-24T20:00:49ZReflection Room: Exploring pandemic-related grief in long-term care homes<figure><img src="https://images.theconversation.com/files/491450/original/file-20221024-6634-l5un5d.jpg?ixlib=rb-1.1.0&rect=181%2C502%2C5341%2C3873&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reflection Rooms are evidence-based, participatory art installations that help people express emotions about death and dying.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/reflection-room--exploring-pandemic-related-grief-in-long-term-care-homes" width="100%" height="400"></iframe>
<p>The COVID-19 pandemic created a tremendous amount of <a href="https://doi.org/10.1177/26323524221092456">collective loss and grieving</a> that requires care and support. This was as true in residential long-term care (LTC) homes, which continue to experience <a href="https://www.cbc.ca/news/canada/toronto/seventh-wave-outbreaks-long-term-care-1.6514707">pandemic-related challenges</a>, as in <a href="https://doi.org/10.1186/s12995-022-00352-4">hospitals</a> and among the <a href="https://www.canada.ca/en/public-health/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-42-no-5-2022/self-rated-mental-health-community-belonging-life-satisfaction-perceived-change-mental-health-adults-covid-19-pandemic-canada.html">general public</a>. </p>
<p>Through the Reflection Room project, our interdisciplinary team of researchers is partnering with LTC homes in Ontario to create physical spaces to pause, reflect, connect and process grief. </p>
<p>Many LTC home communities were <a href="https://doi.org/10.1080/17482631.2022.2075532">seriously affected by COVID-19</a>. On top of the stress from <a href="https://data.ontario.ca/en/dataset/long-term-care-home-covid-19-data/resource/4b64488a-0523-4ebb-811a-fac2f07e6d59">COVID-19 infections and deaths</a>, staff have experienced <a href="https://doi.org/10.1016/j.ajic.2021.03.006">burnout and low morale</a>, and some homes with <a href="https://www.ontario.ca/page/covid-19-guidance-document-long-term-care-homes-ontario?_ga=2.171566758.786944958.1664389787-699570453.1664389787#section-14">outbreaks</a> must continue to restrict residents’ movements, isolate residents in their rooms and limit activities such as social functions to reduce risk of spread. </p>
<p>Many people within these communities have reflected on the <a href="https://doi.org/10.1080/17482631.2022.2075532">trauma</a> the pandemic has caused. <a href="https://www.ontario.ca/page/long-term-care-covid-19-commission-progress-interim-recommendations">Ontario’s Long-Term Care COVID-19 Commission Final Report</a> has recommended reforms and counselling services. However, with the immense levels of <a href="https://doi.org/10.1080/15524256.2021.1881692">grief</a>, and <a href="https://doi.org/10.1177/00302228221107979">feelings</a> of helplessness, regret and sadness, there is also a need for innovative and timely support for LTC communities. </p>
<h2>Reflection Rooms</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/488377/original/file-20221005-16-ym59a3.png?ixlib=rb-1.1.0&rect=22%2C0%2C1137%2C1052&q=45&auto=format&w=1000&fit=clip"><img alt="A white card with 'My reflection' printed in red at the top, and a handwritten note reading 'I can't help but wonder...how long until the fatigue catches up to us? I feels like one wave after another.'" src="https://images.theconversation.com/files/488377/original/file-20221005-16-ym59a3.png?ixlib=rb-1.1.0&rect=22%2C0%2C1137%2C1052&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/488377/original/file-20221005-16-ym59a3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=845&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488377/original/file-20221005-16-ym59a3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=845&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488377/original/file-20221005-16-ym59a3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=845&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488377/original/file-20221005-16-ym59a3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1062&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488377/original/file-20221005-16-ym59a3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1062&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488377/original/file-20221005-16-ym59a3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1062&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A reflection card written by a visitor to a Reflection Room.</span>
<span class="attribution"><span class="source">(SE Research Centre)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Reflection Rooms are evidence-based, participatory art installations created in 2016 by the <a href="https://research.sehc.com/">SE Research Centre</a>, led by Paul Holyoke from the Centre and Barry Stephenson from Memorial University of Newfoundland. The goal of the project is to support people in community and health-care settings to talk about dying and death by providing an immersive space for visitors to read stories written by others and write and share their own stories. </p>
<p>A forthcoming research study evaluated the impact of 62 Reflection Room installations across Canada from 2016-20. We found the installations created space for expressing emotions such as love and regret, and making sense of experiences related to dying and death. </p>
<p>This included making meaning of the mystery of mortality, dying and death, and feeling that connections with memories or with what participants called the spirit can continue after physical death. </p>
<h2>Adaptation during the pandemic</h2>
<p>During the pandemic, <a href="https://vimeo.com/644005228?embedded=true&source=vimeo_logo&owner=57540768">the Reflection Room project was adapted</a> to address experiences of loss and grief in LTC homes in Ontario. In this evolution of the project, LTC homes are provided with an easy-to-set-up kit incorporating instructions and materials at no cost. These materials include elements such as reflection cards, a red curtain to display the cards, and candles. The kit ensures each LTC home can adapt the Reflection Room to the space available, creating opportunities for quiet and reflection. Reflection Rooms have been installed in 27 LTC homes across Ontario.</p>
<figure class="align-center ">
<img alt="A young woman in scrubs sitting with an older woman, holding her hand." src="https://images.theconversation.com/files/491110/original/file-20221021-26-n0u7oa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491110/original/file-20221021-26-n0u7oa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491110/original/file-20221021-26-n0u7oa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491110/original/file-20221021-26-n0u7oa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491110/original/file-20221021-26-n0u7oa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491110/original/file-20221021-26-n0u7oa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491110/original/file-20221021-26-n0u7oa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Reflection Room visitors included long-term care staff, residents and caregivers, all of whom were affected by grief in the context of COVID-19.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Based on 68 surveys completed by Reflection Room visitors — including LTC staff, residents and caregivers — we believe these installations offer an opportunity to work through grief in the context of COVID-19. </p>
<p>Reflection Rooms provide a setting where people can look inward in a helpful way, experience calm and peace, and develop a sense of connection and compassion for others. These elements – finding a calm place, reflecting, writing and allowing emotions to arise — are all part of grief work, according to <a href="https://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/Topics/Topics/Emotional+Health/Grief+Work.aspx">Canadian Virtual Hospice</a>, which provides support and information about palliative and end-of-life care, loss and grieving.</p>
<p>Most people who completed surveys recommend that other LTC homes have a Reflection Room. Many said the project can support those who are grieving and that it is important because it provides a place of respite and self-reflection, and has the potential to support holistic well-being for individuals and communities. </p>
<p>Some visitors to LTC Reflection Rooms commented: </p>
<blockquote>
<p>“It is a coping mechanism, a place to share grief and see how others are feeling, maybe get a tip on how to cope and move on.” – Caregiver</p>
<p>“Some people can’t ‘talk’ about what’s really on their mind, but find it easier to write about it.” – Resident</p>
<p>“It became a heartwarming and meaningful space.” – LTC home staff</p>
</blockquote>
<p><a href="https://ontario.cmha.ca/documents/loss-and-grief-during-the-covid-19-pandemic/">Experiences of grief</a> can include a range of emotions that come and go unpredictably, including anger, joy, numbness and anguish. Acknowledging and naming grief can be an important step in processing loss in a healthy and transformative way. </p>
<p>In grief and bereavement research, <a href="https://doi.org/10.1017/s1478951513001211">studies have found</a> that storytelling has an affirming, healing effect on the storyteller and on those who hear the stories. The Reflection Room project does this by providing an opportunity to acknowledge grief, feel less alone and externalize grief through storytelling. </p>
<p>The Reflection Room has evolved to respond to societal and personal needs surrounding loss and grief. One constant throughout the project is that Reflection Rooms offer visitors an opportunity to slow down, work on processing their grief and feel a sense of connection and solidarity with others. </p>
<p><em>This article was co-authored by Neeliya Paripooranam, Reflection Room project manager.</em></p><img src="https://counter.theconversation.com/content/191245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Celina Carter works for SE Research Centre.</span></em></p><p class="fine-print"><em><span>Elizabeth Kalles works for the SE Research Centre, SE Health. </span></em></p><p class="fine-print"><em><span>Justine Giosa is the Managing Director of the SE Research Centre, SE Health.</span></em></p><p class="fine-print"><em><span>Paul Holyoke is the Executive Director of the SE Research Centre.</span></em></p><p class="fine-print"><em><span>Barry Stephenson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Reflection Rooms support people making sense of experiences related to dying and death. They provide an immersive space to read stories written by others and write and share their own stories.Celina Carter, Instructor, University of TorontoBarry Stephenson, Associate Professor, Religious Studies, Memorial University of NewfoundlandElizabeth Kalles, PhD student, School of Public Health Sciences, University of WaterlooJustine Giosa, Adjunct Assistant Professor, School of Public Health Sciences, University of WaterlooPaul Holyoke, Sessional Lecturer, Health Studies program, University College, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1864562022-09-06T20:16:25Z2022-09-06T20:16:25ZHow caregivers can help build children’s emerging language skills<figure><img src="https://images.theconversation.com/files/482378/original/file-20220901-14792-5mbmre.jpg?ixlib=rb-1.1.0&rect=0%2C200%2C4677%2C2928&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It is not just the number of words that children hear that is important — the quality of the language children hear also matters.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>When children develop the ability to understand language, as well as speak and communicate, this helps them interact with others and learn about their world. Research shows that children’s early language skills have a long reach in <a href="https://doi.org/10.1177/0265659020947817">affecting later life outcomes</a>. </p>
<p>Children with better language skills have an <a href="https://doi.org/10.1111/cdev.13540">easier time regulating their emotions and interacting with their peers</a>, likely in part because they can more easily communicate their thoughts, feelings and ideas. </p>
<p>Children with better language skills are also more likely to be ready for, and <a href="https://doi.org/10.1016/j.ecresq.2015.10.002">succeed in school</a>, and have better <a href="https://doi.org/10.1016/j.cogdev.2018.04.005">reading and writing skills</a>. When they are older, they are <a href="https://doi.org/10.1044/1058-0360(2009/08-0083)">more likely to be successful and fulfilled at work</a>.</p>
<p>Given the clear importance of language skills for lifelong outcomes, it is critical to set children up early for language success. Parents, grandparents, caregivers as well as early learning and care programs can play vital roles in supporting children’s language skills. We present three ways to help build children’s emerging language skills.</p>
<figure class="align-center ">
<img alt="A woman seen holding up fingers to a toddler and talking with him." src="https://images.theconversation.com/files/482381/original/file-20220901-27-t4jryr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/482381/original/file-20220901-27-t4jryr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/482381/original/file-20220901-27-t4jryr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/482381/original/file-20220901-27-t4jryr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/482381/original/file-20220901-27-t4jryr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/482381/original/file-20220901-27-t4jryr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/482381/original/file-20220901-27-t4jryr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Early learning and care programs can play vital roles in supporting children’s language skills.</span>
<span class="attribution"><span class="source">(Bridget Coila/Flickr)</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>1. Use language around children as often as possible</h2>
<p>Talking to, around, and especially with children <a href="https://doi.org/10.1542/peds.2017-4276">supports their language learning</a>. This is the case for children of all economic and cultural backgrounds. </p>
<p>Both the <a href="https://doi.org/10.1111/cdev.13508">quantity and the quality of what caregivers say matter</a> for children’s language learning. </p>
<p>Our research shows that children who hear more words and sentences have more words in their vocabulary and stronger language skills. So, as much as possible, talk with your children. Even when they can’t speak, children are still absorbing and learning from the language they hear around them.</p>
<figure class="align-center ">
<img alt="A man with two young children and a baby sit around a table." src="https://images.theconversation.com/files/481910/original/file-20220830-35381-ix7qgq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481910/original/file-20220830-35381-ix7qgq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481910/original/file-20220830-35381-ix7qgq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481910/original/file-20220830-35381-ix7qgq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481910/original/file-20220830-35381-ix7qgq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481910/original/file-20220830-35381-ix7qgq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481910/original/file-20220830-35381-ix7qgq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children who hear more words and sentences have more words in their vocabulary and stronger language skills.</span>
<span class="attribution"><span class="source">(Pexels/Keira Burton)</span></span>
</figcaption>
</figure>
<p>Pretend you are a commentator, talking out loud about what you are doing, why you are doing it, and what’s happening in the child’s environment. For example, when sitting at a park with your baby or preschooler, you might say: </p>
<blockquote>
<p>“Look at the green tree. It’s a maple tree. How many trees do we see? That tree looks different from the tree by the bench…..” </p>
</blockquote>
<p>It is not just the number of words that children hear that is important — the quality of the language children hear also matters. </p>
<p>That means it is important to use a variety of words and sentence structures when talking to children. For example, instead of just pointing to a dog and labeling it, you can describe the fur colour of the dog, talk about what the dog is doing, and ask questions about the dog. </p>
<p>For example: </p>
<blockquote>
<p>“Look at the dog. The dog is so big and fluffy and has such long legs. The dog is running towards the ball. That ball sure bounces. I hope the dog can catch it.”</p>
</blockquote>
<p>Caregivers can also ask questions starting with words like “who, what, when, where, and why” to encourage children to provide a more complex response. This gives them the opportunity to use new words and sentence structures in their own speech. </p>
<p>Open-ended statements are also great to encourage language growth. You can use statements like: Tell me more, is that so, and then what happened…? Try to wait at least five to ten seconds to give your child time to respond. </p>
<figure class="align-center ">
<img alt="A mother, daughter and dog." src="https://images.theconversation.com/files/481911/original/file-20220830-35381-phq2k6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481911/original/file-20220830-35381-phq2k6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481911/original/file-20220830-35381-phq2k6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481911/original/file-20220830-35381-phq2k6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481911/original/file-20220830-35381-phq2k6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481911/original/file-20220830-35381-phq2k6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481911/original/file-20220830-35381-phq2k6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Talking about different attributes of children’s environments and the objects around them helps children make connections.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>2. Read books with children daily</h2>
<p>Shared book reading provides another great opportunity for language learning. Book reading exposes children to new words that are less commonly used in everyday speech as well as a variety of sentence structures. Books are a great way to expose children to high quality language as well as create a unique bonding experience. </p>
<p>Reading together also helps children focus and pay attention for longer periods of time, which helps them learn and sets them up for success in school. </p>
<p>Caregivers can try to make reading with children part of their everyday routine. How you read can help improve the child’s ability to learn new words. Describe pictures, give a definition for new words, ask questions, and incorporate music. Stories provide an opportunity to make links with your child’s experiences. Even when children are still young, invite them to turn the pages of the book and ask them what they think might happen next.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/parents-play-a-key-role-in-fostering-childrens-love-of-reading-121089">Parents play a key role in fostering children's love of reading</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="A dad seen reading to his baby." src="https://images.theconversation.com/files/482377/original/file-20220901-4342-arjlg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/482377/original/file-20220901-4342-arjlg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/482377/original/file-20220901-4342-arjlg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/482377/original/file-20220901-4342-arjlg8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/482377/original/file-20220901-4342-arjlg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/482377/original/file-20220901-4342-arjlg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/482377/original/file-20220901-4342-arjlg8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Reading with children helps them focus and pay attention for longer periods of time.</span>
<span class="attribution"><span class="source">(Pexels/Nappy)</span></span>
</figcaption>
</figure>
<h2>3. Engage in ‘serve and return’ interactions</h2>
<p>Language skills can be developed through everyday interactions between caregivers and children. Sensitive caregivers notice vocalizations, cries, facial expressions, and other clues signaling that children need help, comfort or reassurance. </p>
<p>Sensitive interactions are often called “serve and return” interactions because they are like a game of tennis. The child “serves” a cue by pointing to something, asking a question, or saying something, and the caregiver needs to “return” the serve by repeating, answering or commenting. </p>
<p>While parents can be sensitive when speaking with their child, they can also show sensitivity by comforting a child who is sad or hurt. Our research shows that <a href="https://doi.org/10.1542/peds.2018-3556">when caregivers are sensitive to their child’s needs and engage in serve and return interactions</a>, children develop better language skills.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KNrnZag17Ek?wmode=transparent&start=17" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Video on ‘serve and return’ interactions from Center on the Developing Child at Harvard University.</span></figcaption>
</figure>
<p>Even young infants benefit from serve-and-return interactions. For instance, ask your infant a question, and give them some time to answer! When they do, through uttering a sound like “da”, repeat it again, and then elaborate by saying “dada” and connect it to a reference point (like “daddy”) to encourage more language use and understanding. That way, we can support children’s inherent drive to connect and communicate with us.</p>
<p>Children begin learning language as very young babies and continue to develop their language abilities throughout childhood. Caregivers can help develop and enhance this important skill in everyday life by talking, singing, reading and tuning into them!</p><img src="https://counter.theconversation.com/content/186456/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Audrey-Ann Deneault receives funding from the Social Sciences and Humanities Research Council of Canada and from the Fonds de recherche du Québec - Société et culture.</span></em></p><p class="fine-print"><em><span>Lorraine Reggin receives funding from the Social Sciences and Humanities Research Council and has completed two Mitacs Accelerate Internships in collaboration with Calgary Reads, a not-for-profit literacy organization in Calgary, AB. </span></em></p><p class="fine-print"><em><span>Penny Pexman receives funding from the Social Sciences and Humanities Research Council and the Natural Sciences and Engineering Research Council. </span></em></p><p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, and the Canada Research Chairs program.</span></em></p><p class="fine-print"><em><span>Susan Graham receives funding from the Social Sciences and Humanities Research Council, the Natural Sciences and Engineering Research Council of Canada, and the Alberta Children's Hospital Foundation through the Owerko Centre.</span></em></p>Given the clear importance of language skills for lifelong outcomes, it is critical to set children up early for language success.Audrey-Ann Deneault, Postdoctoral Research Fellow, Department of Psychology, University of CalgaryLorraine Reggin, PhD student, Cognitive Psychology, University of CalgaryPenny Pexman, Professor of Psychology, University of CalgarySheri Madigan, Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgarySusan Graham, Professor, Department of Psychology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1868562022-08-16T14:45:25Z2022-08-16T14:45:25ZPeople with intellectual disability have a right to sexuality – but their families have concerns<figure><img src="https://images.theconversation.com/files/478750/original/file-20220811-6992-vr0mgb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with intellectual disability are entitled to their human rights like everyone else.</span> <span class="attribution"><span class="source">Shutterstock </span></span></figcaption></figure><p>Many South Africans living with intellectual disability don’t have opportunities to be part of community life. They may lack the opportunity to learn, work or enjoy leisure activities and social connections like anyone else.</p>
<p>There are various reasons for this. Inadequate health and social services, stigma and poor understanding of intellectual disability in society are some of them. One reason that researchers haven’t explored much relates to family members’ legitimate fears of the risk that their relatives will be sexually abused. </p>
<p>There are common <a href="https://doi.org/10.1007/s11195-014-9344-x">misconceptions about and negative attitudes</a> towards the sexuality of people with intellectual disability. They are also <a href="https://doi.org/10.2989/17280583.2012.735498">easy targets for sexual crime perpetrators</a> who take advantage of their diminished ability to understand or judge other people’s intentions. They are often eager to please others and face communication challenges which make it difficult to report if anything happened to them. </p>
<p>Data on sexual violence against people with intellectual disabilities in South Africa is scanty. But the available literature suggests that <a href="https://doi.org/10.2989/17280583.2012.735498">this group is at high risk</a>. </p>
<p>Intellectual disability <a href="https://www.ncbi.nlm.nih.gov/books/NBK332877/#:%7E:text=DSM%2D5%20defines%20intellectual%20disabilities,and%20practical%20areas%20of%20living.">affects</a> a person’s mental abilities including reasoning, problem solving, abstract thinking, judgement and academic learning. These challenges affect a person’s ability to be independent. The <a href="http://cs2016.statssa.gov.za/wp-content/uploads/2018/07/CS-2016-Disability-Report_-03-01-232016.pdf">2016 Community Survey</a> in South Africa placed intellectual disability in a category relating to difficulties with remembering or concentration. It reported an estimate of 3.3% of the population as having mild difficulty and 1% as having severe difficulty. </p>
<p>Despite their limitations, people with intellectual disability are entitled to their human <a href="https://www.justice.gov.za/legislation/constitution/SAConstitution-web-eng-02.pdf#page=2">rights</a> like everyone else. These include the right to sexual autonomy and sexuality education. But sexuality education and support are not usually available to this population group.</p>
<p>With this lack of support, many family caregivers – especially parents – live with a fear that their child or relative lacks competency. There’s concern that they may be at risk of sexual abuse, or might display inappropriate sexual behaviour. A common response is for caregivers to become overprotective. As a result, the person with intellectual disability is kept under surveillance. </p>
<p>In my <a href="https://open.uct.ac.za/handle/11427/24508">research</a> in the Western Cape province of South Africa I found that some people with intellectual disability were being “detained” at home. They were denied opportunities for education and training, employment, leisure, and other forms of social life. The main reasons related to sexuality.</p>
<h2>Study findings</h2>
<p>I interviewed 25 family caregivers about sexuality issues concerning their relative with intellectual disability. I also interviewed nine service providers about their views of families’ responses.</p>
<p>Family caregivers expressed a range of actions, attitudes and behaviours – from suppression of their relative’s sexuality to support. Responses shifted between the two extremes, depending on availability of professional support and the specific sexuality issue. </p>
<p>In the responses that tended towards suppression of sexuality, one of the main reasons was fear. </p>
<p>When a child reaches puberty and then adulthood, families face the reality of that person’s sexual maturation. Some families would prefer not to think about this at all. Physical body changes, menstruation, masturbation, interest in sexual intimacy, evidence of sexual activity, desire to become a parent and need for independence can be difficult for families to handle. The person with intellectual disability needs support, for example, in the form of sexuality education and empowerment. Family caregivers need emotional and practical support. These are not always available.</p>
<p>Even when the person with intellectual disability has access to some services such as sheltered workshops, it’s common for there to be a lack of collaboration between service providers and families. This leaves all the responsibility with the families. </p>
<p>Due to the lack of support and their fear, caregivers become <a href="https://doi.org/10.1111/j.1468-3156.2012.00758.x">reluctant “jailers”</a> of family members with intellectual disability. But lack of stimulation and exposure to the outside world for the person with intellectual disability has negative implications. It can make a person lonely, unable to learn how to do things, and prone to mental and physical health challenges. </p>
<p>There are some organisations working with people with intellectual disability in South Africa that take the right to sexual autonomy seriously. They offer appropriate support in promoting this right. These organisations have to <a href="https://journals.sagepub.com/doi/10.1177/17446295211048743#:%7E:text=https%3A//doi.org/10.1177/17446295211048743">manage family caregivers’ anxieties</a>. Families sometimes threaten to withdraw their relative from the services to thwart sexual behaviour.</p>
<h2>Implications</h2>
<p>Detaining and protectively watching over people with intellectual disability has implications for the whole family. </p>
<p>The role of “watcher” can affect caregivers’ own independence, flexibility, productivity and well-being. This reinforces the <a href="https://hdl.handle.net/10520/EJC189294">connection between poverty and disability</a>. </p>
<p>Service providers and policy makers should promote family centred support services for people with intellectual disability and caregivers. A big part of these efforts should be sexuality education to help people make autonomous, safe choices. </p>
<p>Security is a concern among families, especially those living in high-risk areas. The safety of people with intellectual disability must be prioritised. Where they have been victims of crime, justice must be done. </p>
<p>It takes collaboration to promote social inclusion. A comprehensive <a href="https://doi.org/10.1111/jppi.12318">approach</a> is useful. It should consider the need for support at the levels of the individual, family, work, school and community. And it goes further, to cultural institutions, social structures, policies and the broader cultural context.</p><img src="https://counter.theconversation.com/content/186856/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Callista Kahonde receives funding from the National Research Foundation Innovation Postdoctoral Fellowship. She is a postdoctoral fellow at Stellenbosch University, Centre for Disability and Rehabilitation Studies and a member of the Western Cape Forum for Intellectual Disability. The article is based on her PhD study at the University of Cape Town which was funded by the Vera Grover Scholarship and Sponsorship Trust.</span></em></p>The lack of sexuality education, and common myths and misconceptions about the sexuality of people with intellectual disability can lead to caregivers being reluctant ‘jailers’.Callista Kahonde, Postdoctoral fellow, Disability & Rehabilitation Studies, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1851092022-07-17T13:26:55Z2022-07-17T13:26:55ZCaregivers were traumatized by COVID-19 public health and long-term care policies<figure><img src="https://images.theconversation.com/files/473768/original/file-20220713-24-qoaw40.jpg?ixlib=rb-1.1.0&rect=0%2C3%2C2044%2C1535&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many caregivers were prevented from seeing and taking care of their loved ones in long-terms care homes during the COVID-19 pandemic.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span></figcaption></figure><p>We all watched as the horrors unfolded in long-term care (LTC) in Canada during the COVID-19 pandemic. Canadian <a href="https://www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf">LTC residents represented 81 per cent of the national reported COVID-19 deaths</a>. </p>
<p>News reports documented <a href="https://www.theglobeandmail.com/amp/opinion/article-seniors-care-home-neglect-is-our-national-shame/">our national shame</a> as older residents suffered throughout the pandemic. They experienced inhumane treatment, ranging from <a href="https://www.ctvnews.ca/health/coronavirus/like-being-in-solitary-confinement-residents-families-angry-at-return-of-strict-lockdowns-in-long-term-care-1.5730999">physical and social solitary confinement</a> to <a href="https://www.theglobeandmail.com/amp/canada/article-herron-long-term-care-residents-died-of-thirst-malnourishment-quebec/">severe neglect, and even death from dehydration and malnourishment</a>. </p>
<p>Residents were confined to their rooms for extended periods of time without access to recreation programs or visitors, including essential family caregivers who often provided the majority of daily care, like feeding and dressing, as well as socialization. </p>
<p>The Canadian military was deployed to some of the hardest-hit LTC homes across Canada. They <a href="https://www.documentcloud.org/documents/6928480-OP-LASER-JTFC-Observations-in-LTCF-in-On.html?_ga=2.120831688.1397932972.1655573340-435556542.1655573340">documented disturbing accounts of abuse and substandard care</a> — residents were left for days in soiled bedding and were documented choking on their food due to improper feeding. Some LTC homes had insect infestations and poor infection prevention and control practices. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/2Bk874dcynA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Global News reports on the deployment of the military to longterm care homes.</span></figcaption>
</figure>
<p>Family caregivers watched as the tragedies and distress occurred, while they were forbidden from visiting their loved ones in these homes.</p>
<h2>Collective trauma</h2>
<p>Essential family caregivers are defined as any trusted individual chosen by the resident or their substitute decision-maker who provides care and companionship to a resident. </p>
<p>In many provinces, LTC homes began drafting strict rules allowing only a small number of essential family caregivers — one or two — into LTC homes at varying stages throughout the pandemic, and initially only for residents receiving palliative care. This access was often regulated by varying rules. These designated family members were often the only connection LTC residents had to the world outside their room. </p>
<p><a href="https://doi.org/10.3389/fpsyg.2018.01441">Collective trauma</a> can be understood as a “cataclysmic event” that significantly, directly or indirectly, impacts a unique group of people. Our research shows that <a href="https://doi.org/10.1080/17482631.2022.2075532">essential family caregivers of residents in LTC experienced collective trauma caused by prolonged separation, resulting in feelings of extreme helplessness and hopelessness</a>. </p>
<p>Family caregivers felt powerless in the face of draconian visitation bans levied by governments. They had to watch helplessly as their loved ones deteriorated. Relationships between essential family caregivers and LTC staff and management became strained, and often adversarial. Families felt that they were being purposefully kept out to hide the ongoing negligence exposed early on in the pandemic.</p>
<h2>Technological substitutes</h2>
<p>After months of separation, LTC homes attempted to use technology to facilitate communication between family caregivers and residents. Another study showed that <a href="https://doi.org/10.1177/07334648221081850">technology was a poor substitute for in-person communication</a>. This was often due to scheduling issues, poor utility and the devices not being able to adapt to the physical or cognitive needs of the resident. </p>
<p>Additionally, LTC homes <a href="https://doi.org/10.1080/08959420.2021.1927620">lack technological infrastructure</a>, like Wi-Fi or tablets, to support that mode of communication. The majority of homes also do not train their staff to use technologies — facilitating video calls, for example, requires staff to set up the devices for the resident. </p>
<p>Often, calls were inappropriately set up. In one situation, residents were placed in a noisy common area, making it hard for families and residents to hear one another. Video conferencing was also a source of distress and agitation for some residents with dementia. The lack of privacy also prevented residents and families from discussing the care provided. </p>
<p>The futility of these video conferences led family caregivers to give up. Technology, in this case, was promoted as a lifeline to essential family caregivers but it turned out to be an inadequate means of communication. </p>
<p>Finally, essential family caregivers were forced to undergo repeated and invasive polymerase chain reaction (PCR) testing. During times of high community spread, caregivers completed twice-weekly testing to retain their weekly access to residents. One study participant noted completing 50 PCR tests in an eight-month period to merely retain uninterrupted weekly access to her loved one in LTC. </p>
<p>During a period of limited testing, this meant hours of additional time and strain on family caregivers, often adult female children of residents who had to take time off work.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473765/original/file-20220713-24-wobs8o.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two hands holding a phone. The screen shows an elderly man in a wheelchair and a woman wearing a face mask standing behind him" src="https://images.theconversation.com/files/473765/original/file-20220713-24-wobs8o.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473765/original/file-20220713-24-wobs8o.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473765/original/file-20220713-24-wobs8o.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473765/original/file-20220713-24-wobs8o.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473765/original/file-20220713-24-wobs8o.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473765/original/file-20220713-24-wobs8o.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473765/original/file-20220713-24-wobs8o.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Esther Hladkowicz holds an image of her and her father Heinz Ziebell, that was taken during their first visit in eight months because of COVID-19 restrictions.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
</figcaption>
</figure>
<p>Family caregivers also recalled seeing their loved one in person again and experiencing the “shock” from seeing the damage firsthand. The physical, cognitive and psychological harm done to their loved ones from prolonged confinement was described as a “nightmare.” </p>
<p>Many recounted their loved ones’ physical decline from being able to walk to becoming wheelchair-bound. They also witnessed residents’ deterioration, severe weight loss to the point of being “skin and bones,” unexplained injuries and often drastic cognitive changes. </p>
<p>The inability to protect and be there for their loved ones in LTC during COVID-19 is an additional burden that essential family caregivers will have to shoulder.</p>
<h2>Preparing for future pandemics</h2>
<p>As we prepare for potential future pandemics, collectively we must fix the issues that persist within the LTC sector. The future of care must involve more publicly funded and quality models of home care that allow older adults to age in place in their private households. </p>
<p>But because LTC homes will remain to provide extensive and complex care for a growing number of older people and others, like people with disabilities, we propose the following starting points: </p>
<p>1) Policy: There need to be laws, ideally at the federal level, to prevent families from being locked out of LTC homes. Efforts have been made, like <a href="https://www.ola.org/en/legislative-business/bills/parliament-42/session-1/bill-203">Bill 203, More Than a Visitor Act</a> in some provinces, but have yet to be implemented.</p>
<p>2) Practice: Adopting a <a href="https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf">trauma-informed care approach</a>, that emphasizes safety, trust, support, collaboration, empowerment and the consideration of cultural, historical and gender issues. This approach should be integrated into health-care providers’ practices and care guidelines. </p>
<p>3) Interventions: The <a href="http://www.ltccommission-commissionsld.ca/report/pdf/20210623_LTCC_AODA_EN.pdf">Ontarian LTC Commission’s final report</a> highlighted the need for counselling services to be offered to staff and residents, yet no suggestion was made to extend these services to family caregivers. Our research clearly highlights the need for such supports to family caregivers of those living in LTC. </p>
<p>The cumulative consequences of ongoing visitation restrictions in LTC have yet to be fully realized, and will continue to emerge over time for these family caregivers. The combined psychological, social and physical harms incurred by this collective group of caregivers must be recognized. We must prevent these same horrors and collateral damage from occurring again.</p><img src="https://counter.theconversation.com/content/185109/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlene Chu receives funding from CIHR, SSHRC, NFRF, Alzheimer Society of Canada, Center for Aging and Brain Health, and AGE-WELL NCE. </span></em></p><p class="fine-print"><em><span>Vivian Stamatopoulos has received funding from the Social Sciences and Humanities Research Council (SSHRC CRSH)</span></em></p>Family caregivers of residents in longterm care homes experienced a collective trauma as they were kept away from their loved ones during the pandemic. This isolation has long-ranging impacts.Charlene Chu, Assistant Professor, the Lawrence S. Bloomberg Faculty of Nursing, University of TorontoVivian Stamatopoulos, Associate Teaching Professor, Criminology and Justice, Ontario Tech UniversityLicensed as Creative Commons – attribution, no derivatives.