For caregivers, $75 a day matters

Opinion: February 17, 2010 at 12:00a.m.

By HOWARD GLECKMAN

In the congressional debate over the CLASS Act — the proposed national long-term care insurance program — critics and supporters have been arguing over whether a benefit of $50 — or even $75 a day — is worthwhile. Some in the insurance industry, for instance, assert that given the high cost of care in nursing facilities and even at home, a $75 benefit is hardly worth the premium cost. But an important new study tells a different story.

Caregiving in the U.S. (http://www.caregiving.org/) is a data-rich profile of family caregivers — the third such survey in the last 12 years. And it paints a picture of families for whom $75 a day could make a real difference. The study, by the National Alliance for Caregiving and AARP and funded by the MetLife Foundation, estimates that 48 million people are caring for the frail elderly or younger adults with disabilities.

An additional 17 million are assisting children with special needs.

Together, that’s more than a fifth of all Americans. But for now, let’s just focus on those caring for people 50 and older.

Keep this picture in your mind: A 50-year-old woman who is married and trying to hold down a job. The chances are about one in three that she is also raising a child. Typically, she is helping her mother, a 77-year-old widow who is either living in her own home or with her caregiver daughter. The survey found only about 6 percent of those being cared for are in nursing homes. Three-quarters need care due to a long-term physical disability and nearly one of six is suffering from dementia or “confusion.”

Leave of absence

This daughter has been caring for her mom for an average of four years, and she is spending about 20 hours a week helping with grocery shopping, rides to the doctor, housework, making meals, or more intensive assistance such as helping her mother get up from her bed or chair. About one in three caregivers are helping their loved one get dressed or to the bathroom. Among those who work, nearly two-thirds take time off during the workday, 17 percent take a formal leave of absence from their jobs, and 10 percent quit or take early retirement.

These caregivers are spending a bit less time helping than in 2004.

The reason: They are getting help. About 70 percent receive assistance from other relatives or friends, up 5 percentage points. And 40 percent are relying on paid help from, for instance, home health aides. But that’s down from 45 percent five years ago. Why? The cost, most likely.

The biggest burden of all, however, is on elderly spouses. They spend more than 30 hours a week caring for loved ones. They are more likely to be doing the difficult work of assisting with activities such as bathing. Yet, they are often doing this on their own, without help from relatives or friends. And that’s where even a $50 cash benefit can make all the difference.

That money would pay for nearly three hours-a-day of a home health aide’s time, and even more if the dollars were used to pay a relative or friend.

For a daughter trying to juggle caregiving and work, that could make the difference between having to scale back hours or even quitting her job, and being able to stay in the workforce. And remember, the work hours she gives up today mean she is paying fewer taxes, accruing fewer Social Security benefits and putting less aside in her own 401(k) retirement plan.

For a beleaguered spouse, having the money to pay for help can mean critically needed respite care, or assistance getting her frail husband washed and dressed each morning. No doubt, compared to the more than $200-a-day people pay for care in a skilled nursing facility or the cost of 24-hour home care, $50 or $75 isn’t much. For many, it would only delay by a few months the time when they would go on to Medicaid.

X Howard Gleckman is a resident fellow at the Urban Institute, author of “Caring for Our Parents” and a frequent writer and speaker on long-term care issues. He wrote this for Kaiser Health News, an editorially independent news service that is a program of the Kaiser Family Foundation, a nonpartisan health-care policy-research organization that isn’t affiliated with Kaiser Permanente.