The value of unpaid family caregiving keeps on climbing, soaring past the $600 billion mark in 2021. That’s one of the key findings from a comprehensive, updated look at family caregiving just released by AARP.
The data appears in a 32-page report under the title, Valuing the Invaluable 2023 Update: Strengthening Supports for Family Caregivers . It’s a comprehensive piece of research, but the conclusion is inescapable: without the work of millions of unpaid caregivers, our health care system would be facing an insurmountable challenge, yet support for this army of unsung caregiving heroes is sadly lacking. The AARP study includes a host of recommendations for changes in national policy to better meet the needs of the men and women providing unpaid in-home care.
We’ve summarized a few key findings and recommendations here on the Blog, but we encourage you to read the full report, or – if 32 pages seems daunting – this summary article that was published recently on the website of AARP’s Public Policy Institute.
Essential Role in a Fractured System
“Family caregivers fill an essential role in our fractured long-term services and supports (LTSS) system,” the summary article states. The value of that role in actual dollar terms is staggering: approximately $600 billion, based on about 38 million caregivers providing an average of 18 hours of care per week. That represents 36 billion hours of care, at an average value of $16.59 per hour.
“This conservative estimate does not consider the financial cost of care (out-of-pocket and lost wages) or account for the complexity of care provided (i.e., medical/nursing tasks),” says the article. It also represents a jump from $470 billion in 2017. AARP states that the value of home care has been rising steadily for 25 years, and that the value of unpaid family care vastly exceeds the value of paid home care.
Demographic Trends Affect Caregiving
There’s no doubt that the graying of the population is putting extra demands on in-home unpaid caregivers. “By the year 2034, adults ages 65 and older will outnumber children under the age of 18,” says AARP, “and the share of potential caregivers is projected to continue shrinking relative to the number of older adults potentially at risk for needing long-term care.”
One of the most urgent needs, given the aging population, is to address the pressure being placed on “sandwich generation” caregivers who are attempting a difficult balancing act. “In 2019,” says the AARP report, “roughly 30 percent of family caregivers of older Americans lived in a household that also includes children or grandchildren. They are increasingly Gen Z and millennial caregivers and are more likely than other caregivers to be working while performing their caregiving responsibilities.”
Most Unpaid Caregivers Hold Down Outside Jobs
“Sixty-one percent of family caregivers work either full or part time,” the report states. “Working caregivers face financial risks such as lost income, reduced career opportunities and savings, and subsequently lower Social Security and retirement benefits.”
Unfortunately, as the need for caregivers grows, availability of paid direct-care workers is on the decline, which puts more pressure on family caregivers. AARP says that the direct-care workforce is expected to grow from 4.6 million in 2019 to 5.9 million by 2028, but the industry faces a huge challenge in worker retention: the average turnover among paid caregivers is reported at an unsustainable 40 to 60 percent annually.
State and Federal Initiatives Promise Some Relief
According to the AARP summary, there have been what the article calls “significant federal and state policy developments” in recent years – some spurred by the COVID pandemic – which, if acted upon, could provide some helpful support for unpaid caregivers.
We lack the space to delve into those policy proposals here, but at the federal level they include:
- The National Strategy to Support Family Caregivers: This proposal, says AARP, “offers a unified approach to improving recognition of and support for family caregivers. It highlights hundreds of actions at all levels of government and the private sector, including some already underway, to recognize family caregivers and give them the help they need.”
- Public Health Emergency (PHE) Acute Hospital Care at Home (AHCaH) Waiver: This waiver by the Centers for Medicare and Medicaid Services (CMS) expanded a program called Hospital at Home, a U.S. care model providing acute hospital care in patients’ homes.
- Supplemental benefits under Medicare Advantage: “In 2019,” AARP reports, “Medicare Advantage plans included additional flexibility to offer beneficiaries new and expanded supplemental services, such as LTSS and support services for family caregivers of enrollees.”
That’s a partial list of initiatives cited in the AARP report. At the state level, various states are exploring tax credits or other reimbursement programs to offset the financial costs of caring for a family member. Other states and the District of Columbia have enacted paid family leave programs and expanded paid sick leave for caregivers. AARP also reports that 45 states and territories now have enacted what are called CARE Act laws, which support family caregivers when their relatives go into the hospital and as they transition home. CARE is an acronym that stands for Caregiver Advise, Record, and Enable Act.
AARP Includes Six Recommendations
Along with the detailed report and the slightly less detailed summary, the AARP report on the state of unpaid caregiving included what we found to be the most helpful and easy to understand document of all: this handy one-page infographic that distills the report down to its highlights. The infographic also summarizes AARP’s six policy recommendations:
- Implement the National Strategy to Support Family Caregivers;
- Strengthen paid family leave and paid sick leave to help family caregivers balance care and work responsibilities;
- Support family caregivers when caring for someone in the hospital and as they transition home through CARE Act laws;
- Expand respite care services that give family caregivers a hard-earned break;
- Offer caregiver tax credits or other reimbursement programs to offset the costs of family caregiving;
- Include family caregivers in care through caregiver training and education and caregiver
assessments that connect them to supports and services.
Because this topic affects so many, we’ll keep watching for further developments as these recommendations come up for legislative consideration. Stay tuned.
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(originally reported at www.aarp.org)