What role do family members play in caring for frail older adults and younger people with disabilities? What can society do to make it easier for them?
I got thinking about this when Republican vice presidential candidate JD Vance suggested that families could lower their daycare costs if “grandma and grandpa” took on more child care responsibility.
Who Is Caring For Grandma?
But what about caring for “grandma and grandpa?” The reality is that family members already carry nearly all that burden, and with vastly less public support than those raising children.
While most people think about long-term care in nursing homes, more than 8 in 10 older adults receiving personal care get that assistance at home. And nearly all that help comes from family members or friends. While the estimates of family caregivers vary widely, millions of Americans are providing support for older relatives and friends.
Support ranges from shopping to cooking to help bathing, dressing, or going to the bathroom. The economic value of family caregiving is enormous, though hard to estimate. My colleagues at the Urban Institute calculate the lifetime value of family care provided to an older adult reaches $168,000. AARP estimates the total economic value of family caregiving at $600 billion annually.
Many family members quit their jobs or go part-time to support frail parents. A study by the Rosalynn Carter Institute for Caregivers finds that one in five full-time workers cares for a family member with a serious illness or disability. Nearly 20% of them said they had to quit a job to care for a relative and 40% went to part-time work. Much of that burden falls on low-wage workers who can least afford to lost work time.
Democratic vice-presidential candidate Tim Walz knows the story. His life was upended when his family had to care for his dad, who was dying of cancer.
Limited Government Help
What support do these families get from the government for this difficult work? Almost none.
A handful of states pay family caregivers of relatives who are receiving Medicaid. The Veterans Administration has a program that provides modest financial support for eligible family members.
And 13 states require employers to provide limited paid leave for family caregivers, including both parents of young children and those caring for older adults or younger people with disabilities.
A Different Story For Children
Compare that to government support for parents of young children.
Parents may benefit from the Child Tax Credit, the Earned Income Tax Credit, and the Child and Dependent Care Tax Credit. Combined, a family can have their taxes reduced by nearly $9,000 annually for a first child, and more if they have additional kids. Many of these credits are refundable, which means the government will write you a check if your tax liability is less than the eligible credit amount.
On top of that, 15 states provide their own child credits.
Parents also can put aside up to $5,000 annually for child care in tax-advantaged Flexible Savings Accounts.
And, of course, there is publicly-funded K-12 school, which relieves the burden of family care for 7 or 8 hours a day for 18 years.
What The Candidates Would Do
Democratic Presidential candidate Kamala Harris wants to increase the CTC to up to $6,000 annually for parents of newborns and $3,400 for older children. Vance wants to increase the credit to $5,000 annually, though his running mate, former President Trump, has not endorsed that idea.
Harris also wants to create a federal paid family leave program, which would apply to workers who take time off to care for a newborn or a sick relative. She also would raise pay for Medicaid home care workers. That is important, but also will increase costs for families who pay out of pocket, putting paid support further out of reach for many families. Already, private pay home care costs up to $35 an hour.
Both Vance and Harris favor licensing reform that could expand the pool of child care and elder care workers.
To Vance’s point about grandparents, millions already do care for their grandchildren. About 7 million grandparents live in households with their grandchildren. About one-third report they are primarily responsible for the care of those children. Millions more older adults provide care even though they don’t share a household.
Others can’t help because they are physically or cognitively unable. Or, like adult children who don’t care for aging parents, many grandparents can’t provide hands-on assistance because they live in distant cities.
Rebalancing
I’m not suggesting that families with children don’t need assistance. They do. Childcare is too expensive, and we should try to find solutions or alternatives.
But there is an enormous imbalance between how society supports parents with young children and what it does to help adult children or spouses who are caring for parents. As the candidates promise to spend billions of dollars to help parents and kids, they should not lose sight of the needs of older adults and their family caregivers.