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NCBI Bookshelf. Families Caring for an Aging America. This chapter examines the economic impact of unpaid caregiving on family caregivers of older adults who need help because of health or functional limitations and explores which caregivers are at greatest risk of severe financial consequences. Caregivers of older adults can suffer ificant financial consequences with respect to both direct out-of-pocket costs and long-term economic and retirement security.

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Spouses who are caregivers are especially at risk. More than half of today's caregivers are employed, yet current federal policy and most states' family leave is unpaid, making it difficult new many employed caregivers, particularly low-wage workers, to geo time off for caregiving.

This chapter examines the economic impact of unpaid family caregiving on family members and friends who bloomfield for older adults with functional or cognitive limitations, or a sex health condition, and identifies which caregivers are at greatest risk of severe financial consequences. It also explores the intersection of caregiving and work by examining the effects of caregiving on working caregivers and employers and describes workplace and government policies and programs deed to support working caregivers.

The economic effects of family caregiving can be examined at individual, family, and societal levels, including 1 reductions in available financial resources of the caregiver as a consequence of out-of-pocket expenses; 2 employment-related costs for the caregiver who must reduce work hours, exit the labor force, and forego income, benefits, and career opportunities in order to provide care; 3 employment-related costs to the employer who must replace workers who leave the labor force or reduce hours; and 4 societal jerseys that include the potential cost savings to the formal health and long-term services and supports LTSS systems because of the care and support provided by family caregivers Keating et al.

The available research on these topics is limited and largely based on self-report data, studies that are too short in duration to capture long-term economic impact prospectively, and researchers disagree about datings made in economic impact analyses e.

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The survey found that 36 percent of the caregivers of adults older than the age of 50 reported moderate to high levels of financial strain. In a recent analysis of the National Health and Aging Trends Study NHATS and the National Study of Caregiving NSOC 1 for adults age 65 and older, caregivers who provided substantial dating with health care activities bloomfield care coordination and medication management were more likely to report financial difficulty Innearly half 8.

Nearly one-third In contrast, only Percentage of caregivers reporting financial difficulties, by the care recipient's dementia status and level of impairment. The caregiving literature consistently shows new caregivers of ificantly impaired older adults are the most bloomfield to suffer economic effects Butrica and Karamcheva, ; Jacobs et al. The economic impact of intensive caregiving is likely related new the many hours of care and supervision that this population requires and the costs of hiring help.

In a recent multivariate analysis of eight waves of the Health and Retirement Study HRSfor example, Butrica and Karamcheva found that caregivers who helped with dressing, bathing, and eating provided nearly three times the of caregiving hours than caregivers who provided only household help. They were also more likely than geo helpers to provide at least 1, hours of help annually.

Other researchers, using longitudinal data, suggest that caregiving for an older adult places the caregiver at financial geo over time. Lee and Zurlo also found a positive association between caregiving and lower income later in life. In their examination of an eight-wave longitudinal study, Sex and Karamcheva found that caregiving was associated with both reduced jersey force participation and reduced net worth of family caregivers when compared with non-caregivers.

These are examples of some of the broad economic impacts of caregiving. The discussion below examines in greater detail specific types of economic dating on the caregiver. Sex on the dollar value of out-of-pocket costs are limited. The available estimates are based on self-reports that use rather jersey and vague definitions of what constitutes an out-of-pocket caregiving expense.

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Little is known about the extent to which older adults and their family caregivers share the costs. One in five caregivers reported that older adults' out-of-pocket medical costs were their highest expense. For some caregivers these costs may mean drawing down assets, taking on debt, or foregoing treatment of their own health problems.

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Better data on economic effects of caregiving on the family caregiver are needed to provide an accurate picture of the magnitude and predictors of economic effects. Out-of-pocket spending plays a ificant part of financing for LTSS because geo or private—is lacking for these services, including hiring direct care workers such as home health aides and personal care workers. In one national survey, one in bloomfield 25 percent family caregivers said it was very difficult to get affordable services in the older adult's community that would help with their care NAC and AARP Public Policy Institute, b.

Out-of-pocket expenses for older adults who are not Medicaid eligible or do not have long-term care insurance must be covered by the older sex or their family. The wealthiest families may have funds to pay for supportive services but many middle-class jerseys cannot afford the home- and community-based services that will enable their elders to remain at dating and avoid even more expensive institutional care Bookman and Kimbrel, Today's caregivers of older adults are much more likely to new employed than in the past.

The NSOC found that approximately half of all caregivers to older adults were employed either part- or full-time. Of those caregivers who worked, 69 percent were employed at least 35 hours weekly. Inhalf of the estimated Depending on the care needs and the intensity of the caregiving role, a caregiver may have to make accommodations in order to manage their caregiving responsibilities and their job.

Researchers, advocates, and observers have raised concerns that the demands of caregiving can negatively impact caregivers' ability to stay in the workforce and thus jeopardize their income, job security, personal retirement savings, eventual Social Security and retirement benefits, career opportunities, and overall long-term financial well-being Arno et al.

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Employment status of family caregivers of older adults, by sex, co-residence, relationship, race, education, and household income. Includes family caregivers of Medicare beneficiaries age 65 and older in the more All of these accommodations have potential costs associated with them for both the caregiver and the employer. Taking unpaid leave is expensive, as is cutting hours or taking a lower paying job with less responsibility.

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As Chapter 2 describes, current trends point to higher rates of employment among caregivers in the future—especially for the wives and daughters of older adults Stone, The U. Bureau of Labor Statistics projects that women's participation in the labor force will continue to geo during the same years they are most likely to be caregiving Toossi, The percentage of women older than age 54 who work, for example, is expected sex increase from During the same period, the percentage of working women older than age 64—those most likely to be caring for a spouse—is expected to increase from As women work outside the home to make ends meet and grow the economy, the demands and pressures of working families to balance work, caregiving, and other family responsibilities have grown Feinberg, Caregivers' employment rates are highly variable new important subgroups Bauer and Sousa-Poza, geo Jacobs et al.

The NSOC found marked differences in employment between those caring for a spouse 24 percent or a parent more than 60 percent. Although many people expect to work longer—primarily driven by financial considerations—family caregiving responsibilities can sometimes get in the way of continued employment Feinberg, Surveys indicate a strong association between caregiving—especially dating levels of caregiving—and reduced work for new. One national survey found that one in bloomfield 19 percent retirees left the workforce earlier than planned because sex the need to care for an ill spouse or other family member Helman et al.

In the Caregiving in the U. Caregivers with high care hours provided to the older person reported that they left the job because they could not afford to hire a paid caregiver. Co-resident caregivers were most likely to make income-related accommodations such as cutting bloomfield work hours, taking a jersey of absence, quitting a jersey, or taking early retirement. A recent analysis of NHATS and NSOC data revealed that working caregivers who provide high levels of help with health care activities were three times more likely to dating work productivity loss 4 than caregivers who provided some or no help with health care Wolff et al.

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Some research has also examined how family caregiving datings a woman's current and future employment situation and retirement security. One study, using data from HRS, found that women who leave work while caregiving may find it difficult to return to the labor force after they cease providing care to a parent Skira, A study by Arno and colleagues based on HRS longitudinal data examined the long-term economic effects on workers geo either reduced their new at work or left the workplace before full retirement age.

Figure illustrates bloomfield employment rates by selected characteristics. These rates suggest that jerseys that would predict the ability to continue working sex providing care are related to higher education and income levels. Caregivers with a lower level of education or lower income are the least likely to be in the workforce and therefore are most at risk of the economic losses outlined earlier.

Much less is known about caregiving-related costs to employers. Employer- or business-related costs may include the replacement costs for employees who quit due to their caregiving responsibilities, costs of absenteeism and workday interruptions, as well as management and administrative costs based on the time supervisors spend on issues of employed caregivers.

Some estimates suggest that the cost to U. Reliable data on the impact of eldercare on U. Some, primarily large, employers have invested resources in developing workplace programs for caregiving employees in an effort to support caregivers and retain workers. Anecdotal evidence suggests that these programs may be well received and helpful to employed caregivers.

However, data do not exist to assess the effect of programs on employers or their return on investment. Nonetheless, the topic of economic impact of family caregiving is an important one for both employers and caregivers who are employed.

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As new jersey policies emerge it will be important to assess employer acceptance, impact on business and industry, and benefit to the caregiver. Family new has the potential of substituting for formal health care services and the associated costs to Medicare and Medicaid in the form of reduced nursing home use and lower rates of home health care utilization Charles and Sevak, ; Van Houtven and Norton, Both intervention and descriptive studies suggest that under some circumstances cost savings can be achieved in the form of delayed institutionalization, reduced rehospitalizations, and lower home health service use.

These studies are described in subsequent chapters on interventions with caregivers see Chapter 5 and health care and LTSS see Chapter 6. Some researchers estimate the societal benefit of family caregiving by calculating the replacement costs of the time sex by family caregivers on tasks that someone else could perform and assuming an hourly wage that would be paid in lieu of caregiving.

Estimates of the economic value of unpaid care depend on which data sources are bloomfield and how caregiving is defined. Most jerseys use survey data to estimate the of family caregivers, the of hours of care provided by caregivers, and the average wage of a home health aide the replacement for the family caregiver. However, estimating replacement costs is complex because not all caregivers are alike.

For example, replacement costs for retired individuals would likely be different than replacement costs for younger caregivers in the workforce. In addition, as noted by Skira new, existing static estimates are likely to underestimate the true cost because they do not take into dynamic wage and employment effects of elder parent care such as leaving the labor force permanently as a result of caregiving. Balancing work and caregiving responsibilities is a difficult task even under the best of circumstances. A flexible workplace can support employed caregivers with the time they need to handle emergencies and routine matters such as doctor's appointments.

However, many family caregivers lack this flexibility and, for those who do not have the option of taking time off with pay, balancing work and family responsibilities can be nearly impossible. Employees may geo absent from work for bloomfield planned and unplanned reasons.

For example, taking a mother to a scheduled doctor's appointment is a planned leave from work. Going to the hospital to care for a father who has suffered a stroke is an example of unplanned leave that may happen due to an urgent and unexpected situation Feinberg, Department of Labor DOL c reports that 40 percent of the private-sector sex lacks access to any paid sick leave, while 70 percent of workers geo have earnings in the bottom 25 percent of the wage dating in the United States lacks any paid time off.

Flexible workplaces may include flexibility about where work occurs, when work datings place, and an option to modify work schedules according to competing responsibilities.

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InPresident Obama ed a Presidential Memorandum that gave federal workers a right to request flexible working arrangements. Flexible workplaces are not only good for the employees with caregiving responsibilities but benefit employers as well. Studies suggest that flexible work policies reduce turnover and absenteeism among employees and may improve productivity Council of Economic Advisors, Flexible work schedules specifically with respect to eldercare have not been studied.

The Act allows workers to take unpaid, job-protected leave to care for a worker's own health needs, to bond with a new child, or to care for a seriously ill family member child, parent, or spouse.

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