My sister Carol loves movies, but she hasn't been out to see one in years. When she tries to watch one at home, she's frequently interrupted. She shrugs this off, saying "Who needs to see movies when you're living one?"
You see, my sister is living the plot from the movie "Groundhog Day." She takes care of our mother, who suffers from dementia. Our mom asks the same questions over and over and only wants to watch a handful of classic TV shows, like "The Golden Girls" reruns. For this my sister earns nothing.
I marvel at how hard my sister works and how much she contributes to our mother's quality of life and yet how little our society recognizes the scope of what family caregivers like her are contributing. As an economist, I also see in her predicament a microcosm of a much bigger problem. Just as our family can't expect my sister to keep this up indefinitely, nor can our society count on unpaid caregivers to perpetually tend to the growing needs of the nation's elderly.
Valuing unpaid elder care
Carol belongs to an army of more than 43.5 million people who provide their loved ones with what AARP estimates to be US$470 billion worth of care – an amount that exceeds the gross domestic product of 170 of the world's 195 nations.
Because no money changes hands, economists don't count unpaid caregiving when they tabulate GDP – the sum of all economic activity. But this work does count tremendously in terms of the well-being, economic and otherwise, of the elderly and the disabled and their relatives.
Expecting that everyone in my mom's predicament will have adult children able and willing to care for them is becoming increasingly unrealistic. Demographers expect that the number of Americans over age 65 will more than double in less than 50 years, rising from 46 million in 2016 to 98 million in 2060. The many seniors with one or more chronic conditions will require professional and informal assistance.
Who will take care of all these additional seniors?
The average number of children women have has declined, falling to 1.9 in 2016 from 3.7 in the 1960s. That leaves fewer children to care for the growing number of elderly parents. And since the share of women who earn a living in the paid workforce rose from about 1 in 3 in the mid-1950s to more than 1 in 2 by the 1980s, grown daughters have become less available to care for their parents at a time when the majority of people providing for seniors are still women. For example, sons caring for a parent did 16 percent of this unpaid caregiving while daughters did 31 percent, in 2011.
Caring for elderly and disabled family members takes a big financial toll, including hundreds of thousands of dollars in lifetime earnings if it means retiring early to do it, according to Fidelity, the investment company.
When no relative steps up to serve as an unpaid caregiver when the need arises, families hire paid caregivers or move their loved one into a nursing home, where a private room may cost $100,000 or more per year. Medicare rarely covers nursing home stays, and eligibility for Medicaid coverage is limited, so institutional care like that is generally out of reach for all but the wealthiest Americans or those with long-term care insurance – which also costs a lot.
The Bureau of Labor Statistics predicts that caregiving jobs will be among the fastest-growing in the years to come, with the number of home health aides increasing by 41 percent from nearly 3 million in 2016 to more than 4.1 million within a decade.