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Unpaid costs of caregiving rival Walmart sales

Family caregiving takes its toll—not just on families, but on the economy.

In 2013, an estimated 40 million family caregivers provided $470 billion in unpaid care, according to a new study from AARP. That's up from $450 billion in 2009.

To put the figure in perspective, the report notes, $470 billion is nearly as much as Walmart sales for that year and surpasses annual spending of both Medicaid and out-of-pocket health care costs. Yet, "it's a conservative estimate," said Susan Reinhard, senior vice president and director of AARP's Public Policy Institute. The figure is based on caregivers providing an average 18 hours of care weekly, valued at an average hourly rate of $12.51 (calculated using data on median home health aide wages).

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Part of the increased value of unpaid care stems from family members undertaking more complicated tasks, particularly medical care, said Reinhard, who is also a registered nurse. "We expect family caregivers to do things that make nursing students tremble," she said—like give injections, care for wounds or operate medical equipment such as ventilators. A 2013 AARP survey found that 46 percent of caregivers were performing such complex tasks.

Almost two-thirds of caregivers work full- or part-time jobs in addition to caring for a loved one, which generates additional strain, according to the study. A little more than half say they're overwhelmed by the amount of care provided, and 38 percent report some level of financial strain.

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Early planning conversations are one of the best ways for families to prepare, although not the easiest, said Carolyn McClanahan, a certified financial planner in Jacksonville, Florida. "The problem is people refuse to talk about what their aging years are going to look like," she said. Or they may insist they never want to go into a nursing home.

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Have frank discussions about what preparations, if any, your parent or loved one has made for care, including insurance, savings and other resources, said McClanahan. Discuss any advance health-care directives. If family caregiving is an option, set out a contract detailing which sibling or other member can help with what, including hands-on care and financial support, she said.

It's also important for potential caregivers to consider technology and resources that could lighten the load. Apps can help remote caregivers monitor their loved one's medication usage and health records, said Dr. Davis Liu, a family physician and the author of "The Thrifty Patient." You can also investigate whether your workplace offers family leave options, flexible hours, telecommuting or unpaid leave.

"Now is the time to prepare for this," said Reinhard.