Wages or welfare? Compensating caregiving in two conservative social welfare states.

While nearly all developed nations have some form of attendance allowance for the elderly and disabled, the United Kingdom and several of the American states have provisions to pay caregivers directly if they are family members. This paper compares and contrasts provisions in the U.K. Invalid Care Allowance with provisions of a program in one American state-Michigan. Such payments potentially benefit disabled people, caregivers, and cost-conscious states. However, two particular goals shape the programs' impacts on caregiver functioning and adequacy. One is the extent to which programs operate as welfare provisions and benefits directed at the social or household economy. The other is the extent to which they function as a substitute for wage labor in the market economy. Each of these can be assessed in relation to the real, personal choices and economic gains it provides caregivers. Presumably, both are important in sustaining adequate and satisfying long-term care. Only by truly expanding choice as well as capacity can governments expect to effectively sustain an optimal mix of care provision in the community.