Contact: Brenda C. Spillman, PhD
(202) 261 5846
bspillma@ui.urban.org

Study Suggests Greater Pressure on Family Care as Baby Boom Ages

Future long-term care needs may take a heavy toll on families and public budgets, according to a new study.

A smaller number of family members were caring for chronically disabled parents or spouses in the mid-1990s than in the mid-1980s, but those who did were more likely to be the primary caregiver. On average they were caring for more highly disabled elders, and their efforts were more likely to be supplemented by formal, paid services, according to a study of trends in informal caregiving for the elderly.

"The decline in informal caregiving shown in our study reflects entirely changes in caregiving behavior rather than a decline in the number of children and spouses available to give care," said study co-author Brenda C. Spillman, PhD. "The lower fertility of the Baby Boom generation implies that in the next 20 to 30 years, there will also be fewer children per recipient potentially to provide care and, very likely, a greater proportion called on to serve as primary caregivers with or without formal support."

Twenty percent of Americans will be 65 or older by 2030, compared with about 13 percent today, with most of the increase occurring between 2010 and 2030 as the Baby Boom generation turns 65. Baby Boomers had an average of less than two children, compared with their parents' fertility rates of between 2.4 and 3.6, according to the study.

To examine shifts in informal family caregiving occurring over the last decade, Spillman, of The Urban Institute, and co-author Liliana E. Pezzin, PhD, of the Johns Hopkins University School of Medicine, analyzed data from the 1984 and 1994 National Long Term Care Surveys. They found an increase in the percent of active caregivers who were 45-54, an age group that is more likely to be in the "Sandwich Generation," with competing child-rearing responsibilities, and in the percent of active caregivers who were themselves quite old. Nearly one-quarter of primary caregivers in 1994 were 75 or older.

The researchers report their findings in the September issue of The Milbank Quarterly.

There was little change in the caregiving by those in the "Sandwich Generation." They were about 24 percent of all potential caregivers, about 8 percent of primary caregivers, and about 24 percent of secondary caregivers in both years. More of the women who were primary caregivers of elderly parents also worked full-time in 1994 than in 1984, the researchers found.

Current proposals for tax credits for the chronically disabled and their caregivers recognize that there is a public interest in the burden long-term care places on families, the authors note. "The demographic changes projected for the coming decades are likely to increase this burden," said Spillman. The shrinking labor pool as the Baby Boom generation begins to retire, may also spur employers and policy makers to provide more support for informal caregiving through such measures as flex time and employer-sponsored long-term care benefits, noted the researchers.

"A better understanding of how demographic trends are changing the caregiving landscape, and how families are responding to these changes, is essential to formulating policy initiatives that enhance the welfare of caregivers and recipients while recognizing the tradeoffs with other policy aims and public budgets," said Spillman.

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The Milbank Quarterly is a journal of public health and health care policy published by the Milbank Memorial Fund. For information about the journal, contact Bradford H. Gray, PhD, at (212) 822-7287.