Availability of caregiver‐friendly workplace policies (CFWPs): an international scoping review

Abstract

Little research has been done to summarise: what is currently available to caregiver‐employees (CEs), what types of employers are offering caregiver‐friendly workplace policies (CFWPs), and the characteristics of employers offering CFWPs. The purpose of this scoping review was to explore the availability of CFWPs within workplaces on an international scale while being observant of how gender is implicated in care‐giving. This paper followed the Arksey & O’Malley (2005) methodology for conducting scoping reviews. The authors applied an iterative method of determining study search strings, study inclusion and data extraction, and qualitative thematic analysis of the search results. Searches were performed in both the academic and grey literature, published between 1994 and 2014. A total of 701 articles were found. Seventy (n = 70) articles met all inclusion criteria and were included in this review. Four main qualitative themes were identified: (i) Diversity and Inclusiveness, (ii) Motivation, (iii) Accessibility, and (iv) Workplace Culture. Policy recommendations are discussed. This scoping review narrows the gap in the literature with respect to determining: (i) the workplaces which offer CFWPs, (ii) the sectors of the labour force shown to be supportive and (iii) the most frequently offered CFWPs.

What is known about this topic

• Lack of employer support has health and financial consequences for caregiver‐employees, such as missed work days, early retirements and reduced productivity.

• Employers have much to gain economically by implementing caregiver‐friendly workplace policies, such as increased employee retention and less employee turnover, and reduced absenteeism.

• The failure to support caregiver‐employees in the workplace has negative consequences for employers, including productivity losses and increased disability costs.

What this paper adds

• Provides the first international synthesis of caregiver‐friendly workplace policies

• Provides an initial understanding of the sectors of the labour force accommodating caregiver‐employees.

• Provides an initial understanding of the characteristics of workplaces accommodating caregiver‐employees.

Introduction and literature review

Given the care needs of the growing ageing global population, labour force participation (the percentage of working age people in an economy who are either employed or unemployed but actively looking for work) is affected (Conference Board of Canada 2012). At the same time, family sizes are decreasing, more women are employed in the labour force, mobility is increasing and the number of seniors requiring care is projected to continue to grow. Globally, the number of seniors aged 60 and over is expected to more than double; from 841 million people to an estimated 2 billion people by 2050 (United Nations 2013). For the first time in history, older persons are projected to exceed the number of children. These trends are impacting the growing number of caregiver‐employees (CEs), defined as family members and other significant people, who provide care and assistance to individuals (i.e. parent, spouse or life partner, adult child, sibling and/or friend) living with debilitating physical, mental and/or cognitive conditions, while also working in paid employment. CEs are found in all industries and all occupations, regardless of workplace size or sector (Yeandle et al. 2006). In Canada, for example, of the 8.1 million Canadians who provided unpaid care‐giving in 2012 (Sinha 2013), approximately 5.6 million were also engaged in paid employment (Fast et al. 2014). Not solely a Canadian phenomenon, developed countries across the globe are facing this same challenge; there are an estimated 26.4 million CEs in the United States, and 3 million CEs in the United Kingdom (Yeandle et al. 2006, Goldstein 2013). The majority of these employees work full time while providing care to their family member or friend. Fifty per cent of CEs are between the ages 45 and 65, representing the most experienced workers in the paid labour market (Employers for Carers 2013, Fast et al. 2014).

While the implementation of limited government‐mandated policies provides security and support for CEs, employers provide another opportunity. Employers who have recognised the importance of retaining skilled staff, and who are now facing the management of employees who are also responsible for unpaid care responsibilities, are finding creative solutions to keeping their staff employed and healthy. One strategy is through caregiver‐friendly workplace policies (CFWPs). CFWPs, otherwise known as family‐friendly workplace policies or work–family initiatives, are defined as ‘deliberate organisational changes – in policies, practices or the target culture – to reduce work–family conflict and/or support employees’ lives outside of work’ (Kelly et al. 2008: p. 310). Minimal literature has been published with respect to the type and availability of CFWPs globally. From the authors review of the literature, commonly offered CFWPs include: flexible work arrangements (such as flexible work schedules, reduction of hours to part time, job sharing, working from home or tele‐work and compressed work weeks) (Liddicoat 2003, Zacher & Winter 2011, Lero et al. 2012, Vuksan et al. 2012); unpaid leaves (at time periods beyond the government‐mandated timeframe) (Zacher & Winter 2011, Vuksan et al. 2012); and support services (such as resource and referral services, information services, counselling, support groups, workshops and seminars on care‐giving issues) (Golden 2005, Vuksan et al. 2012). In exemplary cases, employers have offered extensive support in the form of: case management services, subsidised care‐giving services, adult day care facilities, emergency short‐term care, dependent care, flexible spending accounts and dependent care car parks (Vuksan et al. 2012).

It is important to recognise that lack of workplace supports has health and financial consequences for CEs, such as missed work days, early retirements, reduced productivity and CEs leaving the workforce altogether. CEs are two to three times more likely than non‐caregivers to report poor general health (Yeandle et al. 2006). Labour force participation, absenteeism and productivity are all affected when employees are distracted by their own health, or the health of their ill dependents (Conference Board of Canada 2013).

From an economic perspective, employers have much to gain by implementing CFWPs into their employment practices. The potential costs of these policies can be offset by: increased employee retention and less employee turnover; reduced absenteeism and presenteeism (lowered efficiency); positive staff morale; improved employee satisfaction; ongoing development of skills and knowledge for staff; and a positive company reputation, which can be beneficial both for business and for employee recruitment (Kelliher et al. 2002, Golden 2005, Koerin et al. 2008, Lero et al. 2009, Zeytinoglu et al. 2010, Keating et al. 2013, State Government of Victoria Australia 2012). Thus, from a business perspective, employers benefit economically from offering CFWPs, while simultaneously improving CEs’ overall health and economic well‐being (Swanberg 2006, Lilly et al. 2007, Tompa et al. 2007, Cook & Minnotte 2008, Heymann et al. 2010, Earle & Heymann 2011, Mazanec et al. 2011).

In addition, the failure to support CEs in the workplace also has negative consequences for employers, including increased absenteeism, unplanned absences, increased employee turnover, decreased employee retention, productivity loss and increased disability costs (MetLife 2006, Yeandle et al. 2006, Conference Board of Canada 2013, Fast 2013, Goldstein 2013, Keating et al. 2013, Fast et al. 2014). In the Canadian context, annual productivity losses for employers are substantial. In 2012, an aggregate of 9.7 million days of absenteeism, 256 million fewer hours of paid work and the loss of 557,698 employees from the paid labour force were attributed to the need to provide care (Fast et al. 2014). Considering that CEs play a significant economic role in society, by working in the labour force while also providing care to people with disability, ageing issues and/or critical illness, it is imperative for employers and government to seek strategies that allow CEs to integrate paid work and unpaid care‐giving.

A sex/gender‐based lens is important to use on research related to CEs and CFWPs in order to gain a more accurate picture of the issue. Furthermore, many industries are characterised by the presence or absence of sex/gender‐dominance. For instance, the construction industry employs predominately male workers (Watts 2007). In addition, sex/gender relates not only to the industry that one works in but also the type of job one holds, with highly skilled females often held to the same standards at work as their male counterparts while attempting to meet the different expectations society has with respect to care (Chan et al. 2010). Furthermore, as reflected in theories on labour market segregation, women and other marginalised groups tend to make up the majority of the secondary labour market, which consists mainly of workers in unskilled jobs that are low‐paying, have few benefits and opportunities for advancement, and high turnover rates (Vuksan et al. 2012). Women also tend to work more part‐time positions than men (Gordon et al. 2012).

Like paid labour, care‐giving tasks and associated outcomes are also divided by sex/gender. Although the 2012 Canadian General Social Survey estimated the split at 51% women and 49% men among employed caregivers (Fast et al. 2014), women are found to provide more care‐giving hours, help with more care‐giving tasks and assist with more personal care than men; consequently, women have been found to have higher levels of burden and depression, and lower levels of subjective well‐being and physical health (Pinquart & Sörensen 2003). In Canada, Sinha (2013) used data from the 2012 General Social Survey on Caregiving and Care Receiving to determine that, when compared to men, women were more likely to spend 20 or more hours per week on care‐giving tasks (17% versus 11%).

Studies consistently show that CEs often have to sacrifice their career goals, such as career‐advancing opportunities or professional development, in order to meet their unpaid care needs (Employer Panel for Caregivers 2015). The potential loss of these skilled employees from the paid labour market, poses challenges for the economy. Leaving the labour market is detrimental to CEs because it puts them at risk for lower incomes and smaller pensions, issues with labour force re‐entry, economic losses and poverty over the long term (Lilly 2011).

An in‐depth understanding of caregiver‐friendly workplaces is lacking. This scoping review narrows the gap in the literature with respect to: (i) the workplaces which offer CFWPs; (ii) the sectors of the labour force shown to be supportive; and (iii) the most frequently offered CFWPs. To our knowledge, this paper will be the first to synthesise the literature, with respect to the availability of CFWPs. Through outlining the workplace characteristics which influence the availability of CFWPs, the authors offer recommendations as to how employers can best integrate CFWPs into their workplaces. In addition to recording the descriptive characteristics of the workplaces involved, the authors undertook a critical, qualitative thematic analysis of the articles to determine key themes related to the availability of CFWPs in international workplaces.

Methods

Scoping study methodologies are useful for addressing a broader research question where many different study designs could be incorporated; this is in contrast to systematic reviews, which focus on a specific research question. Furthermore, while systematic reviews are concerned with rigour (assessing the quality of included studies), scoping reviews are more concerned with examining the magnitude of the literature available around a certain topic (Arksey & O'Malley 2005). As scoping studies are particularly useful for identifying gaps in the literature where there is little data available, this methodology was favourable for this research project. The Arksey and O'Malley (2005) methodology was chosen given its rigour and use in various scoping studies, including those on care‐giving. Arksey and O'Malley (2005) use an iterative five‐stage approach to scoping studies: (i) Identifying the research question; (ii) Identifying relevant studies; (iii) Study selection; (iv) Charting the data; and (v) Collating, summarising and reporting the results. This review which follows each of the five stages is summarised in Figure 1.

Figure 1.

Summary of results by Arksey and O'Malley (2005) five‐stage methodology.

Stage 1: Identifying the research question

The primary question guiding this scoping review was: ‘What is the availability of CFWPs internationally?’ In the context of this review, ‘availability’ refers to which CFWPs are offered by employers. Because of the ambiguity surrounding the terminology related to CFWPs and CEs, the authors took special care to define and explain the meaning of these terms before proceeding with the review. Defining the term ‘caregiver‐friendly workplace policies’ posed a challenge as the scoping review suggested that organisations used various terms (such as family‐friendly workplace policies, caregiver policies, flexible policies) to refer to workplace initiatives to support CEs. For this review, the authors used the definition outlined by Kelly et al. (2008, p. 310), whereby CFWPs are defined as ‘deliberate organisational changes – in policies, practices or the target culture – to reduce work–family conflict and/or support employees’ lives outside of work’. In addition, there were diverse caregiver‐related terms (i.e. carer, employed carer, employee‐caregiver, caregiver, etc.). For this review, the authors changed the terminology throughout the paper to be consistent. The term CFWP was chosen to be used in lieu of policy related terms (i.e. family‐friendly workplace policies, caregiver policies, flexible policies, etc.), and the term CE was chosen to be used in lieu of caregiver‐related terms (i.e. carer, employed carer, employee‐caregiver, caregiver, etc.).

Stage 2: Identifying relevant studies

In order to be as comprehensive as possible in this scoping review and to ensure no relevant articles were missed, the authors consulted with a McMaster University librarian for guidance on scoping methodology and grey literature searching throughout the review process. The time span for this review was January 1994 to December 2014. Searches were limited to the available English‐speaking literature. The literature was searched using two main methods. First, databases were identified in consultation with a University librarian, as well as through existing networks, including academic colleagues and knowledge users (e.g. government organisations, organisations with knowledge in the area of research) related to one of the authors’ Chair research programme. These databases included Business Source Complete, Factiva, Academic One‐file, EBSCO Host, Proquest and Lexis Nexus. As the authors anticipated that the grey literature would provide a significant number of results in the search, databases which housed both grey and academic literature were also included. Second, articles were hand searched through relevant sources, which included the Canadian Public Policy Collection, Conference Board of Canada and the European Foundation for the Improvement of Living and Working Conditions (EUROFOUND). After identifying the time span and search methods, the next step was to develop a carefully constructed Boolean search string strategy. This was an essential step, as the terminology surrounding caregiver research is so vast (i.e. ‘caregiver’ versus ‘carer’) that the authors needed multiple strings in order to ensure that the appropriate terminology was used for each country. The search strings also assisted in refining the search results to ensure that the authors were receiving quality articles. The search strategy was tailored to each database, and included the following terms: ‘caregiver’, ‘carer’, ‘adult care’, ‘elder care’, ‘senior care’, ‘spousal care’, ‘workplace’, ‘employer’, ‘employee’, ‘policies’, ‘policy’, and ‘program’. After constructing and testing the strings, searches were performed in the title and abstracts of the articles within the databases. A total of 701 articles were retrieved from all sources.

Stage 3: Study selection

After the search was completed, inclusion and exclusion criteria were developed by the authors. Studies were included if they: (i) were published between 1994 and 2014, (ii) discussed the provision of care to older adults by informal/family/unpaid caregivers, (iii) discussed workplaces which were deemed caregiver friendly or family friendly, and (iv) presented examples of workplaces (including workplace name) and their associated workplace policies. The workplace name was an essential component of this review, as one of the purposes of the paper was to gather a list of employers who provide CFWPs or are deemed caregiver‐friendly. In order to increase the quality of the literature retrieved, exclusion criteria were also developed and applied to the literature. Studies were excluded if they: (i) discussed policies which were only available to children, or childcare policies, (ii) discussed care‐giving provided by paid caregivers (i.e. people who work as caregivers for their paid employment), (iii) discussed policies available from the government or government‐funded policies (however, articles which discussed companies who provided government ‘top‐ups’ were included), and (iv) did not provide a company name.

Once all 701 articles were retrieved from their respective sources, they were imported into Mendeley database management system. Articles were categorised by their respective sources and placed into folders within Mendeley. Duplicate articles were searched for and removed in Mendeley. The application of the inclusion and exclusion criteria for the review was two phase: (i) apply criteria to abstract and title of articles and (ii) apply criteria to full‐text of articles. After applying the criteria to the abstracts and titles of the articles, 402 articles remained. The 402 articles which were deemed relevant from the abstract read were then printed and read in full by the authors.

Stage 4: Charting the data

All three of the authors participated in the application of the inclusion and exclusion criteria to the 402 full‐text articles, the charting and the analysis of the data. If an author was unsure whether or not the article met the criteria for inclusion, the article was reviewed by the other two authors and a joint decision was made. The authors simultaneously read the articles in full, applying the inclusion and exclusion criteria, while charting the data. The authors developed a data extracting form using Microsoft Excel in order to organise the data retrieved from each of the articles and prepare the data for further analysis. The charting form consisted of seven fields, including: (i) authors and year, (ii) country, (iii) workplace name, (iv) CFWP category, (v) workplace characteristics (e.g. size, sector), (vi) labour force characteristics (e.g. age, gender), and (vii) key qualitative themes. The key qualitative themes were discussed in depth by the authors in order to determine those that were most widespread. Given the diversity of literature collected, additional hand searching was done using Mergent Online and LexisNexis Academic databases, as well as employer websites. This additional step allowed the authors to gain a comprehensive understanding of each workplace's specific employer profiles (dossiers), and to collect information necessary to perform a descriptive analysis of the research results. Specifically, the employer profiles and dossiers helped to fill in the gaps with respect to workplace size, sector, public or private status and country of top‐level parent companies.

Stage 5: Collating, summarising and reporting the results

Overwhelmingly, the non‐academic literature represented the majority of articles which were retrieved in this review. Of the total reviewed, 54.3% of the articles were reports, 42.9% of the articles were grey literature (such as trade journals, newspapers, online articles), and only 2.8% of the articles retrieved were peer‐reviewed academic articles. It is important to note that the academic literature addressing this topic was available, but the majority of the academic literature did not report on workplace name, excluding them from this study. Of the 70 articles included in this review, the names and associated CFWPs of 88 unique workplaces were identified. The results of this scoping review are presented below, beginning with an overview of the workplace characteristics, which are followed by the thematic findings.

Findings

Workplace characteristics

Sectors which offer CFWPs

According to Statistics Canada, business size is defined by the number of employees: small‐sized businesses with 1–99 employees, medium‐sized businesses with 100–499 employees and large‐sized businesses with 500 employees or more (Leung et al. 2011). Of the workplaces involved in this scoping review, 86% were large‐sized, 8% were medium‐sized and 6% were small‐sized. In terms of sector, this review found that the financial, healthcare and technology sectors were most supportive in terms of offering CFWPs to their employees, contributing to a combined 55.6% of the workplaces offering CFWPs (Table 1). These findings, with respect to sector and workplace size, were not surprising given that they are supported by the larger literature (Golden 2005, Dembe & Partridge 2011, Vuksan et al. 2012). Similarly, it was not surprising to find the service sector as the sector least likely to offer CFWPs.

Table 1.

Workplaces offering caregiver‐friendly workplace policies (CFWPs), by industry/sector

Industry/sector	n	%
Financial	26	29.5
Healthcare	12	13.6
Technology	11	12.5
Consumer goods	9	10.2
Education	5	5.7
Other	4	4.5
Government	4	4.5
Transportation	4	4.5
Utilities	4	4.5
Basic materials	3	3.4
Legal services	3	3.4
Industrial goods	2	2.3
Services	1	1.1

Types of CFWPs frequently offered

CFWPs which are typically easy and inexpensive to implement were found to be the most commonly offered (Table 2). Support services, which include services such as workshops, seminars and counselling, were offered in 69.3% of all workplaces. This was followed by flexible and customisable work schedules, found in 48.9% of all workplaces.

Table 2.

Categories of caregiver‐friendly workplace policies (CFWPs) offered by workplaces

Categories	N	%a
Support services (i.e. workshops, counselling, etc.)	61	69.3
Flexible and customisable work schedules	43	48.9
Financial assistance/relief	35	39.8
Unpaid leave	27	30.7
Paid leave	24	27.3
Culture change	21	23.9

^aMost workplaces offered more than one category of CFWPs, hence the percentages summing more than 100%.

Thematic findings

Four key themes were identified: (i) Diversity and Inclusiveness, (ii) Motivation, (iii) Accessibility and (iv) Culture. Each of these themes will be discussed as reflected in the 70 articles, together with their respective sub‐themes.

Theme 1: Diversity and Inclusiveness

Defining ‘caregiver‐employees’

As noted earlier, the authors’ review of the articles found diversity in terms of how CEs were defined and subsequently identified within their workplaces. One of the most commonly used terms was working carers, defined ‘as an employee who cares for a relative or friend who is vulnerable as a result of age, illness or disability’ (Bernard & Phillips 2007, Byrne 2011a, Cullen et al. 2011a, Gareis 2011a). In some organisations, there was no formal definition used for CEs or care recipients (Peters 2011a), leaving the policies open to all employees regardless of situation (Peters 2011b). Given the non‐traditional structure of family in the 21st century (Luxton 2011), expanding the term care recipient to include relative, friend, or partner is important to consider given the growing diversity of non‐traditional families. Not every employer was inclusive with respect to the definition of CEs. For example, in one workplace in the Netherlands, employees were required to provide care for a minimum of 8 hours per week, for at least 3 months, before they could be considered for any CFWP arrangements (Peters 2011c). This definition is particularly troubling, given that it requires CEs to potentially experience a lengthy period of stress/burden before they can make use of any policies. Ideally, CFWPs should be made available at the earliest point possible to proactively address the problem in a preventative fashion, thus reducing CE burden over the long term.

Employee position within the organisation

With respect to accessibility of CFWPs, employers made efforts to recognise the diversity of their employees and ensure that policies were wide ranging and accessible to all of their employees, regardless of their position within the organisation (Valenduc & Brotcorne 2011a) or their caregiver status. It was also clear that employers ensured that their human resources (HR) policies were uniformly available to staff at all levels, including management (Business Wire 2000, Kahan 2007, Byrne 2011b, Gareis 2011b, Lilischkis 2011a,b), as well as their family members (Gareis 2011b), as long as the work accommodation did not interfere with company productivity. For example, one workplace in the United States (US) boasted about their flexibility for staff, stating that ‘our policy is that any employee who has a computer at home is allowed to work from home’ (Kahan 2007, p. 43).

As was determined in earlier research, specific cohorts of employees, such as upper management and/or employees who are difficult to replace, were often given special accommodations (Vuksan et al. 2012). On the other hand, employees in casual, seasonal, unregulated, self‐employed or other precarious conditions are often less likely to have access to CFWPs. This is problematic, given that those working in these precarious work situations (such as the service sector) often have few health benefits and are often those who need CFWPs and workplace supports the most. In this review, the authors found that some employers had specific limits imposed on whom was eligible for workplace accommodations. In one workplace in Slovenia, generational barriers existed for younger members of staff, as additional leave hours and flexibility were only offered to older workers (Humer 2011a, Peters 2011a). Some employers offered CFWPs to staff based on their position in the organisation (Steen 2004, Quinn et al. 2014). For instance at Graz University in Austria, academic staff benefited from highly flexible working time options, but non‐academic staff were unable to make use of these policies due to the nature of their jobs (Gareis 2011a). Special consideration (three extra days of paid leave) was also offered by one Slovenian employer to employees who were caregivers to a family member with a disability (Humer 2011b). Although this is beneficial, advocating for CEs regardless of who they provide care for would be a more inclusive practice. It has been suggested that while employers are paying more attention to gender equality (as with other categories of diversity – whether age, or ethnicity for example), policies must include caregivers as a diversity category as a way to extend legal protection to this group of employees against employment discrimination (Byrne 2011ee).

Breaking down ‘norms’ around care‐giving

The scoping review revealed that a higher proportion of women and older adult employees were caregivers (Joslin 1994, Robertson 2004, Gareis 2011a, Valenduc & Brotcorne 2011a). The authors found that some employers were diligent about breaking down gendered norms surrounding care‐giving to encourage the use of work–life balance policies by male employees (Gareis 2011b,c). For instance, T‐Mobile Austria, a telecommunications company, recognised men's role in care‐giving. This company offered workplace accommodations that would allow male employees to request part‐time work so that they can be more engaged as caregivers (Gareis 2011b). In doing so, they hoped to reduce workplace cultural barriers and create a workplace culture where men do not feel any hesitancy to request a care leave (Gareis 2011b). However, this review also found that male dominated sectors, such as the manufacturing, transportation and construction sectors, were also found near the bottom with respect to offering CFWPs. In these industries that are typically dominated by men, care‐giving may not be viewed as an issue that their employees will encounter, given gendered assumptions of who provides care. Thus, employers may not be aware that CFWPs may be necessary to implement (Vuksan et al. 2012). As more men assume the caregiving role, awareness around the need for CFWPs in male‐dominated sectors is necessary. In a society where both men and women are equally engaged in the labour market, the existing cultural expectations that women provide informal care‐giving needs to be reformed (Pillemer & Suitor 2013).

The review did not reveal much information about ethnic diversity. At Centrica, an integrated energy company operating predominately in the UK and North America, diversity and inclusiveness are integral aspects of their corporate social responsibility. The company aims to employ ‘a higher number of older workers and people from ethnic minorities, so that it may better reflect the diverse communities it serves’ (Byrne 2011c, para. 4). Another way in which ethnic diversity is realised is through domestic or international relocation, which is a reality for CEs working in global companies (Sunoo 1997). While there are challenges to domestic relocation (such as employees not accepting the transfer to another location, as they have to stay close to the care recipient), there are even greater challenges in international relocation for global employees. These include different cultural expectations than in the home‐country, complications with medical benefits, and housing and travel costs which may prevent employees to take on overseas assignments. It is the expectation in some cultures that elderly people must be taken good care of – even if the elder is physically and/or cognitively capable of self‐care. Thus, employers can expect ‘employee requests to bring his or her parents along, or lobbies to maintain the same quality of elder care accommodations when the elder decides to stay behind’ (Sunoo 1997, p. 50).

Theme 2: Motivation

Business case

The business case for implementing CFWPs was highlighted as a major motivation for employers. The business case in this review refers to the economic or financial motivations employers had for implementing CFWPs. Internationally, many employers recognised the financial benefits of supporting CEs in the workplace, including the reduction of absenteeism and rates of sick leave, increasing productivity, increasing employee loyalty to the organisation, improving employee engagement, and improving employee morale (Blassingame 2002, Bosley 2005, Biotech Week 2008, Barroso 2011a, Humer 2011b, Peters 2011c,d,e, Valenduc & Brotcorne 2011b, Patton 2012, Sadavoy 2013). Additionally, employers indicated the ‘war for talent’ as a motivation for supporting CEs. Many employers were experiencing difficulty in retaining skilled staff, as well as attracting employees with scarce skills in a competitive labour market. As such, CFWPs offered a solution to attract skilled employees and simultaneously retain staff, the latter in which they had already made a substantial investment (Colours & Hockney 2000, O'Toole & Ferry 2002, Bosley 2005, Byrne 2011a, Gareis 2011b,c, Peters 2011c,d, Walsh 2013). Related to the financial motivation for supporting CEs, many employers were keen on being included on ‘Top‐Employers’ lists for the policies and initiatives they had put in place to support their employees (Business Wire 2000, Ellis 2002, Kahan 2007, Gareis 2011b). The motivation to achieve a good company reputation, through accruing and advertising ‘Top‐Employers’ awards, is constructed, in part, on the impetus to hire and retain skilled staff.

Demography

The review herein suggests that many employers internationally have clearly recognised the demographic challenges which will inevitably influence the paid labour market, including duel income families, increased financial pressures for families, an ageing workforce, a growing number of ageing‐dependent family members, an increased number of working women and mothers, and the need to retain female staff to better service increasingly female clientele (Chelland 2002, Bosley 2005, Human Resources 2007, Cullen et al. 2011b, Gareis 2011d,e, Peters 2011a, Walsh 2013). Implementing CFWPs offers a solution to respond to these inevitable challenges while allowing employees to achieve a better work–life balance and ultimately improve their ability to perform at work.

Social responsibility

Whether CFWP initiatives were implemented when a clear need was demonstrated by employees (Barroso 2011b, Cullen et al. 2011b) or whether employers proactively sought out the opportunity to support employees, some employers felt that it was their social responsibility to support their CEs (Business Wire 2000, O'Toole & Ferry 2002, Byrne 2011c, Humer 2011b, Peters 2011d). A major lesson from Weleda, a pharmaceutical preparation company in Germany, is that:

Employers should not approach measures to support working carers as a means of saving money. This initiative is embedded in a holistic approach to HR management which values employees as human beings with distinct interests in three spheres of paid work, family work and private life. (Gareis 2011f, para. 21)

Furthermore, certain employers recognised the importance of investing in their employees. Communications services provider British Telecom (BT) in the United Kingdom highlighted:

At BT, we feel that carers are worth investing in … for those needing further business incentive, just consider the fact that by supporting carers, we retain the skills and experience of employees who demonstrate reliability and commitment in every aspect of their lives. (Bosley 2005, p. 1)

Theme 3: Accessibility

Barriers to accessibility of CFWPs

While employers actively tried to ensure that CFWPs were accessible to all of their employees, this review identified several barriers contributing to a lack of use of CFWPs. The stigma associated with the use of CFWPs was clearly emphasised in this review. Referring to elder care concerns, Graz University in Austria highlighted that:

The issue of work‐care reconciliation is still something of a taboo in the work context, in contrast to the more well‐established issue of reconciliation of work and childcare. (Gareis 2011a, para. 17)

Additionally, some employees experienced both a lack of awareness and lack of confidence in the ability of their employer to accommodate their unpaid care responsibilities. Wells (2000) suggests that in the US, many employees do not realise how employers can help them with elder care. Employees in other countries (such as the Netherlands) were also not aware of the support services available to them in the workplace (Peters 2011b), or found that the information about the supports available lacked clarity, making it difficult to use the policies (Human Resources 2007). Such a lack of awareness is problematic and calls for more initiative on the part of employers to ensure employees feel educated and comfortable with taking advantage of elder care benefits (Wells 2000). Men, in particular, face stigma surrounding their care responsibilities, often leading them to keep it a secret from their employer and co‐workers (Robertson 2004), or causing them to not self‐identify as caregivers (Employer Panel for Caregivers 2015). In Canada, 49% of CEs are men (Fast et al. 2014), suggesting that these gender barriers need to continue to be broken down in order to allow both men and women to manage elder care responsibilities.

Some employers highlighted that it was the employees’ responsibility to ask for accommodations (Gareis 2011b, Peters 2011a), which is difficult if employees are unaware of what is available or do not feel supported by their employers (Gareis 2011c). Humer (2011b) highlighted that there is a lack of awareness of work–life balance issues, such as elder care, all of which need immediate attention. In a recent survey with Canadian employers, Lero et al. (2012) found while 76% of employers considered healthy work–life balance a mid‐ to high‐level priority in their workplaces, and only 41% of employers considered supporting employees with elder care needs a mid‐ to high‐level priority in their workplaces. This discrepancy highlights the fact that some employers still view care‐giving as a private issue rather than a social responsibility (More companies sharing responsibility for elder care, 1996). Finally, some employers were clear on highlighting that the availability of policies were subject to operational needs (Cullen et al. 2011b,c, Gareis 2011c), suggesting that there may be a large portion of employees who are unable to make use of these policies.

Recent research has highlighted that employers feel ill‐equipped to deal with the needs of CEs due to a lack of knowledge of caregiving challenges and how to best support CEs (Employer Panel for Caregivers 2015). Thus, more information and resources are needed for employers so that they may best support their employees with elder care needs (Lero et al. 2012, Employer Panel for Caregivers 2015).

Case‐by‐case policies

While in some workplaces it was suggested that formal, mandated policies are essential to lowering accessibility barriers for CEs (Peters 2011c,d), the consensus was that case‐by‐case solutions were the best answer. Many employers recognised that one‐size‐fits‐all does not apply in the context of CFWPs (Robertson 2004) and, consequently, a case‐by‐case approach with no formal policy is preferred (Barroso 2011b,c, Byrne 2011b, Cullen et al. 2011a,d, Gareis 2011b, Peters 2011a,c, Świezawska‐Ambroziak & Stelmachowicz‐Pawyza 2011). BT argued that:

No job applicant or employee receives less favourable treatment because of factors such as their race, sex, religion/belief, disability, marital or civil partnership status, age, sexual orientation, gender identity, gender expression or caring responsibilities. (Byrne 2011a, para. 22)

Where possible, BT also takes positive measures to recruit people from underrepresented minority groups. Additionally, it is being recognised that providing care can be an episodic and unpredictable process for CEs, and that employers need to/should be flexible in accommodating the changing needs of their CEs (Employer Panel for Caregivers 2015), while simultaneously taking into consideration organisational needs (Lero et al. 2012).

Theme 4: Culture

The scoping review revealed that the culture of the workplace was critical in the decision to offer policies that assist CEs in achieving a work–life balance. Electric services provider Centrica in the UK practices the philosophy of valuing employees as a means of enhancing their work experience, so that ‘other parts of their lives can coexist with their working life as well as possible’ (Byrne 2011c, para. 26). Two workplaces in the healthcare sector in the Netherlands also demonstrated that fostering a workplace culture that is committed to helping CEs balance their paid work and unpaid care‐giving responsibilities can also be driven by core business values and/or workplace characteristics (i.e. representation of employer in the care/wellness sector or in health insurance sector) (Peters 2011c,d). It seems that when workplace culture focuses on the well‐being of employees (Ellis 2002, Kahan 2007), employers often consider care‐giving as a social rather than ‘private’ responsibility (Humer 2011b). This social responsibility perspective goes hand in hand with the philosophy that work and family life need to be integrated (Byrne 2011a).

On an international scale, the authors observed that some workplaces have CFWPs embedded within the organisational structure (Byrne 2011d, Humer 2011a, Peters 2011c) or within HR policies (Cullen et al. 2011a, Gareis 2011c, Peters 2011a). Employers that recognise the business benefits of helping employees reconcile their work and family life are more likely to provide CFWPs (Ellis 2002). At Varova, a transportation and logistics company in Finland, the company philosophy is that ‘employees are the company's most important resource’, and the organisation follows a life‐cycle approach that allows employees to receive supports needed for their particular key life stage, thus, helping them integrate their work and private life (Heino 2011). Similarly, inspired by the Christian vision of care, Residential care services provider Zorggroep Noordwest‐Veluwe in the Netherlands has implemented ‘life stage conscious policy’, to address the individual needs of each employee based on their particular life stage. Although this organisation does not have a formal work–life reconciliation policy, there are several options (such as flexible working hours, leave arrangements, etc.) available to employees to meet their work and care responsibilities (Peters 2011b).

Some employers clearly recognised that employees may be hesitant to discuss their care‐giving/private lives with their supervisor (Gareis 2011c). Connexxion, one of the largest employers of public transportation in the Netherlands, nurtures a culture that:

Encourages informal support and personal communication about the care topic between direct supervisors and employees, and among employees themselves. (Peters 2011e, para. 12)

Byrne (2011c) convincingly argues that the commitment to enhance the employee work experience requires the support and involvement of senior managers/CEOs regarding the needs of CEs. Lilischkis (2011a) found that AOK Hessen, one of the largest health insurers in Germany, aimed to reduce the double burden of work and care for CEs through the implementation of their Profession and Care Service unit. This allowed them to simultaneously reduce frequent absences from work while increasing work productivity and performance. This policy was initiated from the top‐down, with the Board of Directors working in collaboration with the company's Diversity Management Unit. Furthermore, as employees directly deal with line managers when they need work accommodations, line managers must be given adequate training and autonomy so that they are able to effectively respond to the needs of CEs (Byrne 2011c). Gareis (2011b, para. 17) agrees that the active involvement and support of line managers is essential to ‘fostering a company culture that is fully committed to supporting employees in reconciling their job with family responsibilities’. Fostering healthy relationships between employees and their immediate supervisors is also crucial to the implementation of CFWPs. A workplace culture that supports ‘flexibility, trust, open communication and a willingness to agree on customised solutions with the employee’ is needed to allow CEs to voice their opinion about the workplace culture and provisions available/unavailable (Peters 2011d, para. 26). To ensure this, one company implemented an upward feedback process, whereby supervisors were regularly evaluated by their employees (Callick 1995). The authors also noted a uniquely spiritually focused philosophy of human development (anthroposophy) that considered the importance of addressing employees physical, mental and spiritual health, reflected in HR policies and work–life arrangements (Gareis 2011f, Peters 2011a).

To summarise, a number of policy recommendations, directed at employers and government, are informed by the concerns identified in the scoping review (see Box 1).

Box 1. Recommendations for employers and government.

1	Identify CEs in the workplace and recognise their unique needs
2	Work to change workplace culture to better accept and accommodate CEs
3	Create CFWPs that accommodate diverse CEs (as defined by age, sex, class, gender, immigration status, family structure, care‐giving responsibilities, etc.)
4	Create awareness of existing Human Resources policies and CFWPs
5	Provide training to managers to recognise and support CEs
6	Provide flexibility in work schedules, and, if possible, provide CEs some choice in choosing strategies to best manage work and care‐giving responsibilities
7	Nurture collaboration between policy makers and employers to support caregivers in best integrating paid work and unpaid care‐giving
8	Advocate for campaigns that address stigma related to care‐giving

CFWPs, caregiver‐friendly workplace policies; CEs, caregiver‐employees.

Strengths and limitations of the review

Three strengths of the scoping review methodology are as follows:

1. Provides a comprehensive synthesis of the availability of CFWPs in international workplaces;

2. Highlights characteristics of caregiver‐friendly workplaces; and

3. Identifies a number of themes which contribute to the effectiveness of CFWPs.

A number of limitations were also identified, including:

1. The possibility of gaps given that the grey literature was so vast;

2. The fact that many of the articles were retrieved from one particular source (EUROFOUND), which could have influenced how articles were reported, as well as the key themes determined;

3. That due to discrepancies in the quality of the grey literature articles, additional hand searches needed to be performed in order to establish a complete profile of the workplaces found [although the authors tried to identify the workplace profiles based on the specific branch/subsidiary location identified in the review, in some instances the HQ location was used. If the branch location was in a country other than the Top‐Level HQ (i.e. a UK branch, but the Top‐Level HQ are in the USA), then a UK equivalent was used];

4. Due to the nature of the scoping methodology, corporate discourses, such as mandates and mission statements, were often taken at face‐value (there is a need to examine these corporate discourses more critically in the future); and

5. The focus on articles in the English‐speaking literature could have limited the search in terms of which countries, and subsequently workplaces were revealed (this review could benefit from a broader search across multiple languages, websites and bibliographies in order to best represent the international scope of CFWPs).

Conclusions

In this paper, a scoping approach, as outlined by Arksey and O'Malley (2005), was used to provide the first synthesis of the literature with respect to the availability of CFWPs in workplaces internationally. Furthermore, the scoping review defined the sectors of the labour force and the characteristics of the workplaces known to support CEs. The authors identified key themes emerging from the synthesis of CFWPs and highlighted the gaps they revealed. Given the ageing global demographics, the issue of integrating paid work with unpaid family care‐giving will continue to be a serious concern for employers and the economy in Canada and internationally. CEs must not be penalised for providing care by losing their job. Both men and women must be given equal opportunities to balance good quality work with their care‐giving responsibilities (ETUC 2011). Due to demographic changes, caregivers will continue to be employed in paid labour in later stages of their lives (ETUC 2011), thus government and employer policies must reflect strategies to support CEs in their care‐giving responsibilities while engaging in paid work.

As outlined by the limitations above, there are a number of future steps which could be taken to strengthen the review. First, the review could benefit from exploring the literature in languages other than English, which will improve the international scope of our understanding while potentially providing a greater diversity of available CFWPs. Second, as the search was largely limited to types of CFWPs offered, the review would warrant an examination of the relationship between the presence of CFWPs in the workplace and various outcomes, such as job retention and the health of employees, for example. Furthermore, rigorous methodological approaches are needed to understand how sex and gender intersect with other variables (such as employment status and/or socioeconomic status), which act as determinants of CEs’ health. Additionally, more studies are needed to understand the experiences of racial and minority employees. Continued uptake of CFWPs is necessary to create workplace accommodations that foster work–family balance for CEs while assisting employers to retain talented and skilled workforce.