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School & Program Updates

School & Program Updates

Iowa Researchers Examine the Complicated Costs of Caregiving

Baby boomers are entering their retirement years and reshaping demographics in the U.S.: the number of Americans ages 65 and older will more than double from 46 million today to more than 98 million by 2060. Add in longer life expectancy, and it’s clear that the rapid “graying of America” will increase demands on already strained resources.

To help improve health outcomes for older adults, the University of Iowa established the Aging Mind and Brain Initiative (AMBI). This interdisciplinary group seeks inno­vative ways to diagnose, prevent, and delay natural or disease-related cognitive, functional, and mental decline with aging.

AMBI investigators Dr. Kanika Arora, assistant professor of health management and policy, and Dr. Sato Ashida, assistant professor of community and behavioral health, are both based in the University of Iowa College of Public Health. Each was drawn to the subject of aging partly through their own experiences of having a grandparent affected by dementia. Through their respective areas of study, Drs. Arora and Ashida are examining the impact on families as an aging relative requires more care.

Long-term care can be staggeringly expensive. Nationally, the median annual cost for an in-home health aide (44 hours/week) runs about $49,000. A semi-private room in a nursing home is $85,775. The costs for dementia patients can spiral even higher.

Research has shown that when older adults receive more informal care, they are less likely to go into a nursing home. The intent of Paid Family Leave (PFL) is to make it financially easier for employees to take time off from work to care for children and seriously ill family members. While the United States has no such federal policy, a handful of states are offering PFL programs. Dr. Arora co-authored a recent study that examined the effect of California’s PFL policy on long-term care use.

“We found that after the beginning of paid family leave in California, the proportion of older adults in nursing homes went down,” says Dr. Arora. “This suggests that workers were able to take time off to care for family members, leading to a reduction in nursing home use.”

Some proposals for PFL programs apply only to parental family leave — the birth or adoption of a child — and don’t include care for family members with a chronic illness.

“I think this is a big part of the conversation we’re missing out on, especially if it affects nursing home use,” says Dr. Arora. “Given how expensive nursing homes are, and the fact that seniors like to age at home, policymakers need to consider what is included in paid family leave.”

Caregiving often requires many partners. Dr. Ashida studies caregiver networks — systems of family members, paid help, and others who provide emotional or instrumental support that enables a primary caregiver to care for an individual.

“A lot of studies look at the caregiver and their feelings, but few studies talk to other people to get their perspective of what’s going on in a caregiving relationship and how that might impact the family dynamics and context,” Dr. Ashida says.

One of Dr. Ashida’s studies looked at how the expectations members in a caregiving network have about each other can affect everyone involved.

“If my sister is not meeting my expectations in partici­pating in caregiving, it has a detrimental impact on my psychological well-being,” Dr. Ashida explains. “That sets the tone for the whole family and the cohesion goes down. Ultimately, the care that people receive is impacted by that.”

Both researchers mention the importance of engaging seniors with their communities. Dr. Arora points to the AARP Foundation Experience Corps, whose trained volunteers work with students in high-need elementary schools. Dr. Ashida gives an example from Japan where older adults and families with young children live in condominiums and share a communal kitchen, living spaces, and yard.

“The idea is that older adults can contribute by making meals and supervising kids’ homework or play while their parents are at work,” Dr. Ashida says. “I think the key is inter-generational interactions where older people are contributing to younger people. They enjoy it and have a purpose in life, and the younger children look up to the older adults.”

[Photo: Dr. Kanika Arora]

[Photo: Dr. Sato Ashida]