The Changing Demography of Late-Life Family Caregiving: A Research Agenda to Understand Future Care Networks for an Aging U.S. Population

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

Paid care among older adults with long-term care needs declined in the first year of COVID-19 while families stepped in

Separate strands of research have documented impacts of the COVID-19 pandemic in nursing homes and among paid and family caregivers, yet there is little evidence connecting changes in the residential decisions of older adults with the provision of paid and family care, limiting our ability to identify potential substitutions and gaps in care. Using the 2020 wave of the Health and Retirement Study linked to county-level COVID-19 mortality rates, we found that, among older adults with long-term care needs, higher county-level mortality rates were associated with a decline in nursing home residence and an increase in co-residence with adult children. These changes were coupled with a decline in the likelihood of receiving paid care and in the number of paid caregivers and an increase in the hours of unpaid care received. This analysis documents a reduction in nursing home residence and paid care during the first year of the pandemic and shows that families filled some of the resulting care gaps. Policymaking around long-term care should consider whether declines in the use of paid care are permanent and how they will affect the health of older Americans and their caregivers over the next decade.

Caregiving in a Pandemic: COVID-19 and the Well-Being of Family Caregivers 55+ in the United States

Little is known about the effects of Coronavirus disease 2019 (COVID-19) on older family caregivers. Using data from a national sample of 2,485 U.S. adults aged ≥55, we aimed to describe the magnitude of disruptions to family care arrangements during the initial wave of the COVID-19 pandemic, and the associations between these disruptions and the mental health outcomes (depression, anxiety, loneliness, and self-rated health) and employment outcomes (job loss or furlough, hours or wages reduced, transition to work-from-home) of family caregivers. We found that COVID-19 disrupted over half of family caregiving arrangements, and that care disruptions were associated with increased depression, anxiety, and loneliness among caregivers, compared with both noncaregivers and caregivers who did not experience disruptions. Family caregivers who experienced pandemic-related employment disruptions were providing more care than caregivers who did not experience disruptions. These findings highlight the impact of the pandemic on an essential and vulnerable health care workforce.

The cyclicality of informal care

This paper measures the cyclicality of an important input into elderly health: informal care. Using independent survey measures of informal caregiving and care receipt over the past two decades, we find that informal care from adult children to their elderly parents is countercyclical. By contrast, informal care from spouses is procyclical among individuals in their sixties. We find little corresponding change in the use of formal care, highlighting the potential for unmet care needs across the business cycle. These findings suggest that informal health inputs may play an important role in the interpretation of the cyclicality of elderly mortality.

Effects of the Affordable Care Act Medicaid Expansion on Subjective Well-Being in the US Adult Population, 2010-2016

Objectives. To determine whether the 2014 Affordable Care Act Medicaid expansion affected well-being in the low-income and general adult US populations.Methods. We obtained data from adults aged 18 to 64 years in the nationally representative Gallup-Sharecare Well-Being Index from 2010 to 2016 (n = 1 674 953). We used a difference-in-differences analysis to compare access to and difficulty affording health care and subjective well-being outcomes (happiness, sadness, worry, stress, and life satisfaction) before and after Medicaid expansion in states that did and did not expand Medicaid.Results. Access to health care increased, and difficulty affording health care declined following the Medicaid expansion. Medicaid expansion was not associated with changes to emotional states or life satisfaction over the study period in either the low-income population who newly gained health insurance or in the general adult population as a spillover effect of the policy change.Conclusions. Although the public health benefits of the Medicaid expansion are increasingly apparent, improved population well-being does not appear to be among them.Public Health Implications. Subjective well-being indicators may not be informative enough to evaluate the public health impact of expanded health insurance.

Personality Traits and Performance Contracts: Evidence from a Field Experiment among Maternity Care Providers in India

We study how agents respond to performance incentives according to key personality traits (conscientiousness and neuroticism) through a field experiment offering financial incentives for improving maternal and neonatal health outcomes to rural Indian doctors. More conscientious providers performed better--but improved less--under performance incentives. The effect of the performance incentives was also smaller for providers with higher levels of neuroticism. Our results contribute to a growing body of empirical research on heterogeneous responses to incentives and have implications for worker selection.