Whether the work intensity of caregivers influence their life expectancy?

. The home care industry is proliferating in the US and worldwide. However, there are still tons of problems caregivers have faced. 47% of caregivers have an annual household income of less than $50,000, with a median income of $54,700. African American and Hispanic caregivers are more likely to have a yearly household income below $50k. Women are slightly more likely than men to take care for loved ones. Some divorced women were forced to be caregivers because they needed their parents' monetary support. Caregivers in a family are very stressful because they have children to take care of and the elderly (parents or sometimes even grandparents) As a result, training for paid or professional caregivers is necessary.


Introduction
"When will you return home?"This is very commonly heard from elders in the family, especially when their children are working outside the state.Usually, people think that as long as they provide good financial support to the elders in the family, the elders should live a fairly happy life.However, the truth is that many of these elders are very lonely, but they are afraid of interfering their children's business, so they never brought this up.As a result, caregiver is very necessary.
Caregivers are people taking care of other people.There are two different categories of caregivers, family caregivers and professional caregivers.Family caregivers are those who take care of other family member and not doing it for a payment, and professional caregivers are those who work in other's family or in the nursing house.
Caregivers play a very important role in both providing physical and mental care to the care recipient.For many people, their parents or their children have difficulty to have time taking care of their family members.Some might argue that the elderly in their family is fully capable of walking and hanging out with other elders in their community.However, they ignored that not all the communities are very inclusive and people might have trouble finding friends to chat with.As a result, companionship is very important; an individual always need someone who can accompany them.
Moreover, gender role sort of determine who plays a major role of taking care of family members.The gender role is a prejudice, but act as a tradition and passed down by generations.As a result, statistics shows that women are more willing to take care of other people in their family.
However, the current training and regulatory system of the caregiving industry still have many potential problems.such as that the government of many countries still have no specific regulations about the training and right insurance of both caregivers and care receivers.

Definition of Caregiver
Rosalynn Carter, Former First Lady of the United States once said: There are only four kinds of people in this world: those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers.
Caregiving is universal.The home care industry is proliferating in the US and worldwide.According to ibis world, the market size of the Home Care Providers industry in the US has grown 3.1% per year on average between 2017 and 2022 [1].The primary driver for this growth is the aging of the global population [2].However, the ever-changing nature and personalized experience of caregiving leads to conceptual fuzziness.Many people might not perceive themselves as caregivers since they had only conducted little help to their family or friends, such as purchasing groceries, driving elderly, or taking care of the baby [3].They think that this minor care cannot be categorize as caregivers.In common minds, only those who took care of others for a pay with professional training counts as a caregiver.However, the definition of caregiver is that a person who takes care, no matter the magnitude, of others in any aspect of their daily life [3].This generous definition includes a significant portion of the population all over the world into the caregiving industry.In other words, an individual is considered to be a caregiver as long as they took care of other people in their family or around them for a considerable amount of time every week or month.
Beyond the umbrella term of caregivers, they are divided into two different categories: family and professional caregivers.Family caregivers are those who take care of other members of their family, while professional caregivers are doctors and nurses who work with compensation [3].It is interesting to note that the caregiving industry consists of not only family and professional caregivers but also care recipient.Without the active involvement of care recipients in the industry, it cannot function well [3].

Role of Caregivers
The work of caregivers might seem trivial, but it consists of multiple challenging components.For regular day of caregivers, caregivers have to first adjust their nighttime and wake-up hours based on the preference of care recipients in order to conduct their help [4].Based on the preference of care recipients and the contract, caregivers usually perform tasks such as cooking, cleaning, helping with bathing, and so forth, for caregivers often do not get to control their lifestyle but to accommodate the changes made by their recipients [4].
For family caregivers, there are mainly two different ways for them to provide care for individuals, depending on the distance.Faraway caregivers can only offer monetary or emotional support through video chat or phone calls, especially those who cannot be around the care recipient without a flight.However, those who live close by, especially their care recipients, can provide physical and emotional care by hugging, patting, and handshaking.In this way, caregivers share information with recipients that they are and will always be around and with recipients.Companion is always the best encouragement for care recipients in dealing with challenges in their life.A fascinating phenomenon is that faraway caregivers usually work together with near caregivers to provide the utmost care for an individual [5].
For specific examples in our daily life, a mother who is very busy with her business has no time to accompany her children.The only way she can provide care is to send money to her children to ensure their living conditions.Moreover, she might invite her sister or husband to take more care of her children by being around them and giving them a sense of security and love.
Despite being the backbone of many families, the caregiver role is not highly valued/appreciated, especially in undeveloped or developing countries.According to the National Alliance for Caregiving and AARP, 47% of caregivers have an annual household income of less than $50,000, with a median income of $54,700.African American and Hispanic caregivers are more likely to have a yearly household income below $50,000 (62% and 61%, respectively).The low salary levels of caregivers make the education of caregivers seem unreasonable and impossible [6].The truth is that the lower the income and education a person has, the more likely they will be caregivers.As a result, many people could not find the ideal caregiver they were looking for with the skills they should have acquired during education or special training [6].Some caregivers working for their families for no economic profit had a terrible influence on their careers in the workplace.Company officials might think that these employees who have to take care of their family members might not have enough time to work.In reality, these family caregivers did just as well as other employees do.As a result, it is also essential to eliminate the notion from those employers' minds by establishing policies preventing workplace discrimination against employees with caregiving responsibilities [6].

Gender Role in Caregiving
Caregivers are more likely to be older, and being a caregiver is associated with higher levels of various health information-seeking behaviors [7].Moreover, Caregivers tend to find information helpful to others' health conditions online [7].Caregivers are significantly more likely than other internet users to say that their last search for health information was on behalf of someone else [7].Caregivers tend to turn to people who are knowledgeable about health issues offline.70% of caregivers say they turned to friends and family members for information, care, or support, compared with 47% of non-caregivers who did the same [7].28% of caregivers say they turned to others with the same health condition, compared with 17% of non-caregivers who did so, either online or offline [7].According to statistics, women are slightly more likely than men to take care for loved ones [7].As a result, there are more investigations on why women tend to be family caregivers to answer the question of gender role and its societal influences.
Women are more socioeconomic dependent on their other half or their families [8].Many men in society have heavier workloads, so women in the family think they are responsible for supporting their husbands and kids [8].Often, the caregiver place in a family is absent, and women tend to pay more attention to the place and act as a caregiver because they want to reduce the workload of their husbands [8].Many women admitted that they must do this caring work, and some said they enjoy taking on this responsibility, especially for their kids [8].Some divorced women were forced to be caregivers because they needed their parents' monetary support [8].The absent community alternative is also a significant factor why women have to take a role in caregiving [8].
The aforementioned information depicts the daily routine and potential challenges caregivers face, who often happen to be underpaid female family members.Then, what influences might being a caregiver bring to an individual?The biggest concern might be whether giving care will decrease the life expectancy of the caregiver him or herself.According to the Ohio State University's study in conjunction with the National Institute on Aging, adult children taking care of their parents or parents taking care of their children may have their life span shortened by four to eight years [9].

Training and Regulations Concerning Caregivers
Without a doubt, caregivers with special training can contribute to better care provision [10].For instance, caregivers with specialized training in early childhood education, child development, or daycare showed a higher frequency of positive social interaction with children [10].Children under the supervision of these caregivers tend to perform better in cooperative skills, standardized tests, and other tasks and activities [10].In an experiment conducted by McCartney in 1982, caregivers receiving a different level of education were compared with one another and were rated by the care receiver.Indeed, the researchers discovered that caregivers' education largely influences the satisfaction of the care receivers [10].As a result, the public policy on caregiver standardization should be considered and valued [10].
However, the regulations for different countries, even states, regarding the education requirement of caregivers vary hugely.Some states in the United States, like New York, require lengthy training sessions (40 hours or more); others, like Pennsylvania and California, require less than 10 hours of training with annual training sessions afterward.At the same time, states like Massachusetts, Virginia, and Colorado do not even require any training before an individual can become a caregiver [11].In many less developed countries, though there are requirements for becoming a caregiver, the regulation implementation is fragile, especially in some small cities.For instance, in China, many records show that unregulated caregivers have harmed the care recipients.Since they are not registered in the caregiver training system, they can run away without anyone knowing their real name.On November 13th, 2017, in Changde, Hunan, an unregistered caregiver used a knife to scare a dementia elder and run away.
The United States government enforced several acts to ensure the welfare of caregivers and care recipients: The Family and Medical Leave Act and the Senior Care Act.The former act states that caregivers can have extended time off to ensure the work quality for their long-term ongoing care for an individual recipient, and caregivers should be provided with the same amount of salary upon their return from the time off.It is interesting to point out that in Chinese caregiver regulations, caregivers cannot require time off.Otherwise, they will be punished according to their compact.Many developing and undeveloped countries are experiencing similar problems: the rights of the caregivers and other working individuals are not guaranteed [12].The latter act allows the elderly to stay at home instead of in a facility because the government will provide additional monetary and other support to help the elderly or his or her family pay for caregivers [13].

Analysis
By analyzing all the countries' motives and regulation laws, we hope that countries worldwide can establish laws and regulations for training and regulating the caregiving industry in the foreseeable future.However, a few countries, such as Japan, the United States, and some European countries, have enacted regulations on the caregiving industry and training system in most countries, especially those in underdeveloped and developing countries.
For example, in China, there are regulations about the general labor market.However, there are no regulations referring to the caregiving industry specifically, meaning that both the caregiver and the care receiver have problems with safety, health, insurance concerns, etc.For instance, caregivers who work for a family might not get paid well because the market is not strictly regulated; care receiver might not get the appropriate care because the caregivers are not required to train and getting a license; also, some of the caregivers are bond to a specific family or care recipient because there do not get to choose work hours or the right to leave.Even though there are a few regulations written, there are few law enforcement people to enforce the law and implement regulations in local regions strictly [14].
However, a few countries have regulations about the caregiving industries.For example, Australia, the UK, and Germany ensured caregivers have unpaid leave whenever they are willing to do so and paid leave for ten days every year.Also, all three countries ensured caregivers get paid as long as they have passed the training system of caregivers and get a license, whether directly or indirectly [15].
For a country that has encountered the aging problem for more than 30 years, Japan has several ways to solve this problem and a very mature caregiving industry.Since many family members usually need an individual to take care of them, the Japanese government enacted a law to ensure people that act in a caregiving role in the family take unpaid breaks to take care of their family.Employees with a child or two or more family members to look after will be granted ten days of unpaid leave per year to take care of their family.
For Scandinavian countries, people usually say they are socialist because they have an excellent health care system.They have a concept of providing health care for every individual.In the concept of "Medicare for all," private medical care is even illegal in some countries to achieve a better communal good [16].
There are a few necessary components for a country to have a mature caregiving industry.First, they should have a regulatory system to be implemented to standardize the caregivers: to test the caregivers' ability and to ensure the caregivers get the same treatment and salaries in the market.After ensuring caregivers' abilities, there must be laws enforced on how caregivers should have the ability to choose their working hours and free will in choosing to work for the care recipient.In this way, it is a two-sided selection, so the satisfaction of both sides will be increased.With all of the above discussion about the caregiving industry, it is not difficult to discover that there are still many problems involved with caregiving regulations and training to provide reasonable protection to caregivers and care receivers.
Without a doubt, in an aging society, the importance of caregivers is vastly underestimated.Caregivers in a family are very stressful because they have children to take care of and the elderly (parents or sometimes even grandparents).As a result, training for paid or professional caregivers is necessary.However, without a mature system of caregiver protection or ability certification, the industry cannot be maintained, and the rights of both workers and customers will be diminished.
Granted, a few countries already have a mature caregiving industry.For instance, Japan has many laws to maintain the rights of both paid and family caregivers.In this way, the care recipients can always be made sure that there will be someone taking good care of them, and they will be charged a fair amount of money.Moreover, in many European countries, caregiving has become prevalent work, and they will get good insurance coverage and salary and unpaid leave protection.
Learning from this experience, we should do something constructive for society.Especially for the governments of developing and low-income societies should pay more attention to the caregiving and health industry.Although having a high GDP should be the top priority, looking into the future and trying to ensure the satisfaction of their citizens is also an inevitable stage a country must go through.