The vital importance of family caregivers to the economy was highlighted at the recent "Aging in America" conference in Washington, DC, hosted by the National Council on Aging and the American Society on Aging.

We were told that the value of family caregiving to the American economy is estimated at $306 billion. This is close to US Government spending on Medicare and Medicaid ($400 billion), and it is twice as much as that spent on homecare and nursing homes services combined ($156 billion).

For clarification, the difference between a family caregiver and a care-worker is immense. The family caregiver provides care for the chronically ill or disabled free of charge.

The care-worker is paid and, in most jurisdictions, has the protection of employment, pension, and health insurance legislation. But, just because the caregiver is not paid does not mean that informal, family caregiving comes without a price.

In fact, the opposite is true. The costs associated with informal, family caregiving are enormous – to the economy, the employer, and the individual,

While the answer to the critical question "Who pays?" is complex, it can be partially explained by the impact of modern medicine, changes in our families, and changes in the way we work.

As a result, the family caregiver is providing more care for longer periods, often without the support of spouse or siblings, while working to support herself and her family.

From the figures above, the family caregiver is contributing twice as much to the economy in unpaid care as is being paid out to home care services and nursing homes combined.

At the same time, the cost of health care is increasing exponentially. Health insurance premiums in Bermuda are rising at approximately ten percent per annum — way above the official inflation rate of three to four percent.

This puts a burden on employers and employees alike and, demographically, it will get a lot worse as our population ages.

Most family caregivers not only have to work, they want to work. Comments such as "Work is my salvation" or "Work is my sanity" are common.

At the same time, caregivers acknowledge support networks at work, where colleagues cover for each other when one has to take her mother to the doctor, or go home at lunchtime to check on a housebound parent.

This all forms part of the $33.6 billion that MetLife estimates employers lost in 2006 to absenteeism, staff turnover and lost productivity caused by employees who are also family caregivers. Employers are paying a price for family care management but these costs are, for the most part, hidden behind other headings such as absenteeism.

Caregivers are the lynch-pin of the health care system, yet they are under-recognised and under-supported. This is partly because the need for care can be episodic and variable in intensity.

For example, there can be times of acute health need – in and out of hospital, staying at home with or without paid services — followed by periods of wellness, and then a repeat or repeats of the entire process.

However, it is estimated that there are 44.4 million family caregivers in the US, 60 percent of whom are also in paid work and 40 percent of whom also have children under the age of eighteen.

The majority of people receiving long-term care from both the health care system and family caregivers are elderly, and the number of seniors will double to 22 percent of Bermuda's population by 2030. There are also children and adults living with the impact of trauma and illness who depend on the support of family caregivers to live at home.

Government can fill some of the gaps in the infrastructure while legislation, education, certification, and regulation are all required to advance to the next level of care.

There are also opportunities for social entrepreneurs to grow community-based services that support care management in the home, while Government and the private sector build capacity within our health care institutions.

Who pays for the unpaid work of caregiving? Caregivers and employers are already paying a heavy price, yet demand for homecare is growing. Only by sharing the costs more equitably can we support our caregivers and the very foundations of our health care system.

Marian Sherratt is Executive Director, Bermuda Council on Ageing. She writes on issues concerning ageing each month in The Royal Gazette. Send email responses to info@bdaca.org