Need is Growing, but Little Funding Available to Provide
Long-Term Care at Home
Field Poll Reveals Inability of Families to Afford Care
SAN FRANCISCO—March 4, 2003—According to a new Field poll, 28 percent of Californians aged 40 and older needed in-home care for themselves or a family member in the past year. Of those, more than half (55 percent) needed in-home help for more than six months. Yet a majority of Californians say they cannot afford to pay for that help.
These findings were revealed in a Field Institute poll surveying older Californians' preferences for, attitudes about, and experiences with in-home care. The poll was commissioned by Family Caregiver Alliance's National Center on Caregiving with funding from The California Wellness Foundation.
Results indicate that:
- 51 percent of Californians said they would not be able to afford in-home help for six months or longer, calculated at two hours of help per day at $15 per hour, or $5400 for six months.
- Those least able to pay out-of-pocket for in-home care are those with the lowest incomes, Latinos, African-Americans, women and persons 60 years and over.
- Overall, 32 percent would have an unpaid family member or friend help with care; 30 percent would like to pay a family member or friend to provide care.
- Among middle income people ($40,000-80,000 per year), 38 percent chose unpaid family help, while 40 percent chose paid family help.
- 21 percent would pay a private in-home care provider; and the same number would pay a home care agency.
- Californians want trustworthy, dependable in-home care providers, and are concerned with safety. Caregiver characteristics rated as "extremely important" to families were: someone who would not steal things (89 percent); felt safe and comfortable to be with (88 percent); would come regularly and on time (80 percent); had appropriate education and training (64 percent); had a car (42 percent).
As the Baby Boom generation ages, the need for long-term, in-home care will grow: the percentage of Californians age 50 and over is expected to rise 33 percent by the year 2020.
Contrary to popular belief, most older people who need long-term care live at home and in their communities, not in nursing homes. There is limited public funding to pay for the long-term care of those with Alzheimer's disease, stroke, Parkinson's and other disabling conditions. The care involves the most intimate aspects of people's lives-what and when they eat, personal hygiene, administering medications, dressing.
While unpaid family caregivers-most frequently the wife or daughter of the care recipient--often must quit their jobs to provide needed care for an ill or elderly loved one, they are typically unable to replace income and retirement benefits lost when they leave employment. Such unpaid health care, provided at great sacrifice by families, was worth an estimated $257 billion nationally in 20001.
Medicare and private insurance generally offer no funding to compensate family caregivers; Medi-Cal and Medicaid offer minimal resources with stringent low-income requirements for the care recipient.
"Given the high costs associated with long-term care and the aging of the population, it is critical that Californians-and all Americans-have access to available, affordable and appropriate in-home care," said Kathleen Kelly, Executive Director of Family Caregiver Alliance.
Shortage of Home-Care Workers
"To complicate matters, even if families could afford to pay them, there is a looming shortage of trained home care workers. The future demographic imbalance between the demand for and supply of frontline workers will only worsen over time. Although the California legislature wisely set policy more than 20 years ago to pay low-income families to provide care through the In-Home Supportive Services (IHSS) program, given the aging population and this impending worker shortage, legislators should take a close look at the possibility of paying middle-income family members to provide care. There may be few other options. Clearly the state cannot afford an increase in the nursing home population." 2, 3
The poll, conducted in April 2002, was funded by a grant from The California Wellness Foundation (TCWF). Created in 1992 as an independent, private foundation, TCWF's mission is to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention programs.
The National Center on Caregiving, a program of Family Caregiver Alliance, works to advance the development of high-quality, cost-effective policies and programs for caregivers in every state in the country. FCA seeks to improve the quality of life for caregivers through education services, research and advocacy.
For a copy of the full report, please click here or call (800) 445-8106.
The poll consisted of telephone interviews conducted by the Field Institute between April 19-25, 2002 with a representative sample of 612 California adults age 40 and older. Results were weighted by age, sex, household size and region.
1. Arno, P.S. (2002). "The Economic Value of Informal Caregiving, U.S., 2000," updated figures presented at the American Association for Geriatric Psychiatry meeting, February 24, 2002.
2. See Stone, R.I., (2001). "Long-Term Care Workforce Shortages: Impact on Families," policy brief prepared for "Who Will Provide Care?" a conference convened by Family Caregiver Alliance's National Center on Caregiving, October 26, 2001.
3. See Polivka, Larry, (2001). "Paying family Members to Provide Care: Policy Considerations for States," policy brief prepared for "Who Will Provide Care?" A conference convened by Family Caregiver Alliance's National Center on Caregiving, October 26, 2001.
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