How voters view health care and women’s jobs will have a major impact on the outcome of the presidential election. I say this, not because I’m a pundit or a pollster, but because of what I see in my job as a doctor.
As a hospital physician, I’m often faced with patients who can no longer live independently due to worsening illness or a new disability. They need help to take care of their daily needs like bathing, cooking, and dressing. Some patients have families who seem to move mountains to provide 24-hour care for their loved ones at home – rearranging work schedules, having their family members move in with them, or perhaps hiring outside help –while other patients whose families understandably may not be able to provide this level of care at home may enter a nursing home.
Neither is an easy decision. For patients, losing their independence can be devastating. For family members who assume the role of caregiver, it is equally life-changing. But, it’s common. Researchers estimate that about 70 percent of 65-year-olds will require long-term care at some point. But, here’s a recipe for disaster: With the number of elderly in the US ballooning (In 2000, about 1 in 8 Americans were 65 and older; by 2030, it will be 1 in 5) the need for caregiving will increase tremendously. Add in the draconian cuts to Medicaid proposed by Romney-like health care plans, estimated at $1.7 trillion; financial assistance for nursing home care will become scarce. The ones who will carry those increased economic caregiving burdens will be largely middle and lower class women.
No one plans or hopes to ever require long-term care, but chronic illnesses like cancer or dementia may result in the inability of some people to take care of themselves. Most of the long-term care needs of older Americans are provided by friends and family; of this, the majority is provided by women. The value of the informal care provided by women caregivers is estimated to be $148 to $188 billion annually. Caregivers allow people with long-term care needs to stay at home versus entering a nursing home, an option that can cost upwards of $70,000 a year and largely supported by Medicaid dollars. In 2003, nearly half of the nation’s nursing home bill was paid for by Medicaid. While caregiving can be rewarding, it can also be incredibly draining – physically, mentally, and financially. An estimated 25% of the entire US workforce provided informal care in 1996.
The average American caregiver is 46, female, and working outside the home with an annual income of $35,000/year. One study revealed that nearly half of Baby Boomer women caregivers suffered from financial hardships due to the costs of caregiving. For working women caregivers, their caregiving role is associated with decreased hours working, being passed up for a job promotion, training, or assignment, taking a leave of absence, switching from full-time to part-time employment, quitting their jobs entirely, or retiring early. It has been estimated that financial impact for businesses of replacing employees or absenteeism due to caregiving totals $7.7 billion. While men also provide caregiving, female caregivers generally spend more time providing care, up to 50% more, than their male counterparts. Caregiving is also associated with depression, anxiety, and other physical problems in middle to older-aged women.
The need for long-term caregiving in the US will only grow. We need to be thoughtful about how we can support the backbone of long-term care in the US, women caregivers. Blind cuts to Medicaid without an alternative solution to supporting long-term care for our most vulnerable hurts lower and middle class women preferentially. Of note, the Affordable Care Act recognizes the importance of caregiver support, establishing special centers to help train caregivers in chronic disease management, dementia and mental health.
Who do we care for as a country? Next week’s election will be telling.
Katherine Chretien is an associate professor of medicine at George Washington University.