Thank you very much for the opportunity to share with you what I know about how caregiving responsibilities are related to women's economic security.
As an applied economist who leads an international team that has grown to encompass some 70 researchers and policy and practice partners and who has devoted more than a decade to the study of the link between paid and unpaid work, it's become clear to me that care to family and friends in need can have profound implications for women's economic security.
In a few minutes all I can really do is leave you with a few key messages, and that probably is the key message, that in fact economic security absolutely can be threatened and is threatened by taking on care responsibilities. And that threat is greatest for women. But of course the full picture is much more complex than that.
The responsibilities we're talking about include care for children with and without disability and care for dependent adult family members and friends. The latter group includes both seniors and non-senior adults with chronic illness or disability, and that's where my major expertise lies, for the most part.
Consequences of taking on care responsibilities range fairly widely. They include social consequences—restrictions on social activities, holidays and vacations, and ultimately social isolation—health consequences, including sleep disruptions and deprivation, physical injury, fatigue, and burnout; and economic consequences deriving from out-of-pocket expenses and employment impacts.
Of course these categories of costs are not unrelated to one another either. Health consequences can affect the caregiver's ability to hold down a job or the person's performance on the job. Economic consequences can place additional stress on the caregiver and affect relationships with other family members and friends and the ability to participate in social and community activities, and so on.
There are more than 3.5 million Canadians providing care to someone with a long-term health or physical limitation. They provide in excess of 18 million hours of care to those individuals they are providing care to. It would take almost a half million full-time employed caregivers to do that work, at a cost in excess of $6 billion, if it had to be purchased. They are the mainstay of the health care and continuum care systems.
The majority of these caregivers are women, although it is not as big a majority as you might expect. Estimates range from a 40:60 split to 45:55 split, depending on which group of caregivers we're talking about.
But that's only a small part of the story on gender. Once women become caregivers, they also spend a great deal more time, overall, providing care. They provide help with more of the hands-on and inflexible tasks, such as personal care and housekeeping, and they're more likely to report virtually every type of consequence I've mentioned, with the interesting exception of guilt.
With respect to economic costs specifically, the best estimates are that between 40% and 50% of women caregivers make out-of-pocket expenditures that they would not have made otherwise if they hadn't taken on care responsibilities. The main items on which they spend this money include transportation, prescription and non-prescription medications and medical supplies, and equipment and homemaking supplies. According to one survey, almost one-quarter spent $300 or more per month on these extra items.
Between 30% and 50% of employed women caregivers change their work patterns, missing whole or part days of work, rescheduling or reducing their hours of work, working at home part time, and so on, specifically in order to accommodate their care responsibilities. Those providing end-of-life care are at the upper end of that 30% to 50%.
According to some estimates, as many as 22% of women caregivers quit work or retire early in order to provide care. In Britain, it was estimated that 25% of women stopped working to provide care. So this is an international phenomenon.
It is typically younger women with concurrent child care responsibilities and those caring for someone with a mental health problem who are most likely to quit a job to provide care and are most at risk.
Clearly these employment impacts affect women's economic security in both the short and long term in the form of reduced current wages, and we have estimated that the average loss of wealth from forgone earnings alone, at age 65, across all women in the labour force, ranges between $4,300 and $16,600 annually. As I said, this is across all women in the labour force, not just women caregivers, who are only 15% of all women. So the actual average is much higher than that. In one U.S. pilot study, lifetime wage losses for individual caregivers were estimated at in excess of $566,000 U.S.
Forgone employment benefits are also part of the cost of employment consequences—extended medical benefits, and the like.
Forgone pension benefits are often ignored. One British study found that fewer women who stopped work as a result of caring had employment-related pensions than other groups, and those who did have such pensions had accumulated fewer years of contributions than their counterparts who continued working. Of course, these outcomes have direct implications for pension benefits, once retired.
Women who have employment adjustments also forgo personal retirement investment opportunities. If you don't have the income, you can't invest it.
Moreover, one third of caregivers who reported employment consequences also reported that their work arrangements did not change once they finished caregiving. So the effects on employment are long term: they outlive the caregiving situation.
Another important part of this story is that more than 45% of women caregivers indicated that they had no choice but to provide the care that they were providing, either because they felt that it was a family responsibility, because there was no one else to do it, or significantly because home care services were unavailable or inadequate.
What does the future look like? It's likely to be both a good news and a bad news story. Medical, health promotion, and social advances mean that Canadians are living longer, and more are surviving what previously would have been fatal illness or injury and are reaching later life in better health, on average, than in previous generations. That said, we can expect the demand for care to continue to increase for some time yet, because it's the oldest old cohort that is increasing the fastest and this is the group that is most likely to require care.
How are these needs going to be met? Families are smaller and more geographically mobile, we're marrying and having children later in life, divorce and remarriage rates remain high, more women—the traditional carers—are holding down paid jobs, and more than ever these women are needed in the labour force. The current evidence suggests that this does not mean that we'll be less likely to engage as caregivers. Caregivers do not back away when the other demands in their lives go up, and they don't back away when supports are provided by the formal system. The evidence in fact suggests that most family and friend carers do so willingly, but it does mean that more of us will experience increasingly complex sets of competing demands and that we'll be more likely to encounter the kinds of consequences l've been describing, so finding the means to deal with them effectively is becoming even more critical.
There are presently very few public policies or programs that explicitly address the consequences of caregiving, in particular the economic consequences, and in particular for care other than child care. The few that do exist, notably the caregiver tax credit, and especially the compassionate care benefit, have had extremely limited success. Of particular concern is the lack of effort to address the longer term consequences, and the longer term economic consequences in particular, the loss of pension benefits, both public and private, and the ability to invest for one's own retirement. Also of concern is the fact that women caring for younger adults with chronic illness and disability are largely ignored in both research and policy. There's just a big black hole when it comes to caregivers to persons with disability between the ages of 18 and 65.
At the moment the stage is set for today's caregivers to become tomorrow's sick and poor seniors.