Workforce Sustainability in Our Aging Society: Exploring How the Burden–Burnout Mechanism Exacerbates the Turnover Intentions of Employees Who Combine Work and Informal Eldercare

Abstract

Understanding the labor market participation shift associated with an aging population and the challenges of employees who provide care to old-age relatives is essential to ensure progress toward the Sustainable Development Goals. The current study focuses on the decision of employees who combine paid work with unpaid care to relatives aged 65 and above to stay or leave their jobs. We draw on the Turnover Model and the Informal Caregivers Integrative Model (ICIM) to examine how two primary stressors—care burden and work demand—one secondary stressor—work–family conflict—and emotional exhaustion increase the turnover intentions of employees who combine paid work with eldercare to their old relatives aged 65 and over. By synthesizing these two models and using a survey with three chronological waves among 356 Israeli employees, we analyze a mediation model within a Structural Equation Modeling framework. The findings underscore the fact that work–family conflict (a secondary stressor) and the sense of exhaustion act as key mediators in the relationship between employees’ primary stressors and turnover intentions. The presence of primary stressors in themselves does not increase turnover intentions. Our findings imply that, rather than providing sporadic adaptations at work, policymakers, organizations, and human resource management systems should respond proactively to prevent the process from undermining employees’ ability to achieve equilibrium between their desire to work and care for their old-age relatives. Such a proactive stance would reduce their exhaustion and turnover intention.

1. Introduction

Population aging has implications for the labor market participation of employees who struggle to combine paid work and a career with unpaid care for relatives aged over 65. Globally, by 2030, 1.4 billion people will be aged 60 or over, and by 2050, this figure is expected to rise to 4.1 billion [1]. This projected proportion of the older population has many implications for the sustainability of the jobs of workers who combine paid work with informal eldercare in their families, both for their organizations and for the wider labor market [2,3,4]. As increased longevity amplifies the need for care of older relatives by working family members [5], those employees with eldercare responsibilities will be exposed to real occupational costs [6]. More specifically, employees who combine paid work with care to old-age relatives (over 65) may consider leaving their own jobs to, first, fulfill their family eldercare obligations and, second, to alleviate the burden of the imbalance between work and eldercare. For these employees, care provision may come with a certain cost, since it is time-consuming, stressful, and physically exhausting, all of which can negatively affect their career, employment, and health [7]. Studies show that informal caregiving is associated with an increased willingness to leave the organization, to leave work altogether, or to give up working [8], since it enables an employee to pursue personal interests and fulfill family demands. Furthermore, we posit that it is crucial to investigate the factors that influence the intention of caregivers to leave their positions. In particular, we seek to expand our understanding of how the provision of eldercare is associated with strain, both in terms of the caregiver’s occupational status and the continuation of their career. Similarly, it is crucial to equip organizations grappling with the issue of employee turnover intention due to eldercare responsibilities with the empirical knowledge and practical insights they require to address this challenge effectively.

In organizational reality, turnover intentions describe employees who mentally quit work but physically remain in the organization [9]. Such ambivalence can negatively affect an organization’s productivity and profit [10] and increase the direct costs of recruiting, selecting, and training new staff [11]. The goal of this article, therefore, is to examine the burden–burnout mechanism predicting employee turnover intentions in the work–eldercare setting. Understanding those factors preventing this intentional stage remains pragmatically essential to researchers.

For a large proportion of employees in their mid-forties, concerns about caregiving commitments towards older relatives and the imminence of their own decision to retire rise with time. Thus, the potential psychosocial burden and stressors resulting from their dual responsibilities affect their retirement decisions [8]. In this regard, an emerging, multi-disciplinary stream of researchers has devoted effort to reveal the antecedents and outcomes of the work–eldercare conflict [12,13,14,15,16]. Scholars face two main challenges: first, to understand whether and how far the needs and hardships of employees who combine work and eldercare duties exceed their organizations’ response and, second, to recognize the factors affecting caregivers’ ability to reconcile work and eldercare responsibilities with occupational outcomes. This article focuses largely on the second challenge, namely, on how, from the micro-individual perspective of employees, the presence of objective and psychological stressors affects turnover intentions. Despite considerable scholarly effort about this topic, we still know little about the burden–burnout mechanisms that actually influence employees’ thoughts of quitting, their intention to search for a job elsewhere, or even an intention to quit the labor market entirely. The current study pursues this issue by examining the effect of primary and secondary stressors on individual burnout, which, in turn, increases turnover intentions. This focus on turnover intention is based on the notion that an individual’s intention is the best predictor of his or her actual conduct [17,18]. An employee with turnover intention may physically remain in the organization but mentally may have already quit [9], thus clearly reflecting negative economic costs for their organization. Our investigation tallies with studies indicating that, as an employee faces the competing demands of remaining productive at work while providing complex support to relatives or significant others, he or she is likely to experience work interruptions, opt for reduced labor force participation [19,20,21], reduce their working hours [22], and display a high prevalence of turnover intentions [23].

Our perspective is in line with other researchers on the work–family topic who have distinguished between care demands arising from children and eldercare demands [24,25,26,27]. The examination of the burden–burnout mechanism driving turnover intention is based on the integration of the Turnover Model [28] and the Informal Caregiving Integrative Model (ICIM) [29]. We maintain that to understand the extent to which stressors, burdens, and burnout affect employees’ turnover intentions in informal caregiving contexts, it is also necessary to model it within a comprehensive framework that also incorporates the cost–benefit perceptions of the individual. Accordingly, drawing on Turnover Model principles, we assume that while informal caregivers face the work–eldercare imbalance they may consider a set of conditions as decision criteria with regard to remaining in their job, changing to a new job, or exiting the labor market. In the case of older workers, such turnover may be considered as early retirement and can be expected to constitute the most prevalent reason for leaving the labor market. Using parts of the ICIM framework, the proposed research model examines how two primary stressors and one secondary stressor affect emotional exhaustion (as a form of burnout) and may result in general outcomes, in this case turnover intentions.

This article seeks to make three major contributions. First, in line with Montano and Peter [8], we attempt to account for variance in the turnover process among informal caregivers, thereby broadening our empirical reservoir on the role of primary and secondary stressors and exhaustion in increasing their turnover intentions. This article fills certain theoretical gaps and expands our understanding of the basic equation between care burden, job demand, and turnover intention by interrogating the mediating role of the work–family conflict and emotional exhaustion. Second, considering that knowledge in this area is scattered and eclectic [26], this study contributes by framing the work–eldercare conflict at the micro-individual level and exploring how psychological experiences are reflected in the actual working environment of employees with family care duties. In their life–work reality, informal caregivers are susceptible to work–family imbalances and find themselves juggling contradictory processes. In particular, they are constrained by a conflicting matrix of dual responsibilities—national policies that seem divided between the goal of supporting their work–life balance and trying to help them stay in the labor market but also recruiting them for their second responsibility as primary informal caregivers [30]. As a result, these employees become occupationally vulnerable. Third, our findings raised the discussion on how the work–eldercare imbalance relates to the sustainability of the workforce. Understanding how aging society shifts are associated with employability is critical to responding to the 2030 Agenda for Sustainable Development, particularly Goal no. 8, which focuses on promoting sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all [31]. As long as employers and organizations face a growing number of employees who experience work–life imbalances due to informal eldercare commitments, it will be more difficult to sustain the optimal employability of these workers. Given the rapidly aging demography worldwide and its consequences, any potential for increased inequality among employees with informal eldercare responsibilities is unsustainable. Continuing this line of thought, this study attempts to expand our empirical knowledge on the work–eldercare nexus in the broad context of the care deficit in our aging society. We maintain that more empirical research is needed to identify the factors that influence employees’ decisions to leave or reduce their employment due to the ongoing stress of balancing paid work and eldercare. In this regard, our findings offer insight for employers and organizations into how to prevent employees’ intention to leave their jobs due to their inability to balance their desire to work and care for their old-age relatives.

1.1. Theoretical Framework

This article synthesizes the Turnover Model [28] with the Informal Caregiving Integrative Model (ICIM) [29] to investigate the proposed research model. The Turnover Model is based on the caregiver’s cost–benefit perception since it refers to its expected gain in utility. Simply stated, employees with increasing eldercare responsibilities will exit the labor market if they expect to gain utility from doing so. The Turnover Model suggests a set of accumulative conditions behind the decision to remain in the job, change to a new job, or exit the labor market. In this regard, changes in daily working life may trigger a job search on the internal or external labor markets or (early) labor market exit. However, the Turnover Model covers only a part and specific aspect of the mechanism affecting informal caregivers’ intention to quit. The ICIM, thus, as a complementary framework, provides the emotional–psychological aspects (primary stressors, secondary stressors, and emotional exhaustion as a form of burnout) that shape caregivers’ turnover intentions. The development of the ICIM is based on the combination of the Job Demands–Resources Model from the occupation burnout literature and the Caregiving Stress and Burden Model [29] (p. 10). We used the ICIM conceptual framework, first, to explain the socio-psychological mechanism that determines informal caregivers’ burnout and, second, to predict one specific general outcome—turnover intention. Integrating these reciprocal aspects of the Turnover model and ICIM in the proposed research model enables us to introduce a more holistic picture of the mechanism determining a caregiver’s decision to stay or leave their job.

In this context, the Turnover Model is first used to predict the way informal caregivers exit the labor market if they thereby expect a gain in utility. Schneider et al.’s [32] theoretical explanations hold that “workers leave the labor market if the present value of expected net utility of exiting the labor market is greater than (a) the present value of the expected net utility of staying in the old job and (b) the present value of expected net utility from changing to a new job” (p. 1233). Along the same line of reasoning, we assume that informal caregivers, who consider that the ongoing burden and work demand they experience may be decreased if they realize their turnover intention, will justify such an intention as an expected gain. At a point of greater emotional exhaustion, they may consider a willingness to leave the organization, despite this not constituting their best occupational decision. A breaking point in this process may occur when the ongoing stress harms the equilibrium of work–eldercare, thus causing them to realize their intention to leave the organization, thereby achieving an “expected utility gain”. Second, the Informal Caregiving Integrative Model (ICIM) [29] is integrated in our proposed research model as it encompasses the different determinants of informal caregiver burnout together with its general outcomes. The ICIM is based on the integration of elements from the literature on both informal caregiving stress and professional burnout. The whole model introduces the importance of every category of determinants of informal caregiver burnout (relating to the caregiver, its setting, and the sociocultural context), with a key mediating role for the caregivers’ appraisal of their situation and their relationship with the care recipient [29] (p. 1). The ICIM emphasizes the importance of taking into account the full range of factors and elements at stake when considering the determinants of caregiver burnout, which in turn lead to general outcomes (which may emerge in response to or as a result of caregiver burnout). But, in the current study, we use certain aspects of the ICIM by illustrating how two primary stressors as objective elements in the caregiver setting (burden and work demand) and a secondary stressor (work–family conflict) lead to one derivative of burnout—emotional exhaustion—which in turn increases turnover intention. With this in mind, we now turn to discuss this linkage as presented in the research model (see Figure 1).

1.2. Turnover Intention among Informal Caregivers

Turnover intention refers to the subjective estimation of an individual regarding the probability that she/he will be leaving the organization in the near future [33] and has become widely recognized as the most significant predictor of individual turnover [34,35,36]. It is described as the last stage of cognitive withdrawal, whereby an employee takes active steps to search for alternative employment or to leave the organization. Tett and Meyer [37] define turnover intentions as “conceived to be conscious and deliberate willingness to leave the organization” (p. 262). Such conscious and purposeful willingness is usually measured in intervals of time (days, weeks, months, years) within which an individual decides to leave an organization. In the final stage, turnover refers to the voluntary or involuntary act of leaving an organization, occurring at a specific time which is explained by one’s actual physical separation from the organization [33]. In this respect, the conceptual linkage between intent and actual turnover has remained principal while studies rely on the vital link between attitude and behavior and, therefore, on the assumption that an individual’s intent is the best predictor of his or her actual turnover (see [17,18]). This study does not focus on the turnover act—the actual point of leaving of an organization which includes a time-specific event marked by physical separation from the organization. In accordance with previous work [38], we refer to the three elements in the withdrawal cognition process—(1) thoughts of quitting; (2) the intention to search for another job elsewhere; and (3) the intention to quit (p. 193). The work–family conflict and informal care literature discusses turnover intentions as one common outcome associated with caregivers’ burden, work–family conflict, and burnout symptoms [8]. One common factor causing increased informal caregivers’ turnover is the experience of symptoms of burnout [39] which result in a higher risk of leaving the workforce [12,24,26,40]. Studies indicate that providing informal eldercare is linked to four main negative factors, including increased personal stress, decreased health, work–family conflict, and work interruption [19,41], which, in turn, result in reduced labor force participation [21]. Also, time demands, the physical/cognitive care burden, and the current work environment shape caregivers’ intention to exit the labor market [32]. Different aspects of informal caregiving have been found to be associated with the intention to change jobs and with the anticipated withdrawal from the labor market by both male and female workers. The burden of physical care contributes to an intention to quit the labor market among males, while time-based conflicts between informal care and paid work are associated with a higher relative risk of job changes for female workers [32]. Considering that most informal caregivers are people lacking professional knowledge and with limited care-related training in performing the activities needed to meet the needs of care recipients, they therefore have higher potential to experience a care-induced burden. This burden is more prevalent among caregivers responsible for older-aged relatives diagnosed with Dementia [42].

1.3. Informal Caregivers’ Burden and Work Demand as Primary Stressors

In general, it is easier to manage the multiple responsibilities of work and caregiving when caregiving demands are met outside of work hours. However, frequently, caregiving involves unexpected interruptions to work. The increasing potential for changes in daily work routines, combined with the growing need to manage multiple tasks across the work–life–eldercare axis, creates specific types of stressors for informal caregivers. The current study covers two primary stressors—caregivers’ burden and work demand—as dominant elements of the caregiving and work setting likely to increase turnover intentions. Primary stressors are all the demands defining the caregiving role, and mostly they are referred to as an objective burden [29]. As pointed out in Sörensen’s Model of Carer Stress and Burden [43], primary and secondary stressors are two distinct constructs in the caregiving setting. In the primary stressors category, first, caregiver burden “encompasses the physical, social, psychological, and financial toll of providing care” [44] (p. 1247). Zarit et al. [45] explained caregiver burden as “the degree to which a carer’s emotional or physical health, social life or financial status had suffered as a result of caring for their relative” (p. 261). The literature studying its negative impact focuses on the concept of subjective burden which describes the subjective assessment of the stress that the helping situation can represent [46]. Based on these definitions, in this study, caregiver burden refers to a high level of physical, psychological, emotional, behavioral, occupational, and financial burden that may be experienced by informal caregivers who are caring for their older-aged relatives. We build on previous evidence that caregiver burden is associated with negative health, occupational, and social outcomes [47].

The second primary stressor is caregivers’ work demand, defined as “pressures arising from excessive workloads and typical workplace time pressures such as rush jobs and deadlines” [48] (p. 114). It is suggested that work demand may lead to work stress if it necessitates extra effort above the normal way of attaining work targets [49]. Namely, work stress occurs because of aspects of the job that require a worker to exert additional energy in order to perform. This study refers to perceived demand as “one judgment that goes beyond role overload” [50] (p. 102). Specifically, demand is also viewed as “a perceptual construct that accounts for an individual’s overall view of his or her role responsibilities. This includes pressures that originate from within the individual (e.g., the desire or motivation to accomplish specified work or personal goals) or from the environment (e.g., assigned level of role responsibility)” [50] (p. 103). We draw on the stream of researchers who implicitly indicate that increases in demand are a primary cause of work–family conflict [51,52,53,54,55]. While Boyar et al. [50] have mentioned that an individual may feel positive, negative, or neutral about his or her perceived demand level, the focus in this study is that an employee may feel that such increased work demand makes completing family responsibilities more difficult, potentially causing a conflict which is then attributed to work. This then leads to the following hypotheses:

H1: 

Caregiver burden and work demand will be positively related to work–family conflict.

H2: 

Caregiver burden and work demand will be positively related to exhaustion.

1.4. The Mediation Role of the Work–Family Conflict as a Secondary Stressor and Exhaustion

Secondary stressors are all the demands and resources caused by the primary stressors [29]. In the proposed research model, we refer to the work–family conflict as a secondary stressor. The proposed research model includes two mediators. The first is the work–family conflict which has been defined as “a form of interrole conflict in which the role pressures from the work and family domains are mutually incompatible in some respect. That is, participation in the work (family) role is made more difficult by virtue of participation in the family (work) role” [56] (p. 77). Considering the high cost of work–family disruption, high for both individuals and families [57], work–family imbalance among employees who provide informal family care has become a pressing societal issue [58]. Thus, there is broad and global discussion of this shared issue among researchers and policymakers who underscore the extent to which juggling work and informal eldercare increases work–family conflicts [30,59]. Studies provide consistent results on the personal, psychological, and professionally negative outcomes of work–family conflict among varied occupational groups. Regarding occupational outcomes, work–family conflict is significantly related to turnover intentions [60] and to actual turnover (see [53,61]). In terms of health and psychological outcomes, work–family conflict is also associated with psychological strain [23] and burnout [23,62]. Approximately a quarter of caregivers experience difficulties combining work and eldercare; a high burden is found as well to cause a poor sense of wellbeing, work-related strain, long-term sickness, and absenteeism (see in [47]). Based on the literature reviewed above, we hypothesize the following:

H3: 

Work–family conflict will be positively related to exhaustion.

The second mediator is emotional exhaustion, which is considered as a core dimension of burnout [63]. Burnout has been labeled by the WHO ICD-11 [64] as an occupational phenomenon and “is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”. Among the three dimensions of burnout, one is explained as “feelings of energy depletion or exhaustion” [64]. In our investigation, we refer to exhaustion “as intensive physical, affective and cognitive strain, as a long-term consequence of prolonged exposure to work stressors” [63] (p. 455). Following family care burnout studies showing that informal caregivers reported more emotional exhaustion [46], we assume that prolonged exposure to care, work, and family stressors leads to greater exhaustion and increased turnover intentions. This assumption is based on previous works on the relationship between emotional exhaustion, turnover intention, and withdrawal from the organization [65,66]. To explain this linkage, we draw on theoretical perspectives suggesting that employees engage in cognitive withdrawal as a way of coping, which then lessens the psychological costs of emotional exhaustion [67]. Under high levels of emotional exhaustion, employees are likely to exhibit turnover intentions because their ability to cope with this experience is overwhelmed; they then engage in withdrawal strategies, such as turnover intentions, to protect themselves from potential harm [66]. Based on the literature reviewed above, we hypothesize the following:

H4: 

Exhaustion will be positively related to turnover intention.

Based on the informal caregiver conditions described above, two mediation linkages in the proposed research model were developed. First, by defining the work–family conflict as a secondary stressor [46] leading to burnout and turnover intention, we assume that it plays a significant mediation role in the relationship between caregivers’ burden, work demand, and exhaustion. Namely, caregiving settings with a high level of burden and job demand represent a burden on the caregivers’ daily life and thus become a form of chronic stress [42]. As a result of the discussion above, we have established the following hypotheses:

H5: 

Work–family conflict will be positively related to turnover intention.

H6: 

Work–family conflict will mediate the relationship between caregiver burden and work demand and exhaustion.

Second, in the same vein, we assume that turnover intention occurs when an individual is unable to balance work with family demands and thus experiences ongoing emotional exhaustion. When employees are flooded with work–family conflict and exhausted, their personal resources are depleted and, as a result, to protect themselves from further damage to their well-being, they engage in withdrawal coping strategies [68]. Based on the literature reviewed above, we hypothesize the following:

H7: 

Work–family conflict and exhaustion will mediate the relationship between caregiver burden and work demand and turnover intention.

2. Materials and Methods

2.1. Study Design and Sample Size

A quantitative survey was used to collect the data. Working informal caregivers were invited to participate. An online survey was conducted using iPanel (http://www.ipanel.co.il/en/academic-research/ (accessed on 28 July 2024)), which permits access to diverse population segments in the Israeli labor market. Ipanel adheres to the most stringent ESOMAR criteria. The representative sample includes components that match with key characteristics in the entire population in the Israeli labor market (income, gender, sector, family status, geographical distribution, and religion). All participants were screened to ensure they combined paid work with informal care responsibilities for elderly relatives.

Power analysis was conducted using the G*Power 3 program [69] to determine the sample size. With alpha set at 0.05 and power set at 0.80, a minimum sample size of 309 participants was needed to detect a small-to-medium effect (f² = 0.05) using a regression model with eight predictors.

2.2. Participants and Data Collection

Survey data were collected among 500 employees at three chronological points separated by a lag of two months, and these proximal separation techniques were used to reduce the potential influence of common method bias [70]. More specifically, to ensure a rigorous method and more trustworthy findings, it is necessary to minimize the phenomenon of common method bias (CMB), which occurs in survey research when all data (independent variables, dependent variables, and mediating and moderating variables) are collected by using the same method [71]. One valuable and preferred strategy to control for CMB is to have a separation of the measures of the predictor and criterion variables [70]. By using a time lag separating measures and data collected at different times, we attempt to control for potential common method variance when collecting self-report measures from the same source. A survey measuring caregivers’ burden and work demand was distributed at the first chronological point, followed approximately two months later by a second survey measuring work–family conflict and emotional exhaustion, followed by a third survey measuring turnover intention two months later. T-tests were conducted to determine if there were significant differences in the research variables between those who responded to the questionnaire and those who did not respond to the questionnaire at different times. No significant differences were found in caregiver burden and work demands between those who participated in both Time 1 and Time 2 surveys and those who participated in the Time 1 survey only. In addition, no significant differences were found in work–family conflict and exhaustion between those who participated in Time 1, Time 2, and Time 3 surveys and those who participated in Time 1 and Time 2 surveys.

In the first wave of the online survey, a total of 500 employees completed the entire questionnaire. Following that, the second part of the survey was completed by 443 participants (an 89% response rate). Following that, the third part of the survey was completed by 383 participants (77% response rate). Demographic information was collected during the first wave. Post screening, 356 surveys were considered pertinent for the analysis, and 27 were removed due to apparent response irregularities or incongruities. Demographically, the sample included a proportional number of participants from all main geographical districts in Israel: 115 participants from central Israel, 81 from Tel Aviv, 34 from the northern district, 41 from Haifa, 37 from the southern district, 38 from Jerusalem, and 10 from Judea and Samaria.

The questionnaire was constructed based on several valid English questionnaires. The questionnaire was translated into Hebrew and back-translated into English to evaluate the accuracy of the Hebrew translation [72].

2.3. Ethical Considerations

This study was approved by the Yezreel Valley College’s Ethics Committee prior to conducting the research and data collection. After receiving relevant information and a brief explanation about the general purpose and content of this study, its procedure, and confidentiality, all participants agreed to participate voluntarily in this study. The participants were assured that the survey data would be used only for research purposes and that they could withdraw from participation at any stage.

2.4. Variables and Measurements

2.4.1. Demographic Characteristics

The demographic characteristics of the study participants included gender, age, marital status, number of children, employment, religiosity, education, and income.

2.4.2. Variables Related to the Care of the Elderly

The variables related to support and care for the elderly included the closeness of family ties to the elderly, the strength of the relationship between the subject and the elderly (on a scale of 1–10), the number of hours per week of treatment required, and the different types of support for the elderly (errands, cleaning, cooking, etc.).

2.4.3. Study Measures

The variables collected at Chronological Point 1—care burden and work demand as two different primary stressors:

Caregiver burden: Participants assessed burden using the short version of 12 items developed by Bédard et al. [73]. Items were obtained from the Zarit Burden Interview (ZBI) for the short and screening versions. As they underscore, reducing the number of items did not affect the properties of the ZBI and may lead to easier administration of the instrument [73] (p. 652). Sample items include the following: “Do you feel that because of the time you spend with your relative you don’t have enough time for yourself?”, “Do you feel that your health has suffered because of your involvement with your relative?”, “Do you feel that your relative currently affects your relationship with family members or friends in a negative way?” and “Do you feel uncertain about what to do about your relative?” All questions were answered as “never” (1), “rarely” (2), “sometimes” (3), “quite frequently” (4), or “nearly always” (5). The reliability estimate was α = 0.79, and in our study, α = 0.86.

Work demand: Participants assessed perceived work demand using Boyar et al.’s [50] five-item measure to rate their perceptions regarding demand levels within the work domain. Responses were recorded on a five-point Likert-type scale ranging from 1 = strongly disagree to 5 = strongly agree. Sample items include the following: “My job requires all of my attention”, “I feel like I have a lot of work demand”, “I feel like I have a lot to do at work”, “My work requires a lot from me”, and “I am given a lot of work to do”. The reliability estimate was α = 0.88, and in our study, α = 0.91.

The variables collected at Chronological Point 2—work–family conflict as a secondary stressor:

Work–family conflict: Participants rated work–family conflict using Carlson et al.’s [53] nine-item scale with three different subscales that measured the dimensions of work–family conflict: time-based WIF, strain-based WIF, and behavior-based WIF. Each of the scales in the three-dimensional model showed discriminant validity, internal consistency, and invariance of the factor structure across samples. Responses were recorded on a five-point Likert-type scale ranging from 1 = strongly disagree to 5 = strongly agree. Sample items include the following: “My work keeps me from my family activities more than I would like”, “When I get home from work, I am often too frazzled to participate in family activities/responsibilities”, and “Behavior that is effective and necessary for me at work would be counterproductive at home”. The reliability estimate was α = 0.87, and in our study, α = 0.91 for all nine items.

Exhaustion: Emotional exhaustion was assessed using a five-item version based on the MBI-GS scale [74]. Participants rated how often they felt they experienced symptoms of exhaustion on the job. All items were rated on a seven-point scale ranging from “never” (1) to “every day” (7). Higher scores indicated a higher level of emotional exhaustion. An example item is “I feel used up at the end of the workday”. The mean score of this scale was computed, with a higher score representing a higher level of emotional exhaustion. This instrument has been widely used and has demonstrated good reliability and validity (see [75]). Cronbach’s alpha of this scale was 0.93′, and in our study, α = 0.87.

The variable collected at Chronological Point 3 is the following:

Turnover intention: Turnover intentions were measured with a three-item scale developed to measure overall turnover propensity [76]. Based on Sjöberg and Sverke [77], the three items were “I am actively looking for other jobs”, “I feel that I could leave this job”, and “If I was completely free to choose, I would leave this job”. Responses were recorded on a seven-point Likert-type scale ranging from 1 = strongly disagree to 7 = strongly agree. The Cronbach’s alpha of this scale was 0.83, and in our study, α = 0.81.

2.5. Statistical Analysis

Using IBM SPSS Statistics 28.0 and AMOS 28.0, analysis was conducted for 356 respondents who answered the questionnaire at the three separate points in time. First, descriptive analyses were conducted to categorize the participants’ socio-demographic characteristics and variables that related to support and care for the elderly. Second, Pearson correlations were performed to explore relationships between the variables (work demand, caregiver burden, work–family conflict, exhaustion, and turnover intention). Finally, we tested the research model using SEM and quantified the extent to which the theoretical model fitted the data using the χ² test. A non-significant p value (p > 0.05) and the ratio of χ²/df < 2 represents an adequate model fit [78]. The Root Means Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), Tucker–Lewis Index (TLI), and Normed Fit Index (NFI) were also included, as recommended by Schreiber et al. [79]; the model is considered to fit the data well with a ratio of χ² to df ≤ 2, TLI ≥ 0.95, CFI ≥ 0.95, NFI ≥ 0.95, and RMSEA ≤ 0.06. The bootstrap method was used to provide standard errors (SEs) and significance tests of the indirect and total effects [80].

3. Results

3.1. Demographic Characteristics

This study included 356 participants. Their ages ranged from 45 to 68, with an average age of 54.0 (SD = 6.4). Most participants were male (63.8%), married (80.1%), and parents (91%) with an average of 2.9 children (SD = 1.7). Most participants reported that they are secular (54.5%) or traditional (32.6%). In addition, most of the participants have an academic education (31.7% have a bachelor’s degree and 25.0% have a master’s degree or higher). Moreover, most of the participants are full-time employees (71.3%) and earn an average salary (household income) of NIS 17,547 (SD = 21,052; range = 1500–250,000). The sample demographic characteristics are reported in

Table 1. Demographic characteristics of the sample (N = 356).

		N	%	M	SD
Gender	Woman	129	36.2%
	Man	227	63.8%
Age	45–49	112	31.5%	54.0	6.4
	50–54	87	24.4%
	55–59	72	20.2%
	60–64	59	16.6%
	65–68	26	7.3%
Marital Status	Married	285	80.1%
	Single	22	6.2%
	Divorced	45	12.6%
	Widower	4	1.1%
No. of Children a	0	31	8.7%	2.9	1.7
	1	27	7.6%
	2	82	23.1%
	3	119	33.5%
	4	43	12.1%
	5–6	42	11.8%
	7–8	10	2.8%
	12	1	0.3%
Employment	Part-time employee	52	14.6%
	Full time employee	254	71.3%
	Self employed	50	14.0%
Religiousness	Secular	194	54.5%
	Traditional	116	32.6%
	Religious	36	10.1%
	Very Religious	10	2.8%
Education	High school	27	7.6%
	Professional training	127	35.7%
	Bachelor’s degree	113	31.7%
	Masters’ degree or higher	89	25.0%
Income	1500–9500	68	19.1%	17,547	21,052
	10,000–14,500	90	25.3%
	15,000–19,500	101	28.4%
	20,000–24,500	53	14.9%
	25,000–29,500	20	5.6%
	30,000 and above	24	6.7%

Abbreviations: M, Mean; SD, standard deviation. ^a Missing: 1 (0.3%).

.

3.2. The Care and Support of the Elderly

Most of the participants take care of a parent (74.7%), and the rest take care of a spouse’s parent (8.7%), an uncle or cousin (7.0%), a spouse (3.1%), a grandparent (2.0%), a friend (1.7%), or a sibling (1.4%). Most subjects feel that their relationship with the elderly is strong and meaningful (M = 8.7, SD = 1.5). The scope of support for the elderly is M = 11.2, SD = 12.1. In addition, the main support for the elderly takes the form of errands (89.9%), purchasing products (77.1%), and repairs (58.4%).

3.3. Correlations between Study Variables

Correlations between all the variables were explored and are reported in

Table 2. Pearson correlations, Cronbach’s alpha, means, SDs, and possible ranges of the study variables (N = 356).

	1	2	3	4	5	6	7	Cronbach’s Alpha	M	SD	Range
1. Work demand 1	1							0.914	3.77	0.81	1–5
2. Caregiver burden 1	0.12 *	1						0.885	2.24	0.67	1–5
3. Work–family conflict total 2	0.24 **	0.33 **	1					0.914	2.40	0.89	1–5
4. Work–family conflict time 2	0.22 **	0.30 **	0.88 **	1				0.883	2.36	1.05	1–5
5. Work–family conflict strain 2	0.21 **	0.34 **	0.91 **	0.77 **	1			0.886	2.41	1.03	1–5
6. Work–family conflict behavioral 2	0.19 **	0.21 **	0.80 **	0.51 **	0.58 **	1		0.842	2.42	1.01	1–5
7. Exhaustion 2	0.22 **	0.24 **	0.65 **	0.55 **	0.66 **	0.47 **	1	0.869	2.86	1.36	1–7
8. Turnover intention 3	0.09 *	0.11 *	0.31 **	0.27 **	0.33 **	0.21 **	0.37 **	0.806	3.31	1.65	1–7

Abbreviations: M, mean; SD, standard deviation. ¹ time 1; ² time 2; ³ time 3. * p < 0.05; ** p < 0.001.

. As can be seen in Table 2, all correlations are positive and significant. In particular, there was a significant positive correlation between exhaustion and turnover intention (r = 0.37), between work–family conflict and turnover intention (r = 0.31), between work demand and work–family conflict (r = 0.24), between work demand and exhaustion (r = 0.22), between caregiver burden and work–family conflict (r = 0.33), between work–family conflict and exhaustion (r = 0.65), and between caregiver burden and exhaustion (r = 0.24). The correlations between work demand and caregiver burden and turnover intention are weak (small effect size).

3.4. Structural Equation Modeling for Examining Relationships between Study Variables

To test the research model, we first conducted a Confirmatory Factor Analysis (CFA) to examine the factors of the work–family conflict. We tested two models: a one-factor model and a three-factor model. The one-factor model did not fit the data well. The results of the “goodness-of-fit” indices were as follows: χ² = 360.73; df = 27; p < 0.001; χ²/df = 13.36; RMSEA = 0.187; CFI = 0.841; TLI = 0.789; and NFI = 0.831. In contrast, the three-factor model fit the data very well. The results of the “goodness-of-fit” indices were as follows: χ² = 30.00; df = 24; p = 0.185; χ²/df = 1.25; RMSEA = 0.027; CFI = 0.997; TLI = 0.996; and NFI = 0.986.

SEM was used to examine the research model, controlling for two background variables (age and relationship) that were found to be significantly correlated with the dependent variable, turnover intention, and with the mediating variables, work–family conflict and exhaustion. The model is described graphically in Figure 2. The model fits the observed data very well, as seen in the goodness-of-fit indices: χ² = 15.96; df = 12; p = 0.193; χ²/df = 1.33; RMSEA = 0.030; CFI = 0.995; TLI = 0.985; and NFI = 0.981.

The estimates of direct, indirect, and total effects are reported in

Table 3. Direct, indirect, and total effects of the model (N = 356).

	Work–Family Conflict			Exhaustion			Turnover Intention
	Effect	SE	95% BC CI a	Effect	SE	95% BC CI a	Effect	SE	95% BC CI a
Direct effects
Caregiver burden	0.41	0.07	[0.26, 0.57]	−0.03	0.09	[−0.19, 0.16]	−0.03	0.12	[−0.27, 0.22]
Work demand	0.21	0.06	[0.10, 0.35]	0.11	0.08	[−0.04, 0.28]	−0.00	0.12	[−0.22, 0.22]
Work–family conflict	–	–	–	1.07	0.09	[0.89, 1.26]	0.31	0.17	[−0.04, 0.58]
Exhaustion	–	–	–	–	–	–	0.30	0.09	[0.12, 0.50]
Indirect effects
Caregiver burden	–	–	–	0.44	0.08	[0.28, 0.61]	0.25	0.07	[0.13, 0.39]
Work demand	–	–	–	0.23	0.07	[0.10, 0.38]	0.16	0.05	[0.08, 0.28]
Work–family conflict	–	–	–	–	–	–	0.32	0.10	[0.15, 0.55]
Total effects
Caregiver burden	–	–	–	0.41	0.10	[0.22, 0.62]	0.22	0.12	[−0.03, 0.46]
Work demand	–	–	–	0.33	0.09	[0.16, 0.49]	0.16	0.11	[−0.07, 0.40]
Work–family conflict	–	–	–	–	–	–	0.63	0.13	[0.37, 0.87]

^a Boldface type highlights a significant effect as determined by the 95% bias-corrected confidence interval (95% BC CI). SE = standard error.

.

As can be seen, while caregiver burden and work demand had no direct effect on exhaustion, they did have an indirect effect through work–family conflict [indirect effect = 0.44, SE = 0.08 CI = (0.28, 0.61) for caregiver burden and indirect effect = 0.23, SE = 0.07 CI = (0.10, 0.38) for work demand]. These results indicate that work–family conflict mediated the association between caregiver burden and work demand and exhaustion. In addition, while caregiver burden and work demand had no direct effect on turnover intention, they did have an indirect effect through work–family conflict and exhaustion [indirect effect = 0.25, SE = 0.07 CI = (0.13, 0.39) for caregiver burden and indirect effect = 0.16, SE = 0.05 CI = (0.08, 0.28) for work demand]. These results indicate that work–family conflict and exhaustion mediated the association between caregiver burden and work demand and turnover intention, whereby caregiver burden and work demand were positively associated with work–family conflict (β = 0.32, p < 0.001; β = 0.20, p < 0.001, respectively), which, in turn, was positively associated with the participants’ exhaustion (β = 0.67, p < 0.001), and which, in turn, was positively associated with turnover intention (β = 0.25, p < 0.001).

4. Discussion

By integrating the fundamental premises of the Turnover Model [28] and the Informal Caregivers Integrative Model (ICIM) [29], this study set out to examine the manner by which employees’ two primary stressors—caregivers’ burden and work demand—jointly influence turnover intentions via secondary stressors—work–family conflict and emotional exhaustion. The proposed research model helps explain the burden–burnout mechanism that leads to turnover intentions in a more holistic framework. Based on data from 356 employees who combine work with eldercare, we found that caregiver burden and work demand increase an individual’s work–family conflict, which, in turn, augments their sense of exhaustion and, consequentially, aggravates turnover intention. This study contributes to theory and research in various ways.

First, it contributes to an emerging stream of research on informal caregivers and work–care conflict by focusing on the micro-individual level of employees. Our findings support the importance of the repeated calls from prominent organizational behavior, occupational psychology, family, gerontology, and aging policy scholars [12,13,14,15,16,27,81,82] to investigate the conditions of employees and organizations who are clearly and inevitably confronting the organizational–occupational–personal challenges tied to an aging society. In fact, the findings lend full support to our research hypotheses and, therefore, fill part of an existing gap in the work–family conflict literature regarding the way eldercare and work-related conditions increase turnover intentions among employed caregivers. As found, work–family conflict and emotional exhaustion constitute a consistent mediator between caregiver burden, work demand, and turnover intentions. By confirming H1 and H2, the analysis shows that employees with a high level of primary stressors such as care burden and work demand are likely to display enhanced levels of three dimensions of conflict due to work interfering with family: time-based work interference with family, strain-based work interference with family, and behavior-based work interference with family. These findings support previous studies indicating that caregiver burden positively relates to work–family conflict [83] and that work demand is associated with work–family conflict [84]. Theoretically, these links can be explained by drawing on Hobfoll’s [85] perspective of personal resources which holds that high levels of demand at work require employees to focus personal resources in this area, thus leaving fewer resources to handle demand in other areas, such as those in the family domain. Our findings suggest that the work demand of employed caregivers leads to significant strain as it limits the time and energy available to be devoted to eldercare, and vice versa, resulting in conflict between the two domains.

The findings also confirm H3 and support previous studies indicating that the health and psychological outcomes of work–family conflict are associated with psychological strain [23], burnout in different occupational settings [62,86], and particularly exhaustion [87]. In this regard, while in previous informal caregiver studies emotional exhaustion is often highlighted under the heading of general exhaustion [46], our examination specifies the type of exhaustion that occurs in work and job settings at both the physical and mental levels while predominantly emotional in nature. Following this direction, the findings also confirm H4 and show that emotional exhaustion is a key factor for turnover intentions and therefore add to the growing body of literature linking burnout to turnover intentions in different work settings (see [11]). Specifically, we found that caregivers’ feeling of overload, of no longer being able to carry on, and of being emotionally drained when facing a caregiving situation [88] increase their willingness to leave the organization. The findings also confirm H5 which assumes that work–family conflict is related to turnover intentions and, thus, support previous studies showing that when work strain interferes with family responsibilities and personal activities, employees seek to adjust their continuing conflict and respond by raising the question of leaving their organization [11,89,90]. These findings extend previous studies on work–family conflict (i.e., [83]); however, one should bear in mind that we focus solely on one direction—work interference with family—and its three dimensions—strain-based, time-based, and behavior-based—associated with caregivers’ emotional exhaustion. That said, both work demand and care burden imply special restrictions and conflicts in the daily lives of employees. In this process, while caregiving becomes more burdensome and work demand adds stress over time, employees are faced with emerging contradictory expectations from both dominant roles, and in particular, they experience increased work–family conflict.

The findings fully support the two mediation hypotheses H6 and H7 and show that informal caregivers’ turnover intentions occur as a result of two primary stressors—work demand and caregiver burden—and are due to secondary stressors and burnout. As found, work–family conflict and exhaustion are distinctly key mediators. The presence of primary stressors in themselves does not increase turnover intentions among employed caregivers. That is, in the absence of these two mediators, the association between primary stressors—caregiver burden, work demand, and turnover intention—is weak. This implies that, for some employees, work demand is not solely predictive of negative outcomes. Demand may be perceived as neutral or even positive. Namely, some individuals may identify with demands resulting from work or family domains as integral parts of their personal identity, reflecting a belief that these roles imply or require such demands [50]. We conclude the mediation finding by highlighting that the turnover intentions of employed caregivers are experienced primarily through work–family conflict and, second, through emotional exhaustion.

As a second contribution, this article addressed Schneider et al.’s [32] call to expand our knowledge about “which aspect(s) of informal eldercare affect job and labor market attachment in which ways, and to what extent workplace characteristics matter in this context” (p. 1231). Following their suggestion that there are several dimensions of informal eldercare that could play a role in linking work and eldercare (i.e., time demands, physical care burden, cognitive demands of multitasking, or emotional strain of caring), we have responded by incorporating four dimensions in our research model to explain the burden–burnout mechanism that leads to turnover intentions. Specifically, we empirically investigated how two primary stressors—caregivers’ burden and work demand—jointly increase turnover intentions via secondary stressors—work–family conflict and emotional exhaustion.

Third, this study provides initial theoretical evidence regarding the validity of parts of the Turnover Model [28] and the Informal Caregiving Integrative Model (ICIM)’s [29] assumptions. Yet, there are hardly any studies examining the impact of informal eldercare on a set of different simultaneous labor market choices or intentions [32], particularly within the Turnover Model or ICIM context. Our results provide support for the core tenets of the Turnover Model [28] and specifically support the notion that informal caregivers will display more willingness to leave the organization if they thereby expect a gain in utility. The findings expand this assumption by showing that in the presence of primary objective stressors, increased work–family conflict and exhaustion feelings, the present value of the expected net utility of the intention to leave the job is greater. Thus, this study enriches the Turnover Model in two ways. First, it links its discussion to work–family conflict, psychological stressors, and burnout. Second, the findings open avenues to fresh interpretations of Schneider et al.’s [32] theoretical explanations. Namely, based on the findings, we suggest the following pattern—when informal caregivers experience persistent burdens, stress, and exhaustion that undermine the equilibrium between work and eldercare, this set of conditions, cumulatively, shapes their cost–benefit approach to the decision to change jobs or leave the labor market in terms of “expected utility gain”.

This study also enriches the ICIM in three ways. First, our findings largely provide support for specific core linkages of the ICIM [29]. While the ICIM suggests that the general outcomes of the caregiving impact are twofold, on the caregivers themselves and on the care recipient, under this classification, our findings empirically confirm turnover intentions as outcomes only at the caregiver level. Second, extending the ICIM, we confirm that informal caregiver exhaustion, as one dimension of burnout, functions as a key mediator between primary stressors and caregivers’ outcomes. But rather than providing additional support for burnout as a key element in the ICIM, our findings underscore that one specific dimension of burnout—emotional exhaustion—predicts informal caregivers’ turnover intentions. Third, the examination of the mediating role of work–family conflict as a secondary stressor responds to Gérain and Zech [29] who note that “secondary stressors are often investigated less than primary stressors when exploring caregiving stress and its impact” (p. 7). In developing their theoretical framework, they also noted that future research should therefore focus not only on the objective stressors but also on what they entail (i.e., secondary stressors) and examine what they represent for the caregivers. Our findings confirm that work–family conflict, which is classified as secondary stressor, affects a specific outcome—exhaustion—which, in turn, increases turnover intention as a general outcome at the informal caregiver level. While a vast body of research on the work–care interface has examined the relationship between eldercare responsibilities and caregivers’ labor market participation [2,26,27,32,87,91,92], only a small body of research on the impact of caregiving on employment is devoted to a detailed consideration of the ICIM.

Considering that scant studies examine our synthesized research model, the findings from the Israeli case extend both the Turnover Model [28] and the ICIM [29] by testing the proposed theoretical arguments in the Israeli context of demographic change and its aging society.

In sum, the fact that most informal caregivers are also employed, thus managing multiple role demands [83] while experiencing psychological stressors, facing ongoing work–family conflict, and paying high costs in psychological, social, and occupational terms, creates a compelling case for further research.

Limitations and Future Research

Despite the strength of our findings, several important limitations of the present investigation should be considered in future explorations in this field. First, since the data were all derived from self-reports (obtained from the same source—employees), they are also open to concern about common method variance [93]. Considering our research question and key variables (i.e., perceived care burden, work demand, work–family conflict, and exhaustion), however, self-reporting was deemed the most appropriate way to understand the factors increasing turnover intentions. The temporal separation of variables is an effective means to reduce method biases [94], but common method bias risk could not be fully eliminated despite collecting data in three waves.

Second, the impacts on caregivers’ burden may differ as a function of the nature of the care responsibilities. An important limitation of our research model is that it does not examine the positive aspects of informal caregiving and focuses only on the negative personal outcomes associated with the burden–burnout mechanism. Combining paid work and caregiving need not only be investigated as a burden with negative psychological and occupational outcomes. It may, in fact, provide working informal caregivers with a sense of personal growth and challenge [91]. Future longitudinal research designed to integrate both positive and negative aspects will contribute to a more multifaceted understanding of the complex effects of caregiving while employed. Such new avenues of research should consider whether paid work roles offer caregivers a respite from their caregiving role rather than increasing work–family conflict or the conditions in which providing eldercare could bring satisfaction, a sense of personal resilience, and work enrichment while evoking a sense of purpose and accomplishment.

Third, the exclusion of self-employed caregivers might hamper the generalizability of the findings (see [47]). In the current sample, 50 (14%) informal caregivers reported being self-employed. Given that self-employed caregivers may possess greater flexibility in arranging their paid work schedule [95], additional investigation is needed to understand whether this cohort differently manages the combination of informal care and paid work.

Fourth, our findings reflect responses from Israeli informal caregivers, and it should be considered that late-career employment decisions depend not only on caregivers’ own attitudes towards work and career but also on the social norms determining the individual’s responsibility for caring after older-age relatives who require help with daily living activities or permanent nursing care. In the Israeli case, where home and family serve as sources of honor and respect, family is the major component of a meaningful life, a quality shared in both Jewish and Arab traditions [96,97,98]. Cultural variation between social norms and family contexts means that our findings may not be universally applicable.

5. Conclusions

Caregiving is associated with an increased desire to completely give up employment [8]. The present article contributes to previous research by underscoring the fact that work–family conflict (work interfering with family—time-based, strain-based, and behavior-based) and exhaustion are, distinctly, key mediators, since the presence of primary stressors in themselves does not increase turnovers intention among employed caregivers. In sum, the main strengths of our investigation are as follows: (1) it expands the analysis of informal caregivers’ occupational and psychological stressors that predict turnover intentions; (2) it demonstrates a more holistic understanding of the burden–burnout mechanism behind caregivers’ willingness to leave their organization or work by underlining the important mediating role of work–family conflict and exhaustion; (3) it illustrates the role of two primary objective stressors (care burden and work demand) in enhancing secondary stressor work–family conflict; (4) it adds to the theoretical conceptualization of the ICIM with regard to the role of “burnout as a key mediator between stressors and outcomes” [29] (p. 4); and (5) it provides evidence regarding the validity of the Turnover Model’s arguments [28]. In view of the fact that our aging society has placed unprecedented demands on working family members, this study considers it imperative to investigate the extent to which the primary and secondary stressors along the eldercare–employment axis affect personal wellbeing, turnover intentions, and related occupational costs.

6. Practical Implications

Increased longevity implies that employees and organizations are inevitably confronted by the occupational challenges tied to an aging society and eldercare within the family context. Long-term care policies worldwide rely heavily on the provision of informal eldercare, predominantly by families who also participate in the labor market. At the employee level, where informal caregivers lack the necessary support, resources, and social protection, their turnover intention is likely to increase. Ongoing work–informal eldercare imbalance makes them vulnerable and jeopardizes their job and careers. More specifically, an inability to reconcile their desire to work and fulfill family obligations by providing care for their old-age relatives may raise turnover intentions—where they mentally quit work but physically remain in the organization [9]. From an organizational standpoint, this phenomenon encompasses both direct and indirect costs stemming from reduced employee availability for work, whether due to psychological, mental, or physical constraints. At the macrolevel, the increasing phenomenon of individuals of working age leaving the labor market to fulfill eldercare responsibilities is a significant challenge to the sustainability of the workforce.

The findings of the current article highlight the fact that, within the work–eldercare context, employees’ primary stressors, work–family imbalance, burnout episodes, and turnover intention, are intertwined outcomes at the microlevel of the individual. Based on previous findings highlighting how the “lack of formal HR policies around eldercare within organizations results in a reliance on supervisory discretion” [27] (p. 1460), this article offers some recommendations for organizational-level strategies and HRM regarding ways to respond to the process harming employees’ ability to achieve equilibrium in two core aspects of modern life: family and employment. First and foremost, managers in organizations should be aware of the importance of designing HRM practices which support employability and the intention of employees to remain at work (see [97]). Thus, it is essential to take into account the fact that increased care burden and work demand not only spill over to the work–family conflict and influence emotional exhaustion. Both work and family and eldercare roles compete for one’s time, wellbeing, personal obligations, energy, and behavior, often creating conflicts between them. In this context, organizations and HRM may survey work–family centrality and other burnout as potential moderators to help evaluate the effectiveness of efforts to monitor work demand. HRM may assimilate family-friendly open discourse and implement personal-tailored programs that help employees to balance work and duties for eldercare. Such personal programs may identify specific sources of stressors on the work–eldercare axis and proactively respond appropriately, for example, by adjusting resources, offering job-related support and job control (reducing work demand and workloads, limiting the number of roles or tasks assigned to employees), encouraging colleagues and supervisors to support the completion of work assignments, and offering consulting resources to reconcile multiple responsibilities.

Organizations and HRM should assimilate the idea that employees who juggle paid work and unpaid informal eldercare fulfill normative personal and social obligations. This group of employees constitutes a cornerstone for aging in place and long-term care policies implemented in most developed economies [99]. But, while these informal caregivers may help contain public expenditure, these costs are borne elsewhere [99] and are reflected in barriers to career and labor market participation [100]. Organizations should direct their efforts along a twofold path: First, they should place awareness of the issue on the broader public agenda by calling on decisionmakers to demonstrate leadership at the policy level. Second, they should concentrate on an organizationally friendly eldercare environment, since eldercare programs are still less frequently offered than childcare programs. Specifically, organizations should build clear programs designed to account for those predictors likely to increase turnover intention among employees with eldercare responsibilities, thus avoiding the aggravation of turnover intentions and thereby cultivating more productive, equitable, and aging-friendly workplaces for employees of all ages.

In conclusion, the subsequent stages of the process and the associated policies should ensure the sustainability of work for all parties. They should guarantee that workforces are resilient, focused, and prepared for the future of our aging societies.