Synthesis of the Caregiving
Workforce:
formal/informal, adult/youth,
female/male
Peter S. Arno, PhD
Deborah Viola, PhD
AcademyHealth Annual Research Meeting
Boston, MA
J
June
28,
28 2010
A Traditional Look at Caregivng




Care recipient is elderly
Caregiver is female, mid-forties
Demographic changes result in
increased demand for care
S
Supply
l picture
i t
bl
bleak:
k fformall caregiver
i
shortage, informal caregiver labor supply
has diminished as well
Population
l i
Projections
j
i
65 to 84 and 85 and older, 2000 to 2050
90
80
Population 85
85+
70
60
50
40
30
20
Population 65-84
10
0
2000
2005
2010
2015
2020
2025
2030
2035
2040
2045
Year
Population 65 to 84
Population 85 and Over
U S Dept.
U.S.
Dept of Commerce,
Commerce Bureau of the Census,
Census 2004
2050
More Care Needed

Decreasing
g fertility
y rates means fewer family
y
members are available to provide caregiving

Labor force participation rates for women
have leveled off

At least 20% of the elderly do not obtain the
care they need.
Healthy People 2020

“Reduce the proportion of unpaid
caregivers
g
of older adults who report
p an
unmet need for caregiver support
services ”
services.
PHI (April 2008) Occupational Projections for Direct-Care Workers 2006-2016,
2006-2016 PHI Facts 1,
1 Bronx,
Bronx NY: PHI
PHI.
Home Health Workers Disproportionately
Live in or near Poverty
Percent of workers below 150% of federal poverty line 20
150% of federal poverty line, 20
40%
30%
30%
20%
12%
10%
0%
US Workers
Source: PHI analysis of CPS 2007
DSWs
Home Health Aides: Trends in Real
Wages
$12.00
Median hourly wage, nominal & adjusted for
i fl ti - 1999-2006
inflation
1999 2006
$11.00
$10.00
$9.00
$8.00
$7.00
$6.00
1999
Source: PHI analysis of CPS 2007
2000
2001
2002
Nominal wage
2003
2004
Real wage
2005
2006
Dependence of Home Health Aides
on Public Benefits
Source: PHI analysis of CPS 2007
Make Career more Attractive
IOM Recommendation 5.2
“State Medicaid programs should increase
pay and fringe benefits for direct
direct-care
care
workers through such measures as wage
pass-throughs
pass
throughs, setting wage floors
floors,
establishing minimum percentages of
service rates directed to direct-care labor
costs, and other means.”
In addition to Wage & Benefits,
Benefits
Support Career Ladders

Provide ongoing training and continuing
education to motivate quality care,
including ESL workshops
workshops.

Allow for
All
f tuition
t iti supportt for
f certification
tifi ti
as nurse aide; nurse and; other clinical
th
therapy
occupations.
ti
HCBS and Nursing Home
Tradeoff
Muramatsu et al, 2007
Estimated Home Care, Nursing Home Care,
I f
Informal
lC
Caregiving
i i
and
d
National Health Expenditures, U.S. 2009
Billions o
of Dolla
ars
$2,510
$354
$70
$144
Home Care
Nursing Home
Care
Economic Value
of Informal
Caregiving
Total National
Health
Expenditures
Source: Informal caregiving estimates based on authors’ estimates and
expenditure data from Office of the Actuary, CMS, Health Affairs, 2009
Health Care Reform: CLASS Act

CLASS: Community Living Assistance
Services and Support

CBO estimates Federal savings of $72
$72.5
5 billion
by 2019

CLASS benefits are intended to offset the
costs of Medicaid by paying for non-medical
expenses that allow an individual to stay
independent.
p
Health Care Reform: CLASS Act

Establishes a national voluntary
insurance program for purchasing
community living assistance services
and supports

Seeks to alleviate burdens on
families/caregivers
A Wider Synthesis

40% of people receiving care are adults aged 18-64

Men represent 30% of all informal caregivers

There are an estimated 1
1.3
3 million youth caregivers in
the United States

Three quarters of the 4.3 million people with
developmental disabilities live at home, and 25% of
them are cared for by a family member who is at
least 60 years old.
Socioeconomic
S
i
i C
Consequences affect
ff t
Caregivers and Care Recipients







Income
Education
Race/Ethnicity
Gender
Age
Marital Status
Socialization
Our Research

Our goal is to present a national estimate for
the total cost of caregiving to inform policy
makers as they consider strategies to
address long term care needs for the aging
and disabled members of our communities;
intergenerational effects; and the impact on
productivity and quality of life for both
caregivers and their recipients.
Our Perspective

How do we responsibly value one form of
care over another? This isn’t our goal.

Rather,
R
th if we consider
id th
the “Synthesis
S th i off the
th
Caregiving Workforce” then what matters
more is
i a ttrue understanding
d t di off costs
t and
d
benefits for all caregivers in an effort to build
a better
b tt care economy.
A Better Care Economy

Policy initiatives must be threefold:
•
Make care giving professions an attractive career
choice
•
Compensate direct and indirect costs of informal
caregivers
•
Consider the continuum of care as a mix of informal,
formal and long term care.
Contact Information
Peter S. Arno, PhD
Peter_Arno@nymc.edu
Deborah Viola, PhD
Deborah_Viola@nymc.edu