America is facing a crisis that will make the federal budget deficit look like a simple bank overdraft fee.

If we don’t figure out how to provide financial support to the millions of family members who are taking care of seniors with chronic conditions or disabilities, we will have caregivers so overwhelmed that they will be forced to stop helping their elderly relatives. That cost of care will then transfer to the government, and this would mean astronomically higher health-care costs or more people being placed in nursing homes, according to a new report from the AARP Public Policy Institute.

In 2009, about 42.1 million family caregivers provided assistance to adults with limitations in daily activities, such as going to the bathroom, preparing meals or making it to a doctor’s appointment. The AARP report estimates the economic value of family caregiving that year at $450 billion, based on those 42.1 million caregivers ages 18 or older who provide about 18.4 hours of care per week at an average value of $11.16 per hour.

Just imagine if much of this voluntary care were gone.

Historically, providing care to the elderly wasn’t such a dire public-policy issue. People didn’t live as long as they do now. But what happens when the need for long-term care goes on for years or decades?

The long-term care needs of many of our elderly are straining families, just as family structures have changed and during one of the worst economies in decades. There are more women in the workforce, making it harder for them to provide care. Almost two-thirds of family caregivers are female. More than eight in 10 care for a relative or friend who is 50 or older.

High rates of divorce and smaller family sizes mean that the burden of care will fall, and already is falling, on fewer people in a family. There also are increasing numbers of women without children to rely on. Nearly 20 percent of older women today do not have children, compared with 10 percent in the 1970s.

Expect to see more adult children in their 60s or 70s, with chronic conditions of their own, caring for a parent who is 90 and older, said Lynn Feinberg, senior strategic policy adviser at the Public Policy Institute.

“The burden on today’s families, to provide uncompensated care for a long time, is unsustainable,” said Feinberg, one of the authors of the AARP report. “It’s not that families don’t want to do this for their loved ones, but it comes at a cost.”

Various studies on caregiving continue to show the increasing strain on the caregivers’ own financial situation, retirement security, careers, and physical and emotional health, Feinberg said in an interview. The impact is particularly severe for caregivers of individuals who have complex chronic health conditions and both functional and cognitive impairments. Twenty-two percent of caregivers are assisting two individuals, while 8 percent are caring for three or more, according to the U.S. Administration on Aging.

Right now, I’m trying to help four senior family members with various health issues. There’s my father-in-law, a diabetic. I have an 88-year-old aunt who needs constant care. My mother, who has had two strokes, needs daily living assistance. My husband and I are also providing a monthly stipend to an elderly family friend to help pay for her prescription drugs.

AARP has some policy recommendations that we should be pursuing to assist families. Here are some of them:

●Encourage more companies to implement workplace policies that include flextime and telecommuting, referral to supportive services in the community, and caregiver support programs for employees.

●Expand the Family and Medical Leave Act to cover all primary caregivers, regardless of family relationship.

●Provide paid family leave for caregivers.

●Expand funding for the National Family Caregiver Support Program. This program, created in 2000, provides grants to states and U.S. territories based on their share of the population that is 70 or older. The money is used to fund a range of services to help caregivers provide in-home assistance, allowing seniors to stay in their residences for as long as possible. Total funding for this program is about $160 million. That’s a lot of money, but it’s still not enough. For more about this program, go to

I know that when our public-policy focus is so concentrated on reducing our nation’s debt, it’s hard to argue for increased spending. And yet, in this case, we must. Family caregiving has to become an important public-health concern.

Readers can write to Michelle Singletary at The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Her e-mail address is Questions are welcomed, but because of the volume of mail, personal responses might not be possible.