Employment, child care, and mental health of mothers caring for children assisted by technology

Objective. This study examines 1) the way that children with chronic condit ions are cared for at home and assisted by technology affects maternal empl oyment and child care; 2) the social and clinical factors associated with t he decision of a mother to quit employment to care for a child at home; and 3) the way in which care at home and the decision of a mother to quit a jo b affects maternal mental health. Design. The 6-month postdischarge status of 70 mothers of children assisted by technology (study group) was compared with the 6-month postdischarge st atus of 58 mothers of children (matched for age and gender) hospitalized fo r acute illnesses (comparison group). Between January and December 1993, we gathered information on sociodemographic status, employment status and cha nges in employment, severity of the child's condition, child care and nursi ng services at home, family support, and maternal mental health. Results. One third of mothers in the study group reported that they quit em ployment to take fare of a child at home with only 37.1% remaining employed outside the home, compared with 69.0% of comparison group mothers. Single caretakers were 15 times more likely to quit employment compared with mothe rs in two-parent families. Availability of child care had an independent ef fect on a mother's decision to quit a job, whereas the severity of the chil d's condition did not. Child care hours were significantly lower in study g roup families and were provided mostly by relatives compared with daycare f acilities and regular babysitters in comparison families. Family support wa s highest among employed mothers in both the study and the comparison group s and lowest in study group mothers who were neither employed currently nor before the child's illness or who had quit employment to care for the chil d. Family income was significantly lower in families with a child assisted by technology. Families in the study group had 20-fold higher uncompensated health care costs than did the comparison group. Mothers caring for a chil d assisted by technology reported less good mental health than did comparis on group mothers, and employment seems to mediate this relationship. Conclusions. Caring for a child assisted by technology seems to create barr iers to maternal employment diminishing family resources at a time when fin ancial needs actually may increase. Lack of family support and child care s ervices increase the likelihood that mothers of children assisted by techno logy will stay out of the labor force. Remaining employed buffers the negat ive effects of care at home on maternal mental health. Health policies for children with chronic health problems should address issues of financial bu rdens and the labor force participation of their caretakers.