Problem to be Addressed - 2024 01 14




A common rationale underpinning the transfer of critical care infrastructure from institutional settings to private family homes is, "it costs less to care for patients at home". 

Examples of policies that shift caregiving from institutional settings to private family homes include:

  1. Age in Place
  2. Hospital to Home
  3. Early Discharge
These policies transfer the work of providing critical healthcare infrastructure from professional institutional settings to nonprofessional family settings.

There has not been a commensurate transfer of resources to support families who are providing critical healthcare service (time and material - incl. property cost) as would be received by the institution providing critical healthcare service to this same patient. The expectation is that the family caregiver is going to provide essential care infrastructure from their existing resources, and when these fall short, the family caregiver will navigate the multiple, inter-connected and disparate potential sources of support to find what they need to carry out their caregiving mission. 

To reiterate, the family caregivers are not likely to be professionals in healthcare, and are likely to be in crisis as they scramble to provide care for their family member who can no longer fend for themselves.

In essence, the family caregivers who take on the role and responsibility of looking after family members who can no longer fend for themselves are joining the ranks of those whose time is spent on unpaid work.

At present we have no systems of traceability or accountability for the cost accounting of this transfer of work. The work of family caregiving needs to be accounted for Time and Materials (including property cost). The work of family caregiving also needs to account for opportunity cost (both in terms of time - loss of paid time, financial security and career progress; in terms of material - loss of rental income, loss of living space; and in terms of Quality of Life - loss of time with other family, loss of family visits, loss of family holidays).

Information that is needed to understand the problem to be addressed:

  1. The value of unpaid care
  2. The value of unpaid family caregiving
    1. Does unpaid care = family caregiving or are other groups falling into this category?
  3. The value of unpaid family caregiving for frail elders
  4. The value of family caregiving beds (beds located in family caregiving settings)
  5. The value of family caregiving beds for frail elders needing highest level of care
  6. The value of family caregiving beds in the year preceding death of frail elder
  7. The value of commensurate institutional care for frail elders in the year preceding their death
  8. Quantified evidence of the cost of care in family caregiving settings
    1. - for frail elders
    2. - for frail elders in their last year of life
  9. Quantified evidence of the cost of care in institutional settings
    1. - for frail elders
    2. - for frail elders in their last year of life


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