Jones & Bartlett Learning Health Blog

    Caring For The Caregiver

    Posted by admin on Jul 30, 2010 11:02:00 AM

    Our generation is now being referred to as the “sandwich generation,” i.e., we are the bologna and cheese between two thick slabs of children and parents in the great hoagie of life. Good child care, while not always easy to find, is relatively abundant, accessible and affordable for most working parents. Good elder care? Not so much. In the U.S., the vast majority of eldercare is provided not in continuing care retirement communities, assisted living facilities, or nursing homes, but in the community, by the family (National Alliance for Caregiving and AARP, 2004).

    Dr. Donna Wagner led a diary study for Evercare and the National Alliance for Caregiving (NAC) (2007) and found that out-of-pocket costs of giving care to family members by family members average $5,531, more than 10% of the median income of the group which was $43,026” (Evercare & NAC, p. 7). Respondents indicated that to finance these out-of-pocket costs they cut back on vacations, leisure activities, savings, and home improvement and major purchases. The caregivers made up the difference by taking the personal and financial hits themselves. There is only so long that anyone—even Superman or Superwoman can do this without running aground emotionally, physically, and psychologically. Many caregivers in this study reported “picking up or increasing bad habits (smoking, drinking too much), worsening health problems of their own, inability to go to medical or dental appointments, insomnia, feelings of depression and hopelessness, weight changes, and added stress and anxiety” (Evercare & NAC, p. 27).

    Researchers have found that employers also incurred a staggering total of over $17.1 BILLION in costs due to full time employee quits, replacement costs, absenteeism, and workday interruptions.  “The average cost per employee for all full time, employed caregivers was $2,100 (Metlife Mature Market Institute & NAC, 2006, p. 4). Elder caregiving has been and continues to be a woman’s job. The only place where there is “near parity between men and women caregivers  occurs among those who are in the workplace; male caregivers have increased in number and proportion of caregivers but there continues to be more women than men among the entire caregiving population.” (Wagner, personal communication, January 29, 2010). “Among employed caregivers, women were more likely to report that they assisted with personal care tasks, such as bathing, dressing and toileting. Men were more likely to report that they provided long-distance care” (Metlife Mature Market Institute, NAC, & Center for Productive Aging at Towson University, 2003, p. 2). So, even when employed sons stepped up to the plate to assist with eldercare, the more intimate and physical burdens of eldercare fell on employed daughters.

    Employers have become sensitized to the need for parents to be able to take care of their infants and children, but interest in eldercare as an employers’ issue has lagged. There is a stigma associated with elder care that is not associated with child care. Yet, workers with elderly dependents, like those with small children, need flexible hours and the ability to take time off for crises. Wagner (2003, p. 8) wrote, “Although nearly 25 percent of the companies that employ 100 or more workers report that they have some type of program in place, most American workers are employed by small companies.” With the tsunami of aging demographics about to crash over our nation, this means more financial burdens for family caregivers, along with more stress and emotional and physical exhaustion. What can you do when your employer does not offer any assistance?

    Here are a few ideas gleaned from experts on caregiving:

    • Accept the idea that you need to take care of yourself. “Flight attendants instruct passengers, put your oxygen mask on first--then assist your child” (Family Caregiver Alliance, n.d, para 1). This is true of elder care. If you don’t take care of yourself, you will be useless to your dependent. It is not shameful to take care of yourself. You have needs, too.
    • Journaling has been found to be an effective tool for stress reduction. Keep a diary to record and track your emotional status. Sometimes caregivers try to tell themselves everything is okay, when it really isn’t. Denying your feelings of loss, sadness, or being overwhelmed does not make them go away. When you put something in writing, it forces you to acknowledge your feelings and can motivate you to do something to improve the situation.
    • “Tell your personal physician that you are a caregiver when you go for medical appointments and inform your doctor of any special stress or issues you are facing” (Wagner, personal communication, January 29, 2010).
    • Make a contract with yourself to change unhealthy behaviors. Set goals and stick to them. Tell your family and friends what you are doing--and ask for their help. “I have a quit date for smoking. I need your help.” Or, “I want to get more exercise. Could you please come over and watch Mom so I can get out for a thirty minute walk?” Remember, if you get sick, you can’t take care of your dependents.
    • Allow others to help you. If a friend or neighbor volunteers and says, “If there’s anything I can do, let me know,” say, “Yes, I would love it if…” and you fill in the blank. Of course, you should be reasonable in your requests. It is okay to ask for help, too. The worst thing that will happen is someone will say no. More likely, they will say yes.

    As a country, we have taken great strides in many areas; however we lag behind other nations with respect to eldercare programs. “Health care providers need to be supportive of the very critical role that caretakers play in the well-being of their patients and should give caregivers kudos when they show up with the older patient” (Wagner, personal communication, January 29, 2010). While we can write to our Senators and Congressmen and Congresswomen to work on legislative changes, the first steps must begin at home by caring for the caregiver.

    Sharon B. Buchbinder, RN. PhD
    Professor and Chair
    Department of Health Science
    Towson University
    Towson, MD

    Sharon Buchbinder is an Adjunct Professor of Nursing at Stevenson University in the Graduate and Professional School , and former chair of the Association of University Programs in Health Administration (AUPHA).  She is also the author of two books from Jones & Bartlett: Introduction to Health Care Management and Career Opportunities in Health Care Management.


    Here are some references if you are interested in this topic.

    Evercare & National Alliance for Caregiving (NAC). (2007). Family Care Givers--What They Spend, What They Sacrifice: The Personal Financial Toll of Caring for a Loved One. Retrieved on January 20, 2010

    Family Caregiver Alliance. (n.d.) First, care for yourself. Retrieved on January 29, 2010

    Metlife Mature Market Institute & NAC (1997, June). The Metlife Caregiving Cost Study: Productivity Losses to US Business. Retrieved on January 20, 2010

    Mature Market Institute Metlife, NAC, & Center for Productive Aging. (2003). The Metlife Study of Sons at Work: Balancing Employment and Eldercare. Retrieved on January 20, 2010

    National Alliance for Caregiving & AARP. (2004). Caregiving in the U.S. Washington, DC: National Alliance for Caregiving & AARP, as cited in Caregiving in Rural America, A Report by the Easter Seals and the National Alliance for Caregiving (2007) retrieved on January 20, 2010

    Neal, M. & Wagner, D. (2002).  Working Caregivers: Issues, Challenges, And Opportunities For The Aging Network. Retrieved on January 20, 2010

    Wagner, D.L. (2003). Workplace Programs for Family Caregivers: Good Business and Good Practice. San Francisco (CA): Family Caregiver Alliance Retrieved on January 20, 2010


    Topics: allied health, public health education, Sharon B. Buchbinder, National Alliance for Caregiving (NAC), Public health management, Sharon Buchbinder Blog, caregiver, child care, eldercare, Evercare, sandwich generation

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