Current and Future Replacement and Opportunity Costs of Family Caregiving for Older Americans With and Without Dementia.

Background and objectives: Family caregivers in the United States provide substantial value of unpaid care to older adults while less recognized are the employment-related costs they endure and the trajectory of these costs. We estimate the replacement cost of unpaid family caregiving to U.S. adults aged 70 and older with and without dementia and the opportunity costs of forgone earnings and lost productivity between 2011 and 2060.

Research design and methods: We match caregivers to older adults from the National Study of Caregiving with similar noncaregivers from the Panel Study of Income Dynamics. We use population projections alongside current and historical data on educational attainment, wages, inflation, and average wages for in-home care aides to approximate total replacement and opportunity costs.

Results: Current annual replacement cost of unpaid family care is between $96 and $182 billion, 44% of which is accounted for by dementia caregiving. By 2060, it will increase to $277-571 billion, and 53% will be for dementia caregiving. The opportunity costs of forgone earnings and productivity loss, however, will grow faster, increasing from current levels of $107 billion and $26 billion to $380 billion and $102 billion, respectively, in 2060. Projections show that opportunity costs of family caregiving will be increasingly borne by caregivers of older adults with dementia and racial/ethnic minoritized caregivers.

Discussion and implications: As the employment-related opportunity costs of family caregiving for older adults are on a trajectory to become increasingly similar in value to associated replacement costs of unpaid care, policymakers, health insurance payers, and employers should focus on supporting unpaid family caregivers to remain attached to the labor force through efforts such as strengthening paid family leave options, expanding consumer-directed in-home services options, and offering increased work flexibility.