Every day in America, millions of women and men struggle to succeed on the job while caring for an aging parent, an ill spouse, or a child with special needs. Their struggles are evident in workplaces, homes, and care facilities, and during fraught and hurried commutes from one to the other. Nearly everyone in the United States will experience the challenge of either providing or receiving care at some point in their lives, yet our nation fails to ensure access to even basic supports.
More than 43 million adults in the United States report they have provided unpaid care to an adult or to a child with special needs within the past twelve months. Sixty percent of caregivers are also employed outside their homes, and most of those who hold jobs work full time. (National Alliance for Caregiving and AARP Public Policy Institute, 2015). In 2010, four out of ten workers said they had taken time away from work to care for a loved one in the past five years, and nearly half of workers said they anticipated needing to do so in the next five years (Aumann et al., 2010). Yet whether or not family caregivers can take time away from work without risking a paycheck or their jobs often depends upon their employers, because the United States has failed to establish public standards that most wealthy nations created long ago.
Fortunately, the situation is beginning to change. Three states (California, New Jersey, and Rhode Island) have paid family leave insurance programs in place. Four states (California, Connecticut, Massachusetts, and Oregon), the District of Columbia, one county, and nineteen cities have laws that guarantee workers the right to earn and use paid sick days; twenty-one of these paid sick days laws have been adopted within the last three years, and one has been expanded. Private companies also are establishing new paid leave policies or improving existing ones by increasing the amount of time employees can take. But much more needs to be done to ensure every person in America has access to family leave and other supports needed to protect their jobs and financial security when a family caregiving need arises.
This article summarizes the current situation in the United States, the demographic trends that make the need for change increasingly urgent, and workplace policy advances up until now. It concludes with a roadmap to a more caring America.
More People in Need of Care, Not Enough Caregivers
Two trends—more people in need of care and fewer available caregivers—portend a caregiving tsunami and a caregiver drought in the United States.
The country’s caregiving needs are growing exponentially. There were nearly 48 million people older than age 65 in the United States in 2015 and it is estimated that by 2050, that number will rise to nearly 88 million people, or 22.1 percent of the population (U.S. Census Bureau, 2014b). The population of children with special caregiving needs also is growing. Currently, 6.4 million children between ages 3 and 21 receive special education services in school (National Center for Education Statistics, 2015). And, the number of multi-generational households is rising, while the marriage rate is declining (Fry, Parker, and Passel, 2014), indicating an increased need for siblings, grandchildren, grandparents, and others to provide care.
At the same time, most adults are employed, which means there is no one at home to serve as a default family caregiver. More than threequarters of people in their 30s, 40s, and 50s hold paying jobs, and a growing share of adults remain in the labor force into their 60s and 70s (U.S. Bureau of Labor Statistics, 2015a). Fiftyseven percent of women are now in the labor force and, of those, approximately threequarters work full time (U.S. Bureau of Labor Statistics, 2014b). More than two-thirds of women with children are in the labor force (U.S. Bureau of Labor Statistics, 2015b).
Although the need is great and growing, there is a substantial shortage of paid caregivers in the United States and a dramatic need in the industry to improve wages, working conditions, and training (Lahaie, Earle, and Heymann, 2013). Paid caregiving jobs, including personal care assistants and home health aides, are among the country’s fastest growing occupations (U.S. Bureau of Labor Statistics, 2013), but the workforce is made up largely of low-wage workers who work long and unpredictable hours with few, if any, workplace protections (Lahaie, Earle, and Heymann, 2013). High turnover and burnout are problems for these workers, as well as for those who rely upon them (Ejaz et al., 2015; McHugh et al., 2011). Although workers and advocates recently secured domestic workers bills of rights in California and New York, and federal minimum wage and overtime pay protections for homecare workers, much more is needed to address the serious challenges facing the paid caregiver workforce.
Deficits of Supportive Workplace Policies
Both public policies and employers’ voluntary policies and practices generally fail to recognize the caregiving responsibilities workers face. The majority of workers do not have access to paid time off for caregiving. Just 13 percent of U.S. workers have paid family leave through their employers, and at least 43 million workers (39 percent of the private-sector workforce) do not have a single paid sick day they can use for their own health issues, much less to care for a loved one (U.S. Bureau of Labor Statistics, 2014a). Workers who are paid lower wages, workers with lower levels of formal education, and workers in communities of color disproportionately lack access to paid sick days (U.S. Bureau of Labor Statistics, 2014a; Glynn and Farrell, 2012). And just less than 60 percent of the workforce has unpaid job-protected leave through the Family and Medical Leave Act (Klerman, Daley, and Pozniak, 2012).
Flexibility on the job is rare, too. Nearly half of hourly workers and nearly a third of non-hourly workers say they do not have input about their schedules or cannot adjust their work hours (Lambert, Henly, and Fugiel, 2015). Just 56 percent of full-time workers and 47 percent of part-time workers report having flexible work hours. Only 22 percent of workers say they have flexibility around where they work, such as having the option to occasionally telecommute (Council of Economic Advisors, 2014).
This lack of supportive workplace policies means that caring for a family member often comes at a high cost for America’s workers. Perhaps unsurprisingly, women who care for parents or grandchildren are less likely than non-caregivers to be in the labor force (Lee and Tang, 2013). For workers who have left full- or part-time jobs, losses in income and retirement savings can be significant. When a woman age 50 or older leaves the labor force to care for a parent, she loses, on average, more than $324,000 in income and retirement savings (MetLife Mature Market Institute, 2011). Men are less likely to leave the labor force when caregiving needs arise but when they do, it is estimated they forego, on average, more than $274,000 in income and retirement savings (Lee and Tang, 2013; MetLife Mature Market Institute, 2011).
Being a caregiver often is loving, dutiful, and deeply rewarding, but the costs to workers and their families can be high. Supportive public policies and workplace cultures could help reduce these costs.
Policy Progress So Far
Fortunately, there has been progress. At the federal level, there is one law that supports families’ caregiving needs—the Family and Medical Leave Act (FMLA) of 1993. It guarantees eligible workers unpaid job-protected leave to care for a new child or a seriously ill parent, spouse, or child; to address a serious health issue of their own; to care for a family member wounded while serving in the military; or, to deal with certain exigencies arising from a family member’s military deployment. The law has been used more than 200 million times (National Partnership for Women & Families, 2015) and about a fifth of the periods of leave taken under the FMLA each year are for family caregiving (Klerman, Daley, and Pozniak, 2012).
But the FMLA was intended to be a first step toward establishing public policy standards that reflect working families’ needs. Exclusions in the law mean that only 59 percent of the workforce is covered by its protections and, among those who are eligible, the most common reason cited for not taking leave is the inability to forego pay (Klerman, Daley, and Pozniak, 2012). Moreover, the law does not include all workers who may benefit; some workers report an inability to take leave because the person they sought to care for was not a “covered” family member under the FMLA.
Some states have established policies that help to fill FMLA gaps by providing paid family leave; providing unpaid leave to workers in smaller businesses, or for those who work part time; expanding unpaid leave to care for a broader range of family members; allowing for paid or unpaid time off to attend to more routine health or care needs; or, making workers eligible for unemployment insurance when they leave their jobs to care for a seriously ill family member and until they are ready to re-enter the workforce.
Paid Family Leave. California, New Jersey, and Rhode Island have adopted paid family leave insurance programs. In all three states, women and men may take paid family leave for four to six weeks to provide care to a parent, spouse, or child with a serious health condition. In California and Rhode Island, workers may use the state’s paid family leave programs to care for an extended group of family members, including siblings, grandchildren, and grandparents; in Rhode Island, paid family leave also is available to care for a parent-in-law.
Extended Family. Eleven states (California, Colorado, Connecticut, Hawaii, Maine, New Jersey, Oregon, Rhode Island, Vermont, Washington, Wisconsin) and the District of Columbia have adopted policies that recognize that family care needs often extend beyond caring for a parent, spouse, or child. These states have adopted state FMLA laws that provide unpaid leave to care for domestic partners, grandparents, grandchildren, adult children, some siblings, and others. This is especially significant as the number of multi-generational households continues to rise.
Although domestic partner protections were principally intended to protect lesbian, gay, bisexual, and transgender (LGBT) couples, they also aid unmarried heterosexual couples who have chosen not to marry for financial or other reasons.
Expanded Eligibility. Connecticut, Hawaii, Maine, Minnesota, New Jersey, Oregon, Vermont, Wisconsin, and the District of Columbia have expanded the number of workers eligible to take unpaid leave for family caregiving, either by covering workers in smaller businesses or by including more part-time workers among those who are eligible to take leave. These states’ policies help to expand access to some of the 39 percent of workers nationwide who fall outside the protections of the federal FMLA.
Paid or Unpaid Sick Time. States and cities are increasingly recognizing that some family caregivers need shorter periods of time off (hours or days) to provide care. California, Connecticut, Massachusetts, Oregon, and the District of Columbia, one county, and nineteen cities have, or soon will have, paid sick days laws that require most employers to allow workers to earn paid sick time that can be used to provide medical care or take loved ones to medical appointments (all states but Connecticut cover time to care for ill parents and other loved ones beyond just children and spouses). All but four of these laws have been enacted since 2013. Broad and diverse advocacy coalitions of workers’, women’s, seniors’, caregivers’, civil rights, public health, and faith groups have been instrumental in this nationwide movement to pass paid sick days laws. Massachusetts and Vermont also have separate “small necessities” laws that allow eligible workers to take unpaid leave to take a child or an older family member to a medical appointment.
Type of Family Member (Beyond Child, Spouse, and Parent)
Registered, formerly registered, and surviving registered domestic partner and child of
such partner and stepparent
|Colorado||Civil-union partner and domestic partner|
|Connecticut||Civil-union partner, parent-in-law, and stepparent|
Non-dependent adult child, grandparent, parent-in-law, grandparent-in-law, stepparent,
Domestic partner and child of domestic partner, non-dependent adult child, sibling
who lives with employee
|New Jersey||Civil-union partner and child of civil-union partner, parent-in-law, and stepparent|
Domestic partner and child of domestic partner, non-dependent adult child, grandparent,
grandchild, and parent-in-law
|Rhode Island||Non-dependent adult child and parent-in-law|
Civil-union partner and child of civil-union partner, non-dependent adult child, and
|Washington||Registered domestic partner and child of domestic partner|
|Wisconsin||Registered or unregistered domestic partner and parent-in-law|
Person related by blood, legal custody, or marriage; child who lives with employee and
for whom employee permanently assumes and discharges parental responsibility; and,
person with whom employee lives and maintains a committed relationship
Unemployment insurance. Twenty-one states acknowledge that family caregiving responsibilities can have a significant impact on a caregiver’s ability to hold a job. In these states and in the District of Columbia, unemployment insurance is available for those who had to leave a job to provide care to a family member and who now are available for and seeking employment. Those states are Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Minnesota, Nevada, New Hampshire, New York, Oklahoma, Oregon, Rhode Island, South Carolina, Texas, Washington, and Wisconsin.
State progress does pave the way for federal policy changes, but relying on states alone leaves millions of family caregivers without any protection beyond what the FMLA provides. Twentyone states have done nothing to improve upon federal family and medical leave or unemployment insurance standards for family caregivers, including many of the states with the largest shares of older people (Jacobsen et al., 2011) and highest rates of people in poverty (U.S. Census Bureau, 2014a). These states are Alabama, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, New Mexico, North Carolina, North Dakota, Ohio, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, West Virginia, and Wyoming.
The Road to a More Caring America
The United States has a long way to go to ensure that its policies reflect the urgent and growing needs of the country’s workforce and aging population. Fortunately, the road to a more caring America is clear. But success depends upon advocates and policy makers working across generations, communities, and the private and public sectors to define and strengthen the narrative about the importance of care for workers, families, employers, and the economy. Without an inclusive policy approach—one that addresses the needs of new parents and family caregivers; women and men; higher wage, higher skilled workers, and those in middle-wage and lower wage or lower skilled jobs—some workers and families will be left out and our national policies will remain inadequate.
Advocates nationwide are already fighting to improve state and local policies. In 2015, fifteen state legislatures considered paid family and medical leave proposals that would allow women and men to take leave to care for new children, seriously ill family members, or their own serious health conditions. And an additional seven states considered creating task forces to analyze workers’ need for paid leave and the creation of state paid family and medical leave programs. In Connecticut and New York, lawmakers took substantial action and proposals to establish state paid leave programs attracted bipartisan support. Over the past year, a number of municipalities have adopted paid parental leave programs to cover municipal employees. The U.S. Department of Labor has made available a total of $1.55 million in grants in fiscal year 2016 to help six states, one city, and one county analyze paid family and medical leave programs. Concerted and continued advocacy and education are needed to ensure that family caregiving needs, including eldercare needs, are essential aspects of these policies.
State and local victories and a growing body of evidence demonstrating the utility and value of paid leave have created new energy in support of federal legislation. Family caregiving advocates and professionals who work with caregivers and care recipients are critically important advocates and educators in campaigns to pass proposals such as the Family and Medical Insurance Leave (FAMILY) Act (a national paid family and medical leave proposal that has growing congressional, business, advocacy, and public support) and the Healthy Families Act (a national paid sick days proposal that has been bolstered by a rapid rise in state and local policies).
Other public policy changes would provide critical support for family caregivers as well, including scheduling predictability and flexibility, safeguards for those with longer term caregiving needs through further expansion of unemployment insurance and Social Security credits for time people spent out of the paid workforce providing unpaid care, and jobquality and professionalization measures that invest in the nation’s paid caregiving workforce.
Despite some promising policy developments, legislation also has been proposed that would limit workers’ rights to fair wages and time off. For example, federal proposals that would erode the rights of hourly workers to receive overtime pay in exchange for compensatory time, and state proposals that would erode the ability of localities to adopt laws that provide paid sick days, family leave, or other protections pose real threats to workers and their families. Family caregiver and eldercare advocates have an important role to play in raising awareness of the challenges posed by these proposals.
Employers have an essential role to play, too. In 2014, four out of ten employers reported offering eldercare resource and referral services, up from 2008 when just three out of ten employers offered them. The percentage of employers who reported offering dependent care assistance programs for eldercare nearly doubled between 2008 and 2014 (23 percent to 41 percent) (Matos and Galinsky, 2014). Two high-profile examples include Microsoft and Facebook. Those companies recently adopted policies that require larger contractors and subcontractors to provide a basic amount of annual paid time off. Facebook went even further by requiring stipends for new parents who do not receive parental leave. Additional private-sector initiatives that recognize the time and expense associated with family caregiving needs would help to change working conditions and business norms.
This is an unprecedented opportunity for the United States to make the progress that workers, families, and our country need. Researchers, advocates, and professionals who support family caregivers and want to help advance leave policies should conduct research and share data and stories on the impact that family caregiving has on care recipients, and the benefits of paid leave for family caregivers’ health, their ability to stay connected to the workforce, their financial stability, and their loved ones’ health outcomes.
Workers and their families, employers, and policy makers all have a stake in elevating a national dialogue about the workplace supports family caregivers need. The economic security of workers and families, the dignity of older adults, the strength of our economy, and more hang in the balance. The time for action is now.
Vicki Shabo, J.D., M.A., is vice president of the National Partnership for Women & Families in Washington, D.C.
The author wishes to thank Sarah E. Towne and Sadie Kliner for their assistance with this article.
Editor’s Note: This article is taken from the Winter 2015/2016 issue of ASA’s quarterly journal, Generations, an issue devoted to the topic “Family Caregiving.” ASA members receive Generations as a membership benefit; non-members may purchase subscriptions or single copies of issues at our online store. Full digital access to current and back issues of Generations is also available to ASA members and Generations subscribers at Ingenta Connect. For details, click here.
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