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Walking the Line: Navigating Market and Gift Economies of Care in a Consumer-Directed Home-Based Care Program for Older Adults (Milbank Quarterly)

December 1, 2015

Journal Article

Authors: Jacqueline Torres, MPH, MA, Kathryn G. Kietzman, PhD, MSW, Steven P. Wallace, PhD

​Policies that cut or restrict formal long-term services and supports for older adults can either push caregivers to provide uncompensated care or leave older adults with unmet needs for care. Policies that assume that related caregivers can readily fill gaps in care should be reassessed.

Authors use data from a longitudinal qualitative study with related and nonrelated caregivers paid through California's In-Home Supportive Services (IHSS) program and consumers of IHSS care. The study, based on 330 interviews and completed between 2010 and 2014, reports that related and nonrelated caregivers are often expected to "gift" hours of care above and beyond what is compensated by formal services. Cuts in formal services and lapses in pay push caregivers to further "walk the line" between market and gift economies of care. Both related and nonrelated caregivers who choose to stay on and provide more care without pay often face adverse economic and health consequences. Some, including related caregivers, opt out of caregiving altogether.

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