The relationship between unpaid caregiving and paid work: Trade-offs in eldercare

As older adults age, many will eventually require some degree of assistance with daily activities like getting in and out of bed or walking across a room. Such care needs, often called long-term care (LTC) or long-term services and supports (LTSS), arise as mobility decreases and disability from aging sets in. In the United States, the vast majority of LTSS care for elders is performed by unpaid family and friends due to various factors, including that formal LTSS is prohibitively expensive for most households. As a result, unpaid caregivers account for 75-80% of total care hours, with millions of people in the US taking on this role, according to figures.

With an aging population, the demand for LTC is expected to grow significantly. By 2030, the U.S. Census estimates that the number of Americans aged 65 and older will increase from 56.1 million in 2020 (or 17 percent of the total population) to 73.1 million in 2030 (21 percent of the total population). An estimated 56% of older Americans turning 65 in 2022 will eventually develop a disability serious enough to require LTSS. These trends mean unpaid caregiving will likely expand, making it critical to understand how it impacts paid work and what factors influence caregivers’ choices and outcomes. 

Unseen costs of caregiving

The median monthly cost of formal long-term care can range anywhere from $2,058 to $9,733 in the U.S., depending on the type of service used. Unpaid family and friend caregiving may seem less costly given the high sticker price of LTSS services in the U.S., yet such considerations may not appropriately incorporate what economists call the “opportunity costs” of unpaid care. Such opportunity costs are the result of foregone alternative choices. 

The true cost of unpaid eldercare goes beyond financial savings—it includes what caregivers give up providing care. This often means sacrificing time that could have been spent on paid work or other activities. Many studies highlight that there are indeed costs to the caregiver of providing unpaid eldercare, including foregone work, negative physical, emotional, or mental health impacts, and reduced future financial security. 

Difficulties estimating the effects of care

Estimating how caregiving affects labour force participation and work hours is challenging due to several key factors. First, it’s unclear whether caregiving leads to reduced work hours or if adults who aren’t working are more likely to take on caregiving roles. In reality, both factors contribute.

Second, care is not homogeneous. Some caregivers may be the sole caregiver to a family member, or they might split their responsibilities with other caregivers. Caregiving can also vary in the tasks performed and the frequency and intensity of caregiving. For example, caregivers who provide care once a week, like on weekends, face less pressure balancing care and other activities compared to those providing daily care.

Lastly, caregivers are not a monolithic group. While most caregivers are women and many are over 50, variations within these groups can influence how caregiving impacts work. However, much of the research on caregiving and work behaviour relies on data from those aged 50 and older, overlooking caregivers of a younger age.

Frequency of care matters, as does caregiver age

This study focused on adults already working full-time and examined how their labour force participation and work hours changed over 2-5 months. It analysed caregiving effects based on frequency (daily, several times a week, or once a week or less) and by age groups (25-49 and 50+).

Among this population, caregiving was associated with a decreased probability of being in the labour force by 5.4 percentage points for both men and women, but only among caregivers who provided daily care (Figure 1). Some daily caregivers who had worked full-time months prior were no longer in the workforce. In contrast, employment did not significantly affect those providing care less frequently.

The results also found that the age of the caregiver was another potentially important factor affecting the care and work relationship. Men aged 25-49 who provided daily care, worked fewer weekly hours than those without care responsibilities. However, no significant reductions were found for other age and gender groups. This highlights that findings from studies focused solely on older caregivers may not apply to younger caregivers, who comprised nearly 40% of caregivers between 2011-2018.

Who are unpaid caregivers?

Differences in the caregiver population are important to consider, given that most care is performed by women and that not all groups of caregivers provide the same frequency of care. For example, Black and Hispanic caregivers in the U.S. are disproportionately likely to be daily caregivers compared to white caregivers (Figure 2). This study highlights significant distributional consequences, as daily caregivers are less likely to be employed. Since women of colour are more likely to provide daily caregiving, this raises concerns about whether the burdens of care are unequally distributed among specific groups in the United States.

Three ways policy can improve the situation

Policies that alleviate caregiver burdens, particularly faced by those with the greatest intensity of care responsibilities, can help to relieve constraints on caregivers’ work decisions. These policies could include:

1. National paid leave legislation: Ensure caregivers can address short-term care needs without leaving their jobs or facing job insecurity.
2. Improved access to formal LTC: Expand access to government-funded or subsidized long-term care and improve pay and conditions for LTC workers to increase availability.
3. Enhanced data collection: Improve data collection by increasing the availability of longitudinal data, expanding the scope of current data like the ATUS, and standardizing how important control variables are collected and measured.

These measures can reduce the strain on caregivers and create a more supportive framework for balancing caregiving with work responsibilities.

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Journal reference

Forden, J. (2024). Elder Caregiving Frequency, Labor Force Participation, and Work. Journal of Aging & Social Policy, 1-16. https://doi.org/10.1080/08959420.2024.2422671