The Landscape of State Policies Supporting Family Caregivers as Aligned With the National Academy of Medicine Recommendations

Abstract

In the absence of federal policy, states adopted policies to support family caregivers, but availability and level of support varies.r We describe, compare, and rank state policies to support family caregivers as aligned with National Academy of Medicine recommendations. Context:In the United States in 2020, approximately 26 million individuals provided unpaid care to a family member or friend. On average, 60% of caregivers were employed, and they provided 20.4 hours of care per week on top of employment. Although a handful of patchwork laws exist to aid family caregivers, systematic supports, including comprehensive training, respite, and financial support, remain limited. In the absence of federal supports, states have adopted policies to provide assistance, but they vary in availability and level of support provided. Our objectives were to describe, compare, and rank state policies to support family caregivers over time. Methods:We used publicly available data from the AARP Long-Term Services and Supports State Scorecard, the National Academy for State Health Policy, and Tax Credits for Workers and Families for all 50 states and the District of Columbia (2015Columbia ( -2019.Findings: We found that states had increased supports to family caregivers over this five-year period, although significant variability in adoption and implementation of policies persists. Approximately 20% of states had enacted policies that exceed the federal Family and Medical Leave Act requirements, and 18% offered paid family leave. However, most states had not improved spousal impoverishment protections for Medicaid beneficiaries. For example, from 2016 to 2019, 24% of states provided fewer or no protections, while 71% of states did not improve spousal impoverishment protections over time. Access to training for caregivers varied based on eligibility criteria (e.g., select populations and/or only co-residing caregivers).Conclusions: Overall, state approaches to support family caregivers vary by eligibility and scope of services. Substantial gaps in support of caregivers, particularly economic supports, persist. Although the landscape of state policies supporting caregivers has improved over time, few states provide financial supports as recommended by the National Academy of Medicine, and benefit restrictions hinder accessibility for all family caregivers.

Factors Influencing Caregivers’ Use of Respite Care Services: Secondary Analysis of the National Study of Caregiving

“…Achieving standardization, consistency, and comprehensiveness in Medicaid waivers may be a pivotal step towards increasing accessibility to respite services as well as other resources that can support caregivers and function as a form of respite (e.g., support groups and training). Financial supports (e.g., through paid family leave) that may enable caregivers to take time for respite in order to maintain their caregiving responsibilities, also vary in scope and eligibility (Miller et al, 2022). Policy modifications to increase offering of both in-home and out-of-home respite care services will be critical to ensuring robust support for caregivers.…”

Unmet Support Service Needs Among Rural Family Caregivers: A Population-Based U.S. Study a population-based U.S. study

“…Certain limitations of the data and design warrant consideration. The variability in access, availability, and characteristics of caregiving services vary considerably across states and counties, 28 which may contribute to differences in caregiver experience, qualification for, and familiarity with possible services. The measures used in the BRFSS caregiving module may not adequately capture the nuance between formal home and communitybased services, such as government-or communityfunded services, which may be more impacted by policy, and services provided informally, such as through religious or social groups.…”

Caregiving Across the Life Course: A Health Policy Priority for North Carolina

“…However, data on caregiver support policies show wide state and regional variation in level of benefits provided, eligibility, and coverage. According to a recent national analysis, North Carolina ranked among the bottom five states in terms of the available caregiver supports based on the National Academies of Science, Engineering, and Medicine's caregiver support recommendations: unemployment insurance, family responsibility protected classification, paid family medical leave, spousal impoverishment protection, state-level dependent care tax credits, and caregiver training through Medicaid waivers [14].…”

“…North Carolina has an estimated 1.3 million informal caregivers, accounting for 1.1 billion care hours, an unrealized economic value of $13.1 billion per year [15]. The demographics of North Carolina are changing, with increasing proportions in the population of older adults and of children and youth with complex health needs who often need in-home caregiving [14]. Currently, North Carolina ranks ninth nationally in total population and eighth in the number of people aged 65 and older [14].…”

“…The demographics of North Carolina are changing, with increasing proportions in the population of older adults and of children and youth with complex health needs who often need in-home caregiving [14]. Currently, North Carolina ranks ninth nationally in total population and eighth in the number of people aged 65 and older [14]. Additionally, in the next 20 years, North Carolina's population aged 65 and older is projected to almost double, from 1.7 to 2.7 million.…”