Hostname: page-component-745bb68f8f-g4j75 Total loading time: 0 Render date: 2025-01-11T07:45:12.712Z Has data issue: false hasContentIssue false
  • English
  • Français

Family Caregiving and the Intergenerational Transmission of Poverty

Published online by Cambridge University Press:  01 January 2021

Richard L. Kaplan
Get access Rights & Permissions [Opens in a new window]

Abstract

The United States relies on uncompensated family caregivers to provide most of the long-term care required by older adults as they age. But such care comes at a significant financial cost to these caregivers in the form of lower lifetime earnings and diminished (or even no) Social Security retirement benefits, ineligibility for Medicare coverage of their healthcare costs, and minimal retirement savings. To reduce the impact of uncompensated caregiving on the intergenerational transmission of poverty, this paper discusses three possible mechanisms of compensating family caregivers: public payments, deemed wage credits under Social Security, and income tax incentives.

Type
Symposium 1 Articles
Information
Journal of Law, Medicine & Ethics , Volume 46 , Issue 3: The Medicalization of Poverty; Perspectives of Alzheimer's Disease: Ethical, Legal, and Social Issues , Fall 2018 , pp. 629 - 635
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Associated Press-NORC Center for Public Affairs Research, Long-Term Care in America: Expectations and Preferences for Care and Caregiving 5 (2016), available at <http://www.longtermcarepoll.org/wp-content/uploads/2017/11/APNORC-Long-term-Care-2016_Trend_Report.pdf>(last visited September 14, 2018) [hereinafter AP Survey].(last+visited+September+14,+2018)+[hereinafter+AP+Survey].>Google Scholar
Migliaccio, J. and Cutler, N. E., National Alliance for Caregiving, Caring Today, Planning for Tomorrow 3 (1999), available at <http://www.caregiving.org/data/archives/nacguide.pdf> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
Reinhard, S. C. et al., AARP Public Policy Institute, Valuing the Invaluable: 2015 Update 1 (2015), available at <http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf> (last visited July 10, 2018). See also Chari, A. V. et al., “The Opportunity Costs of Informal Elder-Care in the United States: New Estimates from the American Time Use Survey,” Health Services Research 50, no. 3 (2015): 871-882, at 878 (estimating the opportunity cost of such services at $552 billion per year).Google Scholar
National Academies of Science, Engineering and Medicine, Families Caring for an Aging America 2-7 (2016), available at <http://www.johnahartford.org/images/uploads/reports/Family_Caregiving_Report_National_Academy_of_Medicine_IOM.pdf> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
See Merrill Lynch Bank of America Corp., The Journey of Caregiving: Honor, Responsibility and Financial Complexity 15 (2017), available at <https://www.bofaml.com/content/dam/boamlimages/documents/articles/ID17_1402/merr95416_caregiving_wp_m3b_10_26_17.pdf> (last visited July 10, 2018) [hereinafter Journey of Caregiving].+(last+visited+July+10,+2018)+[hereinafter+Journey+of+Caregiving].>Google Scholar
National Alliance for Caregiving, Caregivers of Older Adults: A Focused Look at Those Caring for Someone Age 50+ 3 (2015), available at <http://www.aarp.org/content/dam/aarp/ppi/2015/caregivers-of-older-adults-focused-look.pdf> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
AP Survey, supra note 1, at 7.Google Scholar
Women caregivers have particular difficulty rejoining the compensated workforce after their informal caregiving responsibilities conclude. See Pavalko, E. K. and Artis, J. E., “Women's Caregiving and Paid Work: Causal Relationships on Late Midlife,” Journal of Gerontology: Social Sciences 52B, no. 4 (1997): s170-s179, at s177.Google Scholar
See Journey of Caregiving, supra note 5, at 12. The comparable figure for a male caregiver was $284,000.Google Scholar
Northwestern Mutual, 2017 C.A.R.E. Study: Caregiving and Longevity 7 (2017), available at <https://www.northwestern-mutual.com/about-us/studies/care-study-2017> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
42 U.S.C. § 413(a)(2)(A) (2012).Google Scholar
Social Security Administration, Automatic Determinations in Recent Years, available at <https://www.ssa.gov/OACT/COLA/autoAdj.html> (last visited July 10, 2018)+(last+visited+July+10,+2018)>Google Scholar
42 U.S.C. § 414(a)(2) (2012).Google Scholar
42 U.S.C. § 415(b)(2)(A)(i), (B)(iii) (2012).Google Scholar
See 42 U.S.C. §§ 426(a)(2)(A), 1395c(1) (2012).Google Scholar
See Frolik, L. A. and Kaplan, R. L., Elder Law in a Nutshell (St. Paul, Minn.: West Academic Press, 2014): at 66-77.Google Scholar
42 U.S.C. § 402(b)(2) (2012).Google Scholar
42 U.S.C. § 416(d)(1) (2012).Google Scholar
42 U.S.C. § 1395i-2(a)(3) (2012).Google Scholar
Medicare.gov, Medicare 2017 & 2018 Costs at a Glance, available at <https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
See, e.g., I.R.C. §§ 219(b)(1)(B) (individual retirement accounts), 408(k)(2)(C) (simplified employee pensions), 408(p)(2)(A)(ii), (iii) (simple retirement accounts), 408A(c) (2)(A) (Roth IRAs) (2017).Google Scholar
Wakabayashi, C. and Donato, K. M., “Does Caregiving Increase Poverty among Women in Later Life? Evidence from the Health and Retirement Survey,” Journal of Health and Social Behavior 47, no. 2 (2006): 258-274, at 268 (emphasis added).CrossRefGoogle Scholar
See Linsk, N. L. et al., Wages for Caring: Compensating Family Care of the Elderly (New York: Praeger, 1992): 253.Google Scholar
See Journey of Caregiving, supra note 5, at 17 (noting that family caregivers enter that role “suddenly and unexpectedly, the result of a crisis”).Google Scholar
See National Academy of Sciences, Families Caring for an Aging America (2016), available at <http://www.jhartfound.org/images/uploads/main/files/Family_Caregiving_Report_National_Academy_of_Medicine_IOM.pdf> (last visited July 10, 2018). See also Genworth, Beyond Dollars 2015, available at <https://pro.genworth.com/riiproweb/productinfo/pdf/157453C.pdf> (last visited July 10, 2018), at 5 (finding that 33% of caregivers reported “an extremely high level of stress”); Schulz, R. and Beach, S. R., “Caregiving as a Risk Factor for Mortality,” JAMA 282, no. 23 (1999): 2215-2219, at 2218-2219 (1999) (finding that caregivers have a 63% higher risk of dying than non-caregivers).Google Scholar
See N. L. Linsk, supra note 23, at 233-35, 242.Google Scholar
Cf. 38 U.S.C. § 1720G(a)(3)(C)(ii) (2012) (requiring that stipends paid to family caregivers of U.S. veterans be “not less than the monthly amount a commercial home health care entity would pay an individual in the geographic area of the eligible veteran to provide equivalent personal care services.”)Google Scholar
See N. L. Linsk, supra note 23, at 190-191.Google Scholar
See Newcomer, R. J. et al., “Allowing Spouses to Be Paid Personal Care Providers: Spouse Availability and Effects on Medicaid-Funded Service Use and Expenditures,” The Gerontologist 52, no. 4 (2012): 517-530, at 518.CrossRefGoogle Scholar
See U.S. Department of Health and Human Services, Understanding Medicaid Home and Community Services: A Primer 132 (2000), available at <https://aspe.hhs.gov/system/files/pdf/73101/primer.pdf>(last visited July 10, 2018).(last+visited+July+10,+2018).>Google Scholar
Such benefits are exempt from federal income taxation as “difficulty-of-care” payments described in I.R.C. § 131(c). See I.R.S. Notice 2014-7, 2014-4 I.R.B. 445.Google Scholar
See Caregivers and Veterans Omnibus Health Services Act of 2010, Pub. L. No. 111-163, § 101(a)(1), 124 Stat. 1130, 1133 (enacting 38 U.S.C. § 1720G(a)((3)(A)(ii)(V), (C)).Google Scholar
S. 786, 114th Cong. §§ 5, 7 (2015).Google Scholar
Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010).Google Scholar
42 U.S.C. §§ 300ll to 300ll-9 (Supp. V 2011) (enacted as part of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, § 8002, 124 Stat. 119, 828-47 (2010)).Google Scholar
42 U.S.C. § 300ll-4(g) (Supp. V 2011).Google Scholar
42 U.S.C. §§ 300ll-1, 300ll-2, 300ll-4 (Supp. V 2011); see generally Kaplan, R. L., “Financing Long-Term Care After Health Care Reform,” Journal of Retirement Planning 13, no. 4 (2010): 7-16, 43, at 7.Google Scholar
See Kaplan, R. L., “Analyzing the Impact of the New Health Care Reform Legislation on Older Americans,” Elder Law Journal 18, no. 2 (2011): 213-245, at 231.Google Scholar
42 U.S.C. § 300ll-7(a), (b) (Supp. V 2011).Google Scholar
See Letter from Kathleen Sebelius, Secretary, Department of Health and Human Services, to Congress (October 14, 2011), available at <http://www.ltcconsultants.com/articles/2011/class-dismissed/Sebelius-CLASS-letter.pdf> (last visited September 14, 2018).+(last+visited+September+14,+2018).>Google Scholar
American Taxpayer Relief Act of 2012, Pub. L. No. 112-240, § 642(a), 126 Stat. 2313, 2358.Google Scholar
Social Security Caregiver Act of 2002, H.R. 4743, 107th Cong. (2002).Google Scholar
See id. § 2(a) (2002) (proposing 42 U.S.C. § 235(a)(1)).Google Scholar
See id. § 2(a) (proposing 42 U.S.C. § 235(b)(1)(A)(i)).Google Scholar
See id. § 2(a) (proposing 42 U.S.C. § 235(b)(1)(B)).Google Scholar
H.R. 473, 108th Cong. (2003); H.R. 5936, 109th Cong. (2006); H.R. 1161, 110th Cong. (2007); H.R. 769, 111th Cong. (2009); H.R. 2290, 112th Cong. (2011); H.R. 5024, 113th Cong. (2014); H.R. 3377, 114th Cong. (2015); S. 2721, 114th Cong. (2016).Google Scholar
AP Survey, supra note 1, at 11. See also “Poll: Women Age 50+ Want Social Security Beefed Up Now,” AARP Bulletin, September 2016, at 4 (reporting that “2 out of 3 women believe that Social Security should be changed to create a credit for people who take time off from work for caregiving responsibilities.”).Google Scholar
National Academies of Science, Engineering and Medicine, supra note 4, at 7-12.Google Scholar
AP Survey, supra note 1, at 11.Google Scholar
I.R.C. § 213(a), (d)(1).Google Scholar
See id. § (d)(1)(C).Google Scholar
See id. § 7702B(c)(1).Google Scholar
See id. § 213(d)(11)(A).Google Scholar
See id.Google Scholar
Parisi, M., “Individual Income Tax Returns, Preliminary Data, Tax Year 2015,” Statistics of Income 36, no. 4 (2017): 2-11, at 2.Google Scholar
I.R.C. § 213(a). The applicable threshold for 2018 is 7.5% of adjusted gross income. Id. § 213(f).Google Scholar
See Kaplan, R.L., “Federal Tax Policy and Family-Provided Care for Older Adults,” Virginia Tax Review 25, no. 2 (2005): 509-562, at 551-559.Google Scholar
Family Caregiver Relief Act of 2003, S. 1214, 108th Cong. (2003).Google Scholar
Credit for Caring Act of 2017, H.R. 2505, 115th Cong. (2017); S. 1151, 115th Cong. (2017).Google Scholar
N. L. Linsk, supra note 23, at 32.Google Scholar