Making it work: a qualitative study of the work-care reconciliation strategies adopted by family carers in Ireland to sustain their caring role

ABSTRACT

While work-care reconciliation strategies can benefit family carers, employers, wider society and the economy, juggling family caregiving responsibilities with paid employment can lead to role strain. Family carers frequently find themselves engaged in role decisions and role negotiations and being faced with decisions to alter their work commitments in order to fulfil their caregiving responsibilities. The purpose of this study was to explore family carers’ experiences of modifying work arrangements to accommodate caregiving responsibilities for an ill or dependant family member. Ten face-to-face, semi-structured interviews were conducted with family carers in Ireland, which were audio-recorded, transcribed verbatim and analysed using thematic content analysis. The findings highlighted the value placed on work by family carers, but despite this, the caring role always took precedence over the employee role. Family carers adopted a combination of strategies, and where possible, carved out a carer-friendly career for themselves. The findings also revealed the key triggers for work alterations and the sacrifices made by family carers. It is important that family carers are supported by employers to successfully balance work with caregiving responsibilities and that an array of work options are available to them, so that they can make better-informed choices regarding work-care reconciliation.

KEYWORDS:

• Employment
• family carers
• caregiving
• qualitative
• strategies
• work-care reconciliation

Background

Family carers form the backbone of care provision for those living in the community who require care owing to frailty, altered functional ability associated with ageing, disability or chronic illness. Approximately 80% of all care in the EU is provided by unpaid family carers (European Commission, 2020). Recent estimates from the Irish Health Survey suggest that 13% of the Irish population, the majority of whom are women and aged between 45 and 54 years, ‘provide care or assistance to one or more persons suffering from some age problem, chronic health condition or infirmity, at least once a week’ (Central Statistics Office, 2020). Similar statistics have been reported in other European countries (Carers, 2020; Zigante, 2018). With global ageing trends, a greater focus on shorter hospital stays and a shift to community-based care, there are mounting pressures on families to provide care for dependant family members living at home (Houses of the Oireachtas, 2017; Spasova et al., 2018).

The majority of family carers participate in paid employment (Eurofound, 2017). Approximately one in nine employees in Ireland provide care to a family member at home (Ireland, 2020), while as many as one in seven UK employees juggle work with caregiving responsibilities (Carers, 2019). Due to delayed retirement, increased female labour force participation and smaller family sizes, the number of working-age carers who combine employment with caregiving is set to increase even further (Colombo et al., 2011; Eurofound, 2015), leaving many countries facing what has been termed a ‘caregiving crisis’ (Fuller & Raman, 2019; Pickard, 2015). As more people enter ‘the sandwich generation’, in which both children and ageing parents are simultaneously being cared for, the challenges associated with balancing work and care will become even more apparent (Fuller & Raman, 2019).

With appropriate support, paid employment can benefit family carers in several ways and can act as a protective factor against the potentially negative effects of caring. For example, time spent at work can provide respite away from care responsibilities and can facilitate vital positive interactions with colleagues, both of which may prevent some family carers becoming socially isolated (Eurofound, 2017; Hansen & Slagsvold, 2015; Joseph & Joseph, 2019; Reid et al., 2010). Furthermore, enabling family carers to maintain a working identity can increase happiness, leading to a better quality of life and higher levels of self-esteem (Eurofound, 2015). Paid work also ensures that carers can continue to make pension and social insurance contributions, which means greater financial security in later life (Larkin et al., 2019). Enabling carers to remain in employment has the potential, not only to benefit employees, but also employers who get to retain experienced and talented employees, thereby reducing recruitment, training and education costs of new staff (Yeandle, 2017). Moreover, enabling carers to remain in the labour force benefits wider society, as well as the economy (Employers for Carers, 2017; Grayson & Hodges, 2017).

Caring for a family member requires time and energy, which when combined with paid employment, can be challenging. Balancing multiple roles can lead to role strain, defined by Goode (1960, p. 483) as ‘the felt difficulty in fulfilling role obligations’, and those who may not be able to meet all of the demands expected of them, may begin to engage in bargaining and role decisions. Thus, in response to the pressures of balancing work with care, family carers may consider altering work arrangements to fulfil caring responsibilities. Research has shown that family carers frequently reduce or change their working hours, turn down promotions, accept less-demanding roles, take early retirement or leave the workforce entirely to accommodate caregiving responsibilities (AARP & NAC, 2015; Dixley et al., 2019; Ireland, 2020; Longacre et al., 2017; Mooney & Statham, 2002; Phillips, 1994). Consequently, in the absence of suitable workplace policies and supports, employers may experience reduced work productivity, increased absenteeism, decreased employee engagement and morale, increased presenteeism and high staff turnover rates (Carers, 2019; Fujihara et al., 2019; Fuller & Raman, 2019; Mazanec et al., 2011).

Female carers and those with higher intensity care responsibilities are particularly more likely to reduce their work hours when compared to non-caregivers (Moussa, 2019). A review of 35 studies reported that once family carers make the decision to alter their work arrangements, it is highly unlikely they will return to previous levels of employment, even after their caring role has ended (Lilly et al., 2007). Data from the English Longitudinal Study on Ageing (ELSA) indicates that providing care for ten hours or more per week will significantly increase the likelihood of family carers, particularly women in their fifties, leaving employment (King & Pickard, 2013). Family carers exit the labour market because of the stress of juggling multiple roles, a lack of appropriate services, the person being cared for not wanting or qualifying for support services, inflexible work arrangements, poor workplace culture and issues with employers (Arksey, 2002; Carers, 2015; Pickard et al., 2018; Williams & Sethi, 2020). Research is beginning to emerge which suggests family carers in Ireland have altered their work arrangements and have left employment to provide care. An Irish survey of family carers found that 55% of respondents had given up work and over a fifth had reduced their working hours in order to provide care (Ireland, 2020). These findings suggest that there are challenges associated with balancing work and care in Ireland, however, less is known about the circumstances that lead to the decision to alter or leave work.

Irish and European policy context

Across EU member states, the need to support working family carers at a policy-level is beginning to gain traction and recognition, in part due to minimum work-life balance provisions set by the European Commission. The European Pillar of Social Rights (European Commission, 2017) makes a commitment to fair and flexible working for all, especially for those with caring responsibilities. In Ireland, the National Carers’ Strategy also commits to enabling family carers to remain in employment where possible and to ensuring the availability of carer-friendly policies (Department of Health, 2012). Under the Carer’s Leave Act (2001), carers in employment may apply for job-protected leave for a minimum of 13 weeks and up to 104 weeks to provide full-time care to a family member. Although this legislation is relatively progressive in comparison to other international policy provisions, there is a paucity of government-mandated policies offering flexible, shorter or paid leave options for carers. Eligible family carers can avail of direct income support in the form of a means-tested carer’s allowance or carer’s benefit, a social insurance-based carer’s benefit, and they can engage in employment for up to 18.5 hours a week. The forthcoming European Directive on Work-Life Balance for Parents and Carers, due to be transposed into domestic law by all member states, including Ireland, by August 2022, will provide EU employees with family caring responsibilities with additional rights and entitlements, including a minimum of 5 days of carer leave per year and the right to request flexible working arrangements (European Parliament, 2019). National policies, family care norms and the availability of government supports differ across EU countries (Zigante, 2018). Therefore, the experiences of family carers within individual member states necessitates further exploration and consideration in the design and implementation of policy both at national and European level.

While the provision of such policies may be an important step towards enhancing the work-life balance of working family carers, research indicates that despite the availability of policies and legislation, employers and line managers may still have low levels of awareness and understanding of them (Cooper & Baird, 2015). The family caregiving role can be extremely complex and demanding, and services and policy support needs vary over time and are dependent upon the care recipients’ health trajectory (Colombo et al., 2011). Therefore, family carers may feel compelled to approach the challenges of balancing employment with caregiving responsibilities in different ways.

Overall aim

Like many countries internationally, Ireland’s society is also undergoing many changes, with an ageing population, a shift away from institutional models of care, a greater reliance on families to provide community-based care and an increasing proportion of female participation in the labour force. Until recently, the experiences of family carers who balance work and caregiving within the Irish context have been largely unexplored. This may be partial due to the firmly embedded familial and societal structures in Irish society concerning the woman’s role in the home. Written into the Irish Constitution in 1937, women were ‘not to neglect their duties’ and were to remain at home to care for family (Brady, 2012; Hughes & O’Sullivan, 2017).

To enable family carers to remain attached to the labour market, sustainable solutions need to be sought. Therefore, the purpose of this research is to contribute to this gap in knowledge and gather evidence to better understand family carers’ experiences in Ireland. In order to ensure that family carers who wish to remain in paid employment are best supported, it is important to gain a better understanding of their experiences of reconciling work with caregiving responsibilities. While the international research evidence suggests that family carers may alter their work arrangements or choose to leave the workforce, less is known about the compromises they make and the strategies they adopt that enable them to reconcile work with care. The overall aim of this study was to explore family carers’ experiences of altering work arrangements to accommodate caregiving responsibilities for an ill or dependant family member in Ireland.

Methods

Research design

This study was undertaken as part of a larger programme of research, called the CAREWELL project, which aims to develop a workplace programme to promote health and self-care behaviours among family carers. The study adopted a qualitative research design using semi-structured interviews to generate rich narratives of working family carers’ experiences of altering work to provide care (Bowling, 2009). The chosen design aimed to generate data with which to better understand individuals’ experiences without making value judgements during data collection (Carter & Henderson, 2005).

Participant recruitment

The inclusion criteria stipulated that participants were eligible to partake in the study if they had changed their work arrangements, provided care for a family member for a minimum of 10 hours on average per week, and were in paid employment for more than 15 hours per week. The former criterion was applied as 10 hours or more hours a week is considered the threshold at which working carers are at increased risk of leaving employment (Brimblecombe et al., 2017). The latter criterion was applied as recipients of the social welfare payment, ‘Carers Allowance’, paid to eligible fulltime carers in Ireland, were permitted to work and/or study up to a maximum of 15 hours per week at the time of recruitment. Those who met the criteria as former carers and as former employees were also eligible to participate. Therefore, theoretical sampling was used to purposely recruit participants who met these criteria and who were from a variety of backgrounds with a diverse range of work-care scenarios (Baker & Edwards, 2012; Morrow, 2005), using the research team’s networks and social media channels (LinkedIn, Twitter, Facebook). Initial recruitment posts on our channels generated interest from mainly female carers; hence, we made concerted efforts to recruit male participants to the study, in order to recruit a somewhat more gender-balanced sample.

Data collection

Semi-structured, face-to-face interviews were conducted between June and September 2019, prior to the COVID-19 pandemic. The interviews lasted between 45 and 130 minutes and were conducted in a location that was deemed convenient and comfortable by the participant; this included, for example, at the participant’s home, a local hotel or café. An interview guide, which had been developed in consultation with a former working family carer, was used to gather information about participants’ caregiving responsibilities and work arrangements. With permission from participants, the interviews were audio-recorded and transcribed verbatim.

Data analysis

NVivo v.12 software was used to support the management, organisation and retrieval of data. The interview data were organised, analysed and presented using a six-stage thematic content analysis approach (Newell & Burnard, 2006). The steps comprised memo-writing, reading and re-reading the interview transcripts while notetaking, until patterns and themes began to emerge. Open codes were collated into higher-order categories, which were used to revisit the interview transcripts. The themes were then collated together and presented. The interview data were analysed independently by two researchers who met to discuss emerging themes. Through reflection and discussion (Holloway & Wheeler, 2010), a consensus on coding and themes was reached and there was agreement that the emergent themes corresponded to the experiences of the categorised content.

Ethical considerations

The study received ethical approval from the first author’s institutional Human Research Ethics Committee (HREC). All participants provided written informed consent prior to commencing the interview. Process consent was ongoing throughout the interviews. Participants were reminded that their participation was entirely voluntary, and they could withdraw at any point during the interview, without prejudice. Participants received a debrief sheet following the interview, thanking them, and supplying them with contact details for relevant support organisations. All interview data were anonymised by removing any identifiable information.

Findings

Participant profile

Ten participants (7 women and 3 men) shared their experiences of altering work arrangements to accommodate their family caregiving responsibilities (Table 1). Participants’ age ranged from 38 to 65 years, seven were female and all except one, were Irish. Two participants cared for both of their parents, six cared for a child and two participants were spousal carers. All participants spoke about how they had altered their paid employment, so that they could continue to provide care for their dependant family member. The thematic analysis of the interview data identified four overarching themes, as follows: (1) The value placed on work; (2) Catalyst for amending work arrangements; (3) Compromises for care; and (4) Strategies adopted to sustain care.

• The Value Placed on Work

Table 1. Participant characteristics.

No.	Sex	Age	Provides care for:	Care-recipients’ health condition	Employment status at time of interview	Work alteration	Reasons for altering work
1	F	51	Mother & Father*	Frailty	Part-time	Career break	Stress, lack of replacement care
2	F	55	Mother & father	Dementia, frailty	On leave	Carer’s Leave	Inflexible employer, lack of replacement care
3	F	48	Daughter	Spinal injury	Some freelance work	Combination: Job sharing, altered working days, Carer’s Leave, career break, career change	Stress, daughter’s health
4	M	62	Daughters (2)	Profound ID	Retired	Early retirement	No adult service available, lack of replacement care
5	F	53	Husband	Chronic illness	Full-time	Carer’s Leave, career change	Stress/burnout, young family, deterioration of husband’s health
6	F	41	Son	Cancer	On Career break	Career break	Son’s diagnosis, nature of medical appointments, needing to be on call and nearby
7	F	44	Daughter	Severe ID	Full-time	Carer’s leave, voluntary redundancy, career change	Inflexible employer, workplace culture
8	F	42	Daughter	Epilepsy	Full-time	Altered working hours	Issues getting to work in the morning due to caring demands
9	M	65	Wife	Dementia	Retired	Ceased accepting work opportunities & Retirement	Caring demands increased, lack of replacement care
10	M	38	Son	Rare genetic disorder, ID	Full-time	Moved to family-friendly employer, altered working hours	Son starting new school, new routine

Note: ID: intellectual disability.

Participants’ accounts of their experiences revealed the immense value that family carers placed on paid work. Participants indicated that their preference would be to remain working, alongside caring for their family member, and proffered various reasons as to why continuing in employment was particularly important to them. Several participants spoke about the fact that paid employment afforded them the opportunity to retain their personal identity. One carer explained that she believed that she needed to go back to work after caregiving for a year, as she missed ‘the person’ she used to be when she was working:

I was losing my identity, I was just [my daughter’s] carer and that became a massive thing. I wasn’t [me] anymore, I wasn’t the [healthcare professional] anymore and actually I missed trying to help people and I missed being good at something, so I went back to work after the year. (C3)

Participants also spoke about how the separation of work from their caregiving role gave them a break and time away from caring. One carer described work as ‘a different world’ and ‘the normality’ that she needed. Work not only provided income for her, but it was also a source of respite and time she enjoyed away from the pressures of her caregiving responsibilities:

It is like just putting on a different persona and having a break from that (caregiving) and having the reality that I knew before I ever had children, before I ever had a disabled child. Yeah, it is a relief, it is a break, it is a joy and a privilege to be able to keep my job and do the job. (C8)

Carers valued the social outlet that work provided:

I did miss the social aspect of work actually, yeah you know, just you know, meeting other people, and talking about other things other than my sick child all the time. (C6)

One male carer felt that he was left with no alternative but to take early retirement from work to care for his children, but reflected fondly on the value he placed on his work:

I would have been quite happy working another year or two, I enjoyed work, I loved it, I loved the responsibility, I loved the people there, I loved the clients, I was good at what I did. (C4)

Another carer who was living with and caring for both of her ageing parents and had taken carer’s leave spoke about the importance of being financially independent: ‘Financially you’re not earning anything, for me that doesn’t feel right, I like to have my own money and be independent’ (C2). She also viewed her work as an opportunity to have time to herself:

I do miss my job, I do miss it … when you go to work, that’s you know, that’s your headspace, where you focus, like you’re trained to do a job, you’re not trained to do this (caregiving). (C2)

Another spoke about how her work was not only an important source of income, but it was a source of hope, which for her, meant having recognised citizenship and social acceptance within society:

When I go back into work now, I just feel as if I’m part of society or something or I feel as if, I don’t feel like a second class citizen and it’s not because we were claiming social welfare, actually it was because, I don’t know, we were at such a low, we were at rock bottom I suppose [when] working, there’s always a sense of hope that, you know, ok now there’s money coming in and it’s a good salary. (C5)

• Catalyst for Amending Work Arrangements

All of the study participants spoke about reaching a point of realisation where they knew that they had to decide to adjust their work-care arrangements, in order to maintain their caregiving responsibilities. Several carers indicated that they reached this point when their own health had been significantly impacted. One carer stated: ‘I was trying to do everything and I just couldn’t do everything and also my health was deteriorating’ (C3). Another carer described how she had reached ‘breaking point’, due to the pressures of juggling employment with caregiving responsibilities:

I really was losing my mind – do you know what I mean? I was really stressed … I felt like I was going to end up … in a psychiatric hospital … so way back then the stress was there for a long time you know, the feeling of ‘this is too much, I never get a break’ … that made me decide to give up [work]. (C1)

The following carer described her experience of balancing both carer and employee roles and how it caused her to feel physically ill, leading her to question whether she should even continue to work:

There were times where I would be sick coming into work. I was sick with stress trying to get out the door, trying not to let that stress rub off on the children, trying to be calm, knowing ‘I’m going to be 5 minutes late now, I’m going to be 10 minutes late, I’m going to be 15 minutes late’. Constantly feeling like I’m making excuses and that whole feeling of, you know, I’m letting people down as well you know, and questioning whether I should remain in paid employment, is it fair to remain in this job? (C8)

Another trigger for adjusting work arrangements was the care-recipient’s declining health and increasing care needs, which rendered some participants’ current work arrangements no longer feasible. As one carer explained, she was spending more and more time caring for her ageing parents, but she had reached a point where her work-care arrangements were no longer realistic:

So, I started to go down [to my parents] before I went to work in the morning, my workday was 8:30 to 5 but [with] elderly people, you have to have a lot of time with them, you can’t say I’ll go down for half an hour and be gone. So, I’d phone in late to work and say to my boss! … That was happening more and more … so eventually it just wasn’t working out with work. (C2)

Several carers mentioned their employers’ inflexibility and lack of support as the reason for changing their work arrangements. One carer explained how her daughter’s schedule of medical appointments became so demanding that remaining in full-time employment was no longer tenable. However, her employer was not supportive of her working part-time, which would have enabled her to continue to work as well as attend to her daughter’s care needs:

There were just so many important appointments, her needs were so great, there was no way, like even working a 3-day week was really, really tough … there was no way that I could have worked full-time and they wouldn’t let me work part-time, so my hand was completely forced. (C7)

Most of the participants had altered their work arrangements more than once and many acknowledged that they might need to alter their employment again in the future to accommodate their caregiving role. In many cases, the need to alter work was in response to key transition points in the caring role, such as a birth, a medical diagnosis, or a child starting school. For example, one male carer spoke about having to retire when services were no longer available when his daughters had completed school:

Not having a service then, that really forced my mind on it you know and I felt I had no option but to [leave employment], so the girls finished school … and I retired … because we knew for definite we had the summer without any help/ (C4)

• Compromises for Care

All participants spoke of making sacrifices so that they could continue to provide care for their relative. For most, it was never their choice to become a carer. The following carer explained how she had never envisaged herself being at home:

I never intended to be at home full time … I have great admiration for people who choose to do that and that’s fine, but I think it’s tough when you are forced into that situation. (C7)

This same carer went on to say that she and her husband both compromised their earnings to accommodate the care needs of their daughter:

We both had to make sacrifices to the career I suppose … I’m delighted now I’ve got a flexible working arrangement, but I’m earning a lot less now than I was ten years ago or fifteen years ago even, you know, but the hours are flexible. (C7)

Similarly, several other carers spoke about working at a lower grade than they were trained or qualified for, because it provided the flexibility needed to work around their caregiving responsibilities. For example, one carer spoke about how she chose to take a career-break rather than work at a lower grade:

I would have loved to stay in my grade, my grade X, because, you know, to have some career progression, because, you know, you work hard to get to your promotion or whatever, and I didn’t really want to fall back to a lower grade. (C6)

Two carers spoke about the negative impact that balancing the employee and caring roles had on their marriages. For some carers, the reduced income that came with reduced working hours meant that they had to make sacrifices when it came to life milestones such as buying a house:

I looked for a loan and I talked about all these jobs and it was like, what’s regularly coming in, and it’s not enough coming in, and so I’m not in a position to take out a mortgage. (C3)

After taking a career break to care for both of her frail, ageing parents, the following carer returned to work, but felt that her status at work had been compromised. She described the difficulties she experienced when transitioning back to employment under a new line manager:

I went back and they gave him, [my replacement], my office and I mean look, that’s a message. So, I had a huge status drop … that was not my choice really to leave. I only left because I absolutely couldn’t stay. So that, that was very unfair actually. (C1)

• Work Strategies Adopted to Sustain Care

Despite the value placed on work by the study participants, care responsibilities ultimately took precedence over paid employment. Family carers responded by adopting strategies that would enable them to prioritise the care needs of their loved ones. In many cases, carers adopted a combination of strategies, which ranged from taking carer’s leave or a career break, job sharing, altering working hours, remote working, declining work opportunities, changing career direction, taking voluntary redundancy and early retirement. Strategies included actively and strategically carving out a carer-friendly career by retraining and pursuing educational qualifications conducive to caring. One carer explained her strategy for ensuring that she could be more available to care in the future:

I did the master’s, kind of not with a specific job in mind or you know, it was just [a matter of] ‘stay relevant and stay employable’. Like my plan was to do the masters and to somehow find some fantastic flexible employer. (C7)

Supports offered by employers were often perceived as being misaligned with the actual needs of family carers: ‘They do things for the sake of it, to be seen [as] doing employee wellness and care and that, but really and truly, we don’t have part-time, flexitime, or job share’ (C2). In the absence of appropriate supports, participants spoke about taking steps to reconcile work and caring roles through re-employment, self-employment or changing careers entirely:

I was [in the legal profession] practising full-time and I was finding that difficult to juggle, as most [legal professionals] will tell you, it is quite difficult with kids. So I was trying to think strategically about it, you know, how to position myself for the future, so that I could have some sort of a job that would accommodate the young children and a husband with a long-term illness. (C5)

Managing the demands of work and care also meant adopting strategies like remote working and reconfiguring work hours to ensure that care responsibilities were met, such as job sharing, flexitime, and so forth. While remote working was considered another strategy that could facilitate work-care reconciliation, it was not always supported by the participants’ employers. One male carer stated: ‘I was able to work from home, but it was generally not encouraged’ (C10).

In the workplace, being a carer was frequently considered a ‘private’ matter (C2). However, for the following family carer, it was not until she established a rapport with her employer and colleagues that she could then be supported to balance her work with care responsibilities. She explained how she was reluctant to divulge her caring role in the first instance:

It took me actually breaking down in the office one day and saying this is what’s happening … I think for people, and for managers in particular, it’s not knowing about that day-to-day reality, because you wouldn’t know it unless you lived it. (C8)

The following male carer chose to be open about his caring situation with his employer from the onset:

There’s no point for me to hide the fact, and then just surprise them with a ‘look I actually need this flexibility, I can only start from 10 or work from home’, those kind of things, and between 7.30 and 8.30 I can’t work because I need to mind my son. (C10)

In addition to employment-related strategies, all participants spoke about using community-level supports, such as formal replacement care, which enabled them to continue working while also providing care:

That was probably the biggest factor [in enabling me to work] on a day-to-day basis. [Having help] with the practical stuff and sometimes with the chat and even for me like the chat we’d have was nice. It was, I used to love to see them (care workers) coming. (C1)

For two carers, they believed that retirement was the only option that would enable them to fulfil their care responsibilities. The following male carer described his gradual transition to full-time caring as his wife’s health deteriorated:

I was gradually doing less and less and working more and more from home, so it just evolved over time you know. It wasn’t a case where one day you’re working full time, and the next day you weren’t working full time. It was over, I suppose, over a matter of a few years. (C9)

Discussion and implications

This study sought to gain a better understanding of family carers’ experiences of altering work arrangements to provide care to family members in Ireland. Findings indicated that care of a relative always took precedence over work commitments and family carers responded by adopting strategies that enabled them to prioritise their relative’s care needs (Chou et al., 2013). A range of work-related strategies were adopted, which enabled the carers in the present study to engage in the family caregiving role, such as taking carers’ leave, making a career change, taking a career break, altering work schedules, working remotely, declining work opportunities, moving to a family-friendly employer, and taking early retirement or voluntary redundancy. Participants had made multiple changes to their employment over the course of their careers and anticipated that they would need to make further changes in the future.

Remaining in employment was particularly important to the family carers who participated in this study, as it afforded them the opportunity to retain their personal identity, achieve financial security, get respite from caregiving responsibilities, and to feel socially integrated. This reflects findings from previous research (Larkin et al., 2019; Stoner & Stoner, 2014). However, certain triggers, such as a deterioration in the carer’s or care-recipient’s physical and mental health, a lack of employer support, or key life transition points, such as a child finishing school or support services no longer being available, forced carers to consider ways of altering their work arrangements to facilitate a reconciliation of work-care responsibilities. In some cases, remaining in employment or sustaining existing working hours were not viable options. Alterations to work came at a cost for the family carers and all had made sacrifices in some way. They compromised on earnings, job status, employment benefits, pension entitlement and career progression to achieve work flexibility, so that they could continue to provide care for their family member. It is, therefore, important that family carers are aware of their rights and entitlements and are informed of the options available to them so that they can carefully consider a range of strategies before making any major decisions about altering their work patterns or exiting the workforce.

Enabling family carers to remain in employment benefits employers, the economy and society at large (Burch et al., 2019). However, public policy needs to recognise the economic value of working family carers and develop policies that further support them in effectively maintaining their dual worker-carer role. Additionally, employers need to recognise the demands placed on working family carers and provide them with the necessary supports and working arrangements to enable them to remain in employment where they wish to do so. A large European study found that reconciling work with care is possible with the appropriate supports, such as cash benefits, flexible workplace arrangements, care leave schemes, crisis help and societal recognition (Hamblin & Hoff, 2012). Furthermore, longitudinal data suggest that ‘replacement care’ such as home care, personal assistants, day care, meals, respite, can also enable carers to remain in the workforce (Pickard et al., 2018). Along with the evidence from these studies, our study suggests that a range of supports may be deployed to enable family carers to remain in employment, including both public policy-derived supports and local workplace supports.

Our study findings indicate that working family carers make adjustments to their employment status to accommodate their caring responsibilities. Often these adjustments are economically disadvantageous, involving reducing working hours or foregoing promotional opportunities. There is evidence that employers and managers may lack awareness and understanding of the nature and extent of care challenges facing employees (Fuller & Raman, 2019). Employers may not be aware of which employees have family care responsibilities, particularly as family carers are reluctant to disclose their caring status for fear of stigmatisation or negatively impacting their careers (Tehan & Thompson, 2013). This is particularly true for male carers who are not traditionally associated with family caring roles (Ireson et al., 2018; Maynard et al., 2018). While not all employees may feel comfortable self-identifying as a carer (Mooney & Statham, 2002), our findings suggest that disclosing family caring responsibilities may help to ensure that carers receive the appropriate supports from employers and work colleagues. Carer-friendly workplace policies can help carers to reconcile work with care and have been found to be associated with improved health (Wang et al., 2018). Employers must create a culture of acceptance and understanding for working carers within the workplace, which can help to foster environments that support the uptake of such policies (Hämmig, 2014; Mooney & Statham, 2002). However, the availability of such policies varies greatly, depending on company size and sector (Ireson et al., 2018). Furthermore, employers’ work policies and wellness supports may not accord with the actual needs of family carers (Fuller & Raman, 2019).

Our study findings also indicate that employers demonstrated inflexibility and a lack of support for working family carers who were faced with the challenge of managing their dual worker-carer role. Although more employers offer carer-friendly workplace policies, employees’ needs are often considered on a case-by-case basis, meaning that the same accommodations may not be available to all employees within an organisation (Employer Panel for Caregivers, 2015; Ireson et al., 2018). Moreover, research suggests that the manager’s own caregiving obligations are positively associated with these negotiated work arrangements, which has the potential for creating policy and practice gaps and inequalities within the workplace (Las Heras et al., 2017). The inclusion of working family carers in policy design is highly recommended.

Findings from our study highlight the need for greater employer awareness and training regarding working family carers’ rights and entitlements, as well as promoting a workplace culture in which there is no stigma associated with having a caring role, to ensure adequate supports for family carers (CIPD, 2020). Therefore, these findings can be used to raise awareness and understanding, particularly among employers and policymakers, of the importance of remaining in employment for family carers, the strategies they adopt and the compromises they make, to enable them to reconcile work with care. This would help to facilitate employees with caregiving obligations to better negotiate work arrangements with their employers, that are flexible enough to allow them to remain working, but also continue to provide care.

Policies such as The European Pillar of Social Rights (European Commission, 2017) and the forthcoming EU Directive on Work-Life Balance for Parents and Carers, promote access to leave entitlements and care services to enable those with caregiving responsibilities to successfully reconcile work with caregiving (European Parliament, 2019). However, these rights must be effectively implemented so that they transcend organisational structures, and benefit working family carers directly. Therefore, employers and managers require adequate training in implementing the provisions set out by the Directive. Furthermore, it is not yet clear how the COVID-19 pandemic will impact the implementation of the EU Directive, particularly for female carers (Phillips et al., 2022). Many of the policy responses to the pandemic have predominantly affected women who tend to be over-represented in unpaid, low-paid and precarious frontline jobs and have provided the most basic and essential community services during the pandemic, such as carers for older people and children, nurses, cleaning staff, retail assistants and teachers (Clark et al., 2020; Fortier, 2020). These gendered impacts are multifaceted and are likely to have long-term consequences on gender equality, women’s economic security and their participation in the workforce (Cook & Grimshaw, 2020).

A number of participants in our study shared their experiences of taking legislated carers’s leave. The Carer’s Leave Act (2001) in Ireland enables carers to take leave from work to provide care, while providing job protection. Even though this legislation may be deemed progressive in comparison to other countries, figures suggest that take-up is rather low (Family Carers Ireland, 2017), therefore there may be a lack of awareness among employers and family carers, or it may not be meeting the actual needs of family carers. Our study findings also suggested that carers experienced difficulties when returning to the labour market after taking carer’s leave or a career break. Hence, those who wish to return to employment after a period of family caregiving leave may need additional supports, such as training, upskilling, further education, a phased return to work or the availability of career guidance or advisors.

Flexible work options have been frequently identified as one option that can enable work-care reconciliation (Lafferty et al., 2020; CIPD, 2020; Dixley et al., 2019; Mooney & Statham, 2002; Phillips, 1994). However, in our study, this was often not encouraged or accepted within workplace culture. The COVID-19 pandemic has since accelerated the implementation of flexible working arrangements, such as remote working (Carers, 2020), but it remains to be seen whether this will continue to be an option in the post-pandemic period. Due to the unpredictable nature of caring and the time and effort required, carers need ‘multi-dimensional flexibility’, which should involve offering a range of options that will support carers’ participation, retention and development in paid employment (Matheson et al., 2020).

Participants in the present study continued to experience difficulties in reconciling caring and work responsibilities, until their health began to suffer, before considering altering their work or exiting the labour market altogether. Governmental, organisational and line manager supports to enable employees to better manage working and family caring need to focus on ameliorating the pressures on working family carers who are constantly having to seek out work opportunities that are amenable to their caregiving situation. Such supports and responses will help to prevent premature workforce exit (Pickard et al., 2018; Schneider et al., 2012) or family carers reaching ‘breaking point’ (Lafferty et al., 2021).

Further research in this field is warranted. Longitudinal research is needed to examine how family carers adapt their work arrangements over time in response to the trajectory of their family care recipient’s changing health status. Much of the published research tends to focus on employees who care for ageing parents (Burch et al., 2019; Clancy et al., 2019; Kotsadam, 2011). While this cohort accounts for a large proportion of family carers, future studies need to include other working family carer cohorts, such as those caring for a chronically sick or disabled partner, sibling or child, whose caring role can last for many years.

Limitations

This study has several limitations. Firstly, the sample size may be considered small. While sample size in qualitative research has received much debate (Guest et al., 2020; Morrow, 2005; Tuckett, 2004; Vasileiou et al., 2018), there is no clear definitive answer as to what constitutes an ‘adequate’ sample size. In the case of the present study, working family carers are a hard-to-reach group due to the time constraints associated with having multiple roles (Atanackovic et al., 2020). Secondly, despite using theoretical sampling, the study sample is not diverse, in terms of sex and age and other sociodemographic characteristics. A sample with a more diverse demographic profile of family carers would provide a better understanding of the experiences of a range of cohorts of carers. For example, in comparison to younger carers, older carers, as well as male carers, tend to hold more senior positions, be more knowledgeable about their rights and entitlements and therefore, tend to be in a stronger position to adopt or ‘negotiate’ work-care strategies that would enable them to balance work with care. Also, the available literature suggests that male carers have a stronger attachment to the labour force and are less likely to experience work interferences when compared to female carers (Maynard et al., 2018). However, this may be attributed to the traditional gendered nature of caring and the perception that men have ‘legitimate excuses’, that is, that they are ‘unable’, rather than ‘unwilling’ to provide care (Finch & Mason, 1993). We experienced challenges with recruiting male carers, therefore, further research exploring the male perspective of balancing work and care as well as factors hindering self-identification and participation in research may be beneficial. Future studies would also benefit from recruiting a sample based on other sociodemographic factors such as income, employment type, disease and dependency levels of care-recipients, as well as available levels of formal and informal supports, as these factors can significantly influence a carer’s ability to remain in employment while also providing care. Thirdly, the study did not explore the strategies adopted by carers to reconcile work and caregiving, who may be working as part of the gig economy, or who are self-employed or on zero-hours contracts. Such ways of working can be particularly attractive to family carers due to the associated flexibility and autonomy (Halvorsen & Morrow-Howell, 2017). While these groups of workers may face a unique set of challenges (Apouey et al., 2020), these types of working could also in themselves be considered work-care reconciliation strategies.

Further research in this field is warranted. Longitudinal research is needed to examine how family carers adapt their work arrangements over time in response to the trajectory of their family care recipient’s changing health status. Much of the published research tends to focus on employees who care for ageing parents (Burch et al., 2019; Clancy et al., 2019; Kotsadam, 2011). While this cohort accounts for a large proportion of family carers, future studies need to include other working family carer cohorts, such as those caring for a chronically sick or disabled partner, sibling or child, whose caring role can last for many years.

Conclusion

The experiences reported by working family carers in this study describe some of the strategies that carers in Ireland deploy when seeking to remain in the workforce, while maintaining their caring responsibilities. The study findings demonstrate the precarious nature of combining work and caregiving, with the former often needing to be reduced or forfeited in the interest of the latter. These findings highlight the importance of promoting employer awareness of the needs and challenges of working family carers and the need for employee supports that enable working family carers to function effectively in their dual role. Working family carers place significant value on remaining in employment. However, without the appropriate supports, combining the employee role with that of family carer can be challenging. In the absence of appropriate employer, policy or community supports, family carers respond by altering their work arrangements, actively seeking out sustainable carer-friendly working arrangements or leaving the labour force entirely to fulfil their caregiving responsibilities. To enable family carers to continue working and to ensure the long-term sustainability of family care provision, it is imperative that employers and policy makers support those working family carers with tangible and effective supports. As the family caring role is dynamic and changes over time, it is likely that a combination of services, supports and flexible working options will be required to successfully enable the sustainability of combining working and family caregiving.

Acknowledgements

Thanks are extended to the family carers who gave up their time to participate in this study and to colleagues and collaborators who assisted with participant requirement. The authors are grateful to the Health Research Board for funding this research as part of the Carewell project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data are not available.

Additional information

Funding

This work was supported by the Health Research Board Emerging Investigator Award [grant reference: EIA-2017-039].

Notes on contributors

A. Lafferty

Attracta Lafferty is a Research Fellow in the School of Nursing, Midwifery and Health Systems at University College Dublin (UCD). Attracta holds a Bachelor’s degree in Social Psychology, a Master’s degree in Applied Psychology, and a PhD from the University of Ulster. She has also completed a Graduate diploma in Statistics from Trinity College Dublin and a Professional diploma in Leadership Development from UCD Michael Smurfit Graduate Business School. Attracta has a substantial number of peer-reviewed publications, reports and conference publications. She has secured several large research grants which have allowed her to develop a portfolio of family carer research, with projects undertaken with family carers of older people, people with dementia, and individuals with intellectual disability. In 2017, Attracta received an Emerging Investigator Award from the Health Research Board to undertake the CAREWELL project, a four year research project, which aims to support family carers who balance work with care responsibilities.