ABSTRACT
Most primary caregivers of older people living in the community are family members. Because this carework is largely unpaid, this contributes to substantial economic advantages for the long-term care system. In fact it has been suggested that without the central role of family, the system would be unable to meet the care needs of its older citizens. Yet, falling birth rates, the increased participation of women in the labor force, changes in households due to increasing divorce rates, and increased geographical mobility challenge the continuing availability of family carers, an assumption upon which most long-term care policy is based (Pickard, Wittenberg, ComasHerrera, Davies, & Darton, 2000). Moreover, many studies demonstrate that informal caregiving for family members can have adverse impacts on personal physical and mental health (Cannuscio et al., 2004; Cranswick, 1999; Hirst, 2003); family and social obligations; and economic status, including employment income, savings, household expenditures, and, in the longer term, pensions (Carmichael & Charles, 1998; Ginn & Arber, 2000; Glendinning, 1990; Keating, Fast, Frederick, Cranswick, & Perrier, 1999; Keefe & Medjuck, 1997). Unless a range of services and other support for family members are included in long-term care policy, these costs and consequences may only result in a redistribution of expenditures in both the shorter
and longer terms. Thus, the issue of payment for family care is at the heart of endeavors to create economically and politically sustainable policies for community-based long-term care. Such policy raises questions about the commodification of family care and the blurring of boundaries between care provided by family that is typically unpaid and that provided by formal (paid) care providers (see Ungerson & Yeandle, 2006).
