Factors to Consider in Caregiver Assessment
Instruments for Evaluating Caregiver Burden continued...
The Family and Medical Leave Act
The Family and Medical Leave Act of 1993 (FMLA) was designed to give employees the option of taking time off from work for their own serious medical condition or that of a relative without losing their benefits or their jobs. Family members are entitled to a maximum of 12 weeks' leave under the law; however, since its implementation, FMLA has been met with resistance from employers and underutilization by employees. In an exploratory study involving 45 caregivers of children with chronic illnesses, FMLA was least used by unmarried women with annual incomes lower than $35,000.
Norms, Roles, and Expectations
The original theoretical models for understanding caregiver burden highlighted caregiver appraisal and role strain.[34,35] Multiple roles performed by caregivers of cancer patients can compete with each other in relation to caregivers' physical and emotional resources.
Role strain theory has been used to explain caregiver burden in numerous studies. Results of a study of 457 middle-aged caregivers showed that the more social roles a caregiver performed, the more likely the caregiver was to experience stress and negative affect. Employed caregivers who were also caring for children reported higher levels of stress; however, employed caregivers beneﬁted from the respite provided by work and from the support of employers and co-workers, which enabled them to replenish their psychological resources. Encouraging caregivers to maintain their roles as employees might therefore be helpful.
Focus has shifted to the treatment of caregiving as a dyadic phenomenon, based on the recognition that family caregiver roles are complex and overlapping. By its nature, caregiving is fundamentally relational  and often reciprocal.[38,39] To be effective, any assessment should take into account not only what the care recipient requires but also what the caregiver is able and willing to provide.
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