Vertical Families, Overburdened Caregivers.

More than 20 years ago, my mother had a stroke.

As her only surviving child, I became her primary caregiver. That choice was one that continues a long tradition of family members taking care of their own, for as long as they can. My choice meant that my mother’s needs became my own, added to the demands and needs of my four children, my husband, my job and myself.

Fast-forward to today, and we see that changes in the structure of families are making matters more burdensome for family caregivers. In the past, families were larger. Not only could caregiving tasks be shared, but there were fewer living parents and grandparents. Today, increased longevity, delayed child bearing and low birth rates have led to the rise of vertical families, or families of multiple generations with only a few members in each. It is no longer unusual to know a small family of four or five generations with more members over 55 than under 18.

This phenomenon—that is the growing numbers of vertical families—is new in the history of mankind and creates profound challenges, particularly for women, who are the primary caregivers in our society. Many are working and struggling to manage jobs, family and caregiving responsibilities—much as I did 20 years ago.

For example, it is not surprising to hear of an older adult, someone in their sixties or seventies, who cares for a parent in their late eighties or nineties and for grandchildren. A friend of mine, an only child in her family, is in her late sixties and works part-time as a consultant. It is not unusual for her to spend a morning taking her 93-year-old mother, who lives independently but requires get-around assistance, to a doctor’s appointment, grocery shopping and lunch.

In another situation, a couple I know juggle their respective work lives to care for their two children and the wife’s mother who is in good physical health but has Alzheimer’s disease.

As a society, we place little value on the work involved in caregiving and the people, mostly women, who provide the care. This reality is reflected in the lack of public policies that support family caregiving and the financial penalty that caregivers pay if they leave the workforce to care for family members. At the same time that vertical families are increasing in number, hospitals and nursing homes are sending patients home who still need high levels of care. As the responsibilities and burdens on family caregivers have increased, policies that are meant to lighten the load, such as the Family and Medical Leave Act, are proving inadequate for the task. Compensation or credit for the valuable work that caregivers provide ranges from not-sufficient to non-existent.

What would a more caregiver-friendly society look like? Information about resources and caregiver support groups is important. However, equally or more important, is a combination workplace support and financial relief. Will there come a time when employees are not penalized for taking time off to take a parent, or child, for a medically necessary appointment? And caregivers who have to take a leave of absence for a protracted period of time to care for a family member are eligible for unemployment insurance to cover a caregiving leave? And individuals who have to leave the workforce long-term to care for a family member, a spouse, child, parent, grandparent or aunt, at least receive social security credit for their work as a full-time caregiver? These are just three policy options that would ease the caregiver burden.


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