The Caregiver's Glass Ceiling
by Phyllis Shelton

Women are on the Titanic and the iceberg of caregiving is only a few miles away.

Women are the caregivers - both paid and unpaid help. The paid help (home health aides and nursing home aides) are among the most oppressed part of the U.S. job market as they are asked to take care of an increasingly frail population at great risk of physical injury to themselves for a minimum wage. These brave women perform heavy labor every day by lifting, turning, and cleaning heavy, sometimes immobile patients.

Two-thirds of the caregivers who perform unpaid help today are women in the form of daughters, daughters-in-law, and wives.1 These silent heroes are asked to be primary caregivers in addition to full-time or part-time employment, as 47% of women caregivers are employed full-time and two-thirds of them are employed full or part-time.2 Almost a third of these women are multiple caregivers, providing care for 2 or more people over age 50.3 Twenty-two percent of them have dependent children at the same time,4 and a significant number of women now spend more years caring for aging parents than raising children.5

Women own 38% of all businesses and one out of 3 small businesses, and that's where the real growth is.6 Between 1994 and 1998, companies with 20 or less employees generated nearly 9 million jobs, representing about 80% of all new jobs created.7 For all size companies, women employ 27 million people, over 20% of the total work force.8 Women have made monumental progress in the workforce in the last twenty or so years. What can stop them now?

Caregiving. Long-term care may be the biggest threat to everything women have accomplished in the work place in the last 100 years. The U.S. Dept of Labor says that on average, caregivers provide 18 hours of long-term care a week, but one-fifth provide at least 40 hours of care per week.9

A Brandeis University study funded by the MetLife Mature Market Institute estimated the loss for a caregiver's lifetime is $659,139, made up of lost wages ($566,443), lost Social Security benefits ($25,494) and lost pension benefits ($67,202).10 Responsibilities at home mean missing out on promotions, training and sometimes travel and/or relocation to pursue better career opportunities.

Some of these women never see retirement - they blow right past it in their role of primary caregiver and eventually need care themselves. The average caregiving time in a major study is reported to be 4.5 years,11 but 21% reported five to nine years and 10% ten years or more.12 Even long-distance caregivers average 35 hours a month helping the care recipient.13 It's not uncommon for a caregiver to predecease the care recipient after a long episode of physical and emotional strain associated with caregiving. Carol Levine, a nurse who has been caring for her husband, who is totally disabled and requires 24-hour care after a brain-stem injury in a car accident ten years ago, wonders, "Does my managed-care company realize that during the past year it paid more for my stress-related medical problems than for my husband's medical care?"

Women are the care receivers. Three-fourths of people who receive care over age 85 are women.14 Women in this older generation today have an average of 2.5 children, but that number has dropped to 1.5 with baby boomer women.15 20% of women in their early 40s today have no children and will likely have a tough time finding a primary caregiver.16

Fifty-four percent of Americans think they will care for an elderly relative in the decade ending 2008,17 and the prediction is in this same decade elder care will replace child care as the number one dependent care need in America.18

Ken Dychtwald, famous gerontologist and author of AgeWave and AgePower, captures the phenomenal weight of this issue:

Caregiving burden is the single most devastating social, economic and spiritual sinkhole of the early decades of the 21st century. It could be a deathblow to our thriving culture and economy.

The prevailing literature says the simple and obvious solution is for the government to provide universal coverage for long-term care at a decent salary for the front-line workers who supply them. Is this possible?

Consider that in 1945, a decade after Social Security was implemented we had 40 workers for every retiree. 19 The ratio is less than four by 1970 and the projection is 2 to one by 2030.20

Consider that we already spend 44% out of every federal income tax dollar for entitlements, mainly Social Security, Medicare and Medicaid, and that number will be 75% by 2030, according to the Comptroller General.21

Consider that Sweden has such a universal system, and the average tax rate in Sweden today is over 50%.22

THERE IS A BETTER WAY, and that is through private long-term care insurance, the private sector's solution to the real health care crisis in America, which is long-term care.

This insurance is less expensive than health insurance at younger ages, and the American Council of Life Insurers recently published a report that says 60% of Americans age 35 and older can afford a minimal long-term care insurance policy that will pay for at least three years of care for only 2% of income or less and 40% can afford a policy that will pay for six years of care.23

The average premium for employer-sponsored plans is only $500 per year,24 because the average purchaser is 42 years old.25 Individual LTC insurance has an average premium of about $1,700 a year but this figure can be lowered if people purchase at younger ages,26 which is really important as 40% of people who need long-term care are working-age adults,27 and most of them are at home with their families, not in nursing homes.28

Today almost half of long-term care is paid by Medicaid, the welfare system in our country, ultimately funded by tax-payer dollars.29 If the baby boomers fall onto Medicaid for long-term care, this is the very issue to which Ken Dychtwald is referring in the above quote that could bring our economy to its knees.

Insurance is so much more efficient than raising taxes to fund a program. Taxes have to pay the full cost of care, while insurance is purchased for pennies on the dollar. It is so much cheaper for many people to pay pennies on the dollar via insurance than to pay for the entire cost of care through taxes.

As a nation, we need to support family caregiving, labor force participation and solvency of public programs. Long-term care insurance does all three, especially family caregiving. Becoming a primary caregiver often means a decreased quality in the relationship between caregiver and care recipient. When a third-party caregiver is in the picture, the daughter can be the daughter. The wife can be the wife. The daughter-in-law can be the daughter-in-law, and time spent together is quality time in the form of more companionship time instead of direct hands-on assistance with such personal tasks as bathing, dressing, and toileting which most parents don't want their children to do for them anyway.

Last but not least, a new MetLife survey just showed that caregivers whose family members have private long-term care insurance are twice as likely to stay in the workforce as those whose family members don't have an insurance policy!30 And another caregiving study published by the Department of Health and Human Services said that half of the care recipients with LTC insurance said they would not be able to stay home if it weren't for the home health care benefits of their long-term care insurance policy!31

In summary, our Congress needs to connect the dots that it is much cheaper to provide tax incentives to encourage the purchase of private long-term care insurance vs. paying for the baby boomers on Medicaid. Currently, that is not happening. The proposed legislation (HR 831 and S.627) that would accomplish this doesn't have enough support and is in danger of not passing at all. The President's 2002 budget proposal calls for a similar package but it wouldn't start until January 1, 2004, and then it's phased in over several years. None of the proposals include a 100% above-the-line tax incentive and not all of them contain the ability for LTCI premiums to be paid by employees with pre-tax dollars in a Section 125, cafeteria plan - a provision that is essential to the growth of the group LTCI market.

The value of informal caregiving is $196 billion.32 Perhaps some of our leadership feels that if we just continue to ignore the situation, the women in the country will continue to bear this burden and save public dollars, at the expense of their own lifestyles.

Because American women are losing their dreams every day because a parent or spouse has a severe stroke or accident or MS or Parkinson's disease or any of the myriad other conditions that require caregiving, more and more people are calling long-term care insurance, LIFESTYLE INSURANCE. Long-term care insurance can mean the difference between a comfortable, secure life and retirement, doing the things you have dreamed of and planned for, instead of a life of caring for someone else's every need, day in and day out.

Phyllis Shelton, the author of Long-Term Care: Your Financial Planning Guide is President of LTC Consultants, a Nashville, Tennessee company that specializes in consulting services, sales and marketing material development and agent training for the long?term care insurance industry. Ask for her book in major book stores, visit www.ltcconsultants.com, call 800-844-4893 or visit www.kensingtonbooks.com.

1. Spillman, Brenda, C., Ph.D., et al, Potential and Active Family Caregivers: Changing Networks and the ‘Sandwich Generation’”, The Urban Institute: John Hopkins University School of Medicine, The Milbank Quarterly, Vol. 78, No. 3, 2000

2. Ibid.

3. Family Caregiving in the U.S., Findings from National Survey, National Alliance for Caregiving/AARP, 1997

4. Ibid.

5. Olson, Laura., “The Public and Private Worlds of Women and Elder Care in the U.S.”, Hallym International Journal of Aging, 2000, p. 15

6. USA Today, 7/30/99; Bureau of Labor Statistics

7. Ibid.

8. Ibid

9. Report, Findings, and Recommendations of the Working Group on Long-Term Care, U.S. Department of Labor, Advisory Council on Employee Welfare and Pension Benefit Plans, November, 2000

10. Balancing Caregiving with Work and the Cost Involved, National Alliance for Caregiving and the National Center on Women and Aging at Brandeis University, MetLife Mature Market Institute, November, 1999

11. “Chronic Illness and Caregiving” survey conducted by Harris Interactive Inc., on behalf of The Robert Wood Johnson Foundation, Johns Hopkins University, and Partnership for Solutions from March 17 – November 22, 2000, published 2/26/01

12. “The Caregiving Boom: Baby Boomer Women Giving Care”, National Alliance for Caregiving 9/98, p.8

13. Braus, Patricia., “When The Helpers Need a Hand”, American Demographics, September, 1998

14. Olson, Laura., “The Public and Private Worlds of Women and Elder Care in the U.S.”, Hallym International Journal of Aging, 2000

15. Peterson, Karen, S., “Many Boomers May Face Old Age All Alone”, USA Today, December 13, 2000

16. Kinsella, Kevin and Velkoff, Victoria A., “An Aging World: 2001”, U.S. Department of Health and Human Services, National Institute of Health, National Institute on Aging, U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, Issued November 2001

17. Fletcher, Lee, “Elder Care A Concern of Aging Workforce”, Business Insurance, March 5, 2001

18. Morris, Ellen Birkett, “Employers Finding Ways to Help ‘Sandwich Generation’”, Business First (The Conference Board), week of January 3, 2000 (weekly publication)

19. Demography is Not Destiny, National Academy on an Aging Society, a policy institute of The Gerontological Society of America, January 1999, p. 11

20. Walker, David M., U.S. Comptroller General, “Medicare: New Spending Estimates Underscore Need for Reform”, General Accounting Office, GAO – 01 – 1010T, 7/25/01, p.8

21. Walker, David M., U.S. Comptroller General, “Medicare: New Spending Estimates Underscore Need for Reform”, General Accounting Office, GAO – 01 – 1010T, 7/25/01, p.12

22. Swedish Embassy, Washington D.C., 2002

23. “Can Aging Baby Boomers Avoid the Nursing Home?”, American Council of Life Insurance, March, 2000

24. U.S. Group Long-Term Care Insurance: 2000 Sales and In Force, LIMRA, 2001

25. Coronel, Susan., Long-Term Care Insurance in 1997-1998, Health Insurance Association of America, March 2000

26. Who Buys Long-Term Care Insurance 2000? A Decade Study of Buyers and NonBuyers, Health Insurance Association of America/LifePlans, Inc., October, 2000

27. Tilly, Jane, et al, “Long-Term Care Chart Book: Persons Served, Payers, and Spending”, The Urban Institute in Collaboration with the Congressional Research Service, May 5, 2000, p. 12

28. American Health Care Association, The Nursing Facility Sourcebook, 2001, p. 6

29. Centers for Medicare and Medicaid Services, 2000 statistics, published February, 2002

30. The MetLife Study of Employed Caregivers: Does Long-Term Care Insurance Make a Difference?, MetLife Mature Market Institute, March, 2001

31. Cohen, Marc, A., Ph.D., et al, A Descriptive Analysis of Patterns of Informal and Formal Caregiving Among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community, Department of Health and Human Services, Office of Disability, Aging and Long-Term Care Policy and the Robert Wood Johnson Foundation Home Care Research Initiative, April, 1999

32. The MetLife Juggling Act Study: Balancing Caregiving with Work and the Costs Involved, National Alliance for Caregiving and the National Center on Women and Aging at Brandeis University, MetLife Mature Market Institute, November, 1999