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Tufts Public Health » Mental Health, Older Adults, Racism » The health needs of caregivers and recipients

The health needs of caregivers and recipients

A woman and an older man holding and reading a book together in a home.

Photo credit: Public Domain, Alterfines

The U.S. is expected to experience a growing demand for caregivers, who include home health aides, personal care attendants, and family members, to support older people and people with disabilities. The number of individuals over age sixty-five, many of whom will need care at some point in their lives, is expected to grow from 15% of the U.S. population in 2014 to 22% in 2060. As the older population copes with the cost of care, caregivers must manage health issues of their own. Although some state and federal programs attempt to provide support, more work is needed to address this public health issue.

As Baby Boomers age in coming years, some members of this generation will need assistance with activities of daily living such as eating, bathing, and getting dressed. Many express a desire to stay in their homes. Though home care may be less expensive than institutional care such as nursing homes, many seniors and their families may struggle to afford care. In addition, older adults are vulnerable to abuse and neglect by caregivers.

Caregivers themselves are also vulnerable. As Binyamin Appelbaum says, “There is little job security; the benefits are meager; the work is physically demanding and emotionally draining.” For many years legislators have excluded caregiving from national labor protections. This divide dates back to the 1930s, when Southern congressmen lobbied to devalue and economically segregate domestic labor because it was predominantly performed by black workers. Only recently did changes by the Department of Labor guarantee caregivers overtime compensation and the federal minimum wage. Caregiving work may create rewarding interpersonal relationships; however, the long hours and associated stress can cause physical and psychological harm. Family members who are caregivers may navigate complicated regulations to be reimbursed through insurance and in some cases are not eligible for payment. All the while, caregiving takes time away from other work and often interferes with their own health needs.

The majority of caregivers are women. Many are immigrants and many have low incomes. In other words, both caregivers and those for whom they care often belong to vulnerable populations. Their wellbeing is an issue not only of public health but also of health disparities. For example, undocumented immigrants providing care may be more wary of raising safety concerns for fear that an employer will use their legal status to retaliate.

Some efforts are being made around country to address these issues. In Massachusetts, the legislature passed the Domestic Workers Bill of Rights in 2014. This law regulates employers of domestic workers, including caregivers. It requires minimum wage pay for these workers; sick time, breaks, and payroll records; and specific protections for live-in workers and immigrants. The Massachusetts Family Caregiver Support Program offers resources for families and caregivers such as education and counseling.

At the federal level, the Affordable Care Act contains many provisions related to caregiving. It provides resources for caregiver training, as well as for research to better prepare for future workforce needs. It established a program that states can choose to include in their Medicaid programs, the Community First Choice Option, that provides funding for services and devices that help individuals continue to live in their homes rather than in institutions. It also provides funding to combat elder abuse.

The future funding of such programs is uncertain in today’s political environment. In the current climate, the future of immigrant healthcare workers is also unclear. Going forward, it is important to prioritize options to protect both people who receive care and those who care for them.

by Cayla Saret, MPH Candidate ’17

Filed under: Mental Health, Older Adults, Racism

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