Caring for the elderly at work and home: Can a randomized organizational intervention improve psychological health?

Ellen Ernst Kossek, Rebecca J. Thompson, Katie M. Lawson, Todd Bodner, Matthew B. Perrigino, Leslie B. Hammer, Orfeu M. Buxton, David M. Almeida, Phyllis Moen, David A. Hurtado, Brad Wipfli, Lisa F. Berkman, Jeremy W. Bray

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Although job stress models suggest that changing the work social environment to increase job resources improves psychological health, many intervention studies have weak designs and overlook influences of family caregiving demands. We tested the effects of an organizational intervention designed to increase supervisor social support for work and nonwork roles, and job control in a results-oriented work environment on the stress and psychological distress of health care employees who care for the elderly, while simultaneously considering their own family caregiving responsibilities. Using a group-randomized organizational field trial with an intent-to-treat design, 420 caregivers in 15 intervention extended-care nursing facilities were compared with 511 caregivers in 15 control facilities at 4 measurement times: preintervention and 6, 12, and 18 months. There were no main intervention effects showing improvements in stress and psychological distress when comparing intervention with control sites. Moderation analyses indicate that the intervention was more effective in reducing stress and psychological distress for caregivers who were also caring for other family members off the job (those with elders and those "sandwiched" with both child and elder caregiving responsibilities) compared with employees without caregiving demands. These findings extend previous studies by showing that the effect of organizational interventions designed to increase job resources to improve psychological health varies according to differences in nonwork caregiving demands. This research suggests that caregivers, especially those with "double-duty" elder caregiving at home and work and "triple-duty" responsibilities, including child care, may benefit from interventions designed to increase work-nonwork social support and job control.

Original languageEnglish (US)
Pages (from-to)36-54
Number of pages19
JournalJournal of occupational health psychology
Issue number1
StatePublished - Feb 2019

Bibliographical note

Funding Information:
Rebecca J. Thompson was a postdoctoral candidate at Purdue University, which provided partial support for this research. This research was conducted as part of the Work, Family, and Health Network (, which is funded by a cooper- ative agreement through the National Institutes of Health and the Centers for Disease Control and Prevention: Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grants U01HD051217, U01HD051218, U01HD051256, and U01HD051276); National Institute on Aging (Grant U01AG027669); the National Heart, Lung, and Blood Institute (R01HL107240); Office of Behavioral and Social Sciences Research; and National Institute for Occupational Safety and Health (Grants U01OH008788 and U01HD059773). Grants from the William T. Grant Foundation, Alfred P. Sloan Foundation, and the Administration for Children and Families have provided additional funding. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of these institutes and offices. Special acknowledgment goes to Extramural Staff Science Collaborator Rosalind Berkowitz King and Lynne Casper, for design of the original Workplace, Family, Health, and Well-Being Network Initiative. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of these institutes and offices.

Publisher Copyright:
© 2019 APA, all rights reserved.


  • elder care
  • health care
  • job stress
  • organizational intervention
  • work-family
  • Nursing Homes
  • Health Promotion/methods
  • Humans
  • Middle Aged
  • Child Care/psychology
  • Family Health
  • Male
  • Caregivers/psychology
  • Young Adult
  • Health Personnel/psychology
  • Adult
  • Female
  • Surveys and Questionnaires
  • Workplace/psychology
  • Child
  • Stress, Psychological/prevention & control
  • Occupational Health
  • Social Support
  • Adolescent
  • Intention to Treat Analysis
  • New England
  • Aged

PubMed: MeSH publication types

  • Randomized Controlled Trial
  • Multicenter Study
  • Journal Article


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