Caring for the Disabled Elderly: Who Will Pay?

By Alice M. Rivlin; Joshua M. Wiener et al. | Go to book overview
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Chapter Thirteen
Support for Unpaid Caregivers

Family-provided help is the backbone of in-home care for the elderly. In 1982 roughly 90 percent of the 4.65 million older persons in the community who had a chronic disability depended on family or friends to remain at home. 1 Fully 78 percent of this group reported no other caregivers. Moreover, these informal arrangements are not temporary. In most cases disabled older persons had received informal, unpaid care for more than one year, and a large minority for more than five years. 2 Family caregivers themselves say they have a permanent commitment to this role. 3 One can argue that without their help in providing home care for the elderly, public expenditures would be several times what they are today. Thus it is not surprising that policymakers are examining ways to maintain and even increase unpaid care. 4

Two approaches to strengthening elderly informal care networks are special income tax credits or deductions and direct payments to family providers.* Proponents of support for informal care contend that government policies to promote their efforts could moderate future medicaid costs by deterring or postponing nursing home placement. Such policies could also moderate public outlays for in-home services, since informal caregivers' time costs less than payments to formal agency-employed care providers. Finally, the quality of in-home assis

Another support approach is to direct services toward the unpaid provider. In general, programs that provide such services are more of a tribute to the organized efforts of dedicated volunteers than to government initiatives. These programs tend to provide education and training to enhance caregiving skills and understanding. Some also offer emotional support, generally in the form of self-help groups, along with some arrangement for respite to give short-term relief to the unpaid provider.


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