The caregiver’s answer was clear.
Today, approximately 38 million people in the United States provide unpaid elder care. This number is likely to increase dramatically in the future as the number of people requiring care increases. One of the biggest challenges with unpaid care is that…well, it’s unpaid – in fact, it often reduce people’s income. Providing care may require caregivers to take time off work, downgrade to flexible work, or leave the workforce entirely. Given this financial challenge, it is not surprising that policymakers are focused on supporting caregivers. The problem, as some colleagues point out in a new study, is that it’s unclear which policies will best benefit caregivers.
To explore what caregivers wanted, the study authors took a novel approach—they asked them! In a series of focus groups, the researchers discussed six policies: 1) paid family leave; 2) direct government payments for the cost of providing in-home care; 3) tax credits for providing care; 4) Social Security benefit credits for caregivers. Deductible; 5) Paid respite care; 6) Reimbursement of caregivers’ out-of-pocket expenses. The groups included 25 caregivers, ranging in age from 26 to 67 years old and with a variety of income, race/ethnicity, and employment status. Figure 1 summarizes the results. While caregivers want any support they can get, the two most important policies have one thing in common: cash, now!
There is far less enthusiasm for some other policies. For some reasons, paying for respite care is less popular than direct payments. As one caregiver succinctly stated, “I don’t trust a lot of people.” Additionally, others were concerned about whether respite caregivers would be able to interact with caregivers. Or, as a focus group member put it: “[i]If you’re going to send someone in there who’s not me, they’re going to need body armor.
Credit performance is even worse. The Social Security credit approach—basically, caregivers receive higher Social Security benefits even if they don’t work gainfully while caring—falls victim to the likely culprit: time. One focus group member stated: “I’m not [going to] Retirement is another 20 years away, so I’d rather have the money now. Tax credits and extended sick leave are even less popular, largely because they are tied to jobs that caregivers may not be able to fill.
So, how do current policies compare to the preferences of these caregivers? Not so good. While most state Medicaid programs do provide direct payments to informal caregivers, one focus group member pointed out the flaws: “It’s a very lengthy approval process that can take four to six months, and you The person being cared for must receive state-funded Medicaid.” And, while the Care Expenses Tax Credit exists, it’s non-refundable, so it doesn’t put cash into caregivers’ pockets, only reduces their tax bills. Regardless, the credit can only be used to cover expenses that enable caregivers to keep their jobs or find work—it is of little use to retired caregivers or caregivers who are unable to work for pay.
Well, if current policies are not enough, what about future policies? Right now, the main action at the state level is paid leave — something no one in focus groups seemed to prioritize. Some states are also investigating respite care pay, which is a slightly more popular approach. At the federal level, recent action by Congress has focused largely on Social Security credits, an approach that was less popular among focus groups.
However, despite the shortcomings of current and proposed policies, for me there were positive takeaways from these focus groups. The best way to help caregivers may be the simplest – give them cash. Tax credits or extended sick leave that tie benefits to employment and future Social Security credits miss two important points. Nursing staff have yes Work, just for no pay, and provide a valuable service. And, they are providing this service but are now experiencing financial costs. So, cash makes the most sense right now.
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