The Broken System of Long-term Care in America

If you’re helping an older parent or spouse meet long-term care needs, join the crowd. One out of five workers in the United States spends an average of 20 hours a week caring for elder family members. These unpaid services have an estimated value of $230 billion a year—$20 billion more than the $210 billion that Medicaid pays each year for long-term care.

Providing these unpaid services imposes high indirect costs on employers, in the form of reduced productivity, absenteeism, a workforce whose own health is compromised by neglect and stress, and higher turnover, as workers leave their jobs to devote themselves to caregiving. All told, these problems cost U.S. employers $33.6 billion a year.

ReACT (Respect a Caregiver’s Time) is a coalition of companies and organizations focused on employers and employed caregivers. In 2012 this organization commissioned the National Alliance for Caregiving (NAC) to examine “best practices in workplace eldercare.” The NAC studied the eldercare programs of 18 corporations in an array of industries with workforces ranging from 35 to 118,000 employees. The models were as ad hoc as volunteer programs managed by employees who had done caregiving themselves and as formal as paid time off for emergency eldercare situations. Interestingly, paid time off for caregiving was offered only by the smallest company (35 employees), which did so as a strategy for retaining valuable talent. Now ReACT is working with AARP to design a Web site with information and ideas for employers and employees.

Thirty years ago, Elaine Brody, a gerontologist, suggested that family caregiving was becoming a “normative” experience. Surveys confirm that increasing numbers of Americans care for an adult or elder with long-term care needs. As 70 million baby boomers lurch into late life, we can count on increasing demand for long-term care services for at least two decades. Absent a national system that provides high quality, long-term nonmedical and medical care, families will continue to underwrite the true cost of long-term care with time, money, and diminished retirement savings. Employers will also continue to subsidize informal caregiving indirectly, whether or not they also invest in support programs directly.

These facts prompt a host of questions and reactions. Do American families generally have even a basic understanding of how long-term care is delivered and paid for here? Many caregivers are stunned to discover that Medicare does not cover long-term care. Many find it repugnant that their elderly parents are required to spend all of their resources before they can qualify for help from the only public payer–Medicaid. And many caregivers pick up the costs of care themselves, regardless of the burden. Why is there no political demand for subsidized long-term care, given the large number of families coping with the fragmented system now in place? If care has become a normative activity, as Ms. Brody predicted, do families consider it only a personal matter—not a political one?

What about employers? How long will the nation’s employers subsidize the lack of a comprehensive system of long-term care?

This past January, Congress established a Commission on Long-Term Care, and gave it a 2014 deadline to develop a “comprehensive, coordinated and high-quality system” of long-term care. It’s time for a powerful partnership of voters, representing current and future caregivers, to join with employers to demand serious solutions for our long-term care problem.