Cuts in Medicaid will take toll on caregivers

Nearly 1 in 5 adult children at some point provide care for at least one elderly parent, according to a new study by the Center for Retirement Research at Boston College. The burden is particularly demanding for daughters, who spend as much time on such care as spouses of older adults, and as much time as sons, in-laws, grandchildren and other relatives combined.

House Republicans’ proposal to slash federal spending on Medicaid by some 25 percent over 10 years, shifting costs to states that could not afford them, would be devastating, because nursing homes, home care and community-based programs for the elderly account for almost two-thirds of Medicaid spending. One of the few ways that adult children can get help with caregiving duties is Medicaid’s support for seniors, which many middle-class people qualify for after spending most of their income and assets on long-term care. Cutting Medicaid could make it more difficult to qualify, so more adult children would have to care for their parents.

The stresses, which are already significant, would become extreme. The researchers at Boston College found that these caregivers spend an average of 77 hours per month with their parents, the equivalent of about two weeks of full-time work. That time is money. Calculations based on the American Time Use Survey indicate that caregivers effectively forfeited $522 billion in 2012 due to such duties; that is more than double the total cost of formal care, at $211 billion. Women caregivers were more likely than men to retire because of these demands, and those who kept working reduced their workweeks by three to 10 hours on average. Beyond this sacrifice, caregivers spend 35 percent of their own budget on parental care, surveys indicate.

Caregiving also takes a toll on physical and mental health. Women who care for parents report more pain, and significantly higher out-of-pocket costs for their own health care. Both women and men say they are more depressed and had poorer health because of parental care.

Even if Medicaid spending were not cut, demand for longterm care would rise as baby boomers age, leading to increased reliance on adult children and formal caregiving arrangements. That unfolding dynamic is not a concern for the distant future. The youngest baby boomers are now 52, the oldest are 71. More than half of 85-years-olds need help with one or more basic selfcare tasks, including getting out of bed, walking across a room, going to the bathroom, bathing, dressing, eating, taking medicine, using a phone, shopping and cooking.

In the face of deep Medicaid cuts, a system of caregiving that is already clearly strained would implode.

If health, prosperity and dignity were driving policymaking, lawmakers would be looking for ways to increase Medicaid coverage, not destroy it.