**3.1 Personal characteristics**

Caregivers in this study are within the age range of 18–35 years old (See **Table 1**). Majority of the caregivers belong to a younger age cohort of 18–23. In terms of educational attainment, most caregivers finished a bachelor's degree in college while other caregivers only finished high school. For religious affiliation, most caregivers


## **Table 1.**

*Personal characteristics of caregivers.*

*Motivation and Social Support Received in Elderly Care: The Case of Geriatric Palliative… DOI: http://dx.doi.org/10.5772/intechopen.93938*

are practicing the religion of Catholicism. Caregivers in this study averages to earn a salary of Php7, 417 monthly. Most monthly income of caregivers fall under the category of 5000–10,000 (75.0%) a month while other caregivers receive 11,000–15,000 a month.

Caregivers have various jobs before working at the nursing home. Majority of the informants come from medical and non-care related jobs before entering the career of being a caregiver (See **Table 2**). Medical related jobs involve nursing and pharmacy while non care related jobs pertain to canteen personnel, station personnel, receptionist, and farming. Provision of care delivery related jobs pertain to being a maid/helper, and being a caregiver. Other caregivers are also seen to have no prior work before entering the nursing home.

#### **3.2 Motivations in caregiving**

Caregivers have mentioned numerous reasons in doing their jobs. This refers to specific reinforcements that push caregivers while working. The identified motivations for caregiving are classified according to intrinsic motivation and extrinsic motivation (See **Table 3**).

Intrinsic motivation refers to the kind of reinforcements that are internal in nature which focuses on the inherent stimulus of caregivers. Majority of the caregivers cited emphatic reasons as intrinsic motivation. Emphatic reasons such as framing a thought that patients can be family are mentioned. Caregivers stated that this kind of reason is a powerful motivational force in caring for their patients.


#### **Table 2.**

*Previous jobs of caregivers.*


Most caregivers claim that they are more motivated to work because they feel that they are actually caring for their parents or grandparents. This scenario was pointed out by majority of the caregivers.

*"I even call them my grandparents. I became very close to them because of that. I actually see my grandparents in them. I even treat them as if they are my family"*

*"I see my parents in them. With that, I more motivated to care for my patients because sometimes I treat them as my own parents."*

This finding is reflected on the idea that Filipinos give utmost priority to close family ties [22]. Caregivers are seen to treat patients as family as a motivation to care for them. Caring for family is a strong motivational force for Filipinos [23]. This emphatic reason is also reflected by Selected Investment Theory (SIL). This theory talks about how social bonds and close relationships drives motivation in giving priority for the betterment of the other [7]. In the case of the result, caregivers having patients as a form of a family provides motivation that makes them suppress personal goals and preferences to promote and give priority on the well-being of the patient.

Emotional reasons are also frequently stated as an intrinsic motivation by most caregivers. This refers to the feeling of concern, care, and love among caregivers to their patients. Most caregivers are found to be assigned to one to two patients in the nursing home. Caring for these patients makes the caregivers attached because there are times that the caregivers want to see their patients happy all the time. Some informants say that they also become sad if their patients are not satisfied or happy. These are true to the majority of the caregivers in the nursing homes.

*"I am more motivated to care for my patients when I see them sad and depressed. I do not want to see them sick. I feel depressed also when they are not happy."*

Having emotional attachment as a motivation is seen as a protective behavior among caregivers. This attachment is seen also to create a strong bond that urges the caregivers to help and increase their wellbeing due to their situation [24]. This attachment is seen to be a two way relationship between the caregiver and the patient. Caregivers feel accomplished when their patients are happy. Emotional attachment to patients is indeed effective in pursuing their fulfillment and good quality well-being [10].

Another classification for the motivations for caregiving among caregivers is extrinsic motivation. This classification of motivation refers to reinforcements that can be seen or tangible in nature which are in the form of different incentives. Majority of caregivers answer having good salary as an extrinsic motivation. This salary is used to help their families to have financial stability.

In some instances, caregivers admitted to have violated some rules and regulations of the institution. With that, sanctions are also an extrinsic motivation for caregiving. These punishments refer to a deduction in salary, warnings and scolding from their superiors, and even expulsion from the nursing home. In that sense, caregivers are expected to have proper decorum and must follow the rules and regulations of the institutions in order not to be reprimanded by their superiors. Also, some caregivers responded that all must follow their superiors because every caregiver in the institution is to be reprimanded. Caregivers are then motivated to work because they do not want to experience these kinds of institutional punishments. This is true in some caregivers.

*Motivation and Social Support Received in Elderly Care: The Case of Geriatric Palliative… DOI: http://dx.doi.org/10.5772/intechopen.93938*

*"Sometimes we experienced being reprimanded by our superiors. If one gets scolded, everyone receives a penalty that is why all of us are motivated to work in order for us to not experience those punishments."*

Negative reinforcement could lead to counterproductive workplace environment among workers according to the study of Kreps [13]. However, based on the results mentioned, caregivers are motivated to work harder not to be reprimanded and experience negative reinforcement. With that, these institutional punishments can be very effective in managing workers in an organization. It is seen as an effective tool for workers to comply with their job roles in the company or organization.

#### **3.3 Social support received by caregivers**

While tending to their patients, caregivers receive different kinds of encouragement from different social actors. Social support ensures that caregivers are motivated and satisfied with their current situation. Social support received by caregivers is classified into two categories, social support structure and social support function.

#### *3.3.1 Social support structure*

Caregivers receive different kinds of support from different social entities. Social support is a coping resource as well as assistance coming from other individuals [14]. Social support structure refers to the people or social actors supporting caregivers in doing their job. According to Wills [17], it measures the quantity or the extent of which an individual is connected to a social network. This category of social support measures the size, frequency, or density of a social network of an individual [18]. The identified social support structure is classified according to proximal social support and institution based support (See **Table 4**).

Caregivers are mentioned to be surrounded by individuals in the nursing homes. These individuals are seen to encourage the caregivers in doing their job. This refers to proximal social support. Majority of caregivers responded that their colleagues are the most proximal in terms of social support. The colleagues of the caregivers are seen to be a significant support by means of encouragement and provision. Also, caregivers and their colleagues converse about their personal and work related problems. This conversation sets as a way of supporting one another to resolve certain kinds of personal and work related problems. According a female caregiver,


*"Most of the time, my colleagues and I talk about our problems. We then help each other at the same time."*

**Table 4.** *Social support structure.*

The patients of the caregivers are also seen to give social support. Caregivers admitted that their patients also tend to encourage and support them. While caregivers are tending to the needs of their patients, it is also seen that these health care workers converse with their patients about personal and work problems. Additionally, caregivers experienced different kinds of encouragement and support from their patients if their caregiver is feeling stressed and problematic. Patients tend to talk to their caregivers about their problems and that patients give encouraging advice to their health care providers in facing their problems. It is seen to be an effective social support because of the feeling that their patients are mutually responsive to certain conversations about their personal and work related problems. According to a young caregiver,

*"Our patients tend to make us feel very comfortable when we talk to them about our problems. Even though they are a bit old, they can still comprehend and connect to our present situations."*

The institution is also seen to be a source of social support. Caregivers tend to receive different kinds of help from the institution itself. The institution is seen to be required to help their caregivers in terms of work related problem. Moreover, superiors are expected to encourage caregivers in their work. This is true to some caregivers in the nursing home.

*"Our superiors taught us everything that we need to do in this nursing home. They serve as our teachers at the same time. They are always there when we need them."*

Having colleagues, family, patients, and other institutional entities as social support is beneficial among caregivers. According to a study by Lau et al. [14], having support from various sources may lead to better wellbeing and good quality of health among individuals. Having different entities as social support systems is beneficial on the part of geriatric palliative caregivers.

#### *3.3.2 Social support function*

The function of social support refers to the quality or functional aspects of social support received by caregivers that looks on the roles of their social network provides. The identified social support function received by caregivers are classified into two, intangible support and tangible support (See **Table 5**).

Caregivers receive support that is seen as an encouragement in boosting their psychosocial wellbeing. This refers to the intangible support caregivers receive. This encouragement pertains to the cognitive kind of support that boosts the moral and behavior of caregivers in their personal and work related life. Social support functions as a boosting stimulus to encourage caregivers when feeling depressed or having personal problem. Majority of the caregivers responded that they are


#### *Motivation and Social Support Received in Elderly Care: The Case of Geriatric Palliative… DOI: http://dx.doi.org/10.5772/intechopen.93938*

mostly encouraged emotionally by the social support they receive. This refers to emotional support. This kind of support indicates that caregivers experience a boost or encouragement on their emotional well-being from different social actors. Conversing with different social actors serves as a way of encouragement for the caregivers to solve their personal and work related problems. According to a female caregiver,

*"We help each other in this nursing home, if there is someone who needs help; we opt to help them so that they would not get depressed. Even our patients tend to talk to us so that we would not be sad. They would even make us happy. I feel very encouraged when our patients are happy because of our work."*

Information support among caregivers is also cited to be a significant social support function. Different social actors are seen to assist caregivers by giving certain kinds of information most especially to the profession of health care. This kind of social support refers to informational gain support. Most caregivers answered that it is a very important social support they receive. The purpose of informational support is to increase the knowledge of caregivers in tending to their patients. Caregivers admitted that the institution and their colleagues help one another in doing geriatric palliative care to their patients.

*"We tend to help each other especially if our colleagues need help with their patients. Sometimes, I tend to seek help from them if I do not know what to do. Even our superiors teach us if we do not know what to do."*

Another classification of social support function is tangible support. This refers to the support that can be seen and used by caregivers. This also serves as an encouragement that can be used externally compared to intangible support functions. Most caregivers receive monetary support from different social actors as reinforcement. This is mostly seen by the support given by the institution to the caregivers.

In-kind support also is a kind of tangible support received by caregivers. This refers to food, supplies, and different tangible encouragement given to caregivers. These are mostly given as a sign of appreciation and inspiration from different social actors. This kind of social support is mostly given by the family of patients. According to a female caregiver,

*"We were given food by the family of our patients because they appreciate that we are caring for their grandparent. They always tell us to take good care of their grandparents."*

All in all, the functions of social support (intangible or tangible) are due to the idea that Filipinos value relationships. According to Medina [22], the function of Filipino social entities such as family and friends as social networks is to provide support to individuals, in this case caregivers, in difficult situations. Caregiving is seen as an exhausting work. The main function of social networks is to help caregivers cope with their current conditions. Caregivers are seen to get through every tiring day with the help of their social networks.
