There was a time when multiple generations of American families lived in close proximity to one another and cared for each other when the need arose. Increasingly, that time is now.

The percentage of adult children taking care of their parents has tripled since 1994, with nearly 10 million people 50 or older doing so in 2008, the Wall Street Journal reported in June.

There are advantages to this kind of care. Most elderly people with chronic illnesses — let's face it, most people in general — would prefer to be cared for in familiar surroundings with family and friends nearby than in a hospital or long-term care facility. That's good for emotional health, which benefits physical health. And keeping people at home is far less expensive than keeping them in an institutional setting.

However, there are big downsides to the trend. Referring to an analysis of the U.S. Health and Retirement Study, the Journal reported that family members who are 50 or older who leave the workforce to care for a relative suffer an average of $303,880 in lost wages, pensions and Social Security benefits over their lifetime. For women the number is higher: $324,044. Even when individuals go part-time rather than quit altogether, the 50s would typically be their highest-earning years. That means they're contributing less to their retirement funds and to Social Security.

There's also an emotional and physical toll. Writing for CNN, Susan Hirsch, director of Social Services at Cleveland Clinic Lou Ruvo Center for Brain Health, noted that 20 percent to 50 percent of family caregivers report some stress or depression and that they "are less likely to address their own health needs and are at greater risk for medical conditions such as increased blood pressure and cardiac disease."

Inevitably, families must turn to professionals at least on a part-time basis to help care for loved ones whose conditions are worsening, to give themselves much-needed breaks from the day-to-day pressures or in order to return to the workforce. Disturbingly, a number of reports have found that many of these home care professionals are as unprepared as family members to provide high-quality services.

The National Academies of Science and the Agency for Healthcare Research and Quality in July released Health Care Comes Home: The Human Factors. The report explores the role of the environment on home care, what devices and tools are available, the impact of health information technology and the roles of both formal (professional) and informal (family) caregivers. And it makes recommendations relating to each of those areas.

The report bluntly asserts that the way home caregivers, both professionals and nonprofessionals, are trained needs to be improved. Among its recommendations: "Relevant professional practice and advocacy groups should develop appropriate certification, credentialing, and/or training standards that will prepare formal caregivers to provide care in the home; develop appropriate informational and training materials for informal caregivers; and provide guidance for all caregivers to work effectively with other people involved."

At the dawn of the accountable care era, hospital leaders, physicians and others are paying more attention to care delivered outside their traditional purviews. As professionals involved in the health care field — not to mention, as individuals with our own aging loved ones and as individuals who ourselves are growing older — it's in all of our interests to make sure home care is a viable option and that the quality of that care continually improves.