The Quiet Price of Household Caregiving

At first, Dana Guthrie thought she could help care for her parents, whose health was beginning to decline, and still hold on to her job managing a busy dental office in Plant City, Florida.

“It was a great paying job and I didn’t want to lose it,” recalled Ms. Guthrie, 59, recently. So she tried shifting to a four-day schedule, working evenings to keep up with the demands of the office, and began spending a few nights a week at her parents’ house instead of her own nearby.

Eventually, however, her mother’s liver disease progressed and her father was diagnosed with dementia. The family learned that the cost of hiring domestic help for two sick 82-year-olds exceeded even a middle-class retirement income and savings. “They really needed me,” Ms. Guthrie said. In 2016, she quit her job “and moved full-time.”

An estimated 22 to 26 million American adults are currently caring for family members or friends, most of whom are elderly, who need help with daily activities; More than half of these nurses have a job. “There’s no doubt that juggling the two can be very difficult,” said Douglas Wolf, a demographer and gerontologist at Syracuse University.

Research has shown that nurses who are employed often reduce their working hours or leave the workplace altogether. However, several recent studies show in more detail the impact of these decisions, not only on professional caregivers, but also on employers and the wider economy.

Yulya Truskinovsky, an economist at Wayne State University, and her co-authors combined data from a Census Bureau survey with Social Security records to track unusually long employment histories for nearly 13,000 people.

Among those who became caregivers, employment fell nearly 8 percent compared to demographically similar non-caregivers, the authors found. “It happens right away, in the first year,” said Dr. Truskinovsky. “We see little evidence that they are either reducing their working hours or becoming self-employed. They drop out of the labor market and stay out of it for quite a long time.”

She added, “Younger caregivers are just as likely to exit the labor market as older ones.” Seven years later, the study found, these caregivers had not returned to the level of labor force participation of demographically-matched non-caregivers.

In addition, there were significant gender differences in those leaving the workforce.

Men began reducing their workload long before they became caregivers; then “they leave the workforce and don’t come back,” said Dr. Trukinovsky. The study could not provide an explanation; maybe men take over the care when their working lives are already drawing to a close.

In contrast, female nurses leave the workforce more abruptly and are more likely to return — after just two years on average — “but for lower wages or fewer hours,” said Dr. Trukinovsky.

The pandemic has exacerbated the conflict between employment and care, noted Dr. Truskinovsky and colleagues found in another study. “Foster care agreements are very fragile,” she noted. While families often patch together paid and unpaid care, “it’s unstable, and if one thing falls through, your whole arrangement collapses.”

In a national sample of adults over the age of 55, half of caregivers reported that Covid-19 had disrupted their care plans, forcing them to provide more care (because paid assistance was no longer available) or less (because of quarantines and fears of a transmission). Before the pandemic, more than a third were employed.

Caregivers faced with disrupted agreements were more likely to be furloughed or lost their jobs; They also showed far higher rates of depression, anxiety, and loneliness than non-caregivers or caregivers who did not experience disorders.

The tribute to professional caregivers takes many forms. Susan Larson, 59, an educational services specialist with the US Army, has declined promotions even when her superiors urged her to apply. “I’m not geographically mobile,” she said.

She can’t leave her home in St. Paul, Minnesota, where she and her husband built an accessible extension for her 83-year-old mother, who needs extensive assistance. The army has been very supportive, Ms Larson said. But she estimated her salary would be nearly 25 percent higher if she had accepted promotions, which in turn would boost both her future pension and her Social Security benefits.

Shawn French, 51, a video game writer from Limerick, Me., and his wife welcomed their widowed father into their home three years ago. Working remotely, Mr. French is able to help his father-in-law with meals, medication and mobility; His wife takes care of doctor visits and other chores.

“I wouldn’t want it any other way,” said Mr. French. But the stress caused him to give up weekend freelance work, which had been making $200 to $300 a week. “We always relied on that when things got tight,” he said. His wife also changed her work arrangements, which resulted in him being removed from her health insurance plan and becoming uninsured.

Even when caregivers keep their jobs, another recent study reports that nearly a quarter report either absenteeism (absenteeism) or reduced productivity (known as presenteeism).

Presenteeism is responsible for the biggest productivity loss, said senior author Jennifer Wolff, a gerontologist and public health researcher at Johns Hopkins University. “Absenteeism is visible, presenteeism less,” she said. “You show up but make doctor visits or manage insurance.”

The labor productivity of the affected employees fell by an average of one third. Based on 2015 data, the latest available data on adults 65 and older, that translates to a $49 billion annual loss.

While better tailored to the more predictable needs of new parents, paid family leave could also help workers caring for the elderly. When California introduced paid leave, which went into effect in 2004, nursing home stay rates fell by about 11 percent, Dr. Wolf out of Syracuse and his co-author Kanika Arora.

Although the study failed to determine the reason, Dr. Wolf that “the law change prompted people to stay in the job, but they took enough time to keep their parents out of a nursing home.” The authors’ recent work shows that paid sick leave also helps increase family caregiving.

President Biden pushed for an ambitious care plan that included 12 weeks of paid annual family leave, tax credits to offset care costs, and Social Security credits for time caregivers spend outside of work. Republican opposition in the Senate prevented its passage.

The debate about how best to support family carers will continue, but there is little debate about their support needs. While many workers can deal with the more predictable needs of aging parents and spouses, some face intense pressures that are incompatible with modern workplaces.

After Mrs. Guthrie’s parents died, she moved to Radcliff, Kentucky, where her sister lives. She has found positions in dental offices there but never matched the compatibility or salary of the position she left in Florida.

Ms Guthrie, who is currently unemployed, has been scouting for job opportunities and wondering if she will ever be able to retire, although she has no regrets for the sacrifices she made to care for her parents.

“We were a close-knit family and I would do it again,” she said. “But I was hit emotionally and financially and couldn’t really recover.”

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