TIME REALLOCATION AMONG ELDER CAREGIVERS IN THE UNITED STATES, 2011-2023
Author(s)
Boshen Jiao, MPH, PhD1, Andrew Huang, None2, Brian Huang, None3, Mengyao Wang, BS, MS4, Shihan Jin, PhD5;
1University of Southern California, Assistant Professor of Pharmaceutical & Health Economics, Los Angeles, CA, USA, 2University of California, Los Angeles, Los Angeles, CA, USA, 3Diamond Bar High School, Diamond Bar, CA, USA, 4Yale University, New Haven, CT, USA, 5University of Southern California, Los Angeles, CA, USA
1University of Southern California, Assistant Professor of Pharmaceutical & Health Economics, Los Angeles, CA, USA, 2University of California, Los Angeles, Los Angeles, CA, USA, 3Diamond Bar High School, Diamond Bar, CA, USA, 4Yale University, New Haven, CT, USA, 5University of Southern California, Los Angeles, CA, USA
OBJECTIVES: Informal elder caregiving affects how individuals allocate their time across daily activities. Some time costs arise when caregiving displaces other activities (time forgone), while others occur when caregiving is performed concurrently with other activities, reducing their quality or productivity without full displacement (time compromised). Existing studies largely focus on direct caregiving time and do not distinguish between these two mechanisms. This study quantifies both time forgone and time compromised attributable to elder caregiving in the United States.
METHODS: We used nationally representative data from the American Time Use Survey (ATUS), 2011-2023. Caregivers were defined as individuals reporting elderly care activities, while non-caregivers reported no caregiving. To estimate caregiving-attributable time reallocation for caregivers, we applied propensity score-based weighting to reweight non-caregivers to resemble caregivers on observed sociodemographic characteristics. Time forgone was estimated by comparing caregivers’ observed time use with counterfactual time use predicted for the same individuals had they not provided care, using fractional regression models with propensity score weights. Time compromised was measured as the weighted average amount of caregiving embedded within non-caregiving activities, identified when elderly care indicators overlapped with leisure, market work, household production, sleep, or other activities, reflecting joint production rather than full activity substitution. Direct elderly care time was identified using caregiving-specific ATUS activity codes.
RESULTS: Relative to their counterfactual non-caregiving time allocation, caregivers experienced time forgone primarily from market work (~30 minutes/day) and leisure (~18 minutes/day), alongside greater time spent in household work (~55 minutes/day). Caregivers also experienced ~140 minutes/day of time compromised, largely embedded within leisure (~75 minutes/day), market work (~35 minutes/day), and sleep (~27 minutes/day). These patterns remained stable from 2011 to 2023.
CONCLUSIONS: Elder caregiving generates substantial indirect time costs through both displaced and compromised activities. Estimating both enables a more complete assessment of caregiving burden for economic evaluation and caregiving policy design.
METHODS: We used nationally representative data from the American Time Use Survey (ATUS), 2011-2023. Caregivers were defined as individuals reporting elderly care activities, while non-caregivers reported no caregiving. To estimate caregiving-attributable time reallocation for caregivers, we applied propensity score-based weighting to reweight non-caregivers to resemble caregivers on observed sociodemographic characteristics. Time forgone was estimated by comparing caregivers’ observed time use with counterfactual time use predicted for the same individuals had they not provided care, using fractional regression models with propensity score weights. Time compromised was measured as the weighted average amount of caregiving embedded within non-caregiving activities, identified when elderly care indicators overlapped with leisure, market work, household production, sleep, or other activities, reflecting joint production rather than full activity substitution. Direct elderly care time was identified using caregiving-specific ATUS activity codes.
RESULTS: Relative to their counterfactual non-caregiving time allocation, caregivers experienced time forgone primarily from market work (~30 minutes/day) and leisure (~18 minutes/day), alongside greater time spent in household work (~55 minutes/day). Caregivers also experienced ~140 minutes/day of time compromised, largely embedded within leisure (~75 minutes/day), market work (~35 minutes/day), and sleep (~27 minutes/day). These patterns remained stable from 2011 to 2023.
CONCLUSIONS: Elder caregiving generates substantial indirect time costs through both displaced and compromised activities. Estimating both enables a more complete assessment of caregiving burden for economic evaluation and caregiving policy design.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR202
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas