"Underlying ageism can explain, in part, why this crisis receives less attention then it warrants," said Dr. Robert Butler, co-director of project and president and CEO of the ILC-USA. "Older people receiving care are deemed disposable and without value."

Caregiving In America profiles the current state of the caregiving system, which is both home-based and institutional. More then 12 million people in the United States, about 80% of whom are age 50 or older need some form of long-term care. Many of those in need of care go without it -- about 20% of adults needing assistance are unable to find either paid or voluntary help.

"If 20% of our older adult population is going without the care they need, imagine what that percent will be as the number of older adults increases," said Wright.

The Project found that 8 in 10 adults who receive long-term care at home get their care exclusively from family, friends and volunteers. A family providing care often suffer from loss of wages and benefits that are sacrificed when they reduce their hours, or quit their job, in order to care for a family member. Disruptions and absenteeism due to employees' caregiving duties cost U.S. employers up to $33.6 billion per year. Family caregivers also report having less time for family and friends, giving up vacations, hobbies and social activities.

As the burden of family caregivers grows, the shortage of paid caregivers, especially of those in home-based settings worsens. The report outlines a critical shortage of direct-care workers. Low wages, few fringe benefits, unpleasant work conditions and lack of career development all contribute to the shortage. Caregiver wages are among the lowest of U.S. occupations -- the median hourly wage in 2004 was just over $10 for nurses aides, under $9 for home health aides and about $8 for personal care and home care aides.

The lack of standards and national consensus about the training required of caregivers hurts their recruitment and retention, the report stated. At present, there is no universally accepted curriculum for either paid or unpaid caregivers. The project findings stressed that development of such standards would enhance the value and reward of caregiver occupations, thus attracting more workers to the field. The number of home health aides needed over the next decade is expected to increase 56%.

"As the gap of demand and supply of caregivers widens, it is crucial we tackle the barriers of affordable, quality care," said Butler. "We must address the regulatory obstacles, the financing of long-term care and the need for better communications between medical practitioners, caregivers and care recipients."

The Project said its purpose in preparing the Caregiving in America report was to offer a context for caregiving and an overview of the caregiving field and to provide an inventory of work done over the years by various academic, professional, and service organizations. It said the report was designed both to map the territory and introduce specific project initiatives, and to offer a context for what has already been done and what still needs to be accomplished in the caregiving field.

Publication of Caregiving in America was sponsored by the Schmieding Foundation and MetLife Foundation. Click here to download the complete report or send an email to caregiving@ilcusa.org to request a copy.