Insight Into the Activities, Concerns and Interests of Higher-burden Family Caregivers

Abstruse

This chapter examines the economic impact of unpaid caregiving on family caregivers of older adults who need help because of health or functional limitations and explores which caregivers are at greatest gamble of severe financial consequences. Workplace and government policies and programs designed to support caregivers and/or mitigate these effects are likewise discussed. Caregivers of older adults can suffer significant financial consequences with respect to both direct out-of-pocket costs and long-term economic and retirement security. Spouses who are caregivers are especially at risk. More than than one-half of today's caregivers are employed, yet current federal policy and virtually states' family leave is unpaid, making information technology difficult for many employed caregivers, particularly low-wage workers, to have fourth dimension off for caregiving.

National surveys show that many family caregivers of older adults report financial strain associated with their roles as caregivers (NAC and AARP Public Policy Establish, 2015b; Spillman et al., 2014; Wolff et al., 2016), suggesting that there are of import economic effects of taking on the caregiving office. This chapter examines the economic touch on of unpaid family unit caregiving on family members and friends who treat older adults with functional or cognitive limitations, or a serious wellness condition, and identifies which caregivers are at greatest risk of severe financial consequences. It besides explores the intersection of caregiving and work by examining the effects of caregiving on working caregivers and employers and describes workplace and government policies and programs designed to support working caregivers.

The economic effects of family caregiving tin can be examined at individual, family, and societal levels, including (1) reductions in available financial resources of the caregiver as a issue of out-of-pocket expenses; (2) employment-related costs for the caregiver who must reduce work hours, get out the labor force, and forego income, benefits, and career opportunities in order to provide care; (three) employment-related costs to the employer who must supplant workers who leave the labor strength or reduce hours; and (4) societal benefits that include the potential cost savings to the formal health and long-term services and supports (LTSS) systems because of the care and back up provided by family caregivers (Keating et al., 2014). The available research on these topics is express and largely based on cocky-written report data, studies that are too short in duration to capture long-term economical impact prospectively, and researchers disagree well-nigh assumptions made in economical impact analyses (e.one thousand., replacement cost of a family caregiver) (Schulz and Martire, 2009).

Wide IMPACTS

Feelings of "financial strain" are a frequently used global measure of the economic costs of caregiving. For example, a recent survey conducted by the National Brotherhood for Caregiving (NAC) and the AARP Public Policy Institute (2015b) asked caregivers about "financial strain" related to family caregiving. The survey found that 36 percent of the caregivers of adults older than the age of 50 reported moderate to high levels of fiscal strain. Those caregivers most likely to written report high levels were caregivers who live at a distance from the older care recipient, those with high levels of caregiving brunt, and those who report they are the "primary" caregiver. In a recent analysis of the 2011 National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) ¹ for adults age 65 and older, caregivers who provided substantial assistance with health care activities (including intendance coordination and medication direction) were more likely to written report fiscal difficulty (23.0 per centum) compared to their counterparts providing some help (12.0 per centum) or no assistance (6.7 per centum) (Wolff et al., 2016).

In 2011, nearly half (viii.v million of 17.vii million) of the nation'due south caregivers of older adults living at abode or in residential care settings (other than nursing homes) ² provided care to loftier-need, older adults. ⁱⁱⁱ As Figure iv-1 illustrates, the caregivers who are helping older adults with the greatest needs are the near likely to study having financial problems. Most i-tertiary (31.three percent) of the caregivers (in NSOC) who helped significantly dumb persons—those with both dementia and the need for aid with at least two personal intendance activities—reported having fiscal difficulties related to caregiving. In contrast, just 16.2 percent of the caregivers of individuals who needed help with fewer than 2 personal care activities and do not accept dementia reported financial difficulties (i.e., the care recipients).

FIGURE 4-1

Percentage of caregivers reporting financial difficulties, by the care recipient's dementia status and level of impairment. NOTES: Includes family caregivers of Medicare beneficiaries historic period 65 and older in the continental United States who resided in community (more...)

The caregiving literature consistently shows that caregivers of significantly impaired older adults are the most probable to suffer economic effects (Butrica and Karamcheva, 2014; Jacobs et al., 2014; Langa et al., 2001; Lilly et al., 2007; NAC and AARP Public Policy Constitute, 2015b; Van Houtven et al., 2013). The economical impact of intensive caregiving is likely related to the many hours of care and supervision that this population requires and the costs of hiring help. In a contempo multivariate analysis of eight waves of the Health and Retirement Study (HRS), for instance, Butrica and Karamcheva (2014) institute that caregivers who helped with dressing, bathing, and eating provided nigh 3 times the number of caregiving hours than caregivers who provided merely household assistance. They were as well more likely than household helpers to provide at least 1,000 hours of assist annually.

Other researchers, using longitudinal data, suggest that caregiving for an older adult places the caregiver at financial risk over fourth dimension. For example, Wakabayashi and Donato (2006) found that caregiving increases the likelihood that women experience poverty and/or reliance on public assistance. Lee and Zurlo (2014) also constitute a positive clan between caregiving and lower income later in life. In their examination of an eight-wave longitudinal study, Butrica and Karamcheva (2014) establish that caregiving was associated with both reduced labor forcefulness participation and reduced net worth of family caregivers when compared with not-caregivers. These are examples of some of the wide economic impacts of caregiving. The give-and-take below examines in greater detail specific types of economic impact on the caregiver.

OUT-OF-POCKET SPENDING

Out-of-pocket spending generally refers to the buy of appurtenances and services on behalf of the person whom the caregiver is helping, including payment for medical/pharmaceutical co-pays, meals, transportation, and goods and services. Data on the dollar value of out-of-pocket costs are limited. The available estimates are based on self-reports that use rather broad and vague definitions of what constitutes an out-of-pocket caregiving expense. Little is known about the extent to which older adults and their family caregivers share the costs. One 2007 phone survey asked caregivers nigh a wide range of spending including medical expenses, food and meals, household goods, travel costs, care recipient services (adult solar day services and domicile intendance), nursing home/assisted living costs, housing costs, caregiving services, home modifications, clothing, medical equipment/supplies, and legal fees. The caregivers reported an boilerplate annual amount of $5,531; long-distance caregivers had the highest average annual expenses ($viii,728) (Evercare and NAC, 2007). One in 5 caregivers reported that older adults' out-of-pocket medical costs were their highest expense. The 2011 NSOC found that 8 per centum of caregivers incurred more than than $1,000 per year in out-of-pocket caregiving costs—divers every bit spending on medications or medical care, Medicare or other insurance premiums or copay-ments, mobility and other assistive devices, dwelling house modifications, and paid dwelling health aides. For some caregivers these costs may hateful drawing down assets, taking on debt, or foregoing handling of their own health problems. Better data on economic furnishings of caregiving on the family caregiver are needed to provide an accurate movie of the magnitude and predictors of economic effects.

Out-of-pocket spending plays a pregnant part of financing for LTSS considering insurance—public or private—is lacking for these services, including hiring straight intendance workers such as dwelling house wellness aides and personal care workers. In one national survey, ane in four (25 percent) family unit caregivers said it was very hard to get affordable services in the older developed's community that would assistance with their intendance (NAC and AARP Public Policy Found, 2015b). Out-of-pocket expenses for older adults who are non Medicaid eligible or do not have long-term care insurance must be covered by the older adult or their family. Medicare does not cover LTSS and Medicaid is only available after people have become impoverished.

The wealthiest families may have funds to pay for supportive services simply many middle-form families cannot afford the dwelling house- and community-based services that will enable their elders to remain at home and avoid even more expensive institutional care (Bookman and Kimbrel, 2011). In 2016 the cost of employing a dwelling health aide total time for 1 year was about $46,480 and use of adult mean solar day services cost nigh $18,000. The median annual price for an assisted living facility was $43,539 in 2016; the median almanac cost for nursing home care was $92,378 in 2016 (Genworth, 2016).

EMPLOYMENT-RELATED COSTS TO CAREGIVERS

Today's caregivers of older adults are much more likely to be employed than in the past. The NSOC found that approximately one-half of all caregivers to older adults were employed either part- or full-fourth dimension. Of those caregivers who worked, 69 per centum were employed at least 35 hours weekly. In 2011, one-half of the estimated 17.7 million caregivers of older adults (eight.7 million or fifty.three percent) in the United States worked (encounter Figure iv-2). Depending on the intendance needs and the intensity of the caregiving role, a caregiver may accept to brand accommodations in guild to manage their caregiving responsibilities and their job. Researchers, advocates, and observers have raised concerns that the demands of caregiving can negatively impact caregivers' ability to stay in the workforce and thus jeopardize their income, job security, personal retirement savings, eventual Social Security and retirement benefits, career opportunities, and overall long-term financial well-being (Arno et al., 2011; Feinberg and Choula, 2012; Lilly et al., 2007; Munnell et al., 2015; Reinhard et al., 2015; Skira, 2015; Van Houtven et al., 2013; Wakabayashi and Donato, 2006).

FIGURE iv-2

Employment status of family unit caregivers of older adults, by sex, co-residence, relationship, race, instruction, and household income. NOTES: N = 8.7 million (employed caregivers). Includes family caregivers of Medicare beneficiaries age 65 and older in the (more than...)

Other survey data (NAC and AARP Public Policy Establish, 2015a) suggest that the bulk (61 percent) of employed caregivers need to make some workplace accommodations such as coming in belatedly to work or leaving early, taking time off to manage care situations, reducing piece of work hours or level of responsibility, and/or taking a go out of absence. All of these accommodations have potential costs associated with them for both the caregiver and the employer. If an employee has wearied his/her paid time off or has no paid fourth dimension off to begin with, each hr of work lost due to caregiving activities bears a fiscal cost to the employee. Taking unpaid leave is expensive, as is cut hours or taking a lower paying job with less responsibility. Not only does the caregiver have an immediate loss of income, his/her long-term economic status may exist affected due to lower retirement savings or benefits.

As Chapter 2 describes, electric current trends point to higher rates of employment amongst caregivers in the time to come—especially for the wives and daughters of older adults (Rock, 2015). The U.South. Bureau of Labor Statistics projects that women's participation in the labor strength will continue to increase during the same years they are most likely to exist caregiving (Toossi, 2009). The percentage of women older than age 54 who piece of work, for example, is expected to increment from 28.5 percent in 2012 to 35.1 percentage in 2022. During the same menstruum, the percentage of working women older than age 64—those most probable to be caring for a spouse—is expected to increase from 14.4 pct to 19.5 percent. As women work outside the home to brand ends run into and abound the economy, the demands and pressures of working families to residue work, caregiving, and other family responsibilities have grown (Feinberg, 2013).

Caregivers' employment rates are highly variable across important subgroups (Bauer and Sousa-Poza, 2015; Jacobs et al., 2014; Lilly et al., 2007; Van Houtven et al., 2013). The 2011 NSOC constitute marked differences in employment between those caring for a spouse (24 per centum) or a parent (more than 60 percentage).

Although many people expect to work longer—primarily driven by financial considerations—family caregiving responsibilities tin can sometimes get in the manner of continued employment (Feinberg, 2014). Surveys signal a potent association between caregiving—especially high levels of caregiving—and reduced work for pay. I national survey establish that 1 in five (19 percent) retirees left the workforce earlier than planned because of the demand to care for an ill spouse or other family unit fellow member (Helman et al., 2015). In the 2015 Caregiving in the U.Southward. survey (NAC and AARP Public Policy Institute, 2015a), working caregivers who quit their job or took early retirement reported doing so in guild to have more than time with the person they were helping (39 percentage) or because their job did not provide flexible scheduling (34 percent). Caregivers with high care hours provided to the older person reported that they left the job because they could not afford to rent a paid caregiver. Co-resident caregivers were near probable to brand income-related accommodations such as cutting back work hours, taking a exit of absence, quitting a job, or taking early retirement. A recent analysis of NHATS and NSOC information revealed that working caregivers who provide high levels of assist with health care activities were three times more likely to feel work productivity loss ⁴ than caregivers who provided some or no assistance with health care (Wolff et al., 2016). Some research has as well examined how family unit caregiving affects a woman'southward electric current and future employment situation and retirement security. Ane report, using data from HRS, establish that women who get out work while caregiving may find it difficult to return to the labor force later on they finish providing care to a parent (Skira, 2015). A study by Arno and colleagues (2011) based on HRS longitudinal data examined the long-term economic effects on workers who either reduced their hours at work or left the workplace before full retirement age. The analysis found that income-related losses sustained by family caregivers ages l and older who exit the workforce to care for a parent are $303,880, on boilerplate, in lost income and benefits over a caregiver'south lifetime. ⁵ More enquiry is needed to fully empathize the factors influencing the working caregiver'south productivity and conclusion to exit and afterwards render to the workplace and whether there are strategies that could mitigate agin economic effects.

Figure four-2 illustrates the employment rates past selected characteristics. These rates suggest that factors that would predict the power to proceed working while providing care are related to college pedagogy and income levels. Caregivers with a lower level of teaching or lower income are the least probable to exist in the workforce and therefore are most at risk of the economic losses outlined earlier.

COSTS TO EMPLOYERS

Much less is known nearly caregiving-related costs to employers. Employer- or business-related costs may include the replacement costs for employees who quit due to their caregiving responsibilities, costs of absenteeism and workday interruptions, besides as management and authoritative costs based on the time supervisors spend on bug of employed caregivers. Some estimates suggest that the toll to U.Southward. businesses due to caregiving may exceed $29 to $33 billion per year, but these estimates should exist viewed charily as they are based on one-time data and the studies make debatable assumptions in carrying out their assay (MetLife Mature Marketplace Found and NAC, 1997, 2006). Reliable information on the impact of eldercare on U.South. businesses are currently not available.

Some, primarily big, employers accept invested resources in developing workplace programs for caregiving employees in an endeavour to support caregivers and retain workers. Anecdotal evidence suggests that these programs may exist well received and helpful to employed caregivers. Still, data do not exist to assess the effect of programs on employers or their return on investment. The few studies undertaken to explore these outcomes are largely dependent on self-reported data with the expected limitations (Gwyther and Matchar, 2015/2016; NAC and ReACT, 2012; Wagner et al., 2012). Only a few studies take been washed to explore the small business surround (Matos and Galinsky, 2014; MetLife Mature Market Institute and NAC, 2006). All the same, the topic of economic affect of family caregiving is an important 1 for both employers and caregivers who are employed. As new workplace policies emerge information technology will be important to assess employer acceptance, impact on business and industry, and do good to the caregiver.

SOCIETAL BENEFITS

Family unit caregiving has the potential of substituting for formal health intendance services and the associated costs to Medicare and Medicaid in the form of reduced nursing home use and lower rates of domicile health care utilization (Charles and Sevak, 2005; Van Houtven and Norton, 2008). Both intervention and descriptive studies suggest that under some circumstances price savings tin be achieved in the form of delayed institutionalization, reduced rehospitalizations, and lower home health service use. These studies are described in subsequent chapters on interventions with caregivers (run across Chapter 5) and wellness intendance and LTSS (see Chapter 6).

Some researchers estimate the societal do good of family caregiving by computing the replacement costs of the time spent by family caregivers on tasks that someone else could perform (and assuming an hourly wage that would be paid in lieu of caregiving). Estimates of the economic value of unpaid care depend on which information sources are used and how caregiving is defined. Nigh studies utilise survey data to estimate the number of family unit caregivers, the number of hours of care provided by caregivers, and the average wage of a home wellness aide (the replacement for the family caregiver). The Congressional Budget Role estimates that, in 2011, unpaid intendance provided by family caregivers to older adults was worth about $234 billion (CBO, 2013). Even so, estimating replacement costs is circuitous because non all caregivers are alike. For instance, replacement costs for retired individuals would likely exist different than replacement costs for younger caregivers in the workforce. In addition, as noted by Skira (2015), existing static estimates are likely to underestimate the true cost because they do not take into account dynamic wage and employment effects of elder parent care such as leaving the labor force permanently as a result of caregiving.

POLICIES AND PRACTICES THAT SUPPORT WORKING CAREGIVERS

Balancing piece of work and caregiving responsibilities is a hard task even under the all-time of circumstances. A flexible workplace tin can support employed caregivers with the time they need to handle emergencies and routine matters such equally md's appointments. However, many family caregivers lack this flexibility and, for those who do non have the pick of taking time off with pay, balancing work and family responsibilities tin can be nearly impossible. Employees may be absent from work for both planned and unplanned reasons. For example, taking a mother to a scheduled doctor'due south appointment is a planned exit from piece of work. Going to the infirmary to intendance for a father who has suffered a stroke is an example of unplanned leave that may happen due to an urgent and unexpected state of affairs (Feinberg, 2013). The U.S. Section of Labor (DOL) (2015c) reports that 40 pct of the private-sector workforce lacks access to any paid sick leave, while 70 per centum of workers who have earnings in the bottom 25 percent of the wage scale in the U.s.a. lacks any paid time off.

Flexible Workplaces

Flexible workplaces may include flexibility well-nigh where work occurs, when work takes place, and an option to modify work schedules according to competing responsibilities. In 2014, President Obama signed a Presidential Memorandum that gave federal workers a right to asking flexible working arrangements. Flexible workplaces are non merely proficient for the employees with caregiving responsibilities but do good employers also. Studies suggest that flexible work policies reduce turnover and absenteeism among employees and may improve productivity (Council of Economic Advisors, 2010). Flexible piece of work schedules specifically with respect to eldercare accept non been studied.

Family and Medical Leave Policies

The federal Family and Medical Get out Human activity (FMLA) has been in identify in the United States since 1993. The Deed allows workers to take unpaid, task-protected leave to care for a worker'south ain health needs, to bond with a new kid, or to intendance for a seriously ill family member (child, parent, or spouse). FMLA simply applies to governmental agencies and private employers with more than 50 employees. Eligibility for FMLA requires a worker to have been employed past the covered employer for at least 12 months and to accept worked at least 1,250 hours. Up to 12 weeks of unpaid leave may be taken during whatever 12-month period and employees must be able to return to their job or equivalent with the same pay, benefits, and working conditions (Mayer, 2013). FMLA can exist taken intermittently, over a 12-week menstruation, or by working part time. In most states, the circumstances that define a worker's correct to FMLA are limited to sure relationships: spouses, domestic partners, children, and parents. Many caregivers of older adults such as in-laws—daughters or sons—step-children, grandchildren, siblings, nieces and nephews, and other relatives are not eligible for the protection of FMLA. Overall twoscore percent of U.S. workers practise non qualify for FMLA due to their family relationship to the care recipient or because of the law's other restrictions (Klerman et al., 2014).

FMLA is as well not a true option for low-income people who cannot afford to forego wages they would lose by taking it (Feinberg, 2013; Umberson and Montez, 2010). In a DOL-sponsored survey in 2011, 17 percentage of caregivers did not take go out because they feared losing their chore even though they were eligible for protected job go out, and eight percent did not access unpaid leave benefits because they were not eligible due to the human relationship with the intendance recipient (Klerman et al. , 2014).

Although DOL has sponsored a series of surveys to track the implementation of FMLA, the agency's information drove is non detailed enough to assess the law's specific impact on caregivers of older adults. The most recent DOL survey indicates that, in 2012, xviii percent of workers who took leave under FMLA did so to intendance for a kid, parent, or spouse with a serious health condition (Klerman et al., 2014). The survey did not distinguish among the dissimilar caregiver categories, so data on exit taken specifically for eldercare are not available.

Fourteen states including the District of Columbia have enacted legislation to extend FMLA to other family unit relationships, nearly oft to domestic partners and parents-in-law simply also including grandparents, grandchildren, and siblings. 6 states have also expanded eligibility to some workers in smaller firms. Tabular array four-one lists the covered categories for each state.

Table 4-1

States with Expansions in Unpaid Family and Medical Leave.

Access to Paid Family unit Get out

The overwhelming majority of U.Due south. workers practice not have admission to paid family or medical leave (Glynn, 2015). According to the National Compensation Survey, only 12 per centum of private-sector workers accept admission to paid family leave benefits through their employers (BLS, 2015a). In this survey, lower-wage workers were less likely than higher-wage workers to have access to paid family go out. Although paid family unit leave is non bachelor to most workers, other forms of paid leave tin can support a working family unit caregiver. When employers provide paid time off, it can exist in the course of vacation days, sick leave, personal days, or every bit "PTO," paid fourth dimension off for any reason (Bishow, 2015; BLS, 2015a). Box 4-1 outlines alternative paid exit options that may exist bachelor to employees. The grade of leave benefits vary widely across occupations, type of worker, industries, institution size, and geographic areas. Nearly all full-time federal, state, and local government employees are entitled to paid leave of some blazon (BLS, 2015a).

Tabular array 4-2 shows the percentage of workers in wage categories without any paid leave. Equally tin exist seen, there is a articulate association between depression wages and part-time status and no paid leave options.

TABLE 4-2

Workers Without Employer-Paid Leave, by Average Wage Category and Weekly Piece of work Hours, 2015.

State and Local Efforts to Expand Access to Paid Leave for Family Caregivers

Land governments provided the leadership in the evolution of the paid family and medical leave policies in place today. Connecticut was the beginning country to enact paid family leave for land employees in 1987. In 2004, California began the first paid family and medical get out program in the nation (Wagner, 2006). Today states are again leading in the development of paid family leave programs. Four states—California, New Jersey, New York, and Rhode Island—take enacted admission to paid family and medical leave programs for new parents and caregivers of certain seriously ill family members. New York and Rhode Isle comprise job protection as a characteristic of their program. The 4 programs share the post-obit blueprint characteristics:

• Financed through an insurance model

• Fully funded by worker payroll deductions

• Provides fractional pay replacement for a finite catamenia of fourth dimension

• Covers caregivers of spouses, parents, and domestic partners (California, New York, and Rhode Island likewise include parents-in-law and grandparents; siblings are eligible simply in California)

• Uses an existing land infrastructure to finance and administer claims (i.eastward., Temporary Disability Insurance [TDI] agencies)

The annual payroll deductions are designed to fully cover the program costs (Fiscal Policy Establish, 2014). Some testify indicates that costs are low because program utilization is low (Appelbaum and Milkman, 2011). Because New York'south program was passed in 2016, information on the program volition not exist available until after the program starts in 2018 (A Better Balance, 2016).

Touch on of Paid Family Go out Programs on Caregivers of Older Adults

Determining the directly impact of these programs on caregivers of older adults is difficult although the programs clearly offer some financial protection for those who tin can use them. The states collect some data on users but not in enough detail to identify the ages or conditions of the older adults who receive care. In every country, the programs are used primarily by new parents for bonding with infants (Andrew Chang & Visitor, 2015; Bartel et al., 2014; EDD, 2014a,b, 2015; Milkman and Appelbaum, 2014; National Partnership for Women and Families, 2015; New Bailiwick of jersey Department of Labor and Workforce Development, 2015) (see Table four-3). People caring for spouses or adult children caring for parents constitute about 6 to x percentage of claimants—presumably many of their intendance recipients are older adults. In New Bailiwick of jersey, 60 percent of family care claims in 2011 were made by employed caregivers aged 45 and older (Feinberg, 2013).

Tabular array iv-iii

Characteristics of State Mandatory Paid Family unit and Medical Leave Programs.

Public awareness of the programs is a trouble particularly with respect to eligibility for paid leave to care for seriously ill family members. In California, the individuals who are most probable to benefit from paid family leave are among those groups to the lowest degree likely to know about it (Andrew Chang & Visitor, 2015; Field Inquiry Corporation and California Middle for Research on Women & Families, 2015). A survey conducted in belatedly 2014, for example, found that only 36 percent of California registered voters knew about the plan and its benefits; awareness was peculiarly low among ethnic minority groups (i.e., persons identifying every bit Latino, African American, or Asian American), individuals with no more than a loftier school didactics, depression-income households, and women (Field Inquiry Corporation and California Center for Research on Women & Families, 2015). A New Jersey poll found that 60 percent of the public did not know almost the family caregiving do good (White et al., 2013). Some workers may non use available paid family leave because the benefit does not guarantee job security, or considering they cannot afford to take the time off because the paid leave do good covers only partial wage replacement.

In 2014, the California legislature funded a public education and outreach entrada that including focused market inquiry on the linguistic and cultural issues that may touch on awareness and employ of family unit leave benefits. Focus grouping discussions—structured to examine the perspectives of eligible Armenian, Chinese, Filipino, Latino, LGBTQ Californians, Punjabi, and Vietnamese—revealed significant challenges in communicating information most paid family leave (Andrew Chang & Visitor, 2015).

Impact of Paid Family Leave Programs on Employers

Near of the published reports on employers' response to their state'south mandated paid leave program draw from small surveys and structured, in-depth interviews with selected employers. About employers appear to have adjusted to the mandates although some report additional costs. A 2010 survey of California employers constitute that nearly 90 percent of employers reported either a positive or no noticeable event on productivity, profitability, or employee turnover (Appelbaum and Milkman, 2011). In-depth interviews with 18 New Jersey employers 4 years afterward the start of the program constitute largely positive responses (Lerner and Appelbaum, 2014). The surveyed employers represented businesses with as few as 26 employees and as many as 36,000 employees. All respondents had at to the lowest degree one employee who submitted a merits for paid family leave. Some employers said information technology improved morale and led to only small-scale to moderate increases in paperwork. However, 2 of the 18 employers said the mandate led to lower profitability.

Prospects for New State and Local Paid Family Leave Programs

California, New Jersey, New York, and Rhode Island have been able to limit the cost of implementing paid family leave past using existing TDI state agencies. These states have extended TDI programs to provide a partial wage replacement do good to employees caring for a relative with an disease (Feinberg, 2013; New York State Legislature, 2016). In April 2016, California expanded its paid family leave police to include more low-income workers and to provide college pay to workers while on leave (effective in 2018). Simply one other land—Hawaii—has the same TDI infrastructure but information technology does not have a paid family get out program (National Partnership for Women and Families, 2015). ⁶ Washington Country—which does not have a TDI program—enacted paid family get out in 2007 but has however to implement information technology due to lack of get-go-up funds (Glynn, 2015). Table 4-3 displays the characteristics of land mandatory paid family and medical leave programs.

Additional insights into other approaches for the blueprint and implementation of paid family unit medical get out programs may be forthcoming from DOL. Since 2014, DOL has awarded more than $two million in grants to 12 states and localities to either evaluate their existing programs or to conduct feasibility studies to encourage their development. The grantees are California; the District of Columbia; Massachusetts; Montana; Montgomery Canton, Maryland; New Hampshire; New York City; Rhode Island; Tennessee; Vermont; and Washington state (DOL, 2015b). Recently DOL appear the third circular of $one one thousand thousand in grants. Chiefly, in this round of paid exit analysis grants, DOL is encouraging states/localities to study issues related to eldercare. DOL will award up to three points to applications that bear upon on paid family unit exit for workers with eldercare responsibilities (DOL, 2016).

Access to Mandatory Paid Sick Leave

Five states—California, Connecticut, Massachusetts, Oregon, and Vermont—have recently enacted paid sick leave laws affecting the employees of all or a large portion of the respective country's employers. The policies, described in Tabular array 4-iv, have important implications for employed caregivers because they stipulate that workers have access to paid sick fourth dimension when caring for certain ill family members. Earned sick day policies differ from paid family and medical leave policies. Public policies roofing sick days at work generally embrace a limited number of paid days off per twelvemonth (typically between 3 and nine days, depending on state or locality) with full wage replacement (Reinhard and Feinberg, 2015). California has the most expansive definition of eligible family members; information technology includes spouses, domestic partners, parents, parents-in-police force, grandparents, and siblings. Connecticut covers spouses simply. The Massachusetts statute—a issue of a 2014 election initiative—allows time off for workers taking family members to a medical appointment.

Tabular array 4-4

Characteristics of State Mandatory Paid Sick Exit Laws.

Employers in a growing number of major metropolitan areas are also discipline to local paid ill leave mandates (National Partnership for Women and Families, 2015; Reyes, 2016). These include Eugene and Portland, Oregon; New York Metropolis; the San Francisco Bay Area; Los Angeles; Montgomery County, Maryland; Philadelphia and Pittsburgh; Seattle and Tacoma; Washington, DC; and ix New Bailiwick of jersey cities. ⁷

Federal workers and contractors as well have access to sick exit. In January 2015, the White House issued a Presidential Memorandum directing federal agencies to advance up to 6 weeks of paid sick leave for federal employees to care for sick family members, including spouses and parents (White Business firm Office of the Press Secretary, 2015a). In September 2015, the President signed an Executive Order requiring federal contractors to offer their employees upwardly to 7 days of paid sick go out annually, including paid leave allowing employees to care for ill family members (White Business firm Office of the Press Secretary, 2015b).

Caregiving and Social Security Benefits

Because Social Security benefits are based on one's earnings history, caregivers who cut their work hours or withdraw from the workforce will ultimately receive lower Social Security payments. Social Security caregiving credits take been proposed as one fashion to reduce the impact of foregone wages on hereafter benefits (Estes et al., 2012; Morris, 2007; White-Ways and Rubin, 2009). In its simplest form, a Social Security credit program would prospectively credit eligible caregivers with a defined level of deemed wages upward to a specified time menstruum. White-Ways and Rubin (2009), for example, have proposed that full-fourth dimension caregivers receive up to four years of Social Security work credits equal to the individual's average wage or cocky-employment income during the previous 3 years. The caregiver'due south eligibility would crave certification by a doctor as to the care recipient'south level of need. Using 2008 estimates, the analysts projected that married caregivers who used the credit for the total 4 years would see a lifetime increment in Social Security benefits of $8,448 and single caregivers would receive $13,632 more.

The costs of developing and administering a Social Security caregiver credit program have not been fully explored. The straight toll of the credits would depend on several variables such equally eligibility criteria (e.g., spouses, developed children, or others), the maximum number of creditable years, and the method used to calculate individual payments (Jankowski, 2011). The development and management of an infrastructure to administrate the program would as well have costs.

Chore Bigotry

Some employed caregivers of older adults may be subject to workplace discrimination considering of their caregiving responsibilities (Bornstein, 2012; Calvert, 2010; Calvert et al., 2014; EEOC, 2007, 2009; Williams et al., 2012). Family unit responsibility discrimination (FRD), also chosen caregiver discrimination, is employment discrimination confronting someone based on his or her family caregiving responsibilities and the assumption that workers with family obligations are not dependable or less productive than their peers (Calvert, 2015). The outcome can exist emotionally draining and plush to the working caregiver. Appendix G includes the stories of 2 workers who reported experiencing task discrimination equally a consequence of their family caregiving responsibilities.

FRD commonly results from unexamined assumptions about how an employee will or should human activity. For case, a supervisor may presume that a woman volition not be as circumspect or committed an employee subsequently she advises her supervisor of her need to take periodic fourth dimension off to intendance for her sick husband. FRD occurs when caregivers—regardless of their piece of work functioning—are rejected for rent, denied a promotion, demoted, harassed, terminated, or subjected to schedule changes that force the employee to quit (Calvert, 2010). One recent national study found that v percent of working caregivers historic period 65 or older had ever received a alarm about their performance or attendance as a consequence of caregiving (NAC and AARP Public Policy Institute, 2015b).

Responses to testify of FRD have been varied. No federal statutes or regulations specifically prohibit FRD. Some states and localities have enacted laws that protect workers with family responsibilities as a specific group or class from discrimination—but the protections are sometimes limited to childcare responsibilities (Reinhard et al., 2014; Williams et al., 2012). In January 2016, the Mayor of New York City signed legislation expanding the protections of the city's Man Rights law against employment discrimination to include caregivers of a small child or an individual with a disability. The police adds "caregiver status" as an boosted protected category for which employment bigotry is prohibited (McHone, 2016).

In 2007, the Equal Employment Opportunity Commission (EEOC) issued a report on FRD, Enforcement Guidance: Unlawful Disparate Handling of Workers with Caregiving Responsibilities (EEOC, 2007). While the report acknowledges that federal equal employment opportunity laws do not prohibit bigotry against caregivers, information technology articulates the circumstances in which employment decisions affecting a caregiver might unlawfully discriminate on the basis of Championship VII of the Civil Rights Deed ⁸ or the Americans with Disabilities Human activity. ⁹ Farther guidance is provided in an EEOC best practices guide for employers (EEOC, 2009). Although the EEOC efforts are valuable, the agency's advice does not carry the weight of regulation nor does it have authority over FMLA and other statutes outside of the agency's jurisdiction.

The magnitude of the impact of FRD on family caregivers of older adults is non known; nigh reported cases relate to pregnancy and parenthood. The Heart for WorkLife Law, which tracks litigated cases of FRD cases decided past courts, agencies, and arbitrators, has compiled a dataset of more than four,400 cases dating from 1996 to 2015 (Calvert, 2016). Overall, 11 percentage of the cases were related to caregiving for aging relatives. The report author suggests that because FRD cases are identified primarily through publicly available court rulings, they may be a modest fraction of the full number of actual cases.

Private EMPLOYER INITIATIVES

More than 30 years ago, employee surveys began to raise concerns among large employers and organized labor about the challenges faced by workers with caregiving responsibilities (Labor Project for Working Families, 1999; Travelers Insurance Companies, 1985). An often cited Fortune mag survey establish that even some CEOs reported they did non believe they could manage their ain jobs if they had to care for a parent (Fortune Mag and John Hancock Financial Services, 1989). In response, large employers began to provide workplace programs to back up workers and mitigate the affect of caregiving on employees' temporary or permanent departures, lower productivity, absenteeism, coming to work tardily or leaving early, accidents or mistakes, and health problems (Galinsky and Stein, 1990; GAO, 1994; Wagner et al., 2012). The 2014 Order for Man Resource Direction (SHRM) survey of employers estimates that five pct of employers provide eldercare referral services, i percent geriatric counseling and i percent eldercare in-home assessments (Matos and Galinsky, 2014). There is lilliputian empirical show about outcomes of the workplace programs and the extent to which they either help the employee with caregiving responsibilities or mitigate work–family conflicts. Early research supports the thought that many employees do not experience comfy bringing a family issue into the workplace and may, equally a result, not use available programs (Wagner and Hunt, 1994). Nonetheless, there is evidence equally discussed before, that workplace flexibility supports those employees with eldercare responsibilities. The three eldercare workplace programs shown in Box 4-2 were selected every bit examples considering of their successes over time (Fannie Mae and Duke Academy) and the thoughtfulness and careful planning that went in to the newly adult Emory University programme. The university used consultants and studied both the campus needs and the resources in the community in their planning.

BOX 4-2

Three Noteworthy Eldercare Workplace Programs.

CONCLUSIONS

The committee'southward cardinal findings and conclusions are described in particular in Box 4-3. In summary, the committee concludes that family caregiving of older adults poses substantial financial risks for some caregivers. Although the relevant evidence is based primarily on caregivers' self-reports, inquiry consistently shows that family caregivers of older adults with significant concrete and cognitive impairments (and associated behavioral symptoms) are at the greatest risk of economic harm. This risk is specially true for low-income caregivers (and families) with express fiscal resources, caregivers who reside with or live far from the older developed who needs care, and caregivers with limited or no admission to paid leave benefits (if they are employed).

BOX 4-3

Key Findings and Conclusions: Economical Impact of Family Caregiving.

Some caregivers cut back on paid work hours or leave the workforce altogether to care for an older adult. As a upshot, they lose income and may receive reduced Social Security and other retirement benefits. They may also incur significant out-of-pocket expenses to pay for help and other caregiving expenses. There is also some show of increasing job-related discrimination against workers with eldercare responsibilities.

Caregiving of older adults has substantial implications for the workplace. Today'southward family caregivers of older adults are more than probable to be in the workforce than ever before—more than one-half are employed either function- or total-fourth dimension. Moreover, the cohort of Americans virtually probable to intendance for older adults—women age 55 and older—are expected to participate in the workforce at increasing rates.

Federal policies provide little protection to many employed caregivers in these circumstances. For example, daughters- and sons-in-law, stepchildren, grandchildren, nieces and nephews, and siblings of older adults are not eligible for FMLA's unpaid exit or chore protections for family get out. Low-wage and part-time workers are peculiarly vulnerable because they cannot afford to take unpaid leave and their employers are less likely to offering paid time off. A handful of states and local governments have taken action to assure admission to some form of paid family or sick get out. However, much remains to be learned virtually how these efforts have specifically affected caregivers of older adults or their employers.

The bear upon of family caregiving on employers has non been well studied. Some large employers have established programs to support workers with eldercare responsibilities. Unfortunately, there is piddling empirical bear witness about the costs and outcomes of workplace programs or the extent to which they help working caregivers juggle their caregiving and job responsibilities. Data and research are clearly needed to learn how to effectively support working caregivers of older adults through workplace go out benefits, protections from chore discrimination, or other approaches.

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1

The prevalence data presented in this report draw primarily from NHATS and NSOC, unless noted otherwise. Run into Chapter two and Appendix E for boosted data almost the surveys and the commission's methods in analyzing them.

2

NSOC includes caregivers of older adults living in any type of residential care setting other than a nursing domicile. Residential care settings include assisted or independent living facilities, personal care and group home settings, continuing intendance retirement communities, and other settings (Kasper and Freedman, 2014).

three

See Chapter 2 for additional statistics describing the caregiver population.

4

"Piece of work productivity loss" in this research was a composite variable based on measures of absenteeism (missed hours of work because of caregiving in relation to typical hours worked) and presenteeism (negative outcome of caregiving on productivity when at work) (Wolff et al., 2016).

5

In this study, the estimates range from a total of $283,716 for men to $324,044 for women, or $303,880 on average. The boilerplate figure breaks down as follows: $115,900 in lost wages, $137,980 in lost Social Security benefits, and conservatively $50,000 in lost alimony benefits.

6

Puerto Rico too has a TDI program.

7

The New Jersey cities are Bloomfield, East Orange, Irvington, Jersey City, Montclair, Newark, Passaic, Paterson, and Trenton.

viii

Public Law 88-352.

9

Public Police force 101-336.

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Source: https://www.ncbi.nlm.nih.gov/books/NBK396402/

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