Academic journal article Generations

Women, Caregivers, Families, and the Affordable Care Act's Bright Promise of Better Care

Academic journal article Generations

Women, Caregivers, Families, and the Affordable Care Act's Bright Promise of Better Care

Article excerpt

More women hold jobs than ever before, and most women also handle the bulk of their family's caregiving duties-but help is on its way with the ACA.

It takes a village to raise a child. But what does it take to care for an older parent, spouse, or sibling with diabetes, dangerously high blood pressure, and early stage dementia? Or to perform both roles at once?

Whether they know it or not, many Americans are going to have to answer these questions in the years ahead. Yet the country is doing precious little to adopt public policies, workplace practices, and caregiver supports that make it possible for an individual to hold a job while caring for a child or an older relative with multiple health problems-perhaps while also combating a chronic illness.

Over the past few years, the economy and society have changed in fundamental ways, creating enormous challenges for workers, families, and employers. What Americans do-and do not do-to address those challenges will be a key determinant of our strength, competitiveness, and health as a nation.

America's Dramatic Demographic Shifts

Representing a dramatic shift from past generations, American women make up half of the nation's workforce today. Nearly four in ten mothers are primary breadwinners. Nearly twothirds are breadwinners or co-breadwinners, bringing home at least one-quarter of their family's earnings (Boushey, 2010).

Women's wages, however, are still not fair or equal to wages paid to men (Institute for Women's Policy Research, 2010). The gender-based wage gap is still causing real harm to families. Too many women remain concentrated in low-wage jobs that offer few benefits and workplace protections (Hegewisch et al., 2010). Decades after laws were put into place to prohibit workplace inequities, research shows that pregnancy discrimination is on the rise (National Partnership for Women & Families, 2008). This discrimination is especially punishing for women of color (Institute for Women's Policy Research, 2010).

Wage and employment discrimination follows women into old age in the form of Social Security benefits that are less substantial due to lower wages and time spent out of the workforce. The Social Security Administration reports that among now retired worker beneficiaries, women average thirteen years of zero earnings (Women's Institute for a Secure Retirement, 2010). This means fewer years to earn a pension if one is available, fewer years to advance to better paying jobs, and fewer years to put money away in savings and retirement plans.

Not only are more women supporting their families, they are also the primary caregivers for most families. Women regularly manage care and make healthcare decisions for children, aging parents, themselves, and often their spouses. Three in five caregivers of adults (61 percent) are women (National Alliance for Caregiving and AARP, 2004). Nearly half of these female caregivers (46 percent) are part of the "Sandwich Generation," meaning they also have children under age 18 at home (Aumann et al., 2008).

Caregiving brings with it challenges exacerbated by inefficiencies within the current healthcare system. Older adults with five or more chronic health conditions have on average thirty-seven physician visits, fourteen doctors, and fifty separate prescriptions each year (Berenson and Horvath, 2002). Managing such care in a fragmented system that fails to deliver coordinated care is a herculean task. How does one get these doctors to communicate with one another in a system that offers very few incentives for coordination? Caregivers are often responsible for ensuring that medical records and test results are passed from one office to the next. They create lists, design spreadsheets, and set up meetings in an effort to keep track of visits, test results, and medications-but even the most organized find it exceedingly timeconsuming and difficult, if not impossible. …

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