Abstract

The purpose of this study is to illuminate how paid family and friend caregivers describe and make sense of their motives for caregiving, and to examine how their reasons for caregiving are related to caregiver well-being. Data were collected from family and friend caregivers formerly paid to care for Medi-Cal eligible disabled and elderly under California's In-Home Supportive Services.

Data collection included a telephone survey of 383 respondents and in-depth interviews with 42 respondents (a sub-set of the survey sample), allowing for a triangulation mixed method design. The qualitative component uses a constructivist grounded theory approach informed by the tenets of Symbolic Interactionism (SI), which emphasizes the importance of understanding a situation from the person's point of view, and Feminist Standpoint Theory (FST), which brings explicit attention to the social and political context. A modified version of Kramer's conceptual model of caregiver adaptation (1997), together with an interdisciplinary literature review of caregiver motivation, provides the theoretical framework for the quantitative analyses, as well as a point of comparison for the emergent theory.

The theory developed from the qualitative data illustrates the complexity of paid family and friend caregiver motivation while also revealing some of its temporal components. Most family members and friends do not identify money as a primary motivator for taking on the caregiver role. Furthermore, their perceptions of choice in assuming the paid caregiver role often reflect existing gender and cultural norms.

The quantitative analysis identifies numerous predictors of caregiver well-being, including caregiver motivation, gender, perceived choice, and perceived importance of payment. The predictive value and direction of these variables varies, however, depending on the specific dimension of caregiver well-being assessed.

The conceptual integration of these two data sources extends understanding of paid family and friend caregiver motivation, identifying both points of concordance and contradiction. Taken together, these data present a more nuanced portrait of caregiver motivation and well-being. Within the realm of clinical intervention and practice, the findings inform efforts to assess potential caregiver availability, as well as the efficacy of policies and programs that finance caregiving.