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Increasing Rates of Employed Caregiving
The rates of employed caregiving have greatly increased in the last 70 years. There are five primary reasons for the increase:
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Deinstitutionalization of psychiatric hospitals
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Workplace standards and policies have lagged in catching up to the new societal realities. It is time for inclusivity for employed caregivers in the workplace.
Medical Cost Cutting
Since the 1980s, the medical system has transferred care to families and friends to manage medical costs. Hospitals and insurers assume loved ones can fulfill medical and nursing responsibilities, from expanding outpatient procedures, decreasing length of stays, to delegating serious illness management to caregivers. “Increasingly, these caregivers are expected to acquire a sophisticated understanding of the recipient's condition and new skills to execute complex medical tasks, previously performed by skilled providers, often with little training or ongoing support.” (1)
Women in the Workforce
In the past, the American economy and social structure relied on unpaid service of women. Women provided fulltime care to family and community needs. Our economy and society are now different, but the workplace still acts like most of their employees have someone at home to manage family and community needs. This expectation is not connected to the realities of our society. The workplace has lagged in creating policies that reflect the fact that women have increased responsibilities. This disconnect has caused increased stress on families, forced difficult and consequential choices for caregivers between providing care and earning an income, and created residual negative effects for those needing care.
Decreased Social Supports
The United States has experienced a decrease in traditional social supports that would provide volunteerism and community networks. The decrease in participation in religious institutions, social organizations that focus on volunteerism, and clubs that increased connectivity has reduced the social network and supports for individuals. This increased isolation has made it more difficult for caregivers to receive backup support. Employed caregivers experience increased responsibility, especially during emergencies and crisis management.
Aging Baby Boomer Generation
There is an increase in caretaking based on the aging baby boomer generation. In 2010, the ratio of family caregivers for people eighty years or older was 7:1, and by 2030, the U.S. Census predicts the ratio will be 4:1. As medical advances extend the life expectancy of the elderly, much of their care falls to family and friends. Informal caregivers who provide for both elderly loved ones and their children are commonly known as the sandwich generation, facing intense pressure to manage opposing responsibilities. “Given that modern medicine continues to extend people's lives, an ever-increasing number of workers find themselves with day-to-day or crisis-based responsibilities for care of ill or elderly family members. At stake are not simply maternity leave and the care of young children: Workers worldwide face caregiving responsibilities that can be very long term, sandwiched between aging parents and children.” (2)
Deinstitutionalization of Psychiatric Hospitals
Starting in the 1950s through the 1980s, the country experienced a period of deinstitutionalization of psychiatric hospitals. Based on the population that was released in the 1980s compared to institutionalized patients of today, over 92% of patients who previously would have received full-time inpatient treatment are now cared for in the society through a thin patchwork of supports. For would-be patients fortunate enough to have loved ones able to help, this work has been absorbed into the informal caregiver network. The responsibilities are significant and many of the disabilities require a lifetime of care.
“Most of those who were deinstitutionalized from the nation's public psychiatric hospitals were severely mentally ill. Between 50 and 60 percent of them were diagnosed with schizophrenia. Another 10 to 15 percent were diagnosed with manic-depressive illness and severe depression. An additional 10 to 15 percent were diagnosed with organic brain diseases -- epilepsy, strokes, Alzheimer's disease, and brain damage secondary to trauma.” (9)
Resources for Increasing Rates
1. Bell, J. F., Whitney, R. L., & Young, H. M. (2019). Family Caregiving in Serious Illness in the United States: Recommendations to Support an Invisible Workforce. Journal of the American Geriatrics Society, 67, S451–S456. https://doi.org/10.1111/jgs.15820 2. Bornstein, S., Williams, J. C., & Painter, G. R. (2012). Discrimination against Mothers Is the Strongest Form of Workplace Gender Discrimination: Lessons from US Caregiver Discrimination Law. International Journal of Comparative Labour Law & Industrial Relations, 28(1), 45–62. 3. Cech, E. A., & O’Connor, L. T. (2017). ‘Like second-hand smoke’: the toxic effect of workplace flexibility bias for workers’ health. Community, Work & Family, 20(5), 543–572. https://doi.org/10.1080/13668803.2017.1371673 4. Earle, A., & Heymann, J. (2012). The cost of caregiving: Wage loss among caregivers of elderly and disabled adults and children with special needs. Community, Work & Family, 15(3), 357–375. https://doi.org/10.1080/13668803.2012.674408 5. Greene, R., & Hunt, G. G. (2017). Who Is My Brother’s Keeper Now? Caregiving: Yours, Mine, and Ours. Generations, 41(2), 71–78. 6. Greenfield, J. C., Hasche, L., Bell, L. M., & Johnson, H. (2018). Exploring how workplace and social policies relate to caregivers’ financial strain. Journal of Gerontological Social Work, 61(8), 849–866. https://doi.org/10.1080/01634372.2018.1487895 7. Hirsh, C. E., Treleaven, C., & Fuller, S. (2020). Caregivers, Gender, and the Law: An Analysis of Family Responsibility Discrimination Case Outcomes. Gender & Society, 34(5), 760–789. https://doi.org/10.1177/0891243220946335 8. Paulson, G. W. (2012). Closing the asylums: Causes and consequences of the deinstitutionalization movement. McFarland & Company, Inc. 9. Torrey, E. F. (1997). Deinstitutionalization: A Psychiatric "Titanic". PBS. Retrieved February 19, 2022, from https://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html#:~:text=Deinstitutionalization%20is%20the%20name%20given,to%20the%20mental%20illness%20crisis.