How Care for Elders, Not Children, Denies Women a Paycheck

Why did women’s rush into the work force stop? Policymakers have been vexed by the question for years. Social scientists have discussed the sudden stop for over a decade, in conferences and academic papers. Almost 12 years ago, I gave the topic a shot in the pages of The Times: why, after a five-decade rise, did the labor-force participation of women in the prime working years stall around the turn of the century?

After years of sometimes scorching debates, over whether highly educated women were “opting out”; whether the stop was merely temporary; and whether it responded to gender roles at home or labor-market conditions, the analysis seems to have converged on a sort of rough consensus: caring for children — overwhelmingly a woman’s task — ultimately took its toll.

Caring for children is, to be sure, a formidable barrier to women’s work. In developed countries where parental leave is guaranteed by law and governments ensure free child care, women work at a much higher rate than in the United States.

Still, the consensus is incomplete. It misses perhaps the most significant impediment to women’s continued engagement in the labor market, one that is getting tougher with each passing year: aging. Focused laserlike on child care, we haven’t noticed that the United States is walking into an elder-care crisis.

Today almost 15 percent of the American population has reached the official retirement age, according to figures from the United Nations. That is about two percentage points higher than at its previous peak in 1995, just a few years before the labor supply of women in the prime working years — 25 to 54 years old — reached a plateau. It means that for every four Americans of working age, there is one of retirement age, the World Bank says.

Lots of these older Americans — 14 million, according to Paul Osterman of the Massachusetts Institute of Technology’s Sloan School of Management — can’t live independently and care for themselves.

The burden of care weighs predominantly on their wives and the daughters. About a quarter of women 45 to 64 years old and one in seven of those 35 to 44 are caring for an older relative, according to the American Time Use Survey.

It takes a toll. Ten percent of caregivers have to cut back on their hours at work; 6 percent leave their jobs entirely, according to a report last year by the National Association of Insurance Commissioners.

A 2015 survey by the insurer Genworth Financial found that caregivers spend about 20 hours a week providing care — about half what a full-time worker would spend at work. Almost four in five said they had missed work, and about one in 10 lost a job. One in six reported losing around one-third of income because of caring responsibilities.

Sean Fahle of the State University of New York at Buffalo and Kathleen McGarry of the University of California, Los Angeles, tracked women in their early 50s to their early 60s for 20 years. Those who provided care, they found, were 8 percent less likely to work. Those at work cut their hours and had lower wage growth. Over time, Professor McGarry told me, caregivers risked lower incomes and a higher risk of poverty in old age.

The Burden of Care

After rising for half a century, the labor force participation rate among prime-age women began to decline in the early 2000s — around the time the elderly share of the population began to rise sharply. Part of the explanation for women’s declining share of the work force may be that women have generally had to assume most of the responsibility for caregiving to the elderly.

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The stress is getting no lighter. By 2030, more than one in five Americans will have reached retirement age. That will call for a lot of caregiving. One study found that retired members of the baby boom generation will need, on average, three years of long-term care. One in five will need more than five years of care.

This is expensive. Older Americans may be healthier than ever. Still, as they age, they will inevitably develop disabilities and chronic conditions like dementia. “If you are superwealthy and can afford all sorts of things, this is not an issue,” noted Lawrence F. Katz, a professor of economics at Harvard. “But if you are middle class, this tends to end with your relatives’ losing all of their assets and relying on Medicaid or family care.”

These pressures may draw more men to take responsibility for care. So far, though, experience suggests the burden will fall mainly on women.

Unlike the boomers now taking care of their parents, their millennial children will not have as many siblings to help care for their parents. Higher divorce rates imply that many aging boomers will have no spouse to care for them, putting additional demands on their children. And the elderly of the future are going to live longer, which suggests there will be a lot of caregivers well into their 50s juggling work with care for their children and their parents.

Much has been made of the fast growth of the caring occupations. The Department of Labor projects that the economy will add roughly 1.2 million home health aides and personal-care aides over the next decade.

One critical challenge is how to turn these minimum-wage, direct-care jobs with few skills into higher-quality and better-paid employment that can attract the millions of new workers who will be in demand.

But there is a broader societal challenge: how to fit a social safety net built in the 1930s, when wives stayed at home and life expectancy was 20 years shorter, into a world in which husbands and wives must juggle work with the demand for care from their elders and their children.

It is probably naïve to harbor these thoughts just as Republicans in Congress and the White House are engineering a tax cut for corporations and wealthy Americans that will reduce government revenue by $1 trillion over a decade. It may sound crazy to say this just as Republican leaders are turning their sights on the next step of the strategy: cutting spending on programs like Medicaid and Medicare to pay for the tax effort. But perhaps this is time to beef up the safety net to incorporate the rising demand for care.

In his book “Who Will Care for Us?,” published this year, Professor Osterman estimates that there are about 21 million family members caring for an adult relative for no pay. By 2040, he predicts demand for such care will rise to 34 million.

Ai-Jen Poo, co-director of Caring Across Generations, a coalition of advocacy groups pushing for an expansion of public insurance to incorporate universal care, notes that private insurers are not the solution: They can’t cobble together a big enough risk pool to cover the enormous cost of care for everyone. “All the insurance companies are trying to get out of that market,” she said. “This is a problem that the market can’t solve.”

With little hope for action at the federal level, Ms. Poo is putting her hope on states. A bill providing for universal long-term care has been introduced in the Washington Legislature. Caring Across Generations has had some success in pushing for adding government subsidies to care in Hawaii. It is backing a referendum on a universal care program in Maine. But without some public intervention, she said, “there will be a humanitarian crisis, both for the aging and the workers that care for them.”

And if prime-age women start leaving the work force in even higher numbers to care for their aging parents, this will also be a problem for the American economy.


Screen Shot 2017-12-29 at 10.14.25 AMBy  @maiasz

Yes, there is a difference. Why one is more likely to trigger serious memory problems?

In a study published in the Journal of Neurology Neurosurgery & Psychiatry, Tjalling Jan Holwerda of the VU University Medical Center in Amsterdam found that participants who reported feeling lonely — regardless of how many friends and family surrounded them — were more likely to experience dementia than those who lived on their own. The scientists focused on nearly 2,200 older adults living in Amsterdam, ages 65 to 86, who did not show signs of dementia and were not living in institutions like nursing homes, and visited them twice over three years. About half of the participants lived alone and 20% reported feelings of loneliness. Almost two-thirds of the elderly in the study were women.

Prior research suggested that having a supportive social network is linked with positive health outcomes, from psychological health to physical health, while lacking such support can be harmful. Indeed, a growing body of studiesfind that loneliness itself can kill, typically by raising blood pressure and increasing risk for heart disease and stroke. High blood pressure is also a risk factor for dementia.

The Dutch study found that after adjusting for other relevant factors like age, feeling lonely raised the risk of dementia by 64%. The research didn’t distinguish between Alzheimer’s, which accounts for 90% of dementia, and other types of the mind and memory-robbing illness. But the authors caution that the results cannot prove loneliness causes dementia: in fact, the opposite could be true since dementia and its resulting changes in mood and brain function may contribute to some of the social withdrawal of loneliness.

“[L]oneliness may be a behavioral reaction to diminished cognition,” the authors write in discussing their findings, because people who are losing their memories may withdraw from others, either due to embarrassment or confusion about how to handle social situations resulting from their brain impairment.

There is also the possibility that “loneliness may also lead to a lack of sensory and cognitive stimulation,” which can be harmful because it reduces levels of nerve growth factors that are necessary for brain health. Both processes could also be occurring at the same time, leading to a vicious cycle in which dementia lowers social support, which then worsens the disorder.

The results add to evidence of the complicated relationship between perception and social engaging, suggesting that a person’s perception of his situation, like whether he feels lonely or not, may have a greater impact on health than objective measures such as whether he lives alone and is isolated from a social network. Many people say they feel lonelier in a bad marriage than they do being single — and people can certainly live alone but still have a large network of friends and family. Research on stress similarly shows the importance of this perception of social connectedness: if you feel you have control over the stress in your life —regardless of whether you actually do — it can have less negative physiological and psychological impact on your health in terms of blood pressure and heart disease.

Of course, controlling whether you feel lonely or not can be difficult — and becoming anxious that being lonely will worsen or cause dementia won’t help, either. But the research increasingly suggests that if you do feel socially isolated, working to improve your social network may be an important first step toward improving your health.



My dog Buddy and I went to visit our 91 year old friend and drop of an Amarylis bulb for Christmas. Carol was in line to see the visiting dermatologist so we took her place in line and I said I would wait for her.

I lovely woman was sitting next to me on the line. She reminded me of my Mom. We started chatting about the dog first, as always. He was being stubborn for some reason, but we continued. I learned that she was 87, and came down here 40 years ago leaving the freeezing winters of upstate New York. Now just thinking of the cold makes her cold. We talked about memories. She said she had 2 strokes and her memories were either gone or jumbled up in her head. Speaking of living in the present!

Carol  was done.  I said good bye to my new friend, and we sent off to her room where I got the Amarylis bulb in the pot for her.  Carol opened a Christmas Card, but couldn’t remember who the sender was, but knew they were nice people.

All it takes is to just be there.

Why are older adults so lonely?

“They are lonely because they are alone,” is the frank response of T. Byram Karasu, M.D., chair of psychiatry and behavioral sciences at the Albert Einstein College of Medicine. “They [seniors] are put in nursing homes, assisted living communities, etc. Those are totally disorienting experiences.”




by Susan V Bosak

In those at either end of the life course – the young and the old – you find striking similarities. We live in a society that values adulthood, and in turn doing – productivity and ongoing activity. The young and the old share a different rhythm. It’s one that focuses not only on doing, but on the power of being. It’s the simplicity of playing with blocks or tending to flowers. The young and the old are most closely connected with the essence of living. They can exist in a moment that’s the grand sum of past, present, and future. Rather than time being the enemy – rushing time or stressing to fit as much into time as possible – time becomes a comfortable companion, a circle rather than a line.

Excited preschoolers crowded around men and women old enough to be their grandparents, ready to read.


But the people narrating picture books and acting out plotlines with their hands weren’t their relatives. Rather, they were senior citizens at the retirement home and assisted-living facility Legacy Lodge at Jackson Hole.

“I was looking for ways to branch out and try some things that would be really beneficial for our residents,” said Alenlia Woerner, director of life enrichment. “We play a lot of cards around here, but it doesn’t really bring the joy or the engagement I was looking for.”

Woener partnered with Children’s Learning Center teachers Michelle Rutecki and Heather Menke to offer a twice-a-month opportunity for generations to collide and unite over something that makes them both happy: reading. Children’s Learning Center is the area’s largest early education center serving kids ages birth through 5, and it just happens to have a location across the street from Legacy Lodge.

“It’s just wonderful to be able to spend time with older people in a sweet setting,” said Patti Boyd, the learning center’s executive director. “There’s nothing like reading together that is a really intimate, wonderful activity for children to do.”

Legacy Lodge cited information from Generations United, a nonprofit that works to improve the lives of children and older adults, that shows that intergenerational programs are beneficial for all participants. Children show improved reading scores compared with their peers when older adults are frequent volunteers in schools, and interacting with older adults helps kids develop a more positive attitude toward aging, according to the nonprofit.