(July 2010) Today, Americans are more likely to marry and to divorce than in almost any other Western nation. Serial marriages, rising levels of cohabitation, delayed childbearing, and nonmarital parenthood have added complexity to American families. At the same time, increases in women's attachment to the labor force have altered the allocation of time to work and caregiving for older and younger generations. Demographically, the coming generation of elderly Americans—the baby boomers—were themselves the pioneers in the great changes that have transformed family life over the past several decades, and their aging is one of the most anticipated demographic events of this century. While the number of Americans without medical insurance is high, the number without any insurance against the costs of long-term care is far greater. The burden of day-to-day care falls most often to family members and friends who provide unpaid assistance. Declines in fertility and increasingly diffuse and complex kin ties thus have substantial consequences for long-term care in the United States: There may be an increase in the demand for formally provided services and reductions in the availability of family support.

On June 23, 2010, the Population Reference Bureau and the Hopkins Population Center sponsored its 4th Annual Symposium on Policy and Health: "Family Care for an Aging Population: Demographic Contexts and Policy Challenges."

This year's presenters were:

  • Andrew Cherlin, Benjamin H. Griswold III, Professor of Sociology and Public Policy, Dept. of Sociology, Johns Hopkins University (PDF: 416KB)
  • Nancy Folbre, Professor of Economics, University of Massachusetts (PDF: 1.28MB)
  • Madonna Harrington Meyer, Laura J. and L. Douglas Meredith Professor for Teaching Excellence, Professor of Sociology, Maxwell School, Syracuse University.
  • John Haaga, Deputy Director, Division of Behavioral and Social Research, National Institute on Aging (PDF: 852KB)

Andrew Cherlin highlighted recent changes in the nuclear family structure as a possible cause of problems when the elderly need family members as caregivers. The above-65 age group is growing rapidly and is projected to make up 19 percent of the population by 2030. At the same time, fertility rates are not increasing to keep up with the number of elderly people and family structures are undergoing major transformations. In the past, nuclear family structures and low divorce rates encouraged tight family bonds and made the responsibility of caring for the elderly more straightforward than today. As the divorce rate and the proportion of births outside of marriage increased, and as partnerships turned over more frequently and became shorter in duration, the traditional family unit was disrupted. The result is that the younger generation tend to form weaker personal ties with family. This trend might have a significant impact on the younger generation's contribution to caring for the elderly, at a time when the elderly population is rapidly expanding.

Nancy Folbre talked about the roles of family care and public assistance programs, and the urgent need for policy reform. The major sources of elderly care are families and the government. About 19 percent of U.S. residents provide care to persons ages 50 or above, averaging at least 19 hours per week. This unpaid work saves taxpayers a lot of money every year. However, when families are unwilling or unable to provide enough care, public support programs like Medicare and Medicaid and private long-term care insurance make up the difference. These alternatives are mostly inefficient and expensive. Some of the policy reforms Folbre noted include economic support for family care, a universal adult care system, and regulation of market provisions and public care.

Madonna Harrington Meyer emphasized several policy solutions to the problems affecting public assistance programs. In the United States, families perform about 75 percent of elderly care, although the elderly are hesitant to fully rely on their family members. As a result, many people are left without the care they need. The long-term formal care system is fragmented, difficult to navigate, and uneven across states. In addition, Medicaid has an institutional and policy bias toward institutionalization. Some policy solutions for the current problems might include increased access to personal care, reduced burden for family caregivers, and mandatory waivers so that all states can provide home-based care options.

John Haaga called attention to the limitations surrounding private long-term care options. Overall, 50 percent of women and 30 percent of men will stay in a nursing home at some point in their lives, many for long periods. One year in a nursing home costs about $70,000, significantly more expensive than home health services. On the other hand, private insurance for long-term care is rare, the industry is heavily regulated, and quality is difficult to measure. The Community Living and Supportive Services Act of 2010 has the potential to overcome some of the problems associated with private long-term care insurance and provide more options to the elderly.


Andrew J. Cherlin is Benjamin H. Griswold III Professor of Sociology and Public Policy at Johns Hopkins University. His research interests include the well-being of parents and children in low-income families and the changing nature of marriage and family life over the past century. His recent articles include "The Deinstitutionalization of American Marriage" (Journal of Marriage and Family) and "Family Instability and Child Well-Being" (American Sociological Review). He is the author of The Marriage-Go-Round: The State of Marriage and the Family in America Today (Vintage, 2010).

Nancy Folbre is professor of economics at the University of Massachusetts at Amherst. Her academic research explores the interface between feminist theory and political economy, with a particular focus on the organization of care work. She has published numerous articles in academic journals and is the author of Greed, Lust, and Gender: A History of Economic Ideas (Oxford, 2009) and Saving State U (New Press, 2010). She currently serves as an associate editor of the journal Feminist Economics and coordinates a working group on care work sponsored by the Russell Sage Foundation.

Madonna Harrington Meyer is Laura J. and L. Douglas Meredith Professor for Teaching Excellence in Sociology, and senior research associate, at the Center for Policy Research, Syracuse University. She is co-author, with Pamela Herd, of Market Friendly or Family Friendly? The State and Gender Inequality in Old Age (Russell Sage, 2007), and the recipient of the Gerontological Society of America, Section on Behavioral and Social Science's Richard Kalish Publication Award. She was the editor of Care Work: Gender, Labor, and the Welfare State (Routledge Press, 2000), and has authored numerous articles on the old-age welfare state in the United States.

John Haaga is deputy director of the Division of Behavioral and Social Research Program at the National Institute on Aging. He holds a Ph.D. in public policy from the RAND Graduate School of Policy Studies, an M.A. in international relations from Johns Hopkins University, and a B.A. from Oxford University. Prior to taking his current position, he was director of Domestic Programs at the Population Reference Bureau and has worked on projects and initiatives in the area of reproductive health, welfare reform and the family, immigration, and racial and ethnic differences in health.