"Estimating the economic value of unpaid caregiving which requires assumptions about the cost of replacing the services of informal caregivers, as well as estimates of the prevalence of caregiving and the hours of care given cannot be done with precision. But with even the most conservative assumptions and estimates, the value is huge, dwarfing the value of paid home health care and nearly matching the total national spending on home health care and nursing home care." From the AARP issue brief Valuing the Invaluable: A New Look at the Economic Value of Family Caregiving
Nancy Folbre, U of Mass economics professor, echoes the AARP's assessment in The Depreciation of Care at Home, stating that current health care policy undervalues home caregiving including care given by family members and paid caregivers, who often supplement the care families can provide. She argues that home caregiving, while more cost-effective and often preferable to institutionalized long-term care, is 'underpaid and not subject to federal labor regulation'Current and future family caregivers should favor better federal protections for paid home care workers out of respect for the value and dignity of caregiving itself.
One federally-funded insurance program that people could voluntarily use to cover the costs of potential long-term care needs was the now-dead in the water Community Living Assistance Services and Support (CLASS) Act. Such federal support and protections would improve the quality of life for patients in need of long-term care and their caregivers, argues Don Taylor, associate professor of public policy at Duke University. On The Incidental Economist, Don writes, Benefits in the range of $50-$75/day like what CLASS would have provided could enable family caregiving situations to be continued longer, possibly keeping people out of [nursing homes], or could enable care plans that result in less harm to caregivers.
So the question of how to finance long-term care remains unanswered. Nearly a year ago, Trudy Lieberman asked, Does long-term care insurance have a future? and pointed out that "nursing home care doesn't come cheap," especially with ongoing, significant insurance price increases. One year later, in Health Reform's First Casualty, she details the effects that the demise of the CLASS Act will have on Americans.
One "quiet but intriguing" alternative to a traditional nursing home or at-home caregiving is the Green House project, writes the New York Times. In Green Houses, small groups of seniors live together assisted by two certified nursing aides with two or three houses under the oversight of one registered nurse. The homes do require 'comparatively large initial capital investments" so they may not be a viable nationwide solution, but initial data suggest that Green Houses offer improved care. Could better care translate to better value?