Caregivers for the elderly are contributing more unpaid labor to society than two years ago, and that's straining families to the breaking point, according to a new report from the AARP Public Policy Institute.

According to the report, in 2009 about 42.1 million caregivers helped an elderly person with daily activities like bathing or going to a doctor's appointment. At $11.16 an hour and 18.4 hours a week, the estimated value of that care is $450 billion, up from $375 million in 2007. That's far more than Medicaid spending, which totaled $361 billion in 2009. It's even more than Wal-Mart's sales for the year, which reached $408 billion.

From 2007 to 2009, the total number of caregivers rose 23%, while the hours of care increased 9%, the report said.

Women, who make up 65% of caregivers, bear most of the burden, even though more work outside the home than ever before. Squeezed by the recession, 27% of caregivers reported a moderate to high degree of financial hardship as a result of their decision to be caregivers.

The report notes that those who leave the workforce to take care of an elderly person face other financial pressure as well: Not only lost wages, but also employment benefits such as health insurance and retirement savings. Those who remain in the workforce often lose time to caregiving and cost employers more in health care costs because they have more depression, diabetes, hypertension and pulmonary disease than non-caregivers of the same age. They also report more social isolation and stress.

But the outlook is bleak. Last year, more than half of the states noted a rise in demand for home and community-based services such as home-delivered meals and transportation. And since the downturn began in 2007, requests for caregiver support services rose 67%.

Yet in 2010, 31 states cut non-Medicaid aging and disability services programs, and an estimated 28 states are expecting to reduce such services this year.

While a number of federal initiatives that have helped caregivers in recent years, including passage of the Affordable Care Act and the Caregivers and Veterans Omnibus Health Services Act, the report noted that more help is needed, particularly as older Americans are living longer than ever before. Among AARP's recommendations: Encourage flextime and telecommuting; expand the Family and Medical Leave Act to cover all primary caregivers, regardless of family relationship; improve Social Security benefits for caregivers who leave the workforce to provide care; provide more financial assistance and paid family leave to caregivers; and expand the National Family Caregiver Support Program which gives grants to states for in-home assistance programs based on the proportion of the population that is age 70 or older.

Supporting family caregivers will contain health costs on many levels, particularly by delaying or preventing seniors' use of nursing homes, and their need for hospital inpatient care and re-hospitalizations. Plus, the report says, it's "the right thing to do."