It’s hard to put a price on loving care, but sometimes highlighting the bottom line is the only way to draw attention to a mounting problem.

So the AARP Public Policy Institute crunched the numbers for its national "Valuing the Invaluable" study on the cost of family caregiving.

And the numbers are startling. In Hawaii, the economic value of the unpaid labor by family members caring for frail loved ones at home totaled $1.9 billion — up nearly 22 percent since the last survey four years ago. That’s what it would cost to cover the care of elders if not for the contributions of family caregivers. Who could cover such a bill? Not the families, and not the government.

That’s why state and federal leaders must not lose sight of the imperative to support family caregivers as key to the well-being of a growing elderly population. This includes continued funding for at-home support programs such as Kupuna Care on the state level and, nationally, making family-centered elder care part of the federal health-care system overhaul. Care at home is better for them, with costs that are more manageable by society.

A closer look at statistics underscores just how little time remains to create this more sustainable system, especially in Hawaii. AARP-Hawaii projects that over the next 20 years, the number of people age 65 and older will increase by 78 percent, said spokesman Bruce Bottorff. At the same time, the family-caregiver "workforce" of people ages 50-64 will shrink by 10 percent.

The 2011 study tallies 169,000 Hawaii adults who are regular family caregivers, and when those who are tapped for service sometime during a given year are counted, the number rises to 247,000. When all their work hours are totaled, it comes to $12.33 per hour, a fraction of what a professional might command.

And although family members aren’t professionals, increasingly they are called to handle demanding tasks — suggesting that providing training would be one way of supporting their work. According to the study: "The impact of shorter hospital stays, limited hospital discharge planning, and the spread of home-based medical technologies is reflected in the complex and physically demanding nursing tasks that family caregivers are increasingly carrying out in the home … bandaging and wound care, tube feedings, managing catheters, giving injections, or operating medical equipment."

"We’re going well beyond the ‘give mom a bath’ stage," Bottorff observed. "We’re getting to where caregivers are becoming auxiliary health care professionals."

These are also people under increasing economic strain. In the wake of the recession, caregivers were less willing to take off work time or were faced with working more hours or getting an additional job to cover costs.

Hawaii has a tradition of embracing the duty of elder care, but that kind of devotion should not be taken for granted. To cite one example of misplaced priorities: Of the state’s long-term care dollars from Medicaid, about four-fifths go to institutional care. The community-based caregivers who shoulder such a large proportion of the burden need more than nominal support.

State and federal agencies, as well as the Legislature, must acknowledge that family caregiving is not a supplemental service but an integral part of the social safety net.