This is a pivotal time. Converging sociodemographic trends and more complex care needs are contributing to historically unprecedented challenges in family care of older people in the U.S.
For most of human history, requiring help in old age was uncommon. As Atul Gawande writes in Being Mortal , “The natural course was to die before old age.”
In sharp contrast, an estimated 84 percent of people born in 2010 will live to age 65 or older. In the past three decades, the population 90 years and older has nearly tripled. The majority of the very old have one or more disabilities and need supportive services.
There is no going back to the “old days” of family caregiving.
Historically, most care for older relatives was short term. It was an expected role of women, who typically did not work outside the home. Care was provided within the privacy of the extended family, all usually living nearby.
Today, families and care needs are changing at a dizzying pace.
The caregiving tasks we ask of families are more complex, overwhelming, costly and difficult to manage than ever. And the situation is urgent: A new study shows that boomers will drive up Alzheimer’s-related costs from $307 billion in 2010 to $1.5 trillion by 2050.
Although recent research shows that 90 percent of unpaid caregiving for people 65 and older currently is provided by family members, we face a growing care gap. Reliance on families to provide care in the way it was delivered in the past is unsustainable.
The modern family looks very different than our grandparents’ generation.
Never before have so many women, the traditional family caregivers, been in the paid labor force. Yet, unlike the old days, a woman’s “provider” role is no longer confined to staying home and taking care of families’ everyday living needs.
Today, two wage earners are needed in most households to support families economically and to ensure retirement security. Among 55- to 64-year-olds (the most common age group to take on eldercare responsibilities), older women’s labor force participation increased from 41 percent in 1980 to 59 percent in 2012 — and is projected to reach 67 percent by 2020.
Several demographic shifts illustrate the dramatic changes in family composition, creating complex family structures for caregiving. The share of U.S. adults who have never married is at a historic high. About 1 in 5 (20 percent) adults (25 and older) have never been married, up from 9 percent in 1960. Greater divorce among people 50 and older, and more remarriage (especially among older adults) may also affect patterns of family care in the future.
Public policies need to adjust to the realities of the changing American family.
Many experts believe that our nation’s lack of a comprehensive, coordinated and affordable long-term care system intensifies family caregivers’ insecurity. Working families are increasingly left on their own to fill greater care gaps.
New policies are needed for a better system of community-based long-term care and family support. Also needed is a larger and higher-quality paid workforce to provide supportive services and mechanisms to help families afford paid care.
Lynn Friss F
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