In this research, we explored the impact of outside employment on people with disabilities and their caregivers. The results demonstrate that the longer the hours worked by care recipients in poor health, the lower their sense of accomplishment. The negative consequences of longer work hours that were experienced by a care recipient in poor health as a lower sense of accomplishment were transmitted to the caregiver, who experienced greater stress. This shows that the caregiver is vulnerable to “catching” the psychological distress experienced by the care recipient.
Implications for Theory and Research
This research first demonstrates the spillover effects experienced by a care recipient in poor health. High-quality work has a positive impact on psychological well-being (Handel, 2005; Jahoda, 1982; Kinicki, Prussia, & McKee-Ryan, 2000). But people with disabilities experience severe restrictions in job choice (Goggin & Newell, 2005; Perry et al., 2000) and are more likely to work in jobs that offer few psychological benefits (Perry et al., 2000; Schur et al., 2009). Care recipients in poor health are additionally constrained in the type or amount of work they can perform (Eisner et al., 2002). These work characteristics generate job stress, and more stress is experienced as the care recipient spends more time at work (Steinmetz et al., 2008). Negative workplace experiences spill over into everyday life, contributing to a generalized low level of a sense of accomplishment for care recipients in poor health (Demerouti et al., 2005).
This research also extends the theoretical literature on crossover effects by demonstrating that these effects happen in caregiving relationships. The caregiving relationship is sufficiently intimate (Ashworth & Baker, 2000; Williams & Mfoafo-M'Carthy, 2006) to promote the development of empathic bonds (Westman, 2001; Westman et al., 2001). Caregivers may be particularly attuned to the psychological well-being of the person they assist (Cummins, 2005), facilitating crossover effects.
The results have important implications at a time when welfare-to-work policies for people with disabilities are proliferating. OECD reports from 2005 to 2011 (OECD, 2011) conclude that existing disability benefit systems are too costly and steer people with disabilities into welfare dependency. Correspondingly, recent government initiatives have increased compliance requirements and provided greater incentives for people with disabilities to seek employment. In Australia, legislation now specifies that if a person seeking a disability pension is assessed as capable of 15–29 hours of work per week, the person is obliged to seek part-time work and their pension is adjusted to reflect their capacity to work (Australian Government, 2009).
The move to involve people with disabilities in employment is part of a general “prowork rhetoric” (Cancian, 2001: 309) that assumes work is the norm, work leads to self-sufficiency, and work is good for families. However, our study results caution policymakers against policies that create a compulsion to work for people with disabilities in poor health. Unless welfare-to-work policies are accompanied by supportive government strategies to generate high-quality work options for people with disabilities, care recipients in poor health—and also their unpaid caregivers—may be psychologically worse off, the longer hours they work. We recommend further research with regard to national strategies that will provide support to people with disabilities, especially those in poor health. These strategies include the education of employers and the general public (Pransky, Shaw, Franche, & Clarke, 2004), investment in resources for job placement and support (Burns et al., 2007), workplace based rehabilitation interventions (Williams, Westmoreland, Lin, Schmuck, & Creen, 2007), and training that focuses on increasing self-efficacy, coping, and stress management skills of people with disabilities (De Vente, Kamphuis, Ernmelkamp, & Blonk, 2008; Smeets, Van Lierop, Vanhoutvin, Aldenkamp, & Nijhuis, 2007).
Legislation that seeks to increase workplace participation by people with a disability should simultaneously motivate workplaces to establish supportive working environments for people with disabilities. Workplaces need to “adapt their methods of communication (speaking, nonverbal signaling, written communications), their premises (steps, badly lit areas, induction loops, minicoms, flashing fire alarms, specialist fire evacuation procedures), their locations (accessibility) and all of their job and work station designs” (Woodhams & Danieli, 2000: 413). Flexible boundaries between work and home should be allowed, particularly in relation to the time and location in which work tasks may be carried out (Rosenzweig et al., 2011). Unfortunately, while the websites of most Fortune 100 companies demonstrate a recognition of the importance of diversity, empirical studies show that less than half (42%) have adopted policies and procedures that explicitly include people with disabilities; of those companies who are inclusive, very few explicitly target people with disabilities with regard to recruitment and retention (Ball, Monaco, Schmeling, Schartz, & Blanck, 2005). Some organizations, however, have provided clear support for employees with disabilities, for example, in the form of establishing resource or interest groups, such as Microsoft (Sandler & Blank, 2005), JP Morgan Chase, and Merrill Lynch (Ball et al., 2005). In the UK, DIY retailer B&Q developed a disability program that led to a threefold increase in its number of employees with disabilities within 18 months (Anon., 2001).
Our study findings also suggest that policymakers should include formal assessments of the work capacity of people with disabilities in poor health within any strategy to increase workforce participation. Recent moves by the Australian Department of Education, Employment and Workplace Relations (DEEWR, 2011) to introduce a Job Capacity Assessment have been received favorably by the OECD (2007). In Australia, employment agencies now routinely conduct job capacity assessments to identify a person's health related barriers to employment (e.g., Mission Australia, 2011). These assessments have contributed to the development and administration of interventions to overcome employment barriers (DEEWR, 2011; Killackey & Waghorn, 2008).
Finally, policymakers need to take a broader view of the “work is good” policy to consider the impact of work not just on person with a disability, but on that person's unpaid caregiver. Contemporary policies about people with disabilities and caregiving do “not address adequately the complex nature of caring relationships” (Lloyd, 2000: 136). This study suggests that initiatives encouraging into employment care recipients who have severe impairments and are in poor health can increase the stress of their caregivers. Consequently, moves to increase workplace participation of people with a disability in poor health may have adverse consequences for both the care recipient and caregiver. Over the long term this situation is unlikely to be unsustainable. High levels of caregiver stress are associated with health problems (Vitaliano, Zhang, & Scanlan, 2003) which in turn can reduce the quality of care received by the care recipient. The need for caregivers will only increase with an aging population. In the long run, the stress associated with caring for people with disabilities in poor health will result in significant costs to the caregiver and society. Policymakers are thus advised to recognize the interconnections between caregivers and care recipients and investigate ways to support both parties.
Research Strengths and Limitations
This study has considerable strengths. We used a national, government-collected dataset that gave us access to a large representative sample of people with disabilities who lived in the same households as their caregivers. The large starting sample (over 40,000 people with disabilities) enabled us to identify 170 caregiving household relationships in which both parties were of working age. This sample allowed us to test theoretically-derived hypotheses about the effects of employment on two people engaged in an intimate relationship while controlling for common stressors (e.g., household income). It is unusual to be able to study crossover effects using measures from both dyad members (Westman & Piotrkowski, 1999). Further, by examining the impact of number of work hours, we were able to take account of individuals who were not employed (zero work hours), who were employed at various levels of part-time work, and who were working full-time. In this way, we were able to examine the potential impact of social policies that stress the value of employment. Therefore our analysis makes a unique value-added contribution to the emerging literatures on caregiving and psychological spillover and crossover.
There are also limitations to the study. The results may not be generalizable to all caregiving dyads. Our sample consisted largely of households where the care recipient had a severe or profound impairment. These care recipients are most likely to be negatively affected by inflexible and impractical work accommodations, stereotyped because their disability is most clearly discernible (Tregaskis, 2002), and—when employed—disproportionately represented in low-level jobs (ANED, 2009; Goggin & Newell, 2005).
We suggested that the quality of the work available to people with disabilities was a source of stress (Capella, 2003; Perry et al., 2000; Wells, 2001) but job quality variables were not included in our dataset. Therefore, we used number of work hours as a proxy for these work stressors. While studies that utilize secondary data often make use of proxies (e.g., Zatzick & Iverson, 2006), further investigations should replicate our results using different sources of data that include measures of work quality as well as work quantity. For example, researchers might consider how negative job elements such as narrow responsibilities (Wells, 2001), limited opportunity for growth or achievement (Capella, 2003), few promotion opportunities (Hallock, Hendricks, & Broadbent, 1998), inadequate workplace accommodations (Balser, 2000; Robert, 2003) and low earnings (Schur et al., 2009) influence the workplace experience and resultant psychological outcomes of people with a disability.
We did not have access to parallel psychological measures for the care recipient and caregiver, and therefore we were limited to examining effects that originated from the care recipient and crossed over to the caregiver. But crossover effects within intimate relationships are bi-directional (Song, Foo, Uy, & Sun, 2011; Westman & Etzion, 1995), and ongoing reciprocal crossover effects will ultimately have a downstream effect on relationship satisfaction (Westman, 2001). We encourage future research to move beyond our cross-sectional methodology and use more dynamic data collection strategies (e.g., diary studies or experience sampling methodologies) to examine ongoing reciprocal crossover effects within caregiving dyads. All of our data were collected via self-report, and self-report data may artificially inflate the size of relevant relationships due to common method bias (Crampton & Wagner, 1994). Yet, our most important predictor variable (hours of work engaged in by the care recipient) is objective; objective variables are less vulnerable to common method bias (Podsakoff & Organ, 1986). Overall, despite these limitations, this is a unique study that identifies a subgroup of people with disabilities who, along with their caregivers, might be adversely affected by the well-intentioned strategies that drive contemporary government policy.