In The Care Of Others
A growing trend of male caregivers is rapidly reshaping eldercare in the United States.
Mr. 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鈥檚 best friend, and enjoy the sights and the company as much as the meal.
For seven years, Billy has served as his mother鈥檚 medical advocate, administrator, driver and companion. A retired, single man in his 70s, Billy isn鈥檛 your typical caregiver. But Associate Professor of Economics M贸nika L贸pez-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, L贸pez-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 L贸pez-Anuarbe鈥檚 inspiration. He is her uncle鈥攈er favorite uncle, she admits鈥攁nd his charge is L贸pez-Anuarbe鈥檚 grandmother, whom she describes as her 鈥渇avorite human being on Earth.鈥�
鈥淏illy is the most patient and loving person in the world,鈥� she says. 鈥淭his is really an idyllic situation: Not all caregivers get along with their recipients, who are oftentimes much sicker than my grandma.鈥�
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.
鈥淣ursing homes in 糖心TVecticut cost about $300 to $400 a day,鈥� L贸pez-Anuarbe says. 鈥淚t鈥檚 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.鈥�
The vast majority of America鈥檚 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.
鈥淭he reality is changing, but policies have a lag,鈥� L贸pez-Anuarbe says. 鈥淥utreach continues to be very feminized, and a lot of it is ineffective because men and women care differently.鈥�
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.
鈥淭hey might want to know, 鈥楬ow do I bathe my mom?鈥� But they are less likely to seek help or training,鈥� L贸pez-Anuarbe says.
In one recent study, L贸pez-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鈥攂ut not every day鈥攔eported being significantly less stressed. That indicates men could benefit considerably from even occasional breaks.
L贸pez-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 鈥渟andwich generation,鈥� 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.
鈥淭he boss might know you have two children, but you aren鈥檛 going to say 鈥業鈥檓 taking care of my dad,鈥� even if you are doing it 60 to 70 hours a week, because you just don鈥檛 want to talk about it,鈥� L贸pez-Anuarbe says.
Caregivers shouldn鈥檛 feel guilty about asking for help. In fact, L贸pez-Anuarbe鈥檚 research shows that self-care and regular respite are important to help reduce stress and prevent burnout for all caregivers.
鈥淚f you aren鈥檛 taking care of yourself, you can鈥檛 take care of anybody else. You have to ask, 鈥業s 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.鈥� It鈥檚 too much,鈥� she says.
MOST PEOPLE AREN'T PREPARED to become caregivers. There鈥檚 just so much the average person never thinks about, L贸pez-Anuarbe says.
Caregivers serve as housekeepers, companions, chauffeurs, chefs, medical advocates, nurses, treasurers and financial planners. And the commitment can last decades.
鈥淵ou might end up taking care of someone for 25 years鈥攊t鈥檚 not three years or three months. And unlike children, who become more independent over time, the elderly become more dependent,鈥� L贸pez-Anuarbe says.
鈥淚t鈥檚 all incredibly stressful, emotionally, financially and physically.鈥�
Just as the caregiving population is becoming more male, it鈥檚 also becoming more diverse. It鈥檚 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 L贸pez-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 糖心TVecticut for the elderly and those who care for them, to make it more accessible to the full range of caregivers.
鈥淏asically, I鈥檓 looking at it and saying, 鈥楬ave you considered LGBTQ caregivers?鈥� or 鈥楲isten, this sounds very feminine,鈥欌�� she says.
She is also working on a bilingual website for the New London community, which has a large Hispanic population. In 2016, L贸pez-Anuarbe partnered with Maria Cruz-Saco, the Joanne Toor Cummings 鈥�50 Professor of Economics, on a study of aging and long-term care planning perceptions within the city鈥檚 Hispanic community. Through focus groups and interviews, she and Cruz-Saco found these New London residents were particularly marginalized and weren鈥檛 taking advantage of resources like the New London Senior Citizens Center.
鈥淭hey didn鈥檛 feel welcome. The supply was there, and the demand was there, but they weren鈥檛 meeting,鈥� she said.
New efforts by the center to serve Hispanic elderly are working, L贸pez-Anuarbe said, and she hopes the website will be both user-friendly and practical.
鈥淵ou might say, 鈥極kay, I need to find a dentist who speaks Spanish for my 85-year-old grandpa to change the dentures.鈥� And boom, there it is,鈥� 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鈥攁nd 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 L贸pez-Anuarbe believes much more needs to be done.
Better integrating long-term care into the health care system would help, but ultimately L贸pez-Anuarbe鈥檚 goal is to increase the value of caregiving.
鈥淐aregiving 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,鈥� she says.
鈥淚f you look at home health workers or those who work in nursing homes, they have comparable or lower salaries than someone working at McDonald鈥檚. And what would you rather do? Flip a burger or change an adult diaper?鈥�
L贸pez-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. L贸pez-Anuarbe would like to see those programs expanded.
鈥淎s an economist, I always think, 鈥楲et鈥檚 talk money here.鈥� Can鈥檛 caregivers get a bread crumb every once in a while? Let me at least throw a little something at you so you don鈥檛 die of frustration and your burden and go bankrupt while you are at it.鈥�
Even if the compensation is minimal and largely symbolic, L贸pez-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.
鈥淥ur generation has to understand that if we don鈥檛 value care enough, we are going to be really, really sad elderly.鈥�