Changes in Americans’ Views on Who Should Provide and Pay for Assistance to Older Adults with Activity Limitations,2012 to 2022

Abstract

An aging U.S. population means more older adults in need of care over time. Although government programs that supply financial support for older adults receive high levels of backing, social norms dictate that when it comes to care, families should be held responsible. Although families do provide most of the care older adults receive, it can often be in balance with more formal provisions such as paid care. However, there is a divide between what older people themselves feel is best compared with other groups. The authors ask, What are American attitudes toward the provision of elder care and payment for such care, how have these attitudes changed in the past decade, and are there differences by age? The authors use cross-sectional data from the 2012 and 2022 General Social Survey and find that younger adults were more likely to support government provision and payment for elder care over time.

The U.S. population is aging, with roughly 10,000 people turning 65 every day (U.S. Census Bureau 2019). Age reflects a naturally increasing need for care assistance (Freedman 2018). Families and other unpaid caregivers provide the bulk of support (Freedman and Wolff 2020), though government systems may also provide financial and other supports (Moskowitz 2019). Receiving help with daily tasks can help older adults “age in place” (i.e., in the community and not in institutions), often a less costly solution overall (Friedman et al. 2019). Most Americans support families providing either direct household help to older adults or covering the cost, with almost half supporting both care and financing by family (Janus and Koslowski 2020; Patterson 2022). However, older adults often feel differently than younger adults about solutions for aging concerns (Patterson and Reyes 2022).

We examine the General Social Survey 2012 and 2022 cross-sections and ask whether support for the provision of care to older adults and payment for that care have changed over time and across age groups, adjusting for weights and survey design for national representativeness (Davern et al. 2023; NORC 2022). Our sample includes adults who answered the elder care questions and their age (n = 2,381; see appendix for a Stata do file to replicate findings). Totals in the figures do not add up to 100 percent because we focus on support for family versus government (see the supplemental figure for additional categories). The results reveal a decrease in support for family provision of care and an increase in government-provided support and payment over time (Figure 1A). In 2012, 61 percent of Americans felt that families should provide this care, and by 2022, only 48 percent felt this way (p < .001); support for government agencies’ providing help increased from 13 percent to 25 percent during this time (p < .001). However, these patterns were not consistent across age. Although adults aged 65 years and older increased their support for family and government care (though not significantly), younger adults, as a population, were more likely to change their views over time for both family and government care (p < .001).

Figure 1.

Changes in attitudes toward elder care in the United States, General Social Survey, 2012 and 2022.

With respect to who should pay, we observe a similar flip between families and government over time (Figure 1B). In 2012, 37 percent of Americans felt that the government should pay; by 2022, 51 percent felt this way (p < .001). In 2012, 44 percent felt that older adults or their families should pay; by 2022, 28 percent felt this way (p < .001). Again, we see age differences in the magnitude of change. Younger adults increased their support for government over family payment for elder care from 2012 to 2022 (p < .001). There were more modest, nonsignificant changes among older adults across time, though older adults were more likely to say that older adults or their family should pay compared with younger adults in 2022 (p < .05).

Younger adults, who might need to provide this care, were less likely to think that the family should provide this care, whereas older adults who might need care were more likely to think that the family should provide this care. These results could be due to increasing pressure from an aging population or potentially a reaction to a real-world event (i.e., the coronavirus disease 2019 pandemic) that unevenly affected older adults and affected families’ ability to provide care (Reyes, Thunell, and Zissimopoulos 2021; Stokes and Patterson 2020). There was also a shift in attitudes toward who should pay, especially for younger adults, with more than half thinking that the government should pay in 2022. This change in attitudes may reflect changing norms about the social programs the government should provide to older adults and changes in family expectations for care.

Supplemental Material

sj-docx-2-srd-10.1177_23780231231225574 – Supplemental material for Changes in Americans’ Views on Who Should Provide and Pay for Assistance to Older Adults with Activity Limitations, 2012 to 2022

Supplemental material, sj-docx-2-srd-10.1177_23780231231225574 for Changes in Americans’ Views on Who Should Provide and Pay for Assistance to Older Adults with Activity Limitations, 2012 to 2022 by Sarah E. Patterson and Adriana M. Reyes in Socius

Supplemental Material

sj-txt-1-srd-10.1177_23780231231225574 – Supplemental material for Changes in Americans’ Views on Who Should Provide and Pay for Assistance to Older Adults with Activity Limitations, 2012 to 2022

Supplemental material, sj-txt-1-srd-10.1177_23780231231225574 for Changes in Americans’ Views on Who Should Provide and Pay for Assistance to Older Adults with Activity Limitations, 2012 to 2022 by Sarah E. Patterson and Adriana M. Reyes in Socius