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Toni Calasanti, Neal King, Taking ‘Women's Work’ ‘Like a Man’: Husbands' Experiences of Care Work, The Gerontologist, Volume 47, Issue 4, August 2007, Pages 516–527, https://doi.org/10.1093/geront/47.4.516
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Abstract
Purpose: We adopted a feminist, structural approach to husbands' experiences of caring for wives with Alzheimer's disease. This framework posited that men and women draw upon gender repertoires—situational ideals of behavior based upon their respective structural locations—that create gendered experiences of stress and coping strategies. Design and Methods: We used a qualitative, constructivist approach to analyze in-depth interviews with 22 spousal caregivers and observations within support groups. Our analysis focused on the nine husbands, the strategies these men reported using to deal with problems that arose in their care work, and the extent to which these are congruent with the masculinities of White men in the United States. Results: We found that these husbands' approaches to caregiving and their strategies for dealing with the work and feelings involved were rooted in their sense of selves as men. We outline their overall approaches to caregiving, identify six strategies husbands used to deal with problems stemming from care work—exerting force, focusing on tasks, blocking emotions, minimizing disruption, distracting attention, and self-medicating—and tie these to their structural positions as working-, middle-, and professional-class men. Implications: Theories of gender differences in the performance or quality of care work should tie these to structural arrangements. Unless the gendered bases upon which different styles or experiences are removed (i.e., structural inequality), designers of interventions cannot and should not expect to use the experience of one group to inform appropriate strategies for the other.
Recent interest in men's caregiving has spawned debate about the quality of care that men provide. Based on an implicit if not overt comparison to women's work, some scholars see male caregivers as “ineffective and inconsequential,” whereas others see them as “capable … adaptive and innovative, able to manage as well as nurture in providing competent care” (Russell, 2001, p. 353). Researchers have argued that men are less likely than women to suffer stress or to report depressive symptoms that result from their care work (Shirey & Summer, 2000; Yee & Schulz, 2000). Some have suggested that designers of interventions might learn from the strengths of men's approaches, using these to teach women better strategies (Yee & Schulz, 2000). Such debate over men's and women's caregiving styles and efficacy tends to ignore both the force of gender relations and the importance of the type of relationship between primary caregiver and care receiver. Though researchers discuss gender, as Thompson (2000) maintained, they tend to treat manhood and womanhood as individual attributes rather than positions in a relation of structural inequality.
In this article, we focus on spousal care and reframe these issues by taking a feminist approach that explains gender differences in terms of structural gender relations, which allows us to suggest appropriate policies (Calasanti & Slevin, 2001). Using cross-gender comparison and self-reports of gender ideals of behavior in order to delineate the role of masculinity in the organization of caregiving, we focus on men who care for their cognitively impaired wives. We set aside debates over whose care work is better or worse. Rather than evaluate the effectiveness of men's caregiving relative to women's, we demonstrate the extent to which their strategies are congruent with the masculinities rooted in the structural positions of working-class and professional White men in the United States. We show that the men in our sample adopted a gendered approach to care work and marital nurturance that allowed them to deal with the work and their feelings as men. This understanding should influence care work policies and interventions.
A feminist, structural approach emphasizes adaptation to ongoing interaction as social networks hold women and men accountable to sex- and situation-specific ideals of behavior (Risman, 1987). We define masculinity as the invocation of such ideals by stratified groups of men in their various contexts. Those ideals vary with structural location (e.g., class position or racial category) and guide behavior even though few men live up to many of them (Coltrane, 1994). Indeed, people do not simply orient to expectations of themselves learned in early life, but they manage their conduct with contemporary situations in mind, be those occupational contexts, family organizations, or novel situations encountered outside typical networks and routines (West & Zimmerman, 1987, p. 127). West and Zimmerman's theory of the context-sensitive invocation of ideals of behavior provides for theoretical understanding (and methodological operationalization) of such vital matters as inequality, institutionalization, and change over time. It has for these reasons become an influential theory of gender, race, sexual, and other relations of inequality (for a more in-depth discussion of this approach and debates surrounding it, see King, 2006).
In relation to caregiving, this framework posits that groups apply situational ideals of behavior relevant to their respective structural locations, thereby creating experiences of stress and coping strategies that vary with divisions of labor and authority. Thus, one would expect that, in performing care work, people would draw upon gender repertoires—sets of skills and resources that affirm identities formed in a context of gender inequality. For instance, if men do not see themselves as nurturers, then shortcomings in that area should cause them less stress than should perceived inabilities to maintain masculinity.
Researchers have applied this perspective to caregiving and demonstrated that group structure has an independent effect on decisions to care. In terms of eldercare, for instance, sons without siblings in close geographical proximity often become primary caregivers for their parent or parents (Thompson, 2000). And among spouses, the marital relationship is more important than gender in determining caregiving decisions: Both husbands and wives demonstrate commitment to providing care for one another (Arber & Ginn, 1995).
However, researchers have applied this feminist approach to caregiving less frequently. Russell (2001) suggested that, given that women are believed to have life experience that equips them for giving care, researchers have rendered judgments as to whether men's approaches are as effective or competent. Others have used different caregiving styles to explain men's presumably lower psychiatric morbidity. Scholars have advanced men's “managerial” approach to care work, lower levels of emotional engulfment, and greater sense of mastery as reasons why men experience less stress (Russell, 2001; Thompson, 2000; Yee & Schulz, 2000).
Rarely addressed in such discussions is the basic question of how group organization and gender ideals affect care work. Assessing this requires, first, that researchers appreciate the importance of structural arrangements in caregiving; some occur in formal institutions, others between peers, and others still between spouses or parents and children. Though women carry primary responsibility for care work across the life course, few gender differences in terms of amount or type of care provided accrue to spousal care (Arber & Ginn, 1995). For both women and men, caring for a spouse differs from caring for a child, for example (Calasanti, 2006).
Second, scholars need to theorize gender difference. Most caregiving studies conflate sex with gender such that, for instance, “masculinity standards and men's experiences as men are treated as identical to being male. … Adult sons and elderly husbands; white men and men of color; auto assembly workers and financial planners are classified the same; they are all classified as males” (Thompson, 2000, p. 338). It is not simply the assumed homogeneity within sexes that is problematic. Noting the impact of gender (and not only sex) means tying observed differences to the structure of gender relations—the processes by which divisions of labor, authority, and wealth shape sex-specific ideals of behavior. Thus, even as researchers use observed gender differences in behavior as part of a larger indication of the outcome of structural arrangements, they interpret these observations with a broader theory of structural inequality in mind.
By ignoring such structural bases of gender differences in behavior, researchers would obscure the gendered basis of their knowledge about caregiving in the first place—using a “feminine” model for assessing the effectiveness of men's care work (Thompson, 2000) and for recognizing psychiatric morbidity, for instance. Researchers have long noted the greater likelihood of women reporting depression, but they also realize that this does not necessarily mean men do not experience it at similar rates, especially if one takes men's higher suicide rates into account (Courtenay, 2000). Preliminary qualitative research among caregivers has indicated that the expression of stress may vary across gender, racial, and ethnic lines (Calderon & Tennstedt, 1998). Thus, scholars may not be recognizing the stress that men experience.
In this research, we took structural arrangements into account by focusing on caregiving husbands' experiences of stress and their coping strategies. For men of the cohort under study here, being men—and being husbands—has involved occupations that emphasize problem solving and control. Connell (1995) noted that “middle-class men … are increasingly defined as the bearers of skill” (p. 55) in a social structure in which “men's domination of women is now legitimated by the technical organization of production” (p. 164). Workers can enjoy privileges within most of their networks by being men in gendered occupational niches. These occupations tend to emphasize technical qualifications and the coordination of highly skilled work within complex organizations. Working-class masculinities are rooted in the different environs of industrial shop floors and craft houses, where values of “work skills, social pride, and economic security of the craft tradition” emerged. Manhood, for such workers, came to mean “independence, mutuality, and pride in craft” (Meyer, 1999, p. 118).
Though others have referred to men's “managerial” approaches to care work, the term managerial suggests a professional-class ideal that may not apply to a wide array of men in the U.S. context. In our interviews class differences appeared, and these men also referred to their care work in terms of relationships and family. For these reasons, we drew upon and modified Russell's (2001) earlier framework, which suggests that husbands embody a style of caregiving that combines management, technical skill, and focus on tasks characteristic of occupationally based masculinity, with nurturing rooted in the domestic sphere.
Thus, in this study, we asked how gender structures husbands' interactions with their cognitively impaired wives and shapes their stress and coping strategies. We explored these men's care work from a standpoint that did not assume men's or women's approaches are better or worse; instead, each may have strengths and weaknesses tied to gender relations. We also contribute to the structural study of men's care work by showing how White men's approaches to dealing with caregiving problems (e.g., care receiver resistance, depression) remain congruent with the structural positions of such middle- and working-class men in the United States. Our perspective assumed that masculinities result from structural positions in which men work and from the development of sex-specific behavioral ideals in those contexts. Kimmel (2006) illustrated this perspective with a history of mid-century fears of feminization among middle-class men in the United States: “The truly nurturing dad, emotionally expressive and available [was] regarded as effeminate” by at least some cultural critics (p. 162). The world of work provided ways to avoid the semblance of such nurturance for some men: Manual labor contributed to working-class masculinities, adventurism and authority to masculinities of an executive class. Although occupational, technical mastery was being transformed into a purchase on manhood for the middle class, many hungered for the aggressive, often violent adventures with which they associated a traditional manhood. But for middle-class men, “the work world offered none of those possibilities for manly redemption” (p. 164). Some such men looked instead to fatherhood, which promised a sense of autonomy and control. Family engagement thus offered a complex mixture of potentially feminizing nurturance and masculine, task-oriented authority. Thus, masculinity consists of the institutionalized behaviors, developed in occupational contexts, with which men attempt to attain their ideals of manhood.
Methods
We operationalized masculinity both in terms of gender differences in reported behavior, and in terms of self-reported ideals of manhood. That is, we looked for patterns in the descriptions of their experiences that women and men provided, understanding that their respective social contexts in the larger structure of gender inequality produced different (though overlapping) experiences. When men reported experiences and strategies that women rarely or never mentioned, they provided at least prima facie evidence that masculinity may have been at stake—that men may have been behaving in ways that seemed appropriate to them as men. We looked also for reference to manhood or womanhood by the respondents, because they were often aware of the links between gender and their own decisions, such awareness allowing for agency in the ongoing redefinition of masculinity.
The study used a qualitative, constructivist approach (Hendricks, 1996) to explore the caregiving provided by spouses of individuals with Alzheimer's disease. The first author used semistructured interviews to gather in-depth data from a sample of spousal caregivers for noninstitutionalized victims of Alzheimer's disease. In addition to gathering typical demographic data and a case history of the diagnosis and progression of Alzheimer's disease, questions probed the tasks caregivers performed; the meanings of such tasks, as well as ones caregivers found easiest, most difficult, and why; and the personal, social, formal, and informal resources available to these care workers. We supplemented the interview data through observations with three different support groups.
We obtained our sample primarily through formal agencies and support groups. Interviews lasted from 1.5 to 3 hr, with the average being 2 hr; support group meetings lasted approximately 1.5 hr. Interviews were professionally transcribed and then coded. Where feasible, we took notes during support group meetings; regardless, we wrote field notes immediately afterward.
We collected data and analyzed them in an iterative process, leading to the development of new questions in later interviews (Taylor & Bogdan, 1984). We used a team approach to code the data. In addition to Toni Calasanti, three other individuals met to code two key interviews. Over several meetings, we outlined a code sheet that we developed further over the course of time and more interviews. This process allowed us to examine patterns and develop themes holistically. We used QSR NUD*IST 6.0 to provide ancillary help to examine themes and their relationship with one another.
The final sample included 22 respondents, 13 women and 9 men, of whom all but 1 were White. In this article, we focus on the 9 caregiving husbands. Categorizing older people by class is made difficult by the dramatic ways in which levels of discretionary spending can change in old age, especially when medical bills come due. We took long-term lifestyles into account and placed less emphasis on current income and expenses when assigning respondents to class categories. We considered 2 respondents to be upper middle class; 4, middle class; and 3, working class (see Table 1).
One third of the sample had been married more than once, whereas the other six couples included original partners; all relationships were long term, ranging from 28 to 58 years (1 respondent, George, had never legally married his partner, but they had been living together for 29 years). Among caregivers, husbands' average age was 72 (range = 65–83); among care receivers, wives' mean age was 71.5 (range = 62–82). We assessed a general level of impairment by combining respondents' depictions of the extent to which they had to help spouses with instrumental activities of daily living and activities of daily living with other accounts about their spouses' condition (both in interviews and, when possible, from support group meetings). Based on these rough approximations of care receivers as mildly, moderately, or severely impaired, we found that all but one of the wives receiving care was severely impaired.
Results
The first step in discovering how gender ideals and repertoires influence experiences of stress and coping strategies was to understand how men believed they should perform care work in the first place. Below, we describe husbands' approaches to giving care, and then we discuss how men dealt with sources of stress in ways consistent with their gendered identities.
Husbands' Approaches to Care: “Pick it up Like You Do a Trade”
Consistent with previous research (Russell, 2001; Thompson, 2000), we found that men's approaches to caregiving included, first, identifying and mastering tasks. Gil was typical in his use of occupational metaphors for caregiving:
For men, mastering new tasks also involved the deliberate use of reason. For example, throughout his interview, Herman noted the systematic ways in which he approached problems of noncompliance, the research he had done, and the tactics he had tried, and he asked if his strategies sounded “logical.”At first … when you start taking care of a woman, you know, you don't know exactly how to do it, take care of a woman. I don't believe anybody would. You just have to pick it up like you do a trade. Like laying brick or finishing concrete. You don't go in there and do it as smooth as you do after you do it for a while. You learn a whole lot of shortcuts that helps you out [on] how to do things. You wouldn't have to go back over it if you do it right the first time, I call it.
Class divided the men in this regard (with only 1 man who was not White, we cannot comment on racial variation). Although they all took rational, task-based approaches, some adopted a managerial style that sees the care work as “organizational in nature” (Russell, 2001, p. 355), paying and coordinating others to complete some of the tasks. In this sample, those whom we designated as upper middle class and who had the greatest income at their disposal (see Table 1), as well as some of those who were middle class, adopted this approach.
Larry adopted a “take charge” attitude in line with his work as a police officer and as a security guard. He depicted his wife's Alzheimer's disease as “their” problem, one that they would work through together. His approach allowed him to see her condition as (in his words) “like any other sickness” that could be “handled.” He compared it to high blood pressure, a condition for which he took medications. Viewing her illness as a problem that they could solve together allowed him both to care for her and to keep her as close as before her diagnosis. He had their days, and indeed their weeks, entirely planned, and they did everything together (except on the 2 days that she spent each week in adult day care): They went to senior events, dances, and the recreation center. They sat together during the interview, just as they did when they both attended support group meetings. In all cases, he spoke about her while she was present. He proudly noted that they each had Alzheimer's disease identification bracelets—something they were doing as a couple to deal with her Alzheimer's disease. He tried to plan for potential problems as fully as he could.
Because we recruited most of this sample through agencies that provided some form of respite service, 7 of the 9 husbands used adult day care services at least 1 day a week (and generally more). For instance, Jerry both took his wife to adult day care 5 days a week and also paid for extra care evenings and weekends when needed. Even though he did not use adult day care regularly, Terence used a cleaning service and a bookkeeper and added respite care when he wanted to travel. He had also recently hired care workers to help him with bathing and feeding. Bob paid for full-time help in his home. In all instances, caregivers felt that their use of such help allowed them to keep their spouses at home. Only the wives in our sample reported negative reactions from others to using respite care for their care receivers.
Regardless of this class variation, and as other scholars have noted (Thompson, 2000), the husbands approached care work in terms of a job and often tried to separate their emotions from the tasks. This did not mean that they did not care effectively, or that they did not care about their wives' feelings. Indeed, some husbands learned to apply makeup or do their wives' hair simply to help those women maintain their sense of selves as women (Calasanti & Bowen, 2006). Such care work served no instrumental purpose and was meant rather to maintain the gendered self-esteem of Alzheimer's disease sufferers. But husbands prioritized physical over emotional maintenance when these came into conflict and sometimes detached themselves in order to do so. For instance, Gil spent a great deal of time cleaning up after his wife, whose confusion led her to urinate in a trash can instead of the toilet or to lose bowel control. He said:
His assurance to his wife that that it really did not bother him provided an example of how a task could be what Jerry called “a labor of love.” Consistent with previous research (Rose & Bruce, 1995), we found that, to the extent that husbands completed their tasks, they felt that they performed well and took pleasure in the achievement. Mostly lacking domestic experience, they were proud of their abilities to care for their households and wives.I have all of that mess to clean up and [she] does worse you know sometimes … I get her out of there and get her back in the bed, and I clean up the floors and all. It's a job. That is the worst thing about it … They get messed up and it's all down their legs and all over them. If they have clothes on, it's all over them. … Sometimes you hate to do it … because it's such a mess to get rid of it.
By contrast, the wives in this study tended to see spousal care work as a natural extension of their gender roles across the life course (see Calasanti, 2006). Care work was a part of their identities and thus their expectations of themselves. However, care work for children and for adult spouses are quite different, and their sense of themselves as naturally proficient at women's work was put to the test.
Husbands did not experience this source of stress as they did not view difficulties with caregiving as indictments of themselves as men. Some men—but none of the women—even reported receiving praise for their work. Terence said, “The women that I know are very complimentary and appreciative of what I am doing.” Jerry's remarks were even more telling: “… a lot of people say, ‘You know, you have a lot of courage. You don't find too many men doing what you are doing.’ And that is what they tell me.” He continued, explaining that people view men who give care differently than they do women:
The fact that husbands received positive recognition for their care work (see also Davidson, 2001, p. 300), and without particular expectations concerning how they would do it, may have cushioned them from feeling bad about not performing tasks as well as they might have liked, or from becoming frustrated.Because I am not supposed to do it, like give her a bath, roll her hair. I do all of the personal hygiene that women go through, and I say, you know, if she was young enough to be going through her monthly periods, I would have to take care of that. … I don't know whether all men could give their wives baths everyday, brush their teeth, comb their hair. I don't know that. … [And] the ladies at the day care center … say, “[Jerry] you do an excellent job.” And I don't know whether they tell the other women that are taking care of their spouses that they are doing an excellent job. Maybe this is what they are supposed to do. [In people's minds] it's very different.
This analysis of gendered experiences of stress and satisfaction in spousal care work moves beyond the evaluative approach into a gender relations framework in which women and men, interrelated in gender inequality, bring different but related sets of expectations to their daily routines. Men's relative lack of stress resulted not from a refusal on their part to perform difficult work but rather from their relative freedom from responsibility for particular expectations or from their wives' feelings. They focused on the important tasks and, although they may have experienced the guilt and grief that difficult care work entails, they did not dwell on this, at least not as much as the wives did.
Dealing With Problems in Care Work
All of the caregivers in this study reported stress resulting from their caregiving, and husbands and wives reported similar sources of that stress. Caregivers cited a range of care-receiver behaviors, including noncompliance, confusion, agitation, wandering, and toileting difficulties, as stressful. They also mentioned the new tasks presented by their spouses' illnesses: the many household chores, the making of decisions with little help, and the minding of all other tasks because partners no longer could. Relationship changes also presented difficulties: Respondents reported feeling like they had lost companionship, in terms of lack of conversation and inability to interact with spouses as adults. Loss of affection was also a concern.
Their responses to these problems distinguished the husbands from the wives in our sample. Men met these challenges in ways consistent with their structural positions as men. Below, we describe men's strategies—a general approach toward the care receiver, as well as several strategies directed at themselves: focusing on tasks, blocking emotions, minimizing disruption, and self-medicating. Women might have also employed these techniques but reported them less frequently and then with greater guilt. Most of these tactics reflected men's self-concepts, based in masculinity, as strong, in control, and capable—a pattern also documented by Fennell and Davidson (2003). In at least one strategy (self-medicating), however, the emphases on strength and control gave way to reliance on comfort.
We divide our discussion into two sections: dealing with the care receivers and dealing with caregivers' own feelings and mental states. Within each section, we present those strategies that were used disproportionately or exclusively by men.
Dealing With Care Receivers: “If She Needed a Shower, I Gave Her a Shower”
Because Alzheimer's disease can rob sufferers of knowledge and experience while impairing physical abilities, care receivers behave in ways that, to those around them, make them appear less than adult. They refuse to comply and can become aggressive. In response, spousal caregivers, both men and women, may do care work in ways that could seem to violate personal dignity or shared standards of marital relationships. Care receivers' noncompliance and/or potentially dangerous behaviors force their spouses to make choices that they would not otherwise make. Even though their actions may seem less demeaning, for example, than what might occur in institutional care, caregiving spouses have different bond with their care receivers than do workers in paid care settings. Thus, caregivers' strategies for maintaining compliance take on different meanings. In our interpretations of this difficulty for both husbands and wives, we want to make clear that providing good care was at the forefront of all of the spouses' motivations. Thus, in reporting ways in which masculine identities might have led men to attempt enforcement strategies that caregiving wives avoided, we are not making a case for better or worse care. Instead, our focus is only on how strategies flow from gender repertoires, and the importance of understanding the structural bases for these repertoires when designing interventions.
In many respects, similar strategies obtained across caregivers. Both men and women used familiarity with spouses to gain compliance through manipulation. For example, a husband might have appealed to a wife's sense of appearance; a wife might have convinced her husband to attend respite care because they had already paid for it, thus appealing to his sense of financial obligation. In addition, husbands used a variety of physical or intimidating means to deal with wives' resistance to their caregiving. Men's use of such strategies may have resulted from having wives who were, on average, more severely impaired, a topic to which we will return. Regardless, our interest here is on the ways in which their strategies tied to their masculine identities.
First, husbands sometimes enforced compliance from their spouses. Our notion of enforcement involves the routine care work, commonly observed among caregiving professionals and family members, that has the unintended effect of violating a care receiver's dignity or shared standards of a relationship (the marital relationship, in this case). To be sure, there is an inherent power relationship in care work; in the case of caring for an intimate, the hard choices that must be made can be especially difficult. These husbands often had to choose between their wives' wishes and the completion of tasks (including those that maintained hygiene and safety). They reported that, when contentment could not be ensured while tasks were being completed, they gave priority to the tasks. Caregiving wives also worked to secure compliance but never reported physical means except as options that they avoided. Women relied on manipulation as well as lying (which men did not report), tactics that did not always work and sometimes led to feeling guilty for violating husbands' autonomy or their own notions of the marital bond (see Calasanti, 2006).
Bathing was a common area of struggle that could result in enforcing compliance after husbands had tried other strategies. Terence noted that his wife hated showers and would scream and holler, but “if she needed a shower, I gave her a shower.” Lester also described the battle to get his wife in the shower:
You can't hardly get her to take a bath. … I pulled her clothes off one time and said, “Let's take a shower.” … By the time I got the water adjusted right she had … put them back on. I said, “Pull your clothes off woman”; [and she said] “I can't get in there naked.” And I started pulling them down and she would pull them up, and I would be pulling down.
Herman's situation involved even more struggle:
Husbands disliked the struggles but recognized the importance of maintaining their wives' hygiene.She is so determined that she is really powerful … and I have got a lot of scars on me because of that. … And I … try my best to keep her in a good mood. [But] I can tell when she is not going to give up and then … I will say okay, [and] start taking [her clothes] off. And so I have to forcefully … the problem is her hands, trying to hold both of them with one hand while I start doing something else, and that is a real battle. … She will still fight to the last, even with her bra it's a battle, and I just about have to tear her clothes off.
Other instances of enforcement were less coercive but still restrictive, involving active restraint. Although both husbands and wives might have used padlocks on doors to keep spouses from wandering, men also sometimes kept their wives confined when they needed to complete necessary household tasks. Thus, Gil put his wife in the truck while he mowed the lawns, as did Lester, who explained
These innovative strategies were restrictive but also ensured wives' safety.Sometimes when I mow I put her in the truck and just reverse the belt and lock it and roll the glass down where I can ride the mower and see her. When I come by her, she will say, “Get me out of here, get me out of here, let me out.” I say, “Well, when I finish up, I will get you out.” So when I finish up I go get her and let her out then. But I have had to lock that door on the inside to keep her in. … If there's something I need to do outside, I put her in the truck and reverse the belt and she hasn't learned how to unhook it yet … And [I] lock the doors and roll the glass down and work in the garden a little bit …
All of the care-receiving wives but one were either incontinent or had problematic toileting behaviors (such as confusion about where the bathroom was). Herman had dealt with his wife Julie's toileting behaviors by being “constantly after her,” but her disturbed sleep cycle caused him great difficulty until he came up with a solution: “In our bedroom here we have twin beds. I tie a leash to her ankle and mine so that I know when she is getting up. Otherwise she will pee anywhere in the house.” Although Herman did not use the leash to keep Julie from moving, he did use it to prevent her from moving unsupervised.
If we view enforcement as a continuum, then we can place intimidation—through shouting—on it. Herman found that sometimes speaking to his wife in a stern tone would gain her compliance. Similarly, Terence said, “You know, I get impatient sometimes and I shout. … But you know, sometimes if you say something sharply she will listen, which she won't do if you just say, ‘Come on back, we are not finished’ in a normal tone. She will just keep going.” This differs from those women who raised their voices in frustration and then felt guilty. While some of the men expressed similar sentiments, they also consciously chose to shout.
The gender difference in willingness to use these tactics was apparent in a support group meeting. Herman told the other caregivers that they needed to remind themselves that the care receiver would soon forget if you had to use force, and that by remembering this, they could distance themselves emotionally from what they had to do to gain compliance. Not only had he described his leash trick, but he had also talked about how he had had to force his wife into the car when he picked her up from respite care (and how embarrassing this could be in public). However, the wives seemed to have difficulty with his strategies. Rosemary's husband had also recently begun to complain that he did not want to go to respite care, but she said she still felt bad trying to force him to do things, even those that he ultimately enjoyed. Even though she had used only verbal tactics, she said she feared that they represented to him another area in which he had lost control; she said could not violate his autonomy further. Although the women in the group could understand that Herman's strategy might work, their discussion indicated that their sense of selves as caregivers would not allow them to do this. However, the other man in attendance did not express difficulty with Herman's strategies.
Dealing With Caregivers' Stress/Feelings
In this section we discuss ways in which husbands dealt with the negative feelings they experienced as they performed their care work. We begin with a somewhat proactive strategy that some men employed to keep stress or other negative feelings from arising in the first place.
Focusing on Tasks: “Do What You Have Got to Do.”
How did husbands cope with their distaste for enforcing compliance with their wives? Though Herman wished it weren't so, and he felt that using force and talking sharply to his wife violated their relationship on some levels, he saw it as necessary. So, too, did Terence, but he said that his wife moved so much that she wouldn't stop to let him do what he needed to do if he didn't sometimes shout at her. Gil captured the sentiments of many of these men with his statement that “you just have to buck up and just go up to the plate, like playing ball, you have got to keep on going.”
Although Terence's wife vigorously protested taking a shower, he learned just to do it anyway: “It's just a question of mind over matter.” Bob said, “I just mentally overcome it. … I just tell myself, you know, do what you have got to do …” Essentially, many husbands dealt with distasteful tasks by transforming them into jobs that needed doing or problems that needed solving, rather than negotiations of bodily integrity or spousal bonds:
Terence: I … hated making meals, but I have gotten used to that, it's more routine. I hated to feed her 3 weeks ago, I mean that just added an extra hour, hour and a half to the day … But I have gotten used to that. I didn't think I could handle incontinence, but I guess I can. So on you go.
Bob: [Experiencing stress] is easy at times when you are trying to feed her and she won't eat or the times when you have just cleaned her up and she messes right there before you can get her cleaned up … and then you have to just take hold of it and fix it, you know.
Herman's interview was peppered with discussions of logic, particularly in relation to the difficulty he had getting his wife to bathe. Using force with his wife bothered him (“I remember bruising her once on her arm and ever since then, boy, that is embarrassing to leave a bruise”); but he had been told that she must be bathed, and he could come up with no logical way to do this. He asked the interviewer, “Tell me from your logic how I should do it?” Later, he added, “I just wondered if … my logic was different than normal.”
Blocking Emotion: “Just Keep My Cool and Go On.”
Beyond simply concentrating on tasks, men also reported more directly suppressing such emotions as shame and fear. Implied in the discussion of “doing what you have to do” is a separation of emotions from tasks at hand (Thompson, 2000), and many men spoke of ways that they had learned to control their emotions. Terence said:
I guess I have built kind of a wall between the sorrow and what has to be done in trying to live with it. I mean I can't go around feeling horrible all the time, I go around feeling horrible a lot of the time dealing with my own depression and then dealing with the sorrow of what is happening to her. I have gotten used to it to an extent. I mean I adjust as it gets worse, I make more and more adjustments.
Similarly, Herman said, “I tend to control my feelings. I have always had the philosophy [that] … you can force yourself to be happy, and you are better off doing that than letting the depression set in. And I have always kept that in mind.”
Lester had to deal with “a lot of cursing,” and he handled this by telling himself she doesn't mean it and by controlling his response:
Gil also said that when Hazel gets into “one of her spells”—gets aggressive or tries to fight him—“Well, I just have to ride it out. … I just have to ride it out just like a storm you are waiting on to be over. You can't do nothing else.”I just keep my cool and go on. She uses a word that starts with a h and a d and a c. I just keep cool. … I just keep it cool and don't say anything back to her and go on, and just sit tight. … The doctor she was seeing the other day said, “You know she don't mean it, you just have to ignore it.” I said, “I do,” and just keep my cool and move along with it and whatever she says.
Thus, although husbands acknowledged that “it hurts” when they were subjected to wives' ranting or “getting mean” (Gil), or that they felt very guilty when they became angry with their wives (David), they tried to control their emotional responses in order to maintain their wives' health and their own peace of mind. Their sense of selves as men was not bound to keeping their wives happy (an often impossible task with Alzheimer's disease), as much as they might have wanted to make them so, but rather, to caregiving tasks done well and to getting the jobs done.
The varying approaches to care work were manifest in gender differences in support group use: seeking information/advice versus seeking emotional support. Men's tendency to both focus on tasks and block certain negative emotions meant that they were more likely to seek a “fix” for problems in such groups; they wanted to know how to find doctors and how to correct behavioral problems. They were less concerned with such matters as how to make spouses happier or more stimulated. Larry and Herman exchanged information about residential care facilities they had recently explored in very matter-of-fact ways—looking at costs and discussing physical facilities—and with none of the emotions that Joyce had expressed while discussing her husband's imminent residential placement possibilities at a previous meeting.
Men who attended support groups also shared and may have found comfort, but they tended to do so in ways that demonstrated their competence. Larry seemed to enjoy relating the ways in which he handled his wife and their life together; given that she seemed very easy to care for (she had maintained most activities of daily living) and had an easy-going demeanor, he did appear to have the “best” situation among such spouses. And he was proud of how they were doing. Herman would also share success stories or ask for advice but did not speak of how he felt in that setting. And too much “sharing” could be problematic. Men responded to the “it gets worse” warning—being told by others that things will only deteriorate—in different ways than women. Although wives did not react negatively to being told this, Terence said that this was exactly why he no longer attended a support group; he said, “It was always new people coming in to tell horror stories, and I just didn't find any satisfaction.”
Minimizing Disruption: “Get Back to Being ‘Normal.’”
Similar to Russell's (2001) findings, we found that the men in this study tried to minimize care work's disruption of their lives just as they minimized emotional incursions into their self-esteem. Of course, the extent to which they could maintain comforting routines varied with their wives' behavior and their financial resources. Because his wife was docile and not incontinent, Larry and she maintained an active social life, attending picnics and club functions, church activities, and senior events. Terence hoped to “[get] back outside because, you know, the wall is closing in on me. …” He still traveled, including to Europe, and worked part time; he put his wife in respite care on some of these occasions, although he knew she stood by the door and cried until he returned:
I went up to my daughter's over the weekend and left her in respite care … They have a new center … And most of it is opaque except they have some clear panels. … The door automatically locks so I couldn't get in. So I looked in through one of these and there she is looking back at me. They said that she had spent most of the 3 days by the front door.
Herman and his wife still drove across country every summer to visit family for several weeks as they always had (though the summer of this interview might have been her last trip); and they had recently driven to Florida where they had then embarked on a cruise with relatives. He did all of this despite her inability to communicate and her constant wandering, in part, he said, because she still responded to social contact. He said that he took her everywhere because “she will do anything that I want her to do, basically.” To accommodate her sleeping schedule and his driving, they would drive for a few hours, sleep at a rest stop for a couple hours, and then continue. And Jerry hired sitters so he could go fishing or engage in the other outdoor activities that he had always enjoyed:
George went out less than he was used to but still managed to meet up with friends at a local tavern; he said that Mamie was docile and could be locked in the house. And David said they were able to go out to friends' houses because these friends were understanding. So, although his social life was suffering, David maintained it as much as he can.I try to get back to some form of being “normal”: hunting, fishing. … Go back to my old haunts, to things that I did prior to her being ill. … If I have to pay someone to come in and stay overnight so I can get up at 4:00 in the morning and drive up in [another county] and go deer hunting … I pay them.
Finally, Jerry said that he planned to attend a support group meeting soon, in part because he wanted support; but he stated this in terms of “companionship”—he hoped to find women he could talk with. He had already “taken ladies to dinner, lunch.” Happily, he had his son's blessing.
Distracting Attention: “Get Your Mind Off Things.”
In addition to bearing down on the practical necessities of tasks, controlling their own emotions, and sticking to routines, husbands “got busy” with distracting activities. For instance, Jerry said:
When the sun goes down, there is no one to talk with … and I just get lonesome. I get lonesome for female companionship. So, needless to say, I have a lot of hobbies. I love airplanes, model airplanes. I build model airplanes …
Bob said that, when he got lonely, “I just decide to do something else, read something, fix something or become active.” He elaborated:
Well, there are so many resources available. I mean the computer itself if you just wanted something to do to get your mind off of things … You can go read your e-mail and do some research … I subscribe to a great magazine and it's fun to read about the archaeology review … And so reading is a diversion. … So you know you find diversions and I have got a lot of things I hadn't done to this house that I still want to [do] … [And] I love pretty dishes … So I decided our Christmas present to ourselves … would be a new set of dishes … And those things I think give you something to think about, give you something to do. I actually went to … to visit some friends and took 5 days and went down there and played a little golf … And one of the purposes on this trip was … to pick out a set of dishes, and I did that.
In addition to his own travel—to Europe, Florida, and elsewhere—Terence noted that exercise (once, and sometimes twice, a day) helps stave off depression. Four men were still working for pay; three said their work helped them cope emotionally.
Self-Medicating: “Go Get Another Beer.”
By pursuing these strategies, men may have appeared to be better at taking care of themselves than women were: they minimized disruption to their work habits, their schedules, and their feelings. But when these tactics broke down, men suffered from the stress and experienced the depression and anxiety of care work. Neither their task-oriented approaches to care work nor their minimization of aversive feelings prepared them to deal with stress in ways that satisfied them. Jerry's comments were illustrative:
Most men keep things to themselves. I am not going to tell everybody I know that I am stressing or I feel depressed or I feel I need somebody to hug. I won't tell them. I don't know whether it's a man thing or it's my thing or whether it's my thing being a man [but] I am not going to share them with people. I keep it to myself. And I think men do that. They keep a lot of things to themselves that will kill you. I mean stress will kill you.
When such emotions surfaced, husbands reported, they may not have known what to do with them:
David: I find myself sometimes getting horribly depressed over a short period of time, and I don't know what it is, but I just get really depressed and feel like I want to cry sometimes.
Interviewer: Do you ever let yourself do that?
David: Not much.
The predominant means by which men dealt with stress, when the previous strategies failed to keep it at bay, involved medications. Terence took antidepressants, along with his exercise, but could still feel depressed. David said:
… my mother was sick during this time and in the nursing home for five of those years [since his wife has been ill] and sick before, and my stepfather was drifting into dementia or Alzheimer's, so I had all three at once so it was a little trying … Fortunately Dr. Merlot came in at night and got me through.
At the end of the interview, David indicated that alcohol and antidepressants were his primary means of coping with strain. George said that, if he got too stressed, “I just go get another beer.” And Jerry said that he had stopped taking the antidepressants he had been prescribed but had continued to take a sleeping pill at night until his doctor told him he didn't need that and said, “Why don't you just have a glass of wine?” So now Jerry said that he had a glass of wine, and it put him right to sleep. Among those who did not report use of drugs, Gil said he was “nervous all the time,” and Herman had lost 35 pounds (stabilizing at 130 pounds), despite eating more. He attributed this weight loss to stress.
Discussion
These strategies—exerting force, focusing on tasks, blocking emotions, minimizing disruption, distracting attention, and self-medicating—fit the structural positions of working-, middle-, and professional-class men, whose occupational roles taught them the values of independence and pride in skills. The ways in which husbands' approaches differ from those of the wives should not be taken to mean that they care less about their wives' feelings or that they don't feel bad. Bob said sometimes he just cries when he thinks about the life he and his wife used to share. Gil confessed that despite his attempts just to “ride it out” when Hazel gets mean, “it makes me feel bad. I tell you, I cry sometimes.” But he ended by saying, “I just have to make it the best I can. Ain't nothing else I can do …”
Nevertheless, these are strategies made popular among men by the positions that they occupy in family and occupational contexts. Enforcing compliance is a tool of one accustomed to having authority in a household. By contrast, caregiving wives were reluctant to diminish their husbands' sense of control in ways that mothers do not report being uncomfortable as they discuss coercion in their parenting. The structural position of women and men in households would seem to be salient to this distribution of coercive strategy and discomfort with it, however much the onset of dementia changes standards of behavior within a household.
To the extent that their occupational status as breadwinners has provided prestige, men might be motivated to maintain the associated work habits even when performing women's work. Blocking emotion and focusing on tasks may help men to avoid the stigmatized demeanor of femininity. Though expressions of anger are acceptable for men in most contexts, other emotions, especially those that might indicate a level of stress that demonstrates an inability to handle problems or a lack of competence, violate occupational and other roles in which men gain their privilege.
Finally, recourse to distraction and medication play similar roles, allowing men to ward off as much of the emotional consequence of this heart-breaking work as they can. Regardless of whether these methods necessarily aid in doing the work, each can have long-term consequences that men do not intend.
It was not our goal to ascertain whether men or women experience gratuitous stress, or which group might provide better quality care. Both men and women cared for cognitively impaired spouses who could be noncompliant and engage in potentially dangerous behaviors. Spousal caregivers were thus motivated to respond in manners that diverged from the norms of their previous marital relationships, though they were still geared toward the well-being of their spouses. Instead, we used a relational framework to explore how gender—with its divisions of labor and expectations about work habits—shapes the caregiving experience and the stress that results.
As they age, most men retain the ideals of younger, occupationally based masculinity: minimal expressions of certain emotions, such as fear or shame; successful performance in the face of others' objections; and rational, task-focused problem solving. In line with such notions of masculinity, and consistent with previous research (Davidson et al., 2000; Rose & Bruce, 1995; Russell, 2001), we found that the men in this study engaged in behaviors that drew upon their gender repertoires, including strategies to deal with the negative emotions that might arise.
By contrast, caregiving wives tended not to separate tasks from their immediate empathy for care receivers and thus did not adopt the same strategies of coercion or swallow their empathy for protesting spouses (see Calasanti, 2006, for a lengthier discussion). Both approaches involve gendered strategies that help and hinder the caregiving process and their own coping. Attempts to be stoic may allow men to perform difficult tasks. And given that the care-receiving wives in this study were more impaired, as a group, than the care-receiving husbands, caregiving men's emotional strategies may also allow them to care for spouses at home longer than might otherwise be the case. At the same time, these traits also make it harder for men to deal with stress or depression when it strikes. The one strategy they identified for this is the use of alcohol and other medications.
The fact that care-receiving husbands were generally less impaired and less likely to wander or engage in agitated or aggressive behaviors might help explain why wives did not report more use of physical means of compliance. However, this seems unlikely, in part because the women reported that they would institutionalize their husbands if they became too agitated or aggressive (see Calasanti, 2006). In fact, one woman was unable to restrain her husband and did institutionalize him for short time; when he became more docile, she brought him home. The point is not that using physical means is unacceptable or unwise, but rather that it does not fit women's ideals of behavior as caregivers—ideals rooted in familial divisions of labor. In fact, one could argue that men's willingness to “do what you have to do” to complete a task, and their ability to enforce compliance, allows them to keep their spouses at home longer than do caregiving wives.
Research that focuses on gender differences without attending to gender relations can yield interventions in which women are told that “skills training that teaches them to develop a greater sense of mastery” will reduce their stress, as will using more formal services and being “more assertive” in asking family members for help (Yee & Schulz, 2000, p. 161). However, our framework acknowledges that, unless the gendered bases upon which different styles or experiences are removed (i.e., structural inequality), designers of interventions cannot and should not expect to use the experience of one group to inform strategies for the other. That is, our approach roots strategies within a social structure in which most men maintain privilege within occupational networks and enjoy enhanced status in their homes as recipients of the care work for which women are primarily responsible. In this context, simply to teach and encourage women to act as men do would be to miss two points: first, that men's approaches do not necessarily mitigate against stress; and second, that men's approaches are not simply learned and then retained in a stable manner. Men's and women's caregiving styles are more than holdovers from other times, more than internalized, transsituational values. These husbands are sensitive to changing situations within their employment and family lives. They take on new tasks as family demands shift but approach them in ways that suit their sense of themselves as members of the dominant group in the larger gendered division of labor. Masculinity remains important not simply as a set of internalized expectations that obtain across personalities, situations, and networks. Rather, as men move through their various networks, they interact with people in ways that affirm or alter the importance of various kinds of masculinity to them. This is the point of the sociological literature on gender as situated accomplishment (Risman, 1987; West & Zimmerman, 1987). This dynamic of social reproduction and gradual transformation occurs in an ongoing fashion that is resistant to re-education and thus not replicable in a population of caregiving women by mere education of them without structural change to back it up. We therefore suggest that interventions not depict caregivers as people who can be trained to behave in ways ill-fitting their positions within the intersecting inequalities that make their identities salient. Such behavioral violations, however well intentioned the teachers of them, would amount to resistance to gender norms and would be thus likely to be treated as such—by those who attempt them as well as those who live with or observe them. Most spousal caregivers are trying to reduce discomfort and stress rather than rebel against traditional ideals of gender. Therefore, while we do not advocate against such resistance per se, we do recommend that those who design interventions remain mindful of conflicting pressures acting upon caregivers.
The fact that this research dealt with spousal caregiving for those who suffer from Alzheimer's disease is critical for interpreting some of our findings. Cognitive impairments can manifest different symptoms and produce divergent sources of stress from physical afflictions. Still, the contention that gender shapes caregiving experiences holds; what may vary across contexts is how this occurs. For instance, the respondents in Davidson and colleagues' (2000) study cared for spouses who were suffering from general physical ailments and not Alzheimer's disease. Still, gender relations influenced the process in significant ways. Care-receiving women understood the work involved in domestic labor and were appreciative of their husbands' work; as a result, they were “good” patients. By contrast, care-receiving men struggled to find ways to maintain their dominant positions in their marriages and were “demanding” patients (p. 550). Thus, although the specific sources of stress or coping strategies we found in this study may not hold across contexts, the general notion that gender repertoires matter to the caregiving experiences does.
We do not mean to exaggerate gender differences among caregiving spouses. Consistent with the literature, we found that husbands and wives mostly performed the same tasks with the same sentiments. Still, we also observed different approaches rooted in gendered experience over the life course. Future research into men's care work would do well to consider alternative strategies to help men cope with stress. And interventions should take into account the ways in which strategies are rooted in men's sense of selves as men and their attempts to take it like men.
Research for this study was supported in part by Award 04-2 from the Commonwealth of Virginia's Alzheimer's and Related Diseases Research Award Fund, administered by the Virginia Center on Aging, Virginia Commonwealth University. We appreciate the close reading and comments of two anonymous reviewers and Linda Noelker on earlier versions of this article.
Department of Sociology, Virginia Tech, Blacksburg.
Department of Interdisciplinary Studies, Virginia Tech, Blacksburg.
Decision Editor: Linda S. Noelker, PhD
Caregiving Husband . | Respondent's Age . | Spouse's Age . | Respondent's Marriage; Years . | Spouse's Marriage . | No. of Children . | Cognitive Impairment . | Respondent's Main Occupation . | Spouse's Occupation . | Respondent Employed . | Income . | Class . |
---|---|---|---|---|---|---|---|---|---|---|---|
Larry | 77 | 82 | Second; 28 | Third | 2 (1 his, 1 hers) | Moderate | Security guard (“plant protection”) | Production; waitress; homemaker | No | $30,000–34,999 | Middle |
Gil | 75 | 81 | Second; 37 | First | 1 (his) | Severe | Classified staff, university | Garment factory | No | $24,180 | Working |
Terence | 65 | 67 | First; 44 | First | 3 | Severe | Chemical sales (self-employed) | Assisted in business; bookkeeping | Yes, part time | $80,000+ | Upper middle |
Herman | 72 | 70 | First; 50 | First | 4 | Severe | Engineer | Executive secretary | No | $22,700 | Middle |
David | 66 | 67 | First; 31 | Second | 3 (hers) | Severe | School teacher | Artist | Yes, part time | $35,000–39,000 | Middle |
Jerry | 67 | 62 | First; 34 | First | 1 | Severe | School teacher | School teacher | Yes, part time | $50,000+ | Middle |
Lester | 83 | 75 | First; 58 | First | 4 | Severe | Clerk, production, night watchman | Production, waitressing | No | $20,000+ | Working |
Georgea | 74 | 68 | Twice; together 29 years | Once before | 5 (2 hers, 3 his) | Severe | Painting, construction, etc. | Production, waitressing, secretarial | No | $18,300 | Working |
Bob | 71 | 70 | First; 48 | First | 2 | Severe | Industrial engineer/consultant | School teacher | Yes | $80,000+ | Upper middle |
Caregiving Husband . | Respondent's Age . | Spouse's Age . | Respondent's Marriage; Years . | Spouse's Marriage . | No. of Children . | Cognitive Impairment . | Respondent's Main Occupation . | Spouse's Occupation . | Respondent Employed . | Income . | Class . |
---|---|---|---|---|---|---|---|---|---|---|---|
Larry | 77 | 82 | Second; 28 | Third | 2 (1 his, 1 hers) | Moderate | Security guard (“plant protection”) | Production; waitress; homemaker | No | $30,000–34,999 | Middle |
Gil | 75 | 81 | Second; 37 | First | 1 (his) | Severe | Classified staff, university | Garment factory | No | $24,180 | Working |
Terence | 65 | 67 | First; 44 | First | 3 | Severe | Chemical sales (self-employed) | Assisted in business; bookkeeping | Yes, part time | $80,000+ | Upper middle |
Herman | 72 | 70 | First; 50 | First | 4 | Severe | Engineer | Executive secretary | No | $22,700 | Middle |
David | 66 | 67 | First; 31 | Second | 3 (hers) | Severe | School teacher | Artist | Yes, part time | $35,000–39,000 | Middle |
Jerry | 67 | 62 | First; 34 | First | 1 | Severe | School teacher | School teacher | Yes, part time | $50,000+ | Middle |
Lester | 83 | 75 | First; 58 | First | 4 | Severe | Clerk, production, night watchman | Production, waitressing | No | $20,000+ | Working |
Georgea | 74 | 68 | Twice; together 29 years | Once before | 5 (2 hers, 3 his) | Severe | Painting, construction, etc. | Production, waitressing, secretarial | No | $18,300 | Working |
Bob | 71 | 70 | First; 48 | First | 2 | Severe | Industrial engineer/consultant | School teacher | Yes | $80,000+ | Upper middle |
aGeorge was not legally married.
Caregiving Husband . | Respondent's Age . | Spouse's Age . | Respondent's Marriage; Years . | Spouse's Marriage . | No. of Children . | Cognitive Impairment . | Respondent's Main Occupation . | Spouse's Occupation . | Respondent Employed . | Income . | Class . |
---|---|---|---|---|---|---|---|---|---|---|---|
Larry | 77 | 82 | Second; 28 | Third | 2 (1 his, 1 hers) | Moderate | Security guard (“plant protection”) | Production; waitress; homemaker | No | $30,000–34,999 | Middle |
Gil | 75 | 81 | Second; 37 | First | 1 (his) | Severe | Classified staff, university | Garment factory | No | $24,180 | Working |
Terence | 65 | 67 | First; 44 | First | 3 | Severe | Chemical sales (self-employed) | Assisted in business; bookkeeping | Yes, part time | $80,000+ | Upper middle |
Herman | 72 | 70 | First; 50 | First | 4 | Severe | Engineer | Executive secretary | No | $22,700 | Middle |
David | 66 | 67 | First; 31 | Second | 3 (hers) | Severe | School teacher | Artist | Yes, part time | $35,000–39,000 | Middle |
Jerry | 67 | 62 | First; 34 | First | 1 | Severe | School teacher | School teacher | Yes, part time | $50,000+ | Middle |
Lester | 83 | 75 | First; 58 | First | 4 | Severe | Clerk, production, night watchman | Production, waitressing | No | $20,000+ | Working |
Georgea | 74 | 68 | Twice; together 29 years | Once before | 5 (2 hers, 3 his) | Severe | Painting, construction, etc. | Production, waitressing, secretarial | No | $18,300 | Working |
Bob | 71 | 70 | First; 48 | First | 2 | Severe | Industrial engineer/consultant | School teacher | Yes | $80,000+ | Upper middle |
Caregiving Husband . | Respondent's Age . | Spouse's Age . | Respondent's Marriage; Years . | Spouse's Marriage . | No. of Children . | Cognitive Impairment . | Respondent's Main Occupation . | Spouse's Occupation . | Respondent Employed . | Income . | Class . |
---|---|---|---|---|---|---|---|---|---|---|---|
Larry | 77 | 82 | Second; 28 | Third | 2 (1 his, 1 hers) | Moderate | Security guard (“plant protection”) | Production; waitress; homemaker | No | $30,000–34,999 | Middle |
Gil | 75 | 81 | Second; 37 | First | 1 (his) | Severe | Classified staff, university | Garment factory | No | $24,180 | Working |
Terence | 65 | 67 | First; 44 | First | 3 | Severe | Chemical sales (self-employed) | Assisted in business; bookkeeping | Yes, part time | $80,000+ | Upper middle |
Herman | 72 | 70 | First; 50 | First | 4 | Severe | Engineer | Executive secretary | No | $22,700 | Middle |
David | 66 | 67 | First; 31 | Second | 3 (hers) | Severe | School teacher | Artist | Yes, part time | $35,000–39,000 | Middle |
Jerry | 67 | 62 | First; 34 | First | 1 | Severe | School teacher | School teacher | Yes, part time | $50,000+ | Middle |
Lester | 83 | 75 | First; 58 | First | 4 | Severe | Clerk, production, night watchman | Production, waitressing | No | $20,000+ | Working |
Georgea | 74 | 68 | Twice; together 29 years | Once before | 5 (2 hers, 3 his) | Severe | Painting, construction, etc. | Production, waitressing, secretarial | No | $18,300 | Working |
Bob | 71 | 70 | First; 48 | First | 2 | Severe | Industrial engineer/consultant | School teacher | Yes | $80,000+ | Upper middle |
aGeorge was not legally married.
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