Can We Manage a Balance between Care and Employment? —The Compatibility of Informal Care and Employment at the Alpen-Adria University

Thedemographic trend confronts the younger generation with the decision to care for family members. The care of a loved one is seen as not only a challenge but also a burden. The aim of the present study is to investigate the compatibility of care and employment in the university context by a multilevel triangulations design. First we determined the amount of persons concerned by all staff members of the Alpen-Adria University (AAU) ( n = 919). Subsequently we discussed the problems in depth with ten employees. The results show that 11% of the employees are caring for a family member and are exposed to a variety of burden. In addition to physical and mental disor-ders, there are changes in the work style. The affected employees kept the care secret and formu-lated fears of job loss and degradation of efficiency. These results formed the basis for expert interviews ( n = 7) and the development of concrete solutions.


Introduction
The demographic development towards old people continues. While a person with an age of 100 years old was a notable exception a few decades ago, very old age increasingly is the norm (Rott & Jopp, 2012). Expressed in numbers, the proportion of people aged over 65 in the total population will increase by 9% in the next 30 years (Statistik Austria, 2014). This population group is of particular interests in terms of society as a whole because a longer life goes hand in hand with a higher risk of dementia processes, chronic diseases, the need for help and care (Kreimer, Meier, & Sträußelberger, 2010;Kücük & Piechotta, 2013).
Because of the increase in the proportion of very old people, in the coming years we will more and more be confronted with questions of care takeover and necessary support services (Schneider, Drobnic, & Blossfeld, 2001). For relatives, as well as the caregivers, the wish for individual care is of great importance and the care in private households is preferred (Gerlach & Laß, 2012). We currently are in the situation that will be maintained, namely that for 80% of people care in the family environment by their relatives will be required (Jabsen & Blossfeld, 2008;Pochobradsky, Bergmann, Brix-Samoylenko, Erfkamp, & Laub, 2005). This applies especially to today's Baby Boomer Generation (defined as being born between 1946 and 1965), as well as the Generation X (defined as being born between 1966 and 1979) (Ivancevich, 2007). The care services and nursing tasks are mainly taken over by female relatives (Pochobradsky et al., 2005).
In detail, a parent, followed by spouses or life partners, usually does the care takeover (Pochobradsky et al., 2005). The care services range from support for the physical care, home help and lifestyle to financial support (Schneider, Häuser, Ruppenthal, & Stengel, 2006). In particular, the care of a dementia patient and/or mentally ill people is experienced by informal carers to be particularly time-consuming and stressful (Kittl, 2003;Kofahl, Arlt, & Mnich, 2007;Wancata, 2002). Especially women have to carry the main burden of care normally. They are subject to a higher subjective social and health burden Ponocny, Panholzer, Trukeschitz, Schneider, & Mühlmann, 2010). If you try to characterize the typical informal caregiver, this will be a female, around 50 years old and older, who has mostly completed an apprenticeship or compulsory schooling as the highest completed education and is married in most cases (Pochobradsky et al., 2005;. Just under a third of informal carers are gainfully employed and precisely these people are doubly challenged by the compatibility of work and care (Pochobradsky et al., 2005). If in addition to work and care even school-age children have to be taken care of, this can lead to a further increase of the load experience (Albrecht, 2008;Dammert, 2009).
However, family care giving differs from child rearing, despite some similarities (Dawid et al., 2008;Kreimer et al., 2010;Lüdecke et al., 2007;Schneider et al., 2001) and in many areas represents a greater challenge. While parenting is limited in time and you look to a positive future, the end of care is typically combined by getting to the demise of dependent persons (Dawid et al., 2008;Lüdecke et al., 2007). At the same time the course is often not predictable (Kreimer et al., 2010) and the costs of providing care increase (Schneider et al., 2001). The care can be more easily arranged in children and the possibility of putting them in a playschool exists, which is regarded as positive by society, and is also funded financially by the government. The decision for a retirement or nursing home is a taboo and often considered as getting rid of the elderly relatives (Dawid et al., 2008;Fleischer, 2010). Unlike with child care, with family care giving the part-time work is less likely chosen as a way to lessen the burden; the caregivers rather tend to terminate the employment (Schneider et al., 2001). Schneider, Heinze, & Herring (2011) describe economic consequences arising from the compatibility issues with an annual 14154.20 euros per employee. The operational costs resulting in total per year amount to 10 to 30 billion euros, resulting from adjustment of the affected services, such as absenteeism, presenteeism, work time reduction and fluctuation. Although the issue of reconciling work and care is of great importance, in terms of literature there is not only insufficient information about the situation of care given by employed persons, but also little research having been done in this field so far (Kreimer et al., 2010;Trukeschitz et al., 2008).
The aim of the present study is to give an overview of the affected proportion of informal carers and their loads in terms of compatibility of care and employment. On this basis, options for relief tailored to the individual and target group-adequate approaches will be developed. Through different types of data collection, an awareness of the issue will be created with the employer, which should be a first step to sensitization.

Design
The study followed an "iterative sequential mixed design", in which were more than two quantitative and qualitative phases in chronological order on the application. The discrete but evolutionary study modules are used to supplement the results of the first part in order to provide further explanations to confirm or refute the results. At the end the received information of the different data sources to answer the questions are combined into one result and compared (Creswell & Plano Clark, 2007;Teddlie & Tashakkori, 2009). Figure 1 gives an overview of the three study blocks.

Participants
Study module 1: The online questionnaire was addressed to all employees of the AAU. The study population included 919 persons (400 persons of administrative and 519 persons of academic staff). Of 267 people the questionnaire was answered completely, which corresponds to a response rate of 29%.
The majority of employees, which participated in the survey, were between 30 and 59 years old (79%) and female (69%). Most of the respondents worked full-time (64%) and 30% had specific attendance times. This is in contrastto186 persons (70%), which indicated flexibility in the distribution of the working time. 52% were members of thescientificand48% of the administrative staff. Analysis was performed using descriptive statistical analysis methods.
Study module 2: In the second module, the participants were also employees of the AAU, which currently or in the past cared for a family member. The sampling recruitment proved quite difficult in this module. In a circular email to all employees not a single person answered. Through personal requests and handing out of interview invitations, 10 university employees were acquired for an interview.
Study module 3: For the last study module, individuals were selected, which have experience and knowledge in the area of reconciliation between work and care or were contact person for these issues at the AAU (Flick, 2007). Five experts took part, which are employed at the AAU, and two external experts. The internal company interview partners included the rector, the vice rector for personnel, the works council of general staff, the representative of the works council for academic Staff and the chairman of the working group on equal opportunities of the AAU. The external experts are employed as head of the staff department for gender equality policy at the Johannes Kepler University Linz and as head of unikid & unicare at the Karl-Franzens-University Graz.

Measures
Study module 1: To get an overview of the affected employees at the AAU, on the basis of the work of Kreimer et al. (2010) and Mühlmann, Ludescher, Trukeschitz, & Schneider (2009), an online questionnaire was developed (https://wwwu.edu.uni-klu.ac.at/limesurvey2011/index.php?sid=78168&lang=de) and made available to all employees (N = 919). In part A of the questionnaire sociodemographic characteristics of employees, such as age, sex, activity (type, duration and flexibility) and the housing situation were collected, followed by the question whether they have actually or taken care activities in the past and how they reconcile the assessment of care and professional activities at the AAU. Part B of the questionnaire was open only to persons concerned. There key data of the patient, professional problems of compatibility and the use of support measures are explored. The analysis was performed using descriptive statistical analysis methods.

Study module 2:
Starting from the baseline surveys in study module 1 a purely qualitative approach was chosen to deepen the available data for more, concrete evidence on the compatibility issues for the follow-up survey. Following Kreimer et al. (2010) an interview guide was developed that focused on four topics. A narrative hook sequence served as relationship bonding, in which a free report can be given on the development of the care situation. In the subsequent part, situations in which heavy workloads were experienced and the effects, that taking over the care of an elderly person had on one's own life and the job situation were discussed. Finally requests of support were explored. The interviews were conducted over a period of six months and lasted between 7:43 and 55:18 minutes (M = 27.51).The interviews were recorded on tape, the consent to do so was given by all interviewees. The transcribed interviews were evaluated using inductive and deductive category creation (Mayring, 2008) and were supplemented with the findings of the questionnaire survey.
Study module 3: In the third study module expert interviews were conducted to discuss the results obtained in terms of solutions and implementation ideas. First, the experts were presented the key findings of the questionnaire survey and the qualitative interviews and evaluated as to their relevance and implementation priority (for further details see Frate, 2014). It was placed on a differentiation between general and scientific university staff value. Following allocation was made for the ranking: 2 points were awarded if the support measure was described as "very important", 1 point was given to proposals, which were "important", and no points were given to the topics that were assessed "not important" or "not very important". With the experts, a target group adequate catalogue of measures has been developed for the AAU.

Study Module 1
The results in this module show that 29 employees at the AAU were taking care of a relative. Half of these (n = 15) is between 40 and 49 years old and about two-thirds female (n = 19). In the majority of cases (n = 17) the need for care occurred suddenly. More than half of those affected (n = 18) did not live with the person being cared for in the same household.
Results regarding the employment situation showed that 20 of the persons concerned were employed full-time. 17 of 29 people were active in the scientific field and 12 persons in the administrative area. The data show that eleven affected employees rated "bad" or "very bad" concerning reconciling work and care at the AAU. Nobody rated "very good" and only four people "good" (Figure 2).
Problems regarding compatibility of work and care were shown mainly by the fact that the vast majority of informal carers from the AAU (n = 22) suffered from increased fatigue. Nearly half of the subjects (n = 13)   stated that they dedicated work breaks, holidays and the likes to care. Eleven people described a lack of concentration and nine people that had abandoned the work earlier, described that there were agreements with colleagues and that overtime, training, work-related social events, as well as business trips were avoided. Six people described a lack of understanding in the business environment, as well as fears of devaluation of performance. 21 people who had responded to the questionnaire after receiving support reported to have been supported by relatives, but no one stated that colleagues, supervisors, council, works council member or staff representatives supported them. Every second person concerned (n = 16) did not communicate the situation to the superiors.

Study Module 2
Seven female and three male persons took part in the interviews. Their age was 34 -64 years. Eight people were employed in the administrative area and two in the scientific field. The staff were on average 21 years (range: 7 -42 years) and for the most part (seven out of ten) working full time on the AAU.
The interviews showed that care was taken over mainly for a parent (mother 5×, father 2×). At the time of interviewing, four care arrangements had been completed and six still going on. In the current six nursing situations the dependend persons were on average 86 years old (range 76 -89 years).
Based on the statements of the 10 interviewees in module 2, subjective stress factors of affected employees at the AAU were determined, insight into personal and professional impact could be gained and needs of support were identified.

Subjective stress factors
Stress factors were named 26 times ( Table 1). These result from the care and housekeeping, which is accompanied by a high organizational effort. The informal carers stated worries of the future that stood in relation to possible occupational limitations, while at the same time there was uncertainty regarding how the care situation would develop. Another topic addressed was the taboo of talking about the care situation.

Personal consequences
The stress factors arising from the care are not without personal and professional consequences ( Table 2). In the personal area (35 responses) mainly psychological consequences could be determined; followed by physical consequences, as well as ongoing worrying and financial losses.
Impact on employment As a consequence of the double work load effects on professional life have been reported (Table 3) with 26 nominations. This showed itself mainly in a change in the style of work. The caring staff reduced their working hours. There was short-term leaving the workplace and it came to the cancellation of courses. Taking off work, as granted by the law, which should provide employees with rest and recovery, happened at atypical times. Likewise, the care situation had an impact on working performance, which manifested by its lack of concentration.

Wish for support
The wishes for support (26 mentions) ranged from flexible structuring of time, to being able to leave the   workplace at short notice, the desire for counseling, information and organization of care and assistance, other benefits, such as free parking, up to the possibility of working through home-and teleworking ( Table 4).

Study Module 3
Within the expert interviews initially the main results from module 1 and module 2 were discussed. Then, the determined support wishes of those affected were evaluated for their relevance and priority. Based on this evaluation of the support wishes a catalogue of measures was prepared and assessed by the experts. Table 5 shows the areas of activity separated by five thematic areas. Individual nominations were not considered.
The table shows that measures on work organization were most important and assessed with 80 points by the experts; followed by conveying information with 20 points, kind contributions with 13 points, management and personnel development, as well as workplace health promotion, each with 11 points.
Regarding the options of work organization, the maximum number of points were awarded for flexitime models, as well as flexible work organization. Flexitime models enable those concerned to leave the work short term and they can act on their own responsibility. Regarding flexible work organization it should be noted that for the administrative staff, the use of home and teleworking is difficult because this occupational group is often tied to specific attendance times. The second highest rating points were the options for temporary part-time work, as well as individual and especially short-term reduction of working time, or to be able to take a special leave. Especially when a care exemption cannot be claimed because of separate households, as is often the case with scientific personnel, special leave would offer as a possible measure. However, the existing amount of vacation days and the individual task areas within the company should be taken into account. In third place stood the adjustment of performance requirements, the involvement of colleagues at work into the agreements and concessions for appointments if there is an obligation for attendance. The final points were avoiding additional time expenses such as meetings, business trips, etc. during the period of care and unpaid day releases, which are regarded as critical because these bring a financial burden of care givers with them.
With regard to possible measures for providing information, an individual contact person, followed by the provision of information about mailings, information brochures or the website of the University, awarded the highest rating to individual advice. Stress factors, such as full-time employment, large administrative and organizational effort, as well as lack of time have a negative impact on the information gathering of nursing services and auxiliary power. The experts believe this could be solved by the possibility of individual consultation within the company, as well as provision of information on the part of the AAU.
Free parking, as well as financial assistance for an interest-free advance of salary or a special fund in kind could do assistance to affected employees by contributions.   provision of information about mailings, information brochures or the website of the University 9

Activity
Relevance by score sensitization of executives 11

Domain of practice 4 Workplace health promotion
Activity Relevance by score psychological/psychotherapeutic support 5 publicinformation events 4 placement and organization of care and assistance (coordination without-patientservices) 2

Domain of practice 5 Kind contributions
Activity Relevance by score free parking 7 financial assistance (special funds, interest-free advance of salary, etc.) 6 Within the field of action "management and personnel development", the maximum numbers of points were awarded to the sensitization of executives. There is on the one hand the need to prepare managers better and give them the opportunity to make individual agreements with those concerned. On the other hand, it would be important to make the topic less of a taboo. This would have a positive effect on fears of devaluation of the performance of affected employees.
Measures, which serve to promote health at the workplace, affect the psychological/psychotherapeutic support of affected employees, public information events and the placement and organization of care and assistance.

Discussion
The aim of this study was to develop measures to reconcile informal care and employment at AAU. Through the combination of quantitative and qualitative methods a good overall impression of the topic relevance could be worked out.
In module 1, 29 people (11%) stated that they care for a relative over the age of 18 for more than 2 weeks or did so in the past. Pochobradsky et al. (2005) conducted a survey in Austria which catered to people who were caregivers receiving state money for caregiving and found that 29% of these people also received money through employment. As a possible cause, it was noted that the situation is covered up because of fear or insecurity. The age in this sample is lower, which might also be an explanation for a lower percentage of those affected. Because the parents' generation and / or partners are the ones primarily cared for, the percentages would have to be higher with an older sample. Another explanation could be that many members do not see themselves as care givers. Mühlmann et al. (2009) assume that for caregivers it often can be difficult to assess, which kinds of assistance still fall in the range of normal relationships and which activities go beyond the scope of the traditional relationship.
Main features for the caregivers in module 1 show that two thirds (n = 19) are female. In module 2 it was seven out of ten that women were concerned. This is in correspondence to the literature, where 69% female participation is assumed among working caregivers (Kytir & Schrittwieser, 2003;Mühlmann et al. 2009;. In contrast to literature, only 11 of the 29 affected university staff members live in the same household with the person being cared for. Pochobradsky et al. (2005) speak of two thirds that live in the same household. One explanation for this could be the demanded mobility in the scientific field. It was also found that the majority of those affected live in separate households, which makes nursing leave impossible and represents a considerable negative factor.
The majority of care workers at the AAU (n = 20) were employed full-time at the time of the survey. Also during the guided semi-structured interviews, this was true for seven out of ten interviewees. It is obvious that full-time employees are under duress by the care giving even more. Above all, at the beginning, when care giving becomes necessary, time is lacking for collecting the necessary information on care and assistance. The results of block 2 show that the person concerned felt burdened by the administrative and organizational effort. This can be a big problem especially for unprepared care situations, as was the case for more than half of the interviewed caregivers (n = 17). If the need for care occurs suddenly, it takes rapid, flexible solutions. Responsibilities of being present and lack of information are reinforcing the problem. A potential conflict entails absenteeism when colleagues need to share the work of those affected.
Few assessed the compatibility of care and employment on the AAU as "good" or "very good" (n = 4). 11 people rated this as "poor" or "very poor". The employer does not get a good feedback here.
In the online-survey, six persons concerned reported having encountered a lack of understanding in the business environment. Six of the caring staff described fears of devaluation of performance and no one stated colleagues, the manager, and council or staff representation supported them.
At the same time, more than half of all respondents (n = 16) described that the nursing relationship was hidden from employers or has not been addressed. In this case, those people tended to make adaptations, which were not agreed with at the AAU. These adaptations are an attempt to tackle the double duty and are show themselves primarily as temporal restructuring or reduction of working time, while the work performance however was maintained. Furthermore, in favor of the care, recovery hours were limited, which should serve for regeneration. As a result there may be a low dependability and productivity loss (Mühlmann et al., 2009).
Regarding the employment group, the results showed that 17 affected employees belonged to the academic staff and 12 employees belonged to the general university staff. The administrative staff has little room for ma-noeuvre in terms of attendance times and absenteeism, thus it may come to a depending on superiors and colleagues. The general university staff is further disadvantaged by the limited possibility for homework and teleworking, and especially by a lower salary. So the purchase of care services is difficult and a reduction in working time is only to a few financially accessible. Problem areas for the scientific university staff show up in the fear of devaluation of the performance, because career losses are feared. This could have a direct influence on the reduction of fear, in terms of job loss but also in terms of fear of devaluation of job performance.
Due to changing family constellations that are expressed in high divorce rates and lower birth rates (Schneider et al., 2006) as well as increased employment of women, in the future a lower family care participation is expected (Döhner, Kohler, & Lüdecke, 2007).
On the long run it must be assumed that the imbalance of people who can take care and those who need care by relatives is getting bigger (Haberkern, 2009). In light of the above it is clear how urgent operational support measures are needed. The currently low share of workers with care obligations to the AAU is expected, in regard to demographic developments, to grow rapidly. The currently affected employees are wishing for assistance in the form of flexible working and work organization, consulting and information as well as kind contributions.
From expert's point of view, creating awareness regarding the relevance of the subject is a first step to reconcile. In this case it is important to reach decision makers and to give them the opportunity to come to individual agreements with the affected.
This could have the effect of reducing anxiety, both in terms of fears of job losses and prior validation of performance. It is also important to work on the taboo of threat. A possible positive consequence would be that the willingness to take auxiliary and support measures will be increased. Other areas of activity are related to the work organization, information, kind contributions and workplace health promotion.

Limitations and Suggestions for Future Research
Although we are confident in our results, some shortcomings should be addressed. Due to the small sample size, a generalization of the results is not allowed. It cannot be traced to gender differences; a reliable comparison of scientific and administrative staff cannot be made. The results are merely an orientation in a previously unexplored area. Future studies should include small and medium enterprises, with different working conditions, investigate and approach the issues from different perspectives. It would be especially interesting to work out conditions under which the occupation was ended in favour of care, respectively in the desirable case, where the employment could be maintained.

Conclusion
The aging of our society and changed conditions of life bring it about that many older people no longer live with their children under one roof, but still like to be cared for by them and prefer to stay in the home environment. The individual decision to take care of a family member has far-reaching consequences (and affects all areas of life). To enable familial care in the future and make it more attractive, not only operational measures, funding models and support options are needed, but also social policy and societal solutions will be required that respect and appreciate the task of care giving. Creating awareness and breaking taboos can be the first steps on this path.