1

Lconomlcs of
Careglvlng
!"# %&' & (")*+ ", -*./"'0&')0,&(1+2
%*'3*.*) %&.*4 #51%5 %6..*'3+2 +1*/ "63/1)*
", 35* *71/31'8 5*&+350%&.* (&.9*34 :*
1'3*.'&+1;*) 1'3" & ,636.* (")*+ ", 5*&+35
%&.*<

Katie Quinn, Penn State University
Radboud University, Nijmegen, The Netherlands
Reflections on Science Think-Tank:
The Future of Health Care
"#$% &' $ ($)*+&,*)-
A careglver ls an unpald lndlvldual
(spouse, parLner, famlly frlend, or nelghbor)
who ls lnvolved ln asslsLlng oLhers wlLh
acLlvlLles of dally llvlng (AuL) and/or
medlcal Lasks."
1
Whlle AuLs are formally
deflned
2
Lasks of a careglver can lnclude
household chores, managlng flnances, or
coordlnaLlng docLors and provldlng
LransporLaLlon Lo medlcal servlces.
3

"#$% ./*' $ 0$)*+&,*) 1//2 1&2*-
=' 35* >'13*) ?3&3*/@
ln 2009, an esLlmaLed 21.2 (48.9
mllllon) of adulL Amerlcans provlded care Lo
an adulL wlLh llmlLaLlons ln acLlvlLles of dally
llvlng aL some Llme durlng Lhe year. 1he

1 lacL SheeL: SelecLed Careglver SLaLlsLlcs," lamlly Careglver
Alllance naLlonal CenLer on Careglvlng, 2012.
2 AcLlvlLles of ually Llvlng are deflned as: geLLlng ln and ouL of
beds and chalrs, geLLlng dressed, baLhlng or showerlng, geLLlng Lo
and from Lhe LolleL, feedlng, and deallng wlLh lnconLlnence or
dlapers. Call Clbson PunL, Llnda 8arreLL, and Susan LuLz,
Careglvlng ln Lhe u.S. 2009," naLlonal Alllance for Careglvlng
(november 2009), p 22.
3 Susannah lox and !oanna 8renner, Careglvers ln Lhe u.S.," ew
lnLerneL, !uly 12, 2012.
average" careglver ln Lhe u.S. ls a 49 year-
old woman who works ouLslde Lhe home.
AbouL 66 of careglvers are women and
abouL 37 of careglvers work full-Llme or
parL-Llme [obs. 1he average amounL of Llme
spenL glvlng care per week ls 18.9 hours,
abouL 48 of careglvers provlde 8 hours or
less of care a week.
4

=' 35* A*35*.+&')/@
ln 2008, an esLlmaLed 24 (3.3
mllllon) of uuLch adulLs provlded unpald
care and abouL 60 (2.1 mllllon) of Lhese
careglvers provlded 8 hours or less of care a
week.
3
AbouL 60 of careglvers ln Lhe
neLherlands are women, 30 are beLween
Lhe ages of 43 and 63, wlLh Lhe mosL
common caLegory (32) aged beLween 43
and 34 years old. 71 of adulL careglvers ln
Lhe neLherlands hold a full-Llme or parL-
Llme [ob.
6

1he slmllarlLles beLween Lhe
characLerlsLlcs of careglvers ln Lhe unlLed
SLaLes and Lhe neLherlands show LhaL Lhese
Lwo culLures share a slmllar populaLlon of
unpald careglvers wlLhln a formal healLh
care sLrucLure.
3(/4/5&( 0/'%' /6 0$)*+&,&4+
1he economlc cosLs of unpald
careglvers are noL conLalned on any Lype of
governmenL balance sheeL, buL Lhelr
magnlLude ls felL by Lhe famllles and
employers of people provldlng care.

4 Call Clbson PunL, Llnda 8arreLL, and Susan LuLz, Careglvlng ln
Lhe u.S. 2009," naLlonal Alllance for Careglvlng (november 2009),
p 12.
3 lndex Mundl, neLherlands uemographlcs roflle 2013,"
lebruary 21, 2013.
6 uebble Cudl[k eL al, ln Lhe SpoLllghL: lnformal Care ln Lhe
neLherlands," 1he Pague: neLherlands lnsLlLuLe for Soclal
8esearch, 2010.
2
B"/3/ 3" B&.*81C*.
1he personal cosLs Lo a careglver can
be dlvlded lnLo four caLegorles: flnanclal,
career, psychologlcal, and soclal. llnanclal
cosLs Lo careglvers are consldered Lo be Lhe
addlLlonal ouL-of-pockeL" expenses LhaL
careglvers musL lncur when carlng for Lhelr
older relaLlves. ln unlLed SLaLes Lhese cosLs
were esLlmaLed Lo be on average aL leasL
10 of annual lncome or abouL $3, 331.
7
ln
Lhe neLherlands abouL 72 of heavlly
lnvolved" careglvers reporLed addlLlonal
expenses, wlLh abouL 14 reporLlng
addlLlonal cosLs of over t 1,000.
8

LosL wages and negaLlve career
ouLcomes has an even more slgnlflcanL
lmpacL on careglvers of provldlng regular
unpald care Lo a loved one. ln Lhe unlLed
SLaLes, of Lhe 37 of careglvers employed
full or parL-Llme, more Lhan Lwo-Lhlrds of
Lhese workers have reporLed maklng work
accommodaLlons because of careglvlng.
9

1he neLherlands has a slmllar populaLlon of
worklng-careglvers, one-flfLh of Lhese
workers reporLed negaLlve lmpacLs on
employmenL.
10

1here ls growlng research on Lhe
lncreased psychologlcal burden and soclal

7Lynn lelnberg eL al., valulng Lhe lnvaluable: 2011 updaLe 1he
Crowlng CoLrlbuLlons and CosLs of lamlly Careglvlng," AA8
ubllc ollcy lnsLlLuLe (2011), p 6.
8 Carollne Clendlnnlng eL al, Care rovlslon wlLhln lamllles and
lLs Soclo-Lconomlc lmpacL on Care rovlders," 1he unlverslLy of
?ork Soclal ollcy 8esearch unlL (May 2009),
hLLp://europa.eu/eplc/docs/eu-2342-care-provlslon.pdf.

9 Lynn lelnberg eL al., valulng Lhe lnvaluable: 2011 updaLe 1he
Crowlng ConLrlbuLlons and CosLs of lamlly Careglvlng," AA8
ubllc ollcy lnsLlLuLe (2011), p 6.
10 Carollne Clendlnnlng eL al, Care rovlslon wlLhln lamllles and
lLs Soclo-Lconomlc lmpacL on Care rovlders," 1he unlverslLy of
?ork Soclal ollcy 8esearch unlL (May 2009),
hLLp://europa.eu/eplc/docs/eu-2342-care-provlslon.pdf, p 60.
lsolaLlon faced by unpald careglvers.
8esearch lndlcaLes LhaL provldlng care Lo a
chronlcally lll relaLlve can have negaLlve
effecLs on Lhe careglvers own physlcal,
psychologlcal, and soclal well-belng.
11

D.")6%31C132 E&-
1he cosLs Lo buslnesses ln Lhe
unlLed SLaLes because of losL producLlvlLy
from employees who are careglvers ls
sLrlklng. MeLLlfe MaLure MarkeL lnsLlLuLe
dld a sLudy ln 2007 and deLermlned Lhe
cosLs of losL producLlvlLy from full-Llme
careglvlng employees was over $33.6
bllllon.
12
1hls lncludes cosLs addresslng
absenLeelsm, replaclng employees,
supervlsory Llme, reducLlon ln hours from
full-Llme Lo parL-Llme, and workday
lnLerrupLlons.
13
1he naLlonally aggregaLed
cosL of losL wages, penslons, and soclal
securlLy beneflLs for adulL careglvers over
age 30 ls almosL $3 Lrllllon.
14

7$18* /6 0$)*+&,&4+
F%"'"(1% G&+6*
1he cosLs slde of Lhls equaLlon
shows LhaL unpald careglvers are
shoulderlng a heavy burden Lo care for Lhelr
aglng relaLlves. lL ls hard Lo quanLlfy Lhe
beneflLs of unpald care, buL ln 2009 Lhe
AA8 serles, valulng Lhe lnvaluable"
esLlmaLed LhaL Lhe economlc value of famlly
careglvlng aL $430 bllllon per year.
13
1hls

11 Lynn lelnberg eL al., p 7.
12 MeLLlfe MaLure MarkeL lnsLlLuLe and naLlonal Alllance for
Careglvlng, 1he MeLLlfe
Careglvlng CosL SLudy: roducLlvlLy Losses Lo u.S. 8uslness,
WesLporL, C1: MeLLlfe lnc., 2006, p 17.
13Lynn lelnberg eL al., p 7.
14 Chrls larrell, We Can'L lorgeL Lhe unpald Careglvers,"
8loomberg 8uslnessweek, uecember 03, 2012.

13 Lynn lelnberg eL al., p 2.
3
esLlmaLe ls llkely Lo be far Loo low. AA8
esLlmaLed Lhe number of careglvers aL 42.1
mllllon, provldlng 18.4 hours of care per
week aL an average value of $11.61 per
hour. 1hls esLlmaLe conslders careglvers
provldlng care aL any glven polnL ln Llme.
When conslderlng elderly care, a slgnlflcanL
porLlon of care beglns an ends wlLhln a
glven year. 1hls lncreases Lhe number of
careglvers provldlng care Lo 61.6 mllllon
and largely lncreases Lhe economlc value of
care.
Cne oLher lmporLanL aspecL abouL
Lhls calculaLlon ls recognlzlng lLs Lrend. ln
prevlous years when Lhls reporL has been
publlshed Lhe economlc value of careglvlng
was valued aL $330 bllllon ln 2006, and
$373 bllllon ln 2007. lrom 2007 Lo 2009 Lhe
value of careglvlng lncreased by $73 bllllon.
1hls lncrease was due Lo an lncreased
number of careglvers provldlng lncreased
number of hours of care.
16
arallels can be
made Lo Lhe aglng Lrend ln Lhe unlLed
SLaLes. ln 2011, Lhe baby-boomers" (1946-
1934) wlll began Lo Lurn 63. 8y 2030, Lhe
older populaLlon ls pro[ecLed Lo be Lwlce as
large as lL was ln Lhe year 2000-cllmblng
from 33 mllllon Lo abouL 72 mllllon.
17
lf lL ls
suspecLed LhaL Lhe lncreased value of
careglvlng ls derlved from care provlded Lo
older Amerlcans Lhen Lhe value of unpald
careglvlng wlll lncrease asLronomlcally ln
Lhe nexL 10-20 years.
D*./"'0&')0H&(1+2 B*'3*.*) B&.*
1he slze of Lhe economlc value of
unpald careglvers can overshadow Lhe

16 lbld, p 3.
17 lederal lnLeragency lorum on Aglng 8elaLed SLaLlsLlcs, Clder
Amerlcans 2012 key
lndlcaLors of Well-8elng. WashlngLon, u.C.: u.S. CovernmenL
rlnLlng Cfflce, 2012, p 2.

value derlved by Lhose lnvolved ln Lhe
carlng process. Careglvers can derlve
enormous emoLlonal saLlsfacLlon from
carlng for a loved one. 80 of u.S.
careglvers and 72 of careglvers ln Lhe
neLherlands found Lhe experlence Lo be
rewardlng", and 34 of u.S. careglvers
reporLed LhaL Lhey formed a sLronger-bond
wlLh Lhelr care-reclplenL durlng Lhe Llme of
care.
18

lamlly careglvlng also promoLes a
model of person-and-famlly cenLered care.
aLlenL or person-cenLered care ls a model
of care LhaL places Lhe lndlvlduals needs,
goals, values and preferences aL Lhe cenLer
of all declslons regardlng care. 1he lncrease
ln Lhe prevalence and value of unpald
careglvers has sLarLed Lo lnclude Lhe needs
of famlly careglvers ln Lhls model. 1here ls
new research emerglng ln a model of
lnLegraLed person-and-famlly cenLered
care. ln Lhls model, famlly careglvers are
no longer vlewed as [usL a resource" for
Lhelr loved one, raLher, Lhey are parLners on
Lhe care Leam, and also recognlzed as
lndlvlduals who may Lhemselves need
Lralnlng and supporL."
19

94$1:'&' $4. ;*(/55*4.$%&/4'
Analyzlng Lhe economlcs of
careglvlng shows a lopslded relaLlonshlp
beLween wlnners and losers, or cosLs and
beneflLs. CLher Lhan Lhe moral and
emoLlonal saLlsfacLlon of careglvlng (whlch
cannoL be quanLlfled) careglvlng famllles
are burdened wlLh Lhe ma[orlLy of Lhe cosLs
and few of Lhe beneflLs of unpald
careglvlng. 8uslnesses are Lhe only oLher
ma[or parLy experlenclng cosLs relaLed Lo

18 naLlonal Survey: Careglvers llnd unexpecLed 8ewards ln
1endlng for lamlly
Members," 8WL8, november 20, 2007.
19 Lynn lelnberg eL al., p 11.

4
losL producLlvlLy from careglvlng
employees. 1he unlLed SLaLes and uuLch
governmenLs glean Lhe mosL value from Lhe
sLrucLure of careglvlng-savlng more Lhan
$430 bllllon a year ln addlLlonal healLh-care
expendlLures. Pow can a savlngs, exLernal
of Lhe currenL healLh-care markeL, be
lnLernallzed ln fuLure declslon-maklng?
1he answer ls dlfflculL, and wlll
requlre far-slghLed declslons of pollcy-
makers and buslness leaders. 1here are
Lhree recommended approaches Lo
lmprovlng Lhe careglver experlence ln Lhe
unlLed SLaLes and Lhe neLherlands ln order
Lo move Lowards a model of person-and-
famlly cenLered care and conLaln healLh
care cosLs for a growlng aglng populaLlon.
<= >8'&4*''*' ?)/,&.* '8??/)% ?)/+)$5'
6/) ($)*+&,*)'
As llfe expecLancy lncreases and
Lhe baby-boom populaLlon ages,
producLlvlLy loss Lo careglvers wlll
lncrease. As of 2007, 33 of large
companles had eldercare programs
ln place, buL many smaller
companles may noL have Lhe
resources avallable Lo provlde Lhese
programs. Lmployers should
conslder beneflLs such as: flexLlme,
LelecommuLlng, and [ob-sharlng.
Lmployers should also Lake
advanLage of Lechnologlcal
advancemenLs and dlrecL Lhelr
employees Lo onllne resources LhaL
provlde supporL and educaLlon Lo
careglvers such as: Careglver.org or
nexLSLeplnCare.org, eLc.
20

@= 3A?$4. +/,*)45*4% ?)/+)$5' 6/)
($)*+&,*)'

20 MeLLlfe MaLure MarkeL lnsLlLuLe and naLlonal Alllance for
Careglvlng, 1he MeLLlfe
Careglvlng CosL SLudy: roducLlvlLy Losses Lo u.S. 8uslness,
WesLporL, C1: MeLLlfe lnc., 2006, p 18
CovernmenL offlclals Lend Lo be
shorL-slghLed ln Lhelr pollcy-goals,
and because Lhe governmenL ln Lhe
unlLed SLaLes and Lhe neLherlands
lncurs almosL no cosLs of
careglvlng-Lhey are unllkely Lo Lake
large measures Lo lessen Lhe burden
on careglvers. Powever, supporL for
pollcles addresslng careglvers ls
growlng. 1he Lerm careglver" was
menLloned mulLlple Llmes ln Lhe u.S.
Affordable Care AcL of 2010.
21
A
2009 sLudy by Lhe naLlonal Alllance
for Careglvlng measured Lhe
popularlLy of slx governmenL
programs LhaL u.S. pollcy-makers
are proposlng Lo beneflL careglvers.
1hey found LhaL, ln order of
popularlLy: a careglvers Lax credlL, a
voucher program paylng mlnlmum
wage for some careglvlng hours, and
expanslon of resplLe servlces were
Lhe Lhree mosL deslred pollcles
among careglvers ln Lhe unlLed
SLaLes.
22

B= C)/5/%* )*'*$)(# %/ .*,*1/? $ ?*)'/4D
$4.D6$5&1: (*4%*)*. 5/.*1 /6 ($)*
1here ls exLenslve research on
Lhe beneflLs of person-cenLered
care, and Lhe needs of careglvers.
LxlsLlng research should be
synLheslzed Lo conslder new models
of person-and-famlly cenLered care.
lnLegraLlng Lhe famlly as a parL of
Lhe care Leam and conslderlng Lhe
careglver's unlque needs and
preferences.
23



21 Lynn lelnberg eL al., p 13.
22 Call Clbson PunL, Llnda 8arreLL, and Susan LuLz. Careglvlng ln
Lhe u.S. 2009." naLlonal Alllance for Careglvlng (november 2009),
p 69.

23 Lynn lelnberg eL al, p 13.
3


0/4(18'&/4
1he economlcs of careglvlng ls
characLerlzed by careglvers exlsLlng ouLslde
of Lhe currenL healLh-care markeL. 1he
cosLs and beneflLs of careglvlng need Lo be
lnLegraLed lnLo Lhe markeL by creaLlng and
expandlng exlsLlng supporL sysLems for Lhe
famllles provldlng Lhls care. A person-and-
famlly cenLered model of care ls Lhe mosL
cosL-effecLlve model for fuLure healLh-care
ln an lncreaslngly aglng populaLlon.


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