{"id":516,"date":"2026-10-30T16:00:03","date_gmt":"2026-10-30T20:00:03","guid":{"rendered":"https:\/\/sites.bu.edu\/busharp\/?p=516"},"modified":"2026-10-30T18:50:22","modified_gmt":"2026-10-30T22:50:22","slug":"medicare-as-a-last-resort-caregiver","status":"publish","type":"post","link":"https:\/\/sites.bu.edu\/busharp\/2026\/10\/30\/medicare-as-a-last-resort-caregiver\/","title":{"rendered":"Medicare As a Last Resort Caregiver"},"content":{"rendered":"

For many older Americans, the first line of long-term care (whether post-dementia or other diagnoses) is not a nursing home or paid personal care. It\u2019s a spouse. But what happens when that spouse is suddenly not able to provide that care anymore? A recently published paper from Boston University economist and professor <\/span>Tal Gross<\/span><\/a> and his colleagues offers some insight.<\/span><\/p>\n

\"\"The paper, <\/span>\u201cThe Protective Effects of a Healthy Spouse: Medicare as the Family Member of Last Resort,<\/span><\/a>\u201d was released by the National Bureau of Economic Research in September 2026. Gross, a professor of Markets, Public Policy, and Law at BU Questrom, wrote it alongside <\/span>Itzik Fadlon<\/span><\/a>, <\/span>Alex Hoagland<\/span><\/a>, and <\/span>Timothy Layton<\/span><\/a>. Using Medicare claims and a new method for linking spouses, the team found that when one spouse is suddenly incapacitated, the probability of their partner entering a nursing home rises by 30%.\u00a0<\/span><\/p>\n

\u201cWe also possessed novel data that allowed us to identify couples in Medicare claims, which no one has been able to do before,\u201d Gross said. He stressed that the topic matters beyond the data. \u201cSpousal caregiving is a huge issue! And it\u2019s going to be even more of an issue in the years to come as the population ages and more Americans need help with the activities of daily living.\u201d<\/span><\/p>\n

Do those partners enter nursing homes simply because they have gotten sicker? \u201cThat\u2019s exactly one of the key empirical challenges we face in the paper,\u201d Gross said. The authors\u2019 evidence suggests that the majority of the increase is attributed to a substitution rather than a decline in the person\u2019s health. In other words, formal care replaces the home care a spouse once provided. The team also found that these Medicare recipients become less sensitive to the price of professional care. From these patterns, the authors estimate a lower bound on what a spouse\u2019s informal care is worth.<\/span><\/p>\n

The team also found that the partner\u2019s own health suffers. \u201cCaregiving is definitely an enormous burden, especially when there\u2019s dementia involved,\u201d he said, pointing to other studies that document the toll on caregivers. Dementia appears in the paper through only one data stratification, and the study focuses on sudden events, in Gross\u2019s words a cardiac event, for example, rather than gradual decline. Still \u201cwe suspect that much of the mechanism still applies: when someone\u2019s partner cannot care for them, they are more likely to turn to formal care.\u201d<\/span><\/p>\n

So what paths can policymakers take based on this? Gross sees two possible approaches. \u201cOne approach is what some European governments are doing, which is to condition premiums or eligibility for long-term care insurance on the availability of informal care. That is certainly a valid approach and it is consistent with our paper. Another approach would be to institute family-specific deductibles or out-of-pocket maximums as a way to account for some of the spillovers we are documenting.\u201d<\/span><\/p>\n

The findings also raise questions about fairness for people without a spouse or nearby family. For them, Gross said, \u201cthe co-payments and cost sharing that they face should be lower. So, perhaps Medicare could adjust its plan to be more generous for those who have no potential caregivers.\u201d<\/span><\/p>\n

Ultimately, the message to take away is that public policy \u201cought to become more sophisticated and address not just individuals but households.\u201d For the families of Alzheimer’s and Related Dementia patients, it is a reminder that care is rarely the burden of just one person. <\/span><\/p>\n

post by BU-SHARP Writing Fellow Lindsay Griesman<\/a>\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

For many older Americans, the first line of long-term care (whether post-dementia or other diagnoses) is not a nursing home or paid personal care. It\u2019s a spouse. But what happens when that spouse is suddenly not able to provide that care anymore? A recently published paper from Boston University economist and professor Tal Gross and […]<\/p>\n","protected":false},"author":25693,"featured_media":518,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/posts\/516"}],"collection":[{"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/users\/25693"}],"replies":[{"embeddable":true,"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/comments?post=516"}],"version-history":[{"count":3,"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/posts\/516\/revisions"}],"predecessor-version":[{"id":520,"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/posts\/516\/revisions\/520"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/media\/518"}],"wp:attachment":[{"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/media?parent=516"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/categories?post=516"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sites.bu.edu\/busharp\/wp-json\/wp\/v2\/tags?post=516"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}