Rachel F. Boaz

Paid work and unpaid help by caregivers of the disabled and frail elders.

Informal caregiving by women, and to a lesser extent by men, is a major source of assistance for the chronically disabled and most dependent older persons living in the community. However, because womens commitment to career employment may diminish, this source of help at the time when (according to demographic trends) the number of very old Americans will increase, the effect of employment on the time they devote to informal caregiving is an important social and economic issue. This study examines two related research questions: 1) how the time allocated to paid work affects the time devoted to unpaid caregiving and 2) how caregiving responsibilities affect work outside the home. The results differ for full-time and part-time work. Estimating a simultaneous equation model, it was found that 1) full-time employment by caregivers reduces the time they allocate to providing unpaid help by 20 hours a week and 2) female caregivers were much less likely than their male counterparts to have full-time jobs. Results also indicate that 1) part-time employment by caregivers has no statistically significant effect on caregiving and 2) caregiving has no effect on womens part-time employment.

Full-time employment and informal caregiving in the 1980s.

The study examines the extent to which the effect of full-time employment on informal caregiving has changed over time. Such a change could be expected because women, who constitute the majority of unpaid caregivers, have been increasing their commitment to career employment. Full-time market work by an increasing proportion of successive cohorts of women means that proportionally fewer will be available to provide the amount of assistance needed by persons with disabilities that require the constant presence of a caregiver. This study is based on the National Informal Caregiver Surveys that are linked to the National Long-Term Care Surveys of 1982 and 1989. To achieve comparability between the 1982 and 1989 data, the analysis is based on primary caregivers whose care-recipients were disabled in performing the activities of daily living (ADLs): 1,489 in 1982 and 597 in 1989. A simultaneous-equations model estimates the number of weekly hours of unpaid help and the probability of full-time work for pay. The principal finding is that, compared with nonemployment, full-time employment reduced caregiving by 25 hours a week in 1982 and by 22 hours a week in 1989, but the difference of 3 hours is not statistically significant. The proportion of primary caregivers engaged in market work full time increased from 15.8%, in 1982 to 19.3% in 1989, but this difference is not statistically significant. These findings suggest that full-time employment reduces caregiving time substantially but that the effect of full-time employment on informal caregiving by primary caregivers of ADL-disabled elderly did not change during the 1980s. Primary caregivers with full-time jobs were more likely to assist individuals disabled in bathing and dressing, two activities that do not require the constant presence of a caregiver. The primary caregivers of individuals with more than two ADL disabilities frequently were the spouses of the care-recipients, themselves elderly persons who were not expected to be engaged in market work. The data from the 1980s appear to be reassuring in the sense that full-time employment by primary caregivers of ADL-disabled elderly did not further reduce the amount of time that they devoted to caregiving. In 1989, only about one fifth of these caregivers were engaged in market work full time. But this proportion is likely to increase in the future. As these future increases materialize, proportionally fewer caregivers will be available to provide the amount of help needed by persons with ADL disabilities that require the constant presence of a caregiver.

Improved versus deteriorated physical functioning among long-term disabled elderly.

The usual prognosis for long-term disabled elderly is that they are not likely to improve or regain independent functioning. But computed transition probabilities reveal a significant proportion of improvement. Based on the National Long-Term Care Surveys of 1982 and 1984, this study identifies the personal characteristics that are associated with changed functional status between these 2 years and estimates how much each characteristic contributes to this change. The study distinguishes four mutually exclusive statuses of disabled older persons: improved, remaining unchanged, deteriorated-alive, and deteriorateddead. It shows that cognitive impairment reported in 1982, high-risk medical events that occurred during the year before the 1982 interview, and hospitalization between 1982 and 1984 predict an increased risk of deterioration by 1984. However, similar estimates do not predict improvement. Yet, data compatible with reported improvement suggest that acute medical problems might have caused a temporary worsening of functional status. When the recovery from this status takes more than 3 months, the ensuing change may be recorded as a long-term disability in the initial survey and as an improvement over time. However, long-term disabled elderly seldom improve to such an extent that they regain complete independence in physical functioning. In this study, most of the elderly who improved ended with a functional status similar to that of persons whose ADL disabilities remained unchanged over time.

Does Having More Time After Retirement Change the Demand for Physician Services

Various aspects of the demand for ambulatory services of physicians have been studied by researchers, but so far the effect of increased availability of nonwork time due to retirement on demand has not been examined. This study investigated whether discouraging early retirement (which was the intent of the 1983 Amendments to the Social Security Act) will reduce the use of medical services because persons who continue to work have less time than retirees for visits to doctors. This study found that, for men whose health does not interfere with work and who have had no in-hospital care in the study year, retirement does not increase the demand for ambulatory services when compared with being a part-time or full-time employee. However, compared with full-time self-employment, retirement increases the probability of using any physician services in the year by 14% and the number of physician visits by two visits. Although the self-employed have more control over their work time than employees, they may be more affected than employees by the loss of output and earnings associated with absence from the workplace.

Health as a Reason or a Rationalization for Being Retired

Many studies of the decision to retire have found that self-reported poor health increases the probability of retirement. Yet doubts have been expressed as to whether such reported deterioration in health is a reason rather than a socially acceptable justification for not working. This issue has important implications for public policy.

Early Withdrawal from the Labor Force A Response Only to Pension Pull or also to Labor Market Push

Not-yet-old men whose health is not failing are retiring from the labor market at a time when they do not receive any pension income and the level of their nonwage income is very low. This study examines why such men stop working as early as they do, instead of continuing to work at least until they are old enough to claim social security benefits (to which they are entitled at age 62). It finds that labor market conditions that result in diminished employment opportunities cannot be ruled out as conducive to withdrawal from the labor market before age 62.

Work as a Response to Low and Decreasing Real Income During Retirement

The problem of preserving the purchasing power of retirement income has been a subject of public concern and policy debate. This study examines whether elderly men and women, in reasonably good health, consider work as an option when the real value of their nonwage income is decreasing. It finds that work is a very likely response to a low level of nonwage income at the beginning of retirement; and, for men, work is also a response to the decreasing real value of income during retirement. The indexing of social security benefits and their progressive structure have provided some protection against decreasing real income during retirement and have, therefore, reduced, though not eliminated, the pressure to work during retirement.