The price tag for informal caregiving of elderly people by friends and relatives in the United States comes to $522 billion a year, according to a new RAND Corporation study.

Replacing that care with unskilled paid care at minimum wage would cost $221 billion, while replacing it with skilled nursing care would cost $642 billion annually.

The study, published online by the journal Health Services Research, improves on earlier estimates about the value of informal caregiving by making use of the 2011 and 2012 American Time Use Survey, a new and unique database, to provide up-to-date cost estimates on informal caregiving.

"Our findings provide a new and better estimate of the monetary value of the care that millions of relatives and friends provide to the nation's elderly," said Amalavoyal V. Chari, the study's lead author, a lecturer at the University of Sussex and a former researcher at RAND, a nonprofit research organization. "These numbers are huge and help put the enormity of this largely silent and unseen workforce into perspective."

Across America, people spend an estimated 30 billion hours every year providing care to elderly relatives and friends. The cost is measured by valuing the times caregivers have given up in order to be able to provide care.

Beginning in 2011, the American Time Use Survey, conducted by the U.S. Bureau of Labor Statistics, began asking participants about time spent helping elderly relatives with daily activities. Respondents also reported on their employment status.

Researchers calculated hourly wages for working caregivers by dividing weekly wages by weekly hours worked, and for non-workers by estimating wages based on characteristics such as education, age and gender.

Three out of five caregivers also are in the labor force. Working-age people under the age of 65 provide 22 billion of those 30 billion caregiving hours, and they often lose income due to reduced work hours. Because their hourly wages are higher than those over 65, they account for the largest portion of the informal costs of caregiving, or $412 billion a year — about midway between the replacement cost of paid unskilled caregiving ($221 billion) and paid skilled caregiving ($642 billion).

Other studies estimate that  about $211 billion is spent annually on formal long-term services and support for elderly people in the U.S. -- items such as assisted living centers, adult day care services and nursing homes. This is just a fraction of the cost of care provided by relatives and friends. The bulk of the economic burden of care of elderly people is shouldered by working adults.

"Our findings explain the interest in workplace flexibility policies being considered by a number of states that provide paid time off from work for caregivers, as well as programs such as Medicaid's Cash and Counseling program that allows family caregivers to be paid for their assistance," said Dr. Ateev Mehrotra, co-author of the study. He is a researcher at RAND and an associate professor at the Harvard Medical School.


College Athletes More Likely To Harbor MRSA

College athletes who play contact sports are more than twice as likely to carry the deadly superbug methicillin-resistant Staphylocuccus aureus (MRSA) than peers who play non-contact sports, according to a Vanderbilt study released at IDWeek 2014.

Football, soccer and other contact sport athletes were found to have MRSA on their bodies, usually in their noses and throats, even if they didn't show signs of infection. As MRSA carriers, they are at higher risk for infection and more likely to spread MRSA, which can cause serious and even fatal infections.

Colonization with MRSA ranged from 8 to 31 percent in contact sports athletes during the two-year study, compared to 0 to 23 percent of non-contact athletes. Roughly 5 to 10 percent of the general population is colonized with MRSA.

"This study shows that even outside of a full scale outbreak, when athletes are healthy and there are no infections, there are still a substantial number of them who are colonized with these potentially harmful bacteria," said lead study author Natalia Jimenez-Truque, Ph.D., research instructor in Pediatric Infectious Diseases.

"Sports teams can decrease the spread of MRSA by encouraging good hygiene in their athletes, including frequent hand washing and avoiding sharing towels and personal items such as soap and razors," she said.

Researchers followed a total of 377 male and female varsity athletes playing 14 different sports and compared the 224 playing contact sports, such as football, soccer, basketball and lacrosse, with the 153 athletes playing non-contact sports, including baseball, cross country and golf. Each athlete had monthly nasal and throat swabs over the course of two academic years.

"Skin is our first defense against bacterial infections. Therefore, one of the most effective things athletes can do is simply cover areas of broken skin, such as turf burns," said senior author Buddy Creech, M.D., MPH, associate professor of Pediatric Infectious Diseases.


Malpractice Reform May Not Reduce 'Defensive Medicine'

Changing laws to make it more difficult to sue physicians for medical malpractice may not reduce the amount of "defensive medicine" practiced by physicians, according to a new RAND Corporation study.

Studying the behavior of emergency physicians in three states that raised the standard for malpractice in the emergency room to gross negligence, researchers found that strong new legal protections did not translate into less-expensive care.

The results are published in the Oct. 16 edition of the New England Journal of Medicine.

"Our findings suggest that malpractice reform may have less effect on costs than has been projected by conventional wisdom," said Daniel A. Waxman, M.D., the study's lead author and a researcher at RAND, a nonprofit research organization. "Physicians say they order unnecessary tests strictly out of fear of being sued, but our results suggest the story is more complicated."  

It is widely said that defensive medicine accounts for a substantial part of the hundreds of billions of dollars of unnecessary health care spending that is estimated to occur annually in the United States. Malpractice reform has been advocated by many experts as a key to reining in health care costs.

RAND researchers looked at three states — Georgia, Texas and South Carolina — that about a decade ago changed the legal malpractice standard for emergency care to gross negligence. Other states use the more common ordinary negligence standard, or a failure to exercise reasonable care.

The higher standard means that for physicians accused of malpractice in the three states examined, plaintiffs must prove that doctors consciously disregarded the need to use reasonable care, knowing full well that their actions were likely to cause serious injury.

"These malpractice reforms have been said to provide virtual immunity against lawsuits," said Waxman, who also is an emergency medicine physician at the David Geffen School of Medicine at UCLA.

Researchers examined 3.8 million Medicare patient records from 1,166 hospital emergency departments from 1997 to 2011. They compared care in the three reform states, before and after the statutes took effect, to care in neighboring states that did not pass malpractice reform. 

The study examined whether physicians ordered an advanced imaging study (CT or MRI scan), whether the patient was hospitalized after the emergency visit and total charges for the visit. Advanced imaging and hospitalization are among the most costly consequences of an emergency room visit, and physicians themselves have identified them as common defensive medicine practices.

The malpractice reform laws had no effect on the use of imaging or on the rate of hospitalization following emergency visits. For two of the states, Texas and South Carolina, the law did not appear to cause any reduction in charges. Relative to neighboring states, Georgia saw a small drop of 3.6 percent in average emergency room charges following its 2005 reform.

"This study suggests that even when the risk of being sued for malpractice decreases, the path of least resistance still may favor resource-intensive care, at least in hospital emergency departments," Waxman said.