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A Milken Institute publication says shortages of paid caregivers and Medicaid cuts threaten access to home-based care, potentially leaving families to fill the gaps. The resulting unpaid care can force relatives to reduce work or leave jobs, with consequences for household finances, retirement savings and tax revenue.
Caregiver shortages and Medicaid cuts threaten access to home-based care and could leave families responsible for more of the work, according to a publication released Oct. 20 by the Milken Institute’s Future of Aging and Longevity team. The report’s contributors warn that family members may have to reduce paid work or leave jobs to care for older relatives, affecting household income and long-term financial security.
The publication, titled “A Decade of Progress, A Decade to Act,” brings together essays and perspectives from practitioners on the systems needed to support longer lives. Diane Ty, managing director of the Milken Institute’s Future of Aging and Longevity, said paid care is not available in every community, even for families able to afford it. Where workers are scarce, relatives often take on care that would otherwise be provided by paid aides.
Ty said the federal government’s immigration crackdown has worsened existing workforce shortages. The source report does not quantify how much the crackdown has affected the supply of caregivers, but it identifies labor availability as a major barrier to home-based care. Medicaid cuts could intensify the pressure by further limiting access to services, Ty said, though the material does not specify which cuts or estimate their effects.
When a family caregiver cuts work hours or leaves a job, the consequences can extend beyond immediate earnings. Ty said caregivers may lose retirement contributions and accrue lower future Social Security benefits. She also said reduced employment could lower tax revenue. These are potential consequences identified by Ty; the publication materials cited in the report do not provide estimates of their scale.
How Care Gaps Affect Family Finances
The shift from paid services to unpaid family care can affect employment, household income and future retirement security, not just how older adults receive help. A relative who reduces hours to provide care may lose wages and workplace retirement contributions, while those who leave work could face longer-term effects on Social Security benefits. The burden may fall especially heavily on households already managing affordability pressures, Ty said.
The publication also points to effects on younger people. An essay by National Alliance for Caregiving President and CEO Jason Resendez and Vanderbilt University School of Nursing Assistant Dean for Student Affairs Feylyn Lewis says about 4 million U.S. children under 18 are family caregivers, and another 5 million young people balance caregiving with postsecondary education. The figures are reported in the source material; it does not provide further detail on their measurement or time period.
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The Report’s Proposed Care Framework
In an essay included in the publication, Sarita Mohanty, president and CEO of The SCAN Foundation, and Kapil Dhingra, a physician leader at Kaiser Permanente, argue that aging care should be treated as essential public infrastructure. Their recommendations include making long-term care affordable and available at home, and improving coordination for people enrolled in both Medicare and Medicaid.
Mohanty and Dhingra cite the Program of All-Inclusive Care for the Elderly (PACE) as an example of linking care delivery with community support. The federal program provides eligible older adults with nursing-home-level care in their homes and communities. The authors say participants live longer, healthier and more meaningful lives. They argue that expanding integrated home- and community-based care requires payment models that reward whole-person outcomes, better data sharing between health systems and community organizations, and caregiver input in service design.
Ty said piecemeal reforms are not enough to address the pressures on care. The publication frames its proposals as a longer-term policy and systems agenda, rather than announcing a new government program or a specific change to Medicaid.
““They’re going to have real impacts on families who are already stressed with affordability, and then they’re going to have to make tough decisions about work.””
— Diane Ty
The Scale of Future Care Gaps
The report material does not quantify how many families might take on additional care, how many paid-care positions are unfilled, or how much particular Medicaid cuts could reduce access. It also does not identify specific federal or state policy changes that would address the workforce shortage. The effects of immigration enforcement on caregiver staffing are presented as Ty’s assessment, without a numerical estimate in the source material.
It is also unclear how quickly the proposed payment, data-sharing and caregiver-participation measures could be adopted, or which organizations would lead them. The publication sets out recommendations and warnings, not a funding commitment or implementation schedule.
Policy Changes Over the Next Decade
The publication calls for governments and health care providers to build stronger payment frameworks and care coordination systems to support older adults and the people who care for them. The next steps described by its contributors include expanding integrated home- and community-based care, improving information sharing between health and community organizations, and giving families a role in shaping services.
No specific implementation timetable or next government decision is identified in the source report. Whether its proposals lead to policy changes, and how those changes would affect paid-care availability or Medicaid coverage, remains to be seen.
Key Questions
What did the Milken Institute publication report?
It warned that caregiver shortages and Medicaid cuts threaten access to home-based care and could shift more responsibility to relatives. It also set out policy and care-coordination approaches to better support older adults and caregivers.
How could families be affected?
According to Diane Ty, relatives may have to reduce work hours or leave jobs to provide care. That could affect current income, retirement contributions and future Social Security benefits; the source does not estimate how many people may face those effects.
What is PACE?
The Program of All-Inclusive Care for the Elderly is a federal program that provides eligible older adults with nursing-home-level care in their homes and communities. The publication’s authors cite it as an example of connecting care delivery with community support.
Are specific Medicaid cuts or new policies detailed?
No. The source material warns that Medicaid cuts could intensify pressure on families but does not identify particular cuts, quantify their effects or announce a new policy or funding plan.
Source: homehealthcarenews.com
