Unit 1.2: The Impact of Informal Caregiving and the Need for Support for Carers

This unit provides information on the effects of informal caregiving on carers and their need for support. The first section examines the impact of informal care on carers’ well-being, taking into account key areas of their lives—employment, physical health, emotional well-being, and economic stability. With regard to employment, data are presented both at the European level and nationally for Romania, Cyprus, Greece, Spain, and Italy.

In contrast, the second section discusses the positive impact of informal caregiving, highlighting benefits such as personal fulfilment and sense of duty, stronger family bonds and emotional rewards, the development of new skills and personal growth, as well as contributions to society and advocacy for carers’ rights.

Finally, the unit addresses the crucial need for support from employers, emphasising that recognising the needs of employees with caregiving responsibilities brings multiple benefits. It also presents examples of carer-friendly practices such as flexible work arrangements, leave and financial support, empowerment and recognition, training, and skills development.

The unit concludes with interactive activities designed to raise awareness about the challenges faced by employees with caring responsibilities in the workplace, foster empathy, and support the identification of carer-friendly practices.

Theoretical Content

Effects of Informal Caring on Carers’ Wellbeing

Caregiving responsibilities have an impact on multiple dimensions of carers’ everyday life, and their effects often extend beyond the immediate period of providing care. This section explores how informal caregiving affects key domains in the lives of informal carers – employment and economic sustainability, physical health, and emotional wellbeing.

Employment

Employment is one of the life domains most affected by informal caregiving responsibilities.

Source: Image generated by the authors using Canva AI (2025)

• Balancing paid work with unpaid care generates significant challenges for people with caregiving responsibilities.
• These challenges are not equally distributed: women are far more likely to adjust their careers in order to meet caregiving demands.
• Care work is unevenly distributed between men and women, reinforcing gender inequalities and traditional gender roles (EIGE, 2023; European Commission, 2021). Caregiving roles are traditionally assigned to women to a much greater extent than to men (World Bank, 2022; Guga & Șindreșan, 2021).

Impact on employment choices

Caregiving can influence employment in multiple ways:

• Reducing working hours
• Moving into part-time or flexible jobs
• Declining promotions
• Leaving the labour market entirely

Women are more likely to reduce working hours, change to part-time jobs, or retire early to provide care (European Commission, 2021).

Consequences

• Over time, these adjustments contribute to gender inequalities in income, career growth, and pension entitlements.
• At the same time, employers and economies face lower productivity levels and reduced labour force participation, especially as the population ages and the demand for care increases.

Differences across Europe

The effects of informal caregiving on employment vary across Europe, depending on welfare regimes, labour market structures, and the availability of formal long-term care services.

In countries where public support for care is limited, families—and especially women—carry a larger share of the burden, leading to gender gaps in employment.

EU level data

• Nearly 28% of women work part-time, compared to just 8% of men (Eurostat, 2025a).
• 1 in 3 employed women paused their work due to childcare, compared to only 1.3% of men (2018) (European Parliament, 2025).
• Informal LTC providers are often below retirement age, which creates strong work-life conflicts (European Parliament, 2025).

National level data

Women’s employment rates remain significantly lower than men’s across all five countries.

Gender gaps range from around 9 percentage points in Spain, to over 15 points in Romania and Greece, and nearly 20 points in Italy.

These differences reflect both structural barriers and the unequal distribution of care responsibilities between men and women.

In addition, national data reveal specific vulnerabilities among women carers and older female workers:

• In Cyprus, only 21% of women carers aged 50-64 are employed, compared to 62% of men in the same age group.
• In Spain, among women with caring responsibilities, 17.4% work part-time, compared to just 3.5% of men.

Economic Stability

• Reduced employment and unpaid care lead to financial vulnerability for women. Informal carers are often dependent on the financial support of their family or minimal government aid (Eurofound, 2020). Informal caregiving increases financial stress and reduces long-term financial independence (Koomson et al., 2024).
• Gender pension gap in the EU: 26% → Women receive, on average, about a quarter less in pensions than men (EIGE, 2024).
• The impact of retirement is stronger among women with caring responsibilities: the percentage drop in earnings after retirement being higher among retired women and more persistent over time. This leads to a higher risk of financial difficulties and poverty in later life (Maura & Profeta, 2024).
• Active women also earn less than men: on average, partnered women in the EU earn 69% of their partner’s earnings, which may lead to lower influence in the decision-making process as well as increased financial dependency, limited autonomy, and higher vulnerability.
• 21% of partnered women in the EU between 18 and 64 years old were living in 2019 in household where their partner was the sole earner, compared to only 6% of men (EIGE, 2024).

Structural barriers

These disparities are not only the result of individual choices but are strongly shaped by structural barriers:

• Limited access to formal care services, with rigid labour markets that do not accommodate flexible working arrangements, and insufficient family-friendly policies (e.g. flexible leave, financial support for carers etc.) make it more difficult for women to remain in stable and well-paid jobs while providing care for family members.
• Lack of recognition of informal caregiving, most often seen as a female duty, leads to the absence of financial compensation for carers and to reduced visibility of their work.
• Lack of adequate training affects both the carers’ wellbeing and the quality of care provided.

Economic value of informal care

• Although often unrecognised, the work of informal carers has significant economic value, which is largely absent from official statistics and represents an overlooked contribution to national welfare and care systems.
• If informal care were compensated at market rates, it would account for between 2.4% and 2.7% of EU GDP.
• At the same time, reduced employment and early retirement among carers results in a loss of tax revenues of about 1% of GDP (Huis in ’t Veld et al., 2022).
• In practice, people providing informal care are subsidizing public LTC systems with their unpaid labour.

There is an urgent need for financial compensation and investment in both formal and informal care systems, as well as the recognition of informal caregiving.

Key impacts on female caregivers

• In the long run, interruptions in employment and reduced working hours contribute to persistent gender gaps in income, career growth, and pension entitlements.
• Living in a state of increased financial dependence on a partner is associated with:
  • Negative effects on physical and mental health
  • Reduced opportunities to participate in education or paid employment
  • Higher risk of being a victim of domestic violence (EIGE, 2024).
• Employers and economies bear the costs of these gender disparities as well, through lost productivity and decreased labour force participation, particularly as care demands rise.

Physical Health

Physical strain and immediate health effects

• Carers often report back pain, musculoskeletal disorders, and persistent fatigue (Montero-Cuadrado et al., 2022). Repetitive and physically intensive tasks such as lifting, bathing, and assisting with mobility create physical strain (Darragh et al. 2013).
• Among professional caregivers, irregular shifts and high workloads are linked with poorer physical health outcomes, lower quality of life, and increased risk of chronic illness (Awosoga et. al. 2020).

Impact on lifestyle and self-care

Unpaid family carers frequently neglect their own health and report:

• reduced physical activity
• unhealthy diets
• less preventive healthcare use (Vitaliano et al., 2003).

Long-term consequences

• The negative consequences of caregiving are not limited to the caregiving period.
• Evidence suggests that physical limitation may persist years after caregiving ends, particularly among those providing intensive, long-term care (Capistrant et al., 2012).

Emotional Wellbeing

Although caregiving can strengthen family bonds, it also places a considerable strain on carer’s mental health (Schulz & Sherwod, 2008; Raffnson, Shankar &S Steptoe, 2015). The main challenges may take different forms, such as:

• Blurring of personal boundaries when carers must provide intimate support (e.g. hygiene or medical support).
• Conflicts and tensions within families when making decisions about daily routines or care arrangements.
• Constant stress and worry regarding the health and wellbeing of the dependent relative, which can be a heavy emotional burden.
• Social isolation as social engagement becomes difficult and limited due to care responsibilities.
• Increased risk of mental health problems such as anxiety, depression, and emotional exhaustion (Raffnson, Shankar &S Steptoel, 2015; Shulz & Sherwood, 2008)
• High likelihood of burnout, especially among long-term carers who lack access to respite centres or support networks. (Gérain & Zech, 2019)
• Low use of professional mental health services, as carers often neglect their own needs, lack time, and even prioritize the needs of the dependent relative over their own. (Awosoga, et al., 2020)

Possible solutions for employers and public services to protect the emotional wellbeing of employed informal caregivers

Solutions	Employers	Public services
Facilities and flexible work rights to reduce chronic stress and burn-out	Create a confidential caregiver self-identification processProvide predictable work schedulesOffer remote/hybrid optionsGuarantee paid micro-breaksAllow split shifts or compressed weeksEnable temporary workload adjustmentsProvide at least 3–5 paid days for caregiving, without career penalties.	Provide guidance on caregiver-friendly accommodationsDevelop and share model caregiver support policies for employeesEstablish a dedicated hotline for workers and HR on caregiving issues
Co-funded respite with “recovery goals” to reduce emotional overload and isolation	Offer stipends or vouchers for in-home/day respite servicesAllow respite to be schedule during work hoursIntegrate booking links in HR portals for direct access	Expand day respite services (6–10 hours) to cover working hoursProvide residential respite (with accommodation for 2-3 nights) for caregiversEnsure emergency respite for acute needs, hospitalizations, or caregiver exhaustionSimplify eligibility criteria for respite accessProvide transport services where needed.
Peer support delivered where people work to improve coping skills	Host monthly peer groups (on-site or virtual) co-facilitated by a psychologistOffer micro-learning sessions on boundary setting and difficult family conversations.	Assign a care navigator for employed carers to connect them to benefits, respite, and mental-health services.
Equip homes to reduce physical strain	Offer stipends or vouchers for essential aids (hoists/slide sheets, transfer belts, adjustable beds/chairs)Negotiate bulk-purchase discounts for care equipmentProvide paid time off for delivery/installation of equipmentEnsure access to a rapid physiotherapy/ occupational therapy (OT) hotline for setup guidance	Provide means-tested grants for essential care equipmentCreate community equipment libraries (short-term loans)Fast-track OT home assessments (target: within 7 days from referral)Apply VAT relief/ reimbursement for prescribed devices.
Smart tele-care and coordinated scheduling	Co-fund fall sensors, medication dispensers with alerts, and bed-exit alarmsProvide licenses for shared calendar/care-coordination appsAllow care-related notification exceptions during workInclude brief onboarding/ training for tele-care tools.	Subsidize tele-care for high-need householdsIntegrate tele-care alerts with community nursing/GP triage systemsSet interoperability standards so devices feed into care plansProvide basic digital skills training for carers and households.

While national systems may not explicitly discriminate against them, social norms and expectations place the care responsibilities disproportionately on women.

“Familistic” societies expect and normalize informal care to be undertaken by the family, and especially by women, putting stigma on institutionalization and increasing feelings of guilt and obligation among the younger generation.

Informal caregiving is not recognised as a role that deserves compensation, and is instead regarded as a family matter, leaving carers more exposed to economic insecurity and social inequality.

Positive Impact of Informal Caregiving

Although caregiving is often associated with burden, studies also show positive effects on caregivers, in areas such as family life, personal development, and contribution to society.

Role satisfaction and sense of duty

Caregiving is deeply embedded in cultural norms and moral expectations, particularly in societies where intergenerational solidarity remains strong (Broese Van Groenou & De Boer, 2016). For many, providing daily care to an older parent, spouse, or relative is not experienced solely as a burden, but as a fulfilment of duty and reciprocity.

• Caregivers often describe their role as an act of returning the care once received in childhood or throughout life, thereby reinforcing continuity across generations.
• This sense of moral obligation provides caregivers with role satisfaction, defined as the fulfilment derived from successfully performing a meaningful and socially valued role.
• From this perspective, caregiving satisfies not only instrumental needs but also the caregiver’s desire for moral coherence and identity affirmation (Broese Van Groenou & De Boer, 2016).
• Research demonstrates that role satisfaction and the ability to identify positive aspects of caregiving are associated with lower depressive symptoms and reduced burden among caregivers, suggesting that these positive appraisals buffer the negative mental health consequences of caregiving. Studies show that positive aspects of caregiving, including feelings of competence and personal gain from fulfilling one’s duty, help regulate caregiver burden and mediate the relationship between life satisfaction and psychological distress. (Fauziana et al., 2018; Van Droogenbroeck et al., 2025)

Stronger family bonds and emotional rewards

Caregiving is relational, affecting and reshaping the dynamics of the family.

• Shared caregiving responsibilities often foster cooperation among siblings, extended kin, and spouses, strengthening intra-family solidarity.
• The daily intimacy of caregiving – helping with meals, personal hygiene, or mobility – can deepen emotional ties between caregiver and recipient.
• These relational processes yield significant emotional rewards. Research show that prosocial behaviours such as caregiving enhance well-being by generating feelings of empathy, compassion, and gratitude. Caregivers often experience satisfaction when they see their loved one more comfortable or appreciative of their efforts. These affective exchanges create a feedback loop that reinforces both the caregiving relationship and the caregiver’s emotional resilience. Importantly, these emotional rewards can buffer the stressors of care, offering balance in otherwise demanding contexts (Lee & Li, 2022).

Development of new skills

Caregiving is also a powerful site of skills acquisition and competency development.

• Caregiving experiences can be understood as mastery experiences that increase individuals’ belief in their ability to manage complex and uncertain situations.
• Caregivers frequently report improvements in:
  • Patience – cultivated through dealing with repetitive routines, slow recovery, or progressive decline,
  • Empathy, developed through daily engagement with vulnerability and dependence.
  • Time management -, as the caregivers must coordinate specific tasks, as healthcare visits, domestic tasks, and employment responsibilities (CEDEFOP, 2024).
• These competencies are highly transferable to other domains of life, including the workplace and civic engagement.
• European Commission funded projects such as Care4Skills^[1] and Care4U^[2] specifically address the training needs of the care workforce by facilitating knowledge exchange on daily practices and enhancing both digital and person-centerer care competencies across EU countries. Thus, caregiving functions as an experiential learning process, shaping the caregiver into a more adaptive, safety-conscious, and socially skilled individual with competencies that are increasingly recognized and valued within European health and social care frameworks.

Personal growth and resilience

Caregiving can foster resilience, defined as the ability to adapt positively to adversity.

• The daily unpredictability of caregiving – health crises, emotional strain, or bureaucratic challenges – requires flexibility, resourcefulness, and problem-solving skills.
• Over time, these coping strategies strengthen psychological endurance.
• Caregiving often contributes to personal growth. Frequently, caregivers report greater appreciation of life, stronger relationships, and an enhanced sense of purpose. In many cases, caregiving transforms self-concept: individuals see themselves as stronger, more patient, and more compassionate. This process illustrates that caregiving, while demanding, can be a profound catalyst for identity development and personal flourishing (Autio et al., 2024; Opsomer et al., 2022).

Contribution to society and advocacy for care rights

At the societal level, unpaid caregiving represents a significant form of social capital.

• In countries where LTC systems remain underdeveloped or fragmented, families provide the bulk of daily care, effectively substituting for professional services.
• The economic value of this unpaid labour is substantial, relieving public systems of costs they are unable or unwilling to bear. Thus, caregivers sustain not only their own families but also the resilience of welfare systems at large (EIGE, 2021, EIGE, 2023).
• Moreover, caregivers often evolve into advocates for care rights. Through direct experience of systemic shortcomings – limited services, financial strain, lack of training – they acquire unique insights into policy gaps. Many channel these experiences into collective forms of action: participating in caregiver associations, lobbying for better support policies, or raising awareness about the rights of care recipients and carers.
• Framed through civic engagement, caregiving thus extends beyond the private sphere into the public domain, contributing to policy change and the recognition of care as a fundamental social right. (EIGE, 2023).
• Women caregivers, in particular, become key agents of policy change and contribute to the recognition of care as a fundamental social right rather than merely a private, feminised responsibility (Alvariño, 2025).

Positive Highlights

Caregiving is often experienced as a fulfilment of duty and reciprocity, and not solely as a burden.

Shared caregiving responsibilities foster cooperation and strengthen solidarity among family members.

Caregiving allows carer to acquire or develop new skills such as time management, empathy, and patience.

Caregiving contributes to personal growth, fostering a greater appreciation of life and an enhanced sense of purpose.

Informal carers sustain welfare systems and increasingly advocate for care rights.

The Need for Employer and Organisational Support

Balancing work and care

Providing informal long-term care for relatives is a growing reality for many employees. It often comes with significant physical, emotional, and financial burdens.

• Balancing work responsibilities with caregiving tasks can lead to stress, fatigue, and reduced productivity.
• In some cases, employees with caring responsibilities may even be forced to leave the workforce altogether.
• Without adequate support, informal carers are at higher risk of burnout, poor health outcomes, and economic insecurity.
• These risks ultimately affect employers as well, through increased absenteeism, staff turnover, and lower performance (Eurofound, 2025).

Why should employers act?

Work-life balance is essential for employees in general, and so much more for those with caregiving responsibilities.

• By recognising the needs of employees with caregiving responsibilities, employers can reduce stress, retain staff and improve productivity (Hlebec et al., 2024)
• For those caregivers who are not employed, employers could implement targeted hiring practices aligned with the Work-Life Balance Directive:
  • Offering programs for career re-entry
  • Providing part-time or job-share arrangements
  • Explicitly stating flexible work options in job postings
  • Removing bias against employment gaps in screening processes.
  • Managers might also consider phased return-to-work schedules, remote work opportunities, and clear pathways for advancement that accommodate caregiving realities (European Commission, 2019a).

The role of employers and organisations

Employers and organisations therefore play a critical role in supporting employees who are carers.

• By implementing flexible working arrangements, offering access to information and counselling services, and fostering a culture of understanding, organisations can help employees manage their dual responsibilities more effectively.
• Such measures not only improve the wellbeing and resilience of carers, but also contribute to employee retention, loyalty, and long-term organisational stability (Hlebec et al., 2024).
• In addition, providing structured support for informal carers aligns with broader social responsibility objectives and contributes to a more inclusive and equitable workplace. As populations age and the demand for long-term care increases, forward-looking organisations that recognise and address the needs of working carers will be better positioned to respond to demographic changes while maintaining a healthy and motivated workforce (Hlebec et al., 2024, Eurofound, 2015).

Employers can no longer treat caregiving as “someone else’s problem.” As a growing share of employees quietly shoulder an invisible second shift, proactive support has become a core workforce strategy – one that protects productivity, retains experienced staff, and advances inclusion.

• The invisible second shift: why caregiving impacts the workplace

A significant and growing portion of today’s workforce is juggling a second, often invisible, full-time job: providing informal care for aging parents, sick spouses, or relatives with disabilities. This dual role of employee and caregiver creates immense physical and emotional strain, which inevitably impacts the workplace. The stress of managing appointments, finances, and daily care needs can lead to presenteeism, where employees are physically at work but mentally distracted and less productive. It also results in higher rates of absenteeism due to care-related emergencies. Without adequate support, organizations risk burning out and losing experienced employees who are forced to reduce their hours, turn down promotions, or leave the workforce entirely to manage their responsibilities at home (Das et al., 2024).

• A strategic investment: the business case for support

Implementing support for employee-caregivers is not simply a compassionate gesture; it is a critical business strategy with a clear return on investment. By offering flexible work arrangements, providing access to caregiver resources, and fostering an understanding management culture, employers can directly mitigate the negative impacts of care-related stress. (Hlebec et al., 2024). This support is proven to boost staff retention, as employees who feel valued and supported are far more likely to remain loyal. It also enhances productivity and engagement, as reducing an employee’s outside stressors allows them to be more focused and effective in their role. Ultimately, this support is an investment in building a resilient, stable, and highly motivated workforce (Fuller, 2024).

• Building an inclusive culture for the future

Furthermore, providing robust caregiver support is a powerful and tangible way to advance Diversity, Equity, and Inclusion (DEI) goals. Statistically, caregiving responsibilities still disproportionately affect female employees, and a lack of support can become a major barrier to their career advancement (EIGE, 2021). By creating policies that acknowledge and accommodate these external responsibilities, organizations can better retain female talent and ensure a more equitable path to leadership. Fostering a caregiver-friendly environment sends a clear message that the organization values its employees as whole people, building a compassionate and human-centred culture that strengthens its reputation and makes it an employer of choice in a competitive market (EIGE, 2023).

Examples of carer-friendly practices

FLEXIBLE WORK ARRANGEMENTS Family Working Manifesto (Italy – NHOA Energy, 2020) promotes remote work, flexible schedules, and the recognition of rights such as family time, wellness (physical and mental), and parental responsibilities.

LEAVE AND FINANCIAL SUPPORT KPMG Romania(2023): within a pilot program, it provides an extra 5–7 paid days off for employees to support work–life balance, plus study leave. It recognises the importance of rest and personal time, especially for employees with caring responsibilities. Initiative #RiParto(Italy): funds corporate welfare programmes offering psychological, physical and financial support, along with incentives for returning to work after childbirth or adoption. Implementation across Italy varies regionally, with different strategies such as vouchers, nurseries, and parental leave schemes to improve work-life balance (Presidenza del Consiglio dei Ministri – Dipartimento per le politiche della famiglia, 2022).

EMPOWERMENT AND RECOGNITION Emilia-Romagna Regional Law (Italy, 2014) is the first law in Europe to formally define the informal carer. It grants carers rights to information, training, psychological support, financial allowances, and representation. It also includes a “Caregiver Day.” Citizens: Empowering Women Caregivers (Spain), developed by the Women’s Foundation in Spain, provides guidance, workshops, and participation spaces for women carers to reconcile care with personal and professional development. Day Care Centres and Mobile Units for People with Dementia and Their Families(Greece), developed by the Greek Association of Alzheimer Disease and Related Disorders (Alzheimer Hellas). The programme combines clinical care with psychosocial services, reaching families across multiple regions. Caregivers benefit from counselling, education, and empowerment through innovative cultural programs such as “Writing Our Couples’ Life Book” and “Caregiver’s Voice”, which harness storytelling and theatre to build emotional resilience and raise public awareness. Recognised as a model of holistic dementia care and caregiver inclusion, it offers a replicable framework for other countries.

TRAINING AND SKILL DEVELOPMENT School for Carers (Spain, “la Caixa” Foundation, 2018) offers online workshops for family caregivers on physical care, nutrition, emotional support, and self-care. Entrena Empleo (Spain), developed by the Santa Maria la Real Foundation, supports women re-entering the labour market after periods of long-term unemployment spent providing unpaid care work. It focuses on the importance of caregivers’ mental health and recognises the valuable skills acquired through caregiving. Matia Eskola (Spain) is an online portal with courses, videos, and resources for carers, focusing on good treatment and accompaniment of older persons, awareness of ageing and the needs of this category.