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By: Jessica Forden, Siavash Radpour, Eva Conway and Teresa Ghilarducci
The U.S. disproportionately relies on unpaid caregivers to look after and care for its aging population. In fact, one estimate suggests that 75–80 percent of total care hours for older adults is provided by informal caregivers.1 Unpaid caregivers number in the millions, with 40.4 million individuals ages 15 and older providing some amount of unpaid eldercare between 2017 and 2018.2 Such caregivers provide an invaluable service to society, but many face costs from foregone employment, lost income and benefits, and lost access to work-dependent welfare supports; these costs only compound over time.
Caregivers who stop working due to caregiving responsibilities not only lose their current income but also suffer long-term financial consequences. This is known as the "scarring effect" of non-employment, where prolonged absence from the workforce leads to a permanent reduction in earnings potential, especially for those at the lower and higher ends of the income distribution.3
Non-employment also means that on top of missing out on the opportunity to save for retirement, caregivers do not obtain Social Security work credits, which are earned through paid employment and are crucial for retirement security. Without these credits, caregivers will receive lower Social Security benefits, or may not be eligible for benefits at all, which further worsens their financial situation in retirement.4
Figure 1: Low-Income Caregivers Face High Eldercare Burdens
Source: SCEPA calculations based on American Time Use Survey, 2017–2019 pooled data
Note: Sample includes all individuals ages 25 and over. Person weight, 2006 methodology
Low income and Black and Hispanic caregivers face the heaviest caregiving burdens, which are often compounded by simultaneous child caregiving. Of caregivers, nearly a third of those from low-income families provide daily eldercare, compared to just 15 percent of caregivers from high-income households. It is no wonder that unpaid eldercare labor and economic insecurity are linked; indeed, low income may itself be a result of elder caregiving.
Current demographic projections indicate that the U.S. will see a near 40 percent increase in the share of the population ages 75 and older over the next ten years.5 Such trends in both the number and share of aging older adults will place an increasing burden on family caregivers in years to come, many of whom are already performing unpaid care under significant constraints. To ensure that caregivers have the support and resources necessary to continue providing care without facing economic insecurity, it is crucial that the U.S. implement policies that redefine work and employment and bolster supports for informal eldercare providers.
Economically vulnerable caregivers shoulder the heaviest care burdens
Though higher income households are most likely to provide some amount of unpaid eldercare (see Appendix), economically vulnerable caregivers are most likely to provide daily eldercare. Narratives around informal eldercare often center middle-income white women given that they have the highest prevalence of caregiving (see Appendix), but these narratives fail to acknowledge the differences of burden among caregivers by household income and race/ethnicity. In fact, 35 percent of caregivers in families who make less than $20,000 and 32 percent of caregivers in households making $20,000 to $39,000 are providing daily unpaid eldercare, compared to just 15 percent of caregivers in households that make $100,000 or more (Figure 1). Individuals in this income category are also most likely (63 percent) to provide care only once a week or less often, compared to lower-income brackets. Patterns for the intensity of eldercare responsibilities bear out similarly when looking at the data by race and ethnicity. Specifically, Black and white Hispanic caregivers are more likely than their white non-Hispanic counterparts to provide daily eldercare and less likely to provide lower-intensity care (Figure 2).
Figure 2: Non-White Caregivers Provide More Daily Eldercare
Source: SCEPA calculations based on American Time Use Survey, 2017–2019 pooled data
Note: Sample includes all individuals ages 25 and over. Person weight, 2006 methodology
Unpaid eldercare givers face a double squeeze
Informal childcare responsibilities may compound the burdens of unpaid eldercare. As individuals age, their older family members do too, and unpaid eldercare rates tend to increase with age, peaking for those ages 55–64 (Figure 3). Dubbed the “sandwich generation,” middle-aged caregivers to aging parents may still have dependent children for whom they provide unpaid care or may be providing childcare for a grandchild.6 15 percent of individuals providing unpaid eldercare also engaged in unpaid childcare in the same day, according to pooled American Time Use Survey data for 2017 to 2019 (author’s calculations). Other research suggests that nearly half of adults in their 40s and 50s are facing this double bind when one takes into account the financial support of both parents and children.7
Women and adults age 45 and older are most likely to provide unpaid eldercare compared to men and younger age cohorts. Of all households, women were almost 30 percent more likely to provide care than their male counterparts (Figure 3).
Figure 3: Women and Middle-Aged Adults Are Most Likely to Provide Eldercare
Source: SCEPA calculations based on American Time Use Survey, 2017–2019 pooled data
Note: Sample includes all individuals ages 25 and over. Person weight, 2006 methodology
The costs of unpaid eldercare compound over time
The clear demographic differences in burdens of unpaid eldercare suggest that low income may itself be a result of eldercare giving. Indeed, research indicates that providing unpaid eldercare earlier in life increases individuals’ risk of poverty in older age as caregivers forego employment and thus lose out on income and employment-dependent benefits.8,9 One 2014 study estimated that total foregone income from unpaid U.S. eldercare amounted to $522 billion annually.10 Other research confirms this loss by showing that starting caregiving leads to a reduction in employment, and that this reduction persists even after two years.11
For low-income families, paid eldercare is prohibitively expensive and out of reach. In 2016, for example, the average cost of assisted facility living ranged from $3,628 to $6,844 a month, depending on the accommodations, while hourly rates of home-based care were $20–$20.50 an hour.12 Individuals who can afford to pay for some amount of eldercare services have greater freedom to make choices regarding their time allocations to paid work, unpaid care, or other activities. Lower income individuals, however, are more constrained in their care options.
Though individuals in higher income households have a greater prevalence of unpaid eldercare and are likely to have the highest nominal opportunity costs of foregoing employment, they are also less likely to have to leave the labor force entirely to provide such care. These individuals may also be partnered, have greater retirement savings, and own their homes, all of which are factors that mitigate the risk of poverty due to forgone work. Additionally, individuals from higher income households are much more likely to be able to afford formal eldercare, which they may substitute entirely for or pair with unpaid care.
The economic costs of unpaid care work extend beyond the loss of earnings. Government social and economic policies that systematically undervalue unpaid work and marginalize those without formal employment increase the actual economic costs of unpaid care work for caregivers. Low-income daily caregivers who cannot afford formal employment are excluded from social safety net programs with work requirements, such as the Earned Income Tax Credit (EITC) and are excluded from Medicaid in some states.13 Thus, the costs of providing informal eldercare include losing out on access to social safety net programs that are often important to low-income individuals and households.
Policy Recommendations
Expand program eligibility by redefining work and employment
Social programs that have work requirements, such as EITC or Medicaid in some states, should expand their definitions of employment to include unpaid eldercare work. Other programs like unemployment insurance should consider expanding “good cause quits” to include those forced to leave jobs due to eldercare responsibilities.14 Unpaid eldercare is a reality faced by millions of Americans and excluding such informal labor from definitions of work and employment has significant costs. Policies designed to help low-income households that condition on formal employment ultimately rob caregivers of valuable resources as they provide an invaluable service to the U.S.’s aging population. Polices that redefine work and employment would help provide informal caregivers with basic economic security so that they may continue providing such care.
Provide care credits for Social Security
Caregivers who leave the labor force face a greater risk of poverty at older ages, since in addition to losing earnings and potential retirement savings, they do not accumulate sufficient Social Security benefits. The impact on Social Security accrual is particularly important considering that the majority of those providing unpaid eldercare are women who have longer life expectancies compared to men. Providing care credits for Social Security could help mitigate a cycle of elder poverty brought on by the government’s failure to support vital caregiving activities, including eldercare and childcare.15
Provide paid family care leave and improve access to part-time employment
Some eldercare givers may only need to provide care for short periods following particular incidences or health shocks, while others may only need to provide care on a part-time basis. Providing such caregivers with universal paid family care leave and implementing policies to promote the accessibility of part-time employment16 will help those individuals remain partially employed and ultimately reduce their costs of providing unpaid eldercare work.
Appendix
Data and Methodology
We use American Time Use Survey (ATUS) data pooled across 2017–2019 to calculate pre-pandemic unpaid eldercare prevalence and frequency estimates. The ATUS is a nationally representative survey conducted by the U.S. Bureau of Labor Statistics on non-institutionalized individuals in the United States age 15 and older. Starting in 2011, the ATUS introduced questions about time spent on unpaid eldercare designed to identify eldercare providers and to measure the time they spent performing such care. As part of this module, respondents are asked whether they have provided “any care or assistance for an adult who needed help because of a condition related to aging” in the past three months. If respondents have provided any care, they are then asked how often they provided this care and are given options of “daily,” “several times a week,” “about once a week,” “several times a month,” “once a month,” “one time,” or “other.”
Our prevalence estimates are based on weighted percentages of those who responded yes to the first question, whether they had provided any unpaid eldercare in the past three months. Frequency results are weighted estimates using the second question, though we combine categories into “once a week,” “several times a week,” and “once a week or less.” The ATUS additionally collects demographic information on race and ethnicity, sex, educational attainment, age, and family income. For this analysis, we restrict the sample to adults age 25 and older. Family income is reported categorically in 16 buckets of varying increments up to $149,000, at which point the data just reports those who earn $150,000 or more. We combine these into 5 larger buckets that have roughly equally distributed number of observations.
The ATUS also asks questions regarding individual’s childcare activities from the previous day. If an individual reported any time spent caring for or helping any child in the respondent’s household, regardless of relationship, we count them as having provided childcare in the previous day. We compare this to respondent’s answer to whether they provided any eldercare in the previous day to estimate the weighted percentage of individuals who provided both eldercare and childcare in the same day (as reported on page 3 of this policy note).
Figure A: Higher Income Families are Most Likely to Provide Any Frequency of Eldercare
Source: SCEPA calculations based on American Time Use Survey, 2017–2019 pooled data
Note: Sample includes all individuals ages 25 and over. Person weight, 2006 methodology
Prevalence of eldercare
Individuals in households with family income of $150,000 or more are 4 percentage points more likely to have provided any eldercare to an adult in the past three months. However, this is likely in part driven by the higher likelihood of upper income individuals to have parents who are still living compared to individuals in lower income households.
Individuals with less educational attainment provide more high-frequency unpaid eldercare compared to those with higher degrees. For example, 37 percent of those without a high school degree provide daily eldercare, compared to just 15 percent of individuals with a graduate or professional degree. Given that educational attainment, household income, and work status are often linked, these results unsurprisingly reflect the findings reported in Figure 1 of this policy note, where individuals in low-income families are also most likely to provide daily unpaid eldercare. However, unlike income, educational attainment—often decided at younger ages— is less likely to be affected by providing eldercare.
Figure B: Those with Lower Educational Attainment Provide the Highest Frequency ElderCare
Source: SCEPA calculations based on American Time Use Survey, 2017–2019 pooled data
Note: Sample includes all individuals ages 25 and over. Person weight, 2006 methodology
White non-Hispanic women, followed closely by Black women, are most likely to provide unpaid eldercare across family incomes. Surface level analyses of unpaid eldercare burdens might lead to conclusions that unpaid eldercare responsibilities are a predominately white, middle- and upper- class issue based on Figures A and C, however, when paired with breakdowns of intensity of care provided, such as in Figure 2, it becomes clear that the picture is more nuanced. Though Black women are slightly less likely overall to provide any eldercare compared to White non-Hispanic women, they are more likely to provide daily eldercare (Figure 2), as well as more likely to be in the labor force, suggesting that Black women are facing compounded constraints on their time from both formal and informal work.
Tables for figures 1-3
Table A: Prevalence of eldercare giving by family income, sex, and race/ethnicity (2017–2019)
Table B: Frequency of eldercare giving by family income and race/ethnicity (2017–2019)
Table C. Prevalence of eldercare giving, by gender and age group (2017–2019)
Endnotes
1 Spillman, Brenda C., Eva H. Allen, and Melissa Favreault. “Informal Caregiver Supply and Demographic Changes: Review of the Literature.” Urban Institute, December 2020. https://aspe.hhs.gov/reports/informal-caregiver-supply-demographic-changes-review-literature-0.
2 “Unpaid Eldercare in the United States 2017-2018: Data from the American Time Use Survey.” Bureau of Labor Statistics, November 22, 2019. https://www.bls.gov/news.release/pdf/elcare.pdf.
3Guvenen, Fatih, Fatih Karahan, Serdar Ozkan, and Jae Song. 2017. "Heterogeneous Scarring Effects of Full-Year Nonemployment." American Economic Review, 107 (5): 369-73
4Bond, T., Saad-Lessler, J., & Weller, C. E. (2020). Still Shortchanged. National Institute on Retirement Security.
5 “Employment Projections: Civilian Noninstitutional Population by Age, Sex, Race, and Ethnicity.” Bureau of Labor Statistics. Accessed February 17, 2023. https://www.bls.gov/emp/tables/civilian-noninstitutional-population.htm.
6Jacobs, Barry J. “Challenges of Being a Sandwich Generation Caregiver.” AARP, January 3, 2020. https://www.aarp.org/caregiving/life-balance/info-2020/sandwich-generation-caregivers.html.
7Parker, Kim. “The Sandwich Generation.” Pew Research Center’s Social & Demographic Trends Project (blog), January 30, 2013. https://www.pewresearch.org/social-trends/2013/01/30/the-sandwich-generation/.
8Wakabayashi, Chizuko, and Katharine M. Donato. “Does Caregiving Increase Poverty among Women in Later Life? Evidence from the Health and Retirement Survey.” Journal of Health and Social Behavior 47, no. 3 (September 2006): 258–74. https://doi.org/10.1177/002214650604700305.
9Butrica, Barbara, and Nadia Karamcheva. “The Impact of Informal Caregiving on Older Adults’ Labor Supply and Economic Resources.” Urban Institute, March 10, 2015. https://www.urban.org/research/publication/impact-informal-caregiving-older-adults-laborsupply-and-economic-resources.
10Chari, Amalavoyal V., John Engberg, Kristin Ray, and Ateev Mehrotra. “The Opportunity Costs of Informal Elder-Care in the United States: New Estimates from the American Time Use Survey.” Health Services Research 5, no. 3 (June 2015): 871–82. https://www.rand.org/pubs/external_publications/EP66196.html.
11Maestas, Nicole, Matt Messel, and Yulya Truskinovsky. “Caregiving and Labor Force Participation: New Evidence from the Survey of Income and Program Participation.” Center for Financial Security, September 2021. https://cfsrdrc.wisc.edu/files/working-papers/W120-12_Maestas.Messel.Truskinovsky_FinalPaper_9.16.21-(1).pdf.
12LongTermCare.gov. “Costs of Care.” Administration for Community Living, February 18, 2020. https://acl.gov/ltc/costs-and-who-pays/costs-of-care.
13“Medicaid Work Requirements.” American Academy of Family Physicians, November 2020. https://www.aafp.org/dam/AAFP/documents/advocacy/coverage/medicaid/BKG-MedicaidWorkRequirements.pdf.
14Singh, Sejal. “How Unemployment Insurance Is Failing Working Caregivers — And How to Fix It.” Issue Brief. National Women’s Law Center, August 2021. https://nwlc.org/wp-content/uploads/2021/08/UIPolicyBrief.pdf.
15Hess, Cynthia, Tanima Ahmed, and Jeff Hayes. “Providing Unpaid Household and Care Work in the United States: Uncovering Inequality.” Briefing Paper. Institute for Women’s Policy Research, January 2020. https://iwpr.org/wp-content/uploads/2020/01/IWPR-Providing-Unpaid-Household-and-Care-Work-in-the-United-States-Uncovering-Inequality.pdf.
16“The Schedules That Work Act.” Fact Sheet. National Women’s Law Center, October 2019. https://nwlc.org/wp-content/uploads/2019/10/Schedules-that-Work-Act-Giving-Workers-the-Tools-2019-v3.pdf.
Suggested Citation: Forden, J., Radpour, S., Conway, E., and Ghilarducci, T. (2023). “Reducing the Unequal Burden of Unpaid Eldercare Work.” Policy Note Series, Schwartz Center for Economic Policy Analysis at The New School for Social Research. New York, NY.
