Question #3

Article:

I should have put his socks back on.

The thought kept nagging me as I finished my clinic notes, replaying the afternoon in my head. My final patient of the day a man with dementia was a late addition to the schedule, after his daughter, herself a patient of mine, called to report he hadn't been himself lately. We scheduled him for the last appointment, so she could join after finishing work across town.

She recounted the subtle changes she'd noticed in her father. He'd been eating less, sleeping more. He was less steady on his feet and seemed uninterested in playing with his grandchildren an activity that normally filled him with irrepressible joy.

From her purse, she pulled out no fewer than eight pill bottles each with a dose, time and frequency meticulously labeled. She handed me a handwritten transcript of his other recent appointments: an ophthalmologist, a neurologist, a cardiologist. As I examined him, her phone rang.

"Grandpa isn't feeling well, sweetie," she said. "There's macaroni in the fridge. We'll be home soon."

She hung up and apologized for the interruption. Then she leaned over to pull his socks over his bare feet socks I'd removed moments before and left on the exam table.

I should have put his socks back on.

There are some 40 million Americans like my patient's daughter. Every day, they help a parent, grandparent, relative or neighbor with basic needs: dressing, bathing, cooking, medications or transportation. Often, they do some or all of this while working, parenting, or both. And we as doctors, employers, friends and extended family aren't doing enough to help them.

According to AARP and the National Alliance for Caregiving, the typical family caregiver is a 49-year-old woman caring for an older relative but nearly a quarter of caregivers are now millennials and are equally likely to be male or female. About one-third of caregivers have a full-time job, and 25 percent work part time. A third provide more than 21 hours of care per week. Family caregivers are, of course, generally unpaid, but the economic value of their care is estimated at $470 billion a year roughly the annual American spending on Medicaid.

A recent report from the National Academies of Sciences, Engineering and Medicine suggests that society's reliance on this "work force" largely taken for granted is unsustainable. While the demand for caregivers is growing because of longer life expectancies and more complex medical care, the supply is shrinking, a result of declining marriage rates, smaller family sizes and greater geographic separation. In 2015, there were seven potential family caregivers for every person over 80. By 2030, this ratio is expected to be four-to-one, and by 2050, there will be fewer than three potential caregivers for every older American.

This volunteer army is put at great financial risk. Sixty percent of those caring for older family members report having to reduce the number of hours they work, take a leave of absence or make other career changes. Half say they've gotten into work late, or had to leave early. One in five report significant financial strain. Family caregivers over 50 who leave the workforce lose, on average, more than $300,000 in wages and benefits over their lifetimes.

Even worse, perhaps, is the physical and emotional toll of extended caregiving. Family caregivers are more likely to experience negative health effects like anxiety, depression and chronic disease. One study found that those who experienced mental or emotional stress while caring for a disabled spouse were 63 percent more likely to die within four years than non caregivers who were also tracked. Another study found that long-term caregivers have disrupted immune systems even three years after their caregiving roles have ended. And caregivers of patients with long I.C.U. stays have high levels of depressive symptoms that can last for more than a year.

As overworked and underappreciated as family caregivers are, health systems, under pressure to reduce costs, increasingly rely on them to manage illness at home.

Questions:

• Consider three potential markets: "Volunteer" caregivers, "Professional" caregivers, and the market for "other" types of labor (not involved in caregiving). Explain how the trends discussed in the article would affect supply and demand in each of these markets, and why. (10 points)

• Draw supply-and-demand for these three markets "now" and in the "future." (10 points)

• Discuss what the supply-and-demand diagrams predict will happen in each market as a result of the trends discussed in the article. (5 points)