Health care? Daughters know all about it.
As Washington debates the relative merits of O ba mac are or Trump care, many families have already come up with what is arguably the most reliable form of care in America: It’s called daughter care.
The essential role that daughters play in the American healthcare system is well known but has received little attention. But some healthcare analysts are beginning to sound the alarm about the challenges women face as care givers—not just for children but for aging parents — often while holding full-time jobs.
Last week, the medical journal JAM A Neurology highlighted a looming crisis for women and their employers: the growing ranks of dementia patients who will end up relying on family members, typically daughters, for their care.
“The best long-term care insurance in our country is a conscientious daughter ,” wrote the authors, all of whom are fellow sat Stanford University’ s Clinical Excellence Research Center, which studies new methods of healthcare delivery.
The authors note that by 2030,1 in 5 Americans will be 65 or older, and the number of older Americans living with dementia is expected to increase to 8.5 million, up from 5.5 million now.
Most dementia patients eventually require round the-clock care, yet there is no clear national road map or overarching plan for providing it. Most of the care for older adults in the UnitedStates—frompaying bills to feeding, bathing and dressing—fallsonunpaid caregivers, and most of them are women.
Though men do care giving for older family members with dementia, the burden is not shared equally, experts say.
“Women are at the epic enter of care giving as a whole, and Alzheimer’ s care giving in particular ,” said Ruth Drew, director of family and information services at the Alzheimer’ s Association .“Even though two-thirds of people with Alzheimer’ s are women them selves, two-thirds of the caregivers are also women. So there are more wives caring for their husbands than the reverse, more daughters caring for parents than sons.”
“We see a lot of daughters caring not only for their parents, but their in-laws ,” sheadded.
Most experts don’t anticipate that changing significantly. That’ s because, despite progress, women continue to do a disproportionate amount of childcare.
Though men have become more involved and take non more responsibilitiesat home ,“it hasn’ t been a significant contribution and certainly hasn’ t kept pace with women’ s increased participation in the workforce,” said Dr. Clifford C. She c kt er, a fellow at Stanford University’ s Clinical Excellence Research Center, surgery resident and a co author of the essay.
When it comes to caring for people with dementia, “the numbers are skewed strongly toward women, and it’ s hard to imagine that by 2030 the numbers will even out to 50-50,” said Nicholas Bott, an euro psychologist and another co-author who is also a fellow at the ClinicalCenter .“It shouldn’ t bean unspoken rule that this falls on certain members of the family, but as of now, it still is falling primarily on the daughters and female spouses more than on men.”
She ck terre called how this played out in his own family. When hisgrand mother started losing her cognitive function anddiabetes complications left her blind, She ck te r’ s mother, a nurse, started using her lunch break sat the hospital to run home and check on her.
One days he found her mother backed up in acorner of a room, disoriented and agitated; another time she was trapped in a closet. When the grandmother became in continent, She ckte r’ s mother had to cleanup themes sand bat he her.
Eventually the situation was untenable, and the family placed She ck te r’ s grandmother in a nursing home .“This was my mom’ s mom, so my dad didn’ t really pitch in ,” She ck te rs aid .“I don’ t blame him for that— but it really did fall on my mom.Shewasasaint.”
According to a report from the Alzheimer’ s Association, employed women who are caregivers are seven times more likely than men to cut down from full-time topart-timeemployment because of care givingare more likely than men to take a leave of absence from work, to lose employment benefits because they cut back their hours or to be forced to quit working altogether. A significant percentage say they were penalized at work because of their care giving responsibilities.
“We hear women say their opportunities for advancement or for taking on special projects can be impacted as well ,” Drew said. Care giving can have long-term financialimplications, “affecting a person’ s career trajectory, theirretirement funding, their ability to send their kids to college .”
Women are also more likely than men to say that care giving is physically difficultand has strained their marriages, and caused them to lose contact with friends and become isolated socially.
For many people, the cost of paying for care is prohibit ive. Most American families are caught in what Bot tc all ed“the dementia doughnut hole”— neither wealthy enough to pay for full-time care at home or in a private facility, which can costupwardof$100,000 a year, nor poor enough to qualify for governmentMedicaid. Many will“spend down” family savings in order to qualify.
Other care giving support programs are spot ty.
Some Medicaremay provide limited in-home care giving, hoping to cut down on emergency room visits and hospitalizations, but innovative initiatives like a proposal for“Medicare Part E ”— which would let seniors trade hospital benefits forlong-termcare—have stalled, researchers said.
“As medicine advances, people are surviving longer and longer with chronic conditions, and will need more and more care giving ,” She ck te rs aid .“At some point, our country will have to decide how togo with this.”
Until then, it seems clear that women will continue to should era disproportionate burdenofthecare.