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February 1, 2000

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The Silent Time Bomb: Divorce, Health Care And The Baby Boom Generation

Baby boomers now approaching the Medicare years may be bringing a time bomb with them.

Half of them have been divorced, and researchers at Johns Hopkins have found that elderly people with divorce in their lives will get less care from their children than people who do not. They are even less likely to get help from their stepchildren.

The implications for Medicare and Medicaid could be profound.

This year, 35 million Americans are aged 65 or older, one in eight. By 2010, it will be one in five with the arrival of the first wave of boomers, children born in the euphoria and prosperity of the post-war years. Because their divorce rate was so high, the burden of taking care of them will fall even more heavily on the public sector, already strapped to meet demand. Family structures have changed, according to Liliana Pezzin, a Ph.D., economist and assistant professor of medicine at Johns Hopkins Center for Demography of Aging. In short, something profound is broken with divorce, and it has effects even in the last years of life, sometimes decades removed from the divorce.

The Hopkins study, co-authored with Barbara Steinberg Schone and published in Demography, studied the first wave of the Assets and Health Dynamics of the Elderly (AHEAD) survey, which looked at community residents 70 and older in 1993. The researchers sought out unmarried parents with children or stepchildren, either widowed or divorced, and based their conclusions on a survey sample of 2,840 individuals. (Married couples are likely to take care of each other.) The subjects all were young people before and during World War II, with a comparatively low divorce rate of 7 percent.

The researchers looked at three aspects of the subjects' lives: families living together, financial payments or support from children to parent, and time spent by children with parents.

What Schone and Pezzin found was that people who had been divorced were much less likely to reside with a child and were less likely to receive care from their children even if they were disabled. When they were getting care, their children were paying someone else to do it.

Remarriage did not add stepchildren to the support system, Pezzin says. "Step-kids pretty much don't do anything." They are less likely to have their stepparent live with them, much less likely to provide care and if they do provide care, it was for fewer hours than biological children.

"This was especially true for fathers, but it was disheartening to see the effect of remarriage for mothers," Pezzin says. "Being remarried even reduced the number of hours of care they received from their natural kids." For fathers, the problem is in part more serious because fathers were less likely to be the custodial parent when the children were young and perhaps the bond was different. For example, 68 percent of elderly individuals with biological children received some form of assistance from them; only 30 percent of those with only stepchildren received help. Stepchildren were more likely to buy care rather than provide it personally. Stepchildren also contributed only about half the monetary support of biological children, and less than half the hours of informal care. Daughters were more caring than sons.

The researchers found that if one child takes the lead in caring for the parent, the other children "sit at home and watch. We thought the others would do cash transfers, but that didn't happen," she says.

If the children aren't helping as much, who will step in when the Baby Boomers reach old age? The data in the study were of a generation where divorce was uncommon and family structure stronger. Now comes a generation where divorce almost is the norm and the family safety net is tattered.

While some economists blame social programs for the demise of the traditional family, Pezzin sees social programs as more of the cure than the disease. It may require changing those programs, however.

"We can at least design policies that will not have an adverse effect," she says. "Maybe the way to go about this is to not provide home health care for the elderly as such but to provide cash to the caregivers. That might be a way to influence family dynamics to increase the overall level of care rather than substitute a way."

The paper may be found at:
Pezzin, L. E., Schone, B. S. 1999. Parental marital disruption and intergenerational transfers: an analysis of lone elderly parents and their children. Demography. 36. 3:287-297.

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