In The Care Of Others
A growing trend of male caregivers is rapidly reshaping eldercare in the United States.M
r. Billy takes his 92-year-old mother out to lunch almost every day. She anoints herself with a cocktail of perfumes and creams, selects a stylish outfit from her formidable closet, and completes her always trendy look with a statement necklace. They drive through Los Angeles, meet Billy’s best friend, and enjoy the sights and the company as much as the meal.
For seven years, Billy has served as his mother’s medical advocate, administrator, driver and companion. A retired, single man in his 70s, Billy isn’t your typical caregiver. But Associate Professor of Economics Mónika López-Anuarbe says he is part of a growing trend that is rapidly reshaping eldercare in the United States.
A health and inequality economist who specializes in aging, López-Anuarbe studies the responsibilities, incentives and obstacles inherent in the mostly invisible work of the more than 40 million unpaid caregivers in the U.S.
In several ways, Billy is López-Anuarbe’s inspiration. He is her uncle—her favorite uncle, she admits—and his charge is López-Anuarbe’s grandmother, whom she describes as her “favorite human being on Earth.”
“Billy is the most patient and loving person in the world,” she says. “This is really an idyllic situation: Not all caregivers get along with their recipients, who are oftentimes much sicker than my grandma.”
AMERICANS ARE GETTING OLDER. The U.S. Census Bureau predicts that by 2030, one in five Americans will be over the age of 65. Yet even as the number of elderly increases, the number of nursing home residents is decreasing. In just 10 years, between 2000 and 2010, the nursing home population of the U.S. fell 20 percent, from 1.6 million to 1.3 million, according to the Centers for Disease Control and Prevention.
“Nursing homes in Connecticut cost about $300 to $400 a day,” López-Anuarbe says. “It’s just too expensive. A lot of people assume Medicare, the health insurance program for those 65 and older, will cover the cost of a nursing home, when in fact it covers only up to 100 days.”
The vast majority of America’s elderly are cared for at home by a family member or friend. Statistically, the average caregiver is a 49-year-old woman, according to the National Alliance for Caregiving and the AARP Public Policy Institute. But men now account for 40 percent of unpaid caregivers, and their ranks are growing rapidly.
An estimated 16 million men serve as caregivers, with about half of them choosing the role and the other half taking it on out of necessity.
“The reality is changing, but policies have a lag,” López-Anuarbe says. “Outreach continues to be very feminized, and a lot of it is ineffective because men and women care differently.”
Men often lack emotional support, for example, and are much more likely to be stressed by providing personal care, like bathing, dressing and helping in the bathroom.
“They might want to know, ‘How do I bathe my mom?’ But they are less likely to seek help or training,” López-Anuarbe says.
In one recent study, López-Anuarbe and Associate Professor of Statistics Priya Kohli analyzed data from the 2011 and 2015 National Study of Caregiving to assess the emotional, financial and physical burdens on male caregivers. They found that while men who provided personal care on a daily basis were very stressed, men who provided personal care often—but not every day—reported being significantly less stressed. That indicates men could benefit considerably from even occasional breaks.
López-Anuarbe and Kohli also looked at variations in stress levels based on whether men were caring for a spouse, a parent or another family member or friend. They found that all caregivers experienced a burden in each of the three categories, but sons in particular reported the highest emotional and financial strains.
That could be in part because sons are more likely to be part of the “sandwich generation,” those taking care of the elderly while also raising children. They are also less likely than spouses to be retirement age and therefore more likely to be working outside of the home. And men, in particular, are hesitant to reveal their status as caregivers to their colleagues.
“The boss might know you have two children, but you aren’t going to say ‘I’m taking care of my dad,’ even if you are doing it 60 to 70 hours a week, because you just don’t want to talk about it,” López-Anuarbe says.
Caregivers shouldn’t feel guilty about asking for help. In fact, López-Anuarbe’s research shows that self-care and regular respite are important to help reduce stress and prevent burnout for all caregivers.
“If you aren’t taking care of yourself, you can’t take care of anybody else. You have to ask, ‘Is there someone who can help me clean my house? Because I have to pack the school lunches for my kids and also get my dad dressed.’ It’s too much,” she says.
MOST PEOPLE AREN'T PREPARED to become caregivers. There’s just so much the average person never thinks about, López-Anuarbe says.
Caregivers serve as housekeepers, companions, chauffeurs, chefs, medical advocates, nurses, treasurers and financial planners. And the commitment can last decades.
“You might end up taking care of someone for 25 years—it’s not three years or three months. And unlike children, who become more independent over time, the elderly become more dependent,” López-Anuarbe says.
“It’s all incredibly stressful, emotionally, financially and physically.”
Just as the caregiving population is becoming more male, it’s also becoming more diverse. It’s estimated that between 13 percent and 17 percent of all caregivers are Hispanic, for example, but for millennial caregivers, that number jumps to 32 percent.
Outreach targeting only middle-aged women is unlikely to resonate with this new generation of caregivers, so López-Anuarbe is working to change the message. She is serving as a consultant on My Place CT, a web-based resource from the State of Connecticut for the elderly and those who care for them, to make it more accessible to the full range of caregivers.
“Basically, I’m looking at it and saying, ‘Have you considered LGBTQ caregivers?’ or ‘Listen, this sounds very feminine,’” she says.
She is also working on a bilingual website for the New London community, which has a large Hispanic population. In 2016, López-Anuarbe partnered with Maria Cruz-Saco, the Joanne Toor Cummings ’50 Professor of Economics, on a study of aging and long-term care planning perceptions within the city’s Hispanic community. Through focus groups and interviews, she and Cruz-Saco found these New London residents were particularly marginalized and weren’t taking advantage of resources like the New London Senior Citizens Center.
“They didn’t feel welcome. The supply was there, and the demand was there, but they weren’t meeting,” she said.
New efforts by the center to serve Hispanic elderly are working, López-Anuarbe said, and she hopes the website will be both user-friendly and practical.
“You might say, ‘Okay, I need to find a dentist who speaks Spanish for my 85-year-old grandpa to change the dentures.’ And boom, there it is,” she says.
IF IT TAKES A VILLAGE to raise a child, as the saying goes, it just might take a country to care for elderly—and their caregivers.
The Affordable Care Act, better known as Obamacare, included several provisions to increase support for caregivers, including expanding access to health insurance, Medicaid and home- and community-based services. But López-Anuarbe believes much more needs to be done.
Better integrating long-term care into the health care system would help, but ultimately López-Anuarbe’s goal is to increase the value of caregiving.
“Caregiving and teaching are very noble causes in our society, but they have been undervalued for the longest time because traditionally women have been doing this work,” she says.
“If you look at home health workers or those who work in nursing homes, they have comparable or lower salaries than someone working at McDonald’s. And what would you rather do? Flip a burger or change an adult diaper?”
López-Anuarbe would like to see tax breaks for caregivers, paid leaves of absence from the workplace and even compensation for home-based care of family members. Currently, Medicare does not pay spouses to provide personal care for their husbands or wives, but 14 states do allow for public assistance programs, including Medicaid, to compensate spouses in certain situations. López-Anuarbe would like to see those programs expanded.
“As an economist, I always think, ‘Let’s talk money here.’ Can’t caregivers get a bread crumb every once in a while? Let me at least throw a little something at you so you don’t die of frustration and your burden and go bankrupt while you are at it.”
Even if the compensation is minimal and largely symbolic, López-Anuarbe thinks it could have a significant psychological impact on caregivers, as well as on the public perception of caregiving.
And the state has a vested interest in encouraging at-home care by loved ones, she adds. With an aging population and the soaring costs of facility-based care, eldercare is likely to become an even more critical economic and social issue over the next several decades.
“Our generation has to understand that if we don’t value care enough, we are going to be really, really sad elderly.”