Family Caregiving and Public Policy Principles for Change

ABSTRACT

This chapter examines the economic impact of unpaid caregiving on family caregivers of older adults who demand help considering of health or functional limitations and explores which caregivers are at greatest adventure of severe financial consequences. Workplace and authorities policies and programs designed to back up caregivers and/or mitigate these effects are as well discussed. Caregivers of older adults tin can endure 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 chance. More than half of today's caregivers are employed, all the same current federal policy and virtually states' family go out is unpaid, making it hard for many employed caregivers, particularly low-wage workers, to take time off for caregiving.

National surveys show that many family caregivers of older adults study financial strain associated with their roles as caregivers (NAC and AARP Public Policy Institute, 2015b; Spillman et al., 2014; Wolff et al., 2016), suggesting that there are important economical effects of taking on the caregiving role. This affiliate examines the economical impact of unpaid family caregiving on family members and friends who care for older adults with functional or cerebral limitations, or a serious health condition, and identifies which caregivers are at greatest risk of severe financial consequences. Information technology also explores the intersection of caregiving and piece of 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 can be examined at private, family, and societal levels, including (1) reductions in bachelor fiscal resources of the caregiver as a consequence of out-of-pocket expenses; (ii) employment-related costs for the caregiver who must reduce work hours, exit the labor force, and forego income, benefits, and career opportunities in club to provide care; (3) employment-related costs to the employer who must supplant workers who leave the labor forcefulness or reduce hours; and (4) societal benefits that include the potential price savings to the formal health and long-term services and supports (LTSS) systems because of the care and support provided by family caregivers (Keating et al., 2014). The available research on these topics is limited and largely based on self-report data, studies that are too short in duration to capture long-term economic impact prospectively, and researchers disagree nearly assumptions fabricated in economic affect analyses (east.g., replacement cost of a family caregiver) (Schulz and Martire, 2009).

Broad IMPACTS

Feelings of "financial strain" are a oft used global measure out of the economical costs of caregiving. For example, a recent survey conducted past the National Alliance for Caregiving (NAC) and the AARP Public Policy Institute (2015b) asked caregivers nearly "financial strain" related to family caregiving. The survey constitute that 36 percent of the caregivers of adults older than the age of 50 reported moderate to high levels of financial strain. Those caregivers most likely to report loftier levels were caregivers who live at a distance from the older care recipient, those with high levels of caregiving brunt, and those who study they are the "master" caregiver. In a recent assay 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 management) were more than likely to report financial difficulty (23.0 percent) compared to their counterparts providing some help (12.0 percent) or no assistance (6.seven per centum) (Wolff et al., 2016).

In 2011, virtually one-half (8.5 1000000 of 17.7 million) of the nation's caregivers of older adults living at home or in residential care settings (other than nursing homes) ² provided care to loftier-need, older adults. ³ Every bit Figure iv-1 illustrates, the caregivers who are helping older adults with the greatest needs are the virtually likely to report having fiscal bug. Nearly one-tertiary (31.3 percent) of the caregivers (in NSOC) who helped significantly impaired persons—those with both dementia and the need for assist with at least two personal care activities—reported having financial difficulties related to caregiving. In contrast, only xvi.2 per centum of the caregivers of individuals who needed help with fewer than two personal care activities and do non have dementia reported financial difficulties (i.e., the care recipients).

FIGURE iv-1

Pct of caregivers reporting financial difficulties, by the care recipient'southward 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 customs (more...)

The caregiving literature consistently shows that caregivers of significantly impaired older adults are the nigh likely 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 Institute, 2015b; Van Houtven et al., 2013). The economical impact of intensive caregiving is probable related to the many hours of care and supervision that this population requires and the costs of hiring help. In a recent multivariate assay of eight waves of the Health and Retirement Study (HRS), for case, Butrica and Karamcheva (2014) found that caregivers who helped with dressing, bathing, and eating provided near 3 times the number of caregiving hours than caregivers who provided only household help. They were too more likely than household helpers to provide at least i,000 hours of help annually.

Other researchers, using longitudinal data, suggest that caregiving for an older adult places the caregiver at fiscal risk over time. For case, Wakabayashi and Donato (2006) institute that caregiving increases the likelihood that women experience poverty and/or reliance on public aid. Lee and Zurlo (2014) besides found a positive association between caregiving and lower income later in life. In their examination of an eight-moving ridge longitudinal study, Butrica and Karamcheva (2014) constitute that caregiving was associated with both reduced labor strength participation and reduced net worth of family unit caregivers when compared with non-caregivers. These are examples of some of the wide economical impacts of caregiving. The discussion 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 goods 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 utilise rather wide and vague definitions of what constitutes an out-of-pocket caregiving expense. Little is known nigh the extent to which older adults and their family caregivers share the costs. One 2007 telephone survey asked caregivers almost a wide range of spending including medical expenses, nutrient and meals, household goods, travel costs, intendance recipient services (developed mean solar day services and home care), nursing home/assisted living costs, housing costs, caregiving services, home modifications, clothing, medical equipment/supplies, and legal fees. The caregivers reported an boilerplate almanac amount of $5,531; long-distance caregivers had the highest boilerplate annual expenses ($viii,728) (Evercare and NAC, 2007). One in v caregivers reported that older adults' out-of-pocket medical costs were their highest expense. The 2011 NSOC found that 8 percent of caregivers incurred more $ane,000 per year in out-of-pocket caregiving costs—defined as 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 wellness aides. For some caregivers these costs may mean cartoon down assets, taking on debt, or foregoing handling of their own wellness bug. Better data on economic effects of caregiving on the family unit caregiver are needed to provide an accurate picture show of the magnitude and predictors of economic effects.

Out-of-pocket spending plays a significant part of financing for LTSS because insurance—public or individual—is defective for these services, including hiring direct intendance workers such every bit home health aides and personal care workers. In i national survey, one in four (25 per centum) family caregivers said it was very difficult to get affordable services in the older adult's customs that would help with their care (NAC and AARP Public Policy Institute, 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 embrace LTSS and Medicaid is merely bachelor afterward people have become impoverished.

The wealthiest families may take funds to pay for supportive services simply many middle-grade families cannot afford the habitation- and community-based services that will enable their elders to remain at dwelling and avoid even more than expensive institutional care (Bookman and Kimbrel, 2011). In 2016 the cost of employing a abode health aide full time for one yr was nearly $46,480 and employ of adult day services cost well-nigh $18,000. The median annual cost for an assisted living facility was $43,539 in 2016; the median annual cost for nursing home intendance 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 constitute that approximately half of all caregivers to older adults were employed either part- or full-time. Of those caregivers who worked, 69 percent were employed at to the lowest degree 35 hours weekly. In 2011, half of the estimated 17.vii one thousand thousand caregivers of older adults (8.7 million or 50.3 percentage) in the Us worked (see Effigy 4-two). Depending on the care needs and the intensity of the caregiving role, a caregiver may take to brand accommodations in club to manage their caregiving responsibilities and their job. Researchers, advocates, and observers have raised concerns that the demands of caregiving tin 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 fiscal well-existence (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).

Effigy iv-ii

Employment status of family caregivers of older adults, by sex, co-residence, relationship, race, education, and household income. NOTES: N = 8.seven million (employed caregivers). Includes family unit caregivers of Medicare beneficiaries age 65 and older in the (more...)

Other survey information (NAC and AARP Public Policy Institute, 2015a) suggest that the majority (61 pct) of employed caregivers need to brand some workplace accommodations such as coming in late to work or leaving early, taking time off to manage care situations, reducing work hours or level of responsibility, and/or taking a leave of absence. All of these accommodations have potential costs associated with them for both the caregiver and the employer. If an employee has exhausted his/her paid time off or has no paid time off to begin with, each 60 minutes of work lost due to caregiving activities bears a fiscal cost to the employee. Taking unpaid leave is expensive, as is cutting hours or taking a lower paying job with less responsibility. Not just does the caregiver have an firsthand loss of income, his/her long-term economic status may be affected due to lower retirement savings or benefits.

As Chapter 2 describes, electric current trends point to higher rates of employment amid caregivers in the future—specially for the wives and daughters of older adults (Stone, 2015). The U.S. Bureau of Labor Statistics projects that women'southward participation in the labor force will proceed to increase during the same years they are most likely to be caregiving (Toossi, 2009). The percentage of women older than age 54 who work, for instance, is expected to increase from 28.5 percent in 2012 to 35.1 pct in 2022. During the same period, the pct of working women older than age 64—those most likely to be caring for a spouse—is expected to increase from xiv.4 percent to 19.v per centum. As women work exterior the dwelling house to make ends come across and grow the economic system, the demands and pressures of working families to remainder piece of work, caregiving, and other family responsibilities accept grown (Feinberg, 2013).

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

Although many people expect to work longer—primarily driven by financial considerations—family unit caregiving responsibilities tin can sometimes get in the way of continued employment (Feinberg, 2014). Surveys point a strong association betwixt caregiving—especially high levels of caregiving—and reduced work for pay. One national survey found that i in v (19 percent) retirees left the workforce earlier than planned because of the need to care for an ill spouse or other family member (Helman et al., 2015). In the 2015 Caregiving in the U.South. survey (NAC and AARP Public Policy Institute, 2015a), working caregivers who quit their job or took early retirement reported doing and so in guild to take more fourth dimension with the person they were helping (39 percent) 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 task because they could not beget to rent a paid caregiver. Co-resident caregivers were most likely to make income-related accommodations such as cutting back piece of work hours, taking a leave of absence, quitting a job, or taking early retirement. A recent analysis of NHATS and NSOC data revealed that working caregivers who provide high levels of help with wellness intendance activities were three times more likely to experience work productivity loss ^four than caregivers who provided some or no help with wellness care (Wolff et al., 2016). Some research has also examined how family caregiving affects a adult female's electric current and future employment situation and retirement security. One study, using data from HRS, establish that women who leave work while caregiving may find it hard to return to the labor forcefulness after they finish providing intendance to a parent (Skira, 2015). A study by Arno and colleagues (2011) based on HRS longitudinal data examined the long-term economical effects on workers who either reduced their hours at work or left the workplace before total retirement age. The analysis plant that income-related losses sustained past family unit caregivers ages 50 and older who leave the workforce to intendance for a parent are $303,880, on average, in lost income and benefits over a caregiver'south lifetime. ⁵ More enquiry is needed to fully understand the factors influencing the working caregiver's productivity and decision to exit and after return to the workplace and whether there are strategies that could mitigate agin economic effects.

Effigy 4-2 illustrates the employment rates by selected characteristics. These rates suggest that factors that would predict the power to go on working while providing care are related to college didactics and income levels. Caregivers with a lower level of educational activity or lower income are the to the lowest degree likely to exist in the workforce and therefore are most at hazard of the economic losses outlined earlier.

COSTS TO EMPLOYERS

Much less is known about caregiving-related costs to employers. Employer- or business concern-related costs may include the replacement costs for employees who quit due to their caregiving responsibilities, costs of absenteeism and workday interruptions, likewise as management and authoritative costs based on the time supervisors spend on issues of employed caregivers. Some estimates propose that the cost to U.Southward. businesses due to caregiving may exceed $29 to $33 billion per yr, but these estimates should be viewed cautiously as they are based on one-time data and the studies make debatable assumptions in conveying out their assay (MetLife Mature Market Plant and NAC, 1997, 2006). Reliable data on the impact of eldercare on U.S. businesses are currently not available.

Some, primarily large, employers take invested resources in developing workplace programs for caregiving employees in an try to support caregivers and retain workers. Anecdotal evidence suggests that these programs may be well received and helpful to employed caregivers. Withal, information exercise 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). Simply a few studies have been done to explore the small business surroundings (Matos and Galinsky, 2014; MetLife Mature Market Institute and NAC, 2006). Nonetheless, the topic of economical touch of family unit caregiving is an important one for both employers and caregivers who are employed. As new workplace policies emerge it will be of import to assess employer acceptance, impact on business and manufacture, and benefit to the caregiver.

SOCIETAL BENEFITS

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

Some researchers estimate the societal benefit of family unit caregiving past calculating the replacement costs of the time spent by family caregivers on tasks that someone else could perform (and bold an hourly wage that would be paid in lieu of caregiving). Estimates of the economical value of unpaid care depend on which data sources are used and how caregiving is defined. Near studies use survey data to estimate the number of family caregivers, the number of hours of care provided past caregivers, and the average wage of a domicile wellness adjutant (the replacement for the family caregiver). The Congressional Budget Office estimates that, in 2011, unpaid care provided by family caregivers to older adults was worth about $234 billion (CBO, 2013). All the same, estimating replacement costs is complex because not all caregivers are alike. For example, replacement costs for retired individuals would likely exist dissimilar 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 price because they do not take into account dynamic wage and employment effects of elder parent care such as leaving the labor forcefulness permanently as a result of caregiving.

POLICIES AND PRACTICES THAT SUPPORT WORKING CAREGIVERS

Balancing work and caregiving responsibilities is a difficult job even under the all-time of circumstances. A flexible workplace tin support employed caregivers with the time they need to handle emergencies and routine matters such as doctor's appointments. Yet, many family caregivers lack this flexibility and, for those who do not have the choice of taking time off with pay, balancing work and family responsibilities can be nearly impossible. Employees may exist absent from work for both planned and unplanned reasons. For example, taking a mother to a scheduled doctor'southward appointment is a planned get out from work. Going to the infirmary to care for a father who has suffered a stroke is an instance of unplanned exit that may happen due to an urgent and unexpected situation (Feinberg, 2013). The U.Southward. Department of Labor (DOL) (2015c) reports that forty percent of the private-sector workforce lacks access to any paid sick leave, while seventy per centum of workers who accept earnings in the bottom 25 percent of the wage scale in the United States lacks any paid fourth dimension off.

Flexible Workplaces

Flexible workplaces may include flexibility about where work occurs, when work takes identify, 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 request flexible working arrangements. Flexible workplaces are non merely good for the employees with caregiving responsibilities but benefit employers as well. Studies advise that flexible work policies reduce turnover and absenteeism among employees and may improve productivity (Council of Economic Advisors, 2010). Flexible work schedules specifically with respect to eldercare have not been studied.

Family and Medical Leave Policies

The federal Family unit and Medical Go out Human activity (FMLA) has been in place in the United States since 1993. The Act allows workers to take unpaid, job-protected leave to care for a worker's own health needs, to bond with a new child, or to care for a seriously sick family member (child, parent, or spouse). FMLA merely 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 i,250 hours. Up to 12 weeks of unpaid go out may be taken during whatever 12-month period and employees must be able to render to their job or equivalent with the aforementioned pay, benefits, and working conditions (Mayer, 2013). FMLA tin can exist taken intermittently, over a 12-week period, or past working part time. In most states, the circumstances that define a worker'due south right to FMLA are express to certain 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 non eligible for the protection of FMLA. Overall xl percent of U.S. workers do 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 also not a true choice for depression-income people who cannot beget to forego wages they would lose by taking information technology (Feinberg, 2013; Umberson and Montez, 2010). In a DOL-sponsored survey in 2011, 17 percentage of caregivers did not take leave considering they feared losing their job even though they were eligible for protected job leave, and eight percentage did non access unpaid leave benefits considering they were not eligible due to the relationship with the care recipient (Klerman et al. , 2014).

Although DOL has sponsored a series of surveys to track the implementation of FMLA, the agency's data 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 care for a child, parent, or spouse with a serious health condition (Klerman et al., 2014). The survey did not distinguish among the different caregiver categories, so data on exit taken specifically for eldercare are not bachelor.

Fourteen states including the District of Columbia accept enacted legislation to extend FMLA to other family unit relationships, nearly frequently to domestic partners and parents-in-police but also including grandparents, grandchildren, and siblings. Six states have also expanded eligibility to some workers in smaller firms. Table 4-1 lists the covered categories for each state.

Tabular array iv-1

States with Expansions in Unpaid Family and Medical Leave.

Access to Paid Family Exit

The overwhelming majority of U.S. workers do not have access to paid family or medical leave (Glynn, 2015). Co-ordinate to the National Compensation Survey, only 12 percent of private-sector workers have access to paid family unit 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 exit. Although paid family leave is non bachelor to most workers, other forms of paid leave can support a working family caregiver. When employers provide paid fourth dimension off, it can be in the form of vacation days, sick leave, personal days, or every bit "PTO," paid time off for whatever reason (Bishow, 2015; BLS, 2015a). Box 4-i outlines culling paid leave options that may be available to employees. The form of get out 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 type (BLS, 2015a).

Table 4-two shows the percentage of workers in wage categories without any paid get out. Equally can be seen, there is a articulate clan between low wages and part-time status and no paid leave options.

Table four-two

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

State and Local Efforts to Expand Admission to Paid Leave for Family unit Caregivers

State governments provided the leadership in the evolution of the paid family and medical get out policies in place today. Connecticut was the beginning state to enact paid family go out for country employees in 1987. In 2004, California began the first paid family and medical leave program in the nation (Wagner, 2006). Today states are again leading in the evolution of paid family unit leave programs. Four states—California, New Bailiwick of jersey, New York, and Rhode Island—have enacted access to paid family and medical leave programs for new parents and caregivers of certain seriously ill family members. New York and Rhode Island contain job protection as a feature of their program. The 4 programs share the following design characteristics:

• Financed through an insurance model

• Fully funded by worker payroll deductions

• Provides fractional pay replacement for a finite catamenia of time

• Covers caregivers of spouses, parents, and domestic partners (California, New York, and Rhode Island besides include parents-in-police force and grandparents; siblings are eligible only in California)

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

The almanac payroll deductions are designed to fully cover the program costs (Fiscal Policy Institute, 2014). Some evidence indicates that costs are low because programme utilization is low (Appelbaum and Milkman, 2011). Because New York's program was passed in 2016, data on the program volition not be available until after the program starts in 2018 (A Improve Residual, 2016).

Touch on of Paid Family Exit Programs on Caregivers of Older Adults

Determining the direct impact of these programs on caregivers of older adults is hard although the programs clearly offer some financial protection for those who can apply them. The states collect some data on users but not in enough item to identify the ages or weather condition of the older adults who receive care. In every land, the programs are used primarily by new parents for bonding with infants (Andrew Chang & Company, 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) (come across Table 4-iii). People caring for spouses or developed children caring for parents constitute about 6 to ten percent of claimants—presumably many of their care recipients are older adults. In New Jersey, 60 percent of family intendance claims in 2011 were fabricated by employed caregivers aged 45 and older (Feinberg, 2013).

Table 4-three

Characteristics of Country Mandatory Paid Family unit and Medical Exit Programs.

Public awareness of the programs is a problem peculiarly with respect to eligibility for paid leave to care for seriously ill family members. In California, the individuals who are most likely to benefit from paid family leave are amongst those groups least probable to know about information technology (Andrew Chang & Visitor, 2015; Field Inquiry Corporation and California Center for Research on Women & Families, 2015). A survey conducted in belatedly 2014, for instance, found that only 36 percent of California registered voters knew about the programme 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 than a high school education, low-income households, and women (Field Enquiry Corporation and California Center for Research on Women & Families, 2015). A New Bailiwick of jersey poll found that threescore percent of the public did non know near the family unit caregiving benefit (White et al., 2013). Some workers may not employ available paid family unit leave because the do good does not guarantee job security, or because they cannot afford to take the time off because the paid leave benefit covers merely fractional wage replacement.

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

Impact of Paid Family Leave Programs on Employers

Most of the published reports on employers' response to their state's mandated paid leave programme draw from small surveys and structured, in-depth interviews with selected employers. Almost employers appear to have adapted to the mandates although some report additional costs. A 2010 survey of California employers found that nearly 90 pct of employers reported either a positive or no noticeable effect on productivity, profitability, or employee turnover (Appelbaum and Milkman, 2011). In-depth interviews with xviii New Jersey employers iv years later on the start of the program found largely positive responses (Lerner and Appelbaum, 2014). The surveyed employers represented businesses with as few as 26 employees and equally many as 36,000 employees. All respondents had at least i employee who submitted a claim for paid family unit leave. Some employers said it improved morale and led to just minor to moderate increases in paperwork. All the same, 2 of the 18 employers said the mandate led to lower profitability.

Prospects for New Country and Local Paid Family Leave Programs

California, New Jersey, New York, and Rhode Isle accept been able to limit the cost of implementing paid family leave by using existing TDI state agencies. These states take extended TDI programs to provide a fractional wage replacement do good to employees caring for a relative with an illness (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 higher pay to workers while on leave (effective in 2018). Merely one other state—Hawaii—has the same TDI infrastructure but it does not have a paid family get out program (National Partnership for Women and Families, 2015). ^half-dozen Washington State—which does not take a TDI program—enacted paid family leave in 2007 but has yet to implement it due to lack of get-go-upwards funds (Glynn, 2015). Table 4-iii displays the characteristics of land mandatory paid family unit and medical exit programs.

Additional insights into other approaches for the design and implementation of paid family medical go out programs may exist forthcoming from DOL. Since 2014, DOL has awarded more $two million in grants to 12 states and localities to either evaluate their existing programs or to conduct feasibility studies to encourage their evolution. The grantees are California; the District of Columbia; Massachusetts; Montana; Montgomery County, Maryland; New Hampshire; New York City; Rhode Island; Tennessee; Vermont; and Washington country (DOL, 2015b). Recently DOL appear the tertiary round of $i one thousand thousand in grants. Importantly, in this round of paid exit analysis grants, DOL is encouraging states/localities to study issues related to eldercare. DOL will honor up to three points to applications that impact paid family leave for workers with eldercare responsibilities (DOL, 2016).

Access to Mandatory Paid Ill Go out

Five states—California, Connecticut, Massachusetts, Oregon, and Vermont—take recently enacted paid sick leave laws affecting the employees of all or a large portion of the respective state'southward employers. The policies, described in Table iv-iv, have important implications for employed caregivers considering they stipulate that workers have access to paid sick time when caring for certain ill family members. Earned sick twenty-four hour period policies differ from paid family and medical leave policies. Public policies covering ill days at work generally encompass a express number of paid days off per year (typically betwixt iii and ix days, depending on state or locality) with full wage replacement (Reinhard and Feinberg, 2015). California has the most expansive definition of eligible family members; it includes spouses, domestic partners, parents, parents-in-police, grandparents, and siblings. Connecticut covers spouses only. The Massachusetts statute—a result of a 2014 election initiative—allows time off for workers taking family unit members to a medical appointment.

TABLE 4-4

Characteristics of State Mandatory Paid Ill Leave Laws.

Employers in a growing number of major metropolitan areas are also subject field to local paid ill leave mandates (National Partnership for Women and Families, 2015; Reyes, 2016). These include Eugene and Portland, Oregon; New York City; the San Francisco Bay Area; Los Angeles; Montgomery Canton, Maryland; Philadelphia and Pittsburgh; Seattle and Tacoma; Washington, DC; and 9 New Jersey cities. ⁷

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

Caregiving and Social Security Benefits

Because Social Security benefits are based on 1's earnings history, caregivers who cutting their work hours or withdraw from the workforce volition ultimately receive lower Social Security payments. Social Security caregiving credits have been proposed as ane style to reduce the touch on of foregone wages on future benefits (Estes et al., 2012; Morris, 2007; White-Ways and Rubin, 2009). In its simplest form, a Social Security credit programme would prospectively credit eligible caregivers with a defined level of accounted wages up to a specified fourth dimension period. White-Ways and Rubin (2009), for example, have proposed that full-time caregivers receive up to 4 years of Social Security work credits equal to the individual'due south average wage or self-employment income during the previous 3 years. The caregiver's eligibility would require certification past a dr. equally to the intendance recipient'south level of need. Using 2008 estimates, the analysts projected that married caregivers who used the credit for the full iv years would see a lifetime increment in Social Security benefits of $8,448 and unmarried caregivers would receive $13,632 more.

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

Job Discrimination

Some employed caregivers of older adults may be subject to workplace discrimination because of their caregiving responsibilities (Bornstein, 2012; Calvert, 2010; Calvert et al., 2014; EEOC, 2007, 2009; Williams et al., 2012). Family unit responsibility discrimination (FRD), too called caregiver discrimination, is employment discrimination confronting someone based on his or her family caregiving responsibilities and the supposition that workers with family unit obligations are non undecayed or less productive than their peers (Calvert, 2015). The outcome tin can exist emotionally draining and plush to the working caregiver. Appendix Thousand includes the stories of two workers who reported experiencing job discrimination every bit a consequence of their family caregiving responsibilities.

FRD usually results from unexamined assumptions about how an employee will or should act. For instance, a supervisor may presume that a woman volition not exist as circumspect or committed an employee subsequently she advises her supervisor of her demand to accept periodic fourth dimension off to care for her sick husband. FRD occurs when caregivers—regardless of their piece of work performance—are rejected for hire, denied a promotion, demoted, harassed, terminated, or subjected to schedule changes that force the employee to quit (Calvert, 2010). I recent national study found that v percent of working caregivers historic period 65 or older had always received a warning about their performance or attendance equally a result of caregiving (NAC and AARP Public Policy Institute, 2015b).

Responses to evidence 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 grouping or form from discrimination—just the protections are sometimes express 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 urban center'south Human Rights constabulary against employment discrimination to include caregivers of a minor child or an private with a disability. The law adds "caregiver status" as an additional protected category for which employment bigotry is prohibited (McHone, 2016).

In 2007, the Equal Employment Opportunity Commission (EEOC) issued a written report on FRD, Enforcement Guidance: Unlawful Disparate Treatment of Workers with Caregiving Responsibilities (EEOC, 2007). While the study acknowledges that federal equal employment opportunity laws practise not prohibit bigotry against caregivers, it articulates the circumstances in which employment decisions affecting a caregiver might unlawfully discriminate on the footing of Title Vii of the Civil Rights Act ^eight or the Americans with Disabilities Act. ^ix Further guidance is provided in an EEOC all-time practices guide for employers (EEOC, 2009). Although the EEOC efforts are valuable, the agency's communication does not deport the weight of regulation nor does it take authority over FMLA and other statutes outside of the agency's jurisdiction.

The magnitude of the affect of FRD on family caregivers of older adults is not known; most reported cases chronicle to pregnancy and parenthood. The Center for WorkLife Constabulary, which tracks litigated cases of FRD cases decided by courts, agencies, and arbitrators, has compiled a dataset of more than 4,400 cases dating from 1996 to 2015 (Calvert, 2016). Overall, 11 percent of the cases were related to caregiving for crumbling relatives. The report author suggests that considering FRD cases are identified primarily through publicly bachelor court rulings, they may be a small fraction of the total number of actual cases.

Private EMPLOYER INITIATIVES

More than thirty years ago, employee surveys began to heighten concerns amongst big employers and organized labor nearly the challenges faced past workers with caregiving responsibilities (Labor Project for Working Families, 1999; Travelers Insurance Companies, 1985). An ofttimes cited Fortune magazine survey establish that even some CEOs reported they did not believe they could manage their own 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 support workers and mitigate the impact of caregiving on employees' temporary or permanent departures, lower productivity, absenteeism, coming to work late or leaving early, accidents or mistakes, and health problems (Galinsky and Stein, 1990; GAO, 1994; Wagner et al., 2012). The 2014 Society for Human Resources Management (SHRM) survey of employers estimates that 5 percent of employers provide eldercare referral services, one percent geriatric counseling and 1 percentage eldercare in-abode assessments (Matos and Galinsky, 2014). There is little empirical evidence about outcomes of the workplace programs and the extent to which they either assist the employee with caregiving responsibilities or mitigate work–family conflicts. Early on research supports the idea that many employees practise not experience comfortable bringing a family unit event into the workplace and may, as a result, not use available programs (Wagner and Hunt, 1994). However, there is evidence as discussed earlier, that workplace flexibility supports those employees with eldercare responsibilities. The three eldercare workplace programs shown in Box 4-ii were selected as examples because of their successes over fourth dimension (Fannie Mae and Duke University) and the thoughtfulness and careful planning that went in to the newly developed Emory University plan. The university used consultants and studied both the campus needs and the resources in the community in their planning.

BOX iv-ii

Three Noteworthy Eldercare Workplace Programs.

CONCLUSIONS

The committee's key findings and conclusions are described in detail in Box 4-three. In summary, the committee concludes that family caregiving of older adults poses substantial financial risks for some caregivers. Although the relevant testify is based primarily on caregivers' self-reports, research consistently shows that family unit caregivers of older adults with meaning physical and cognitive impairments (and associated behavioral symptoms) are at the greatest risk of economic damage. This run a risk is especially true for low-income caregivers (and families) with limited fiscal resource, caregivers who reside with or live far from the older adult who needs care, and caregivers with limited or no admission to paid exit benefits (if they are employed).

BOX 4-3

Fundamental Findings and Conclusions: Economic 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 effect, 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 assistance and other caregiving expenses. There is likewise some evidence of increasing job-related bigotry against workers with eldercare responsibilities.

Caregiving of older adults has substantial implications for the workplace. Today's family caregivers of older adults are more likely to exist in the workforce than ever before—more than half are employed either part- or full-time. Moreover, the cohort of Americans most likely to intendance for older adults—women age 55 and older—are expected to participate in the workforce at increasing rates.

Federal policies provide footling protection to many employed caregivers in these circumstances. For example, daughters- and sons-in-police force, stepchildren, grandchildren, nieces and nephews, and siblings of older adults are not eligible for FMLA's unpaid leave or job protections for family leave. Low-wage and part-fourth dimension workers are peculiarly vulnerable because they cannot afford to accept unpaid go out and their employers are less likely to offering paid fourth dimension off. A handful of states and local governments have taken activity to clinch admission to some class of paid family or sick exit. Nonetheless, much remains to exist learned about how these efforts accept specifically affected caregivers of older adults or their employers.

The impact of family caregiving on employers has not been well studied. Some large employers have established programs to support workers with eldercare responsibilities. Unfortunately, there is piddling empirical show 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 exit benefits, protections from chore discrimination, or other approaches.

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one

The prevalence data presented in this report describe primarily from NHATS and NSOC, unless noted otherwise. See Affiliate 2 and Appendix Eastward for boosted data about the surveys and the commission'due south methods in analyzing them.

two

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

three

See Chapter 2 for additional statistics describing the caregiver population.

4

"Work productivity loss" in this research was a blended variable based on measures of absenteeism (missed hours of work considering of caregiving in relation to typical hours worked) and presenteeism (negative result of caregiving on productivity when at piece of 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 boilerplate. The average figure breaks down equally follows: $115,900 in lost wages, $137,980 in lost Social Security benefits, and conservatively $50,000 in lost alimony benefits.

vi

Puerto Rico likewise has a TDI program.

7

The New Jersey cities are Bloomfield, Eastward Orangish, Irvington, Jersey Metropolis, Montclair, Newark, Passaic, Paterson, and Trenton.

8

Public Law 88-352.

9

Public Law 101-336.

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