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A Milken Institute publication says home-care workforce shortages and Medicaid cuts threaten access to care for older adults and could leave families filling more gaps. Caregivers may have to reduce paid work, affecting household income and future retirement benefits; the report calls for stronger payment systems and care coordination.
A new Milken Institute publication warns that shortages of home-care workers and Medicaid cuts could leave more families responsible for supporting older adults at home, with caregivers potentially cutting paid work and risking their own financial security. The report, published Oct. 20, calls for stronger payment frameworks and coordination among health care providers and community services.
The publication, titled A Decade of Progress, A Decade to Act, brings together essays and practitioner perspectives from the Milken Institute’s Future of Aging and Longevity team. Diane Ty, the team’s managing director, said paid-care shortages vary by location and mean families are already absorbing some unmet care needs. She said federal immigration enforcement has exacerbated existing workforce problems.
Ty said caregiving gaps can lead relatives to reduce work hours or leave jobs. That can affect current household income as well as retirement contributions and future Social Security benefits. She also warned that Medicaid cuts could intensify those pressures for families already facing affordability challenges. The report does not quantify how many households would be affected or estimate the size of the potential employment and income effects.
The publication also points to the effects on younger people. An essay by National Alliance for Caregiving President and CEO Jason Resendez and Vanderbilt University School of Nursing Assistant Dean Feylyn Lewis says about 4 million U.S. children under 18 are family caregivers, while another 5 million young people balance caregiving with postsecondary education. Those figures are presented in the report; the supplied material does not specify the data years or methods behind them.
Families Face Work and Income Trade-Offs
When paid home care is unavailable or unaffordable, care does not simply disappear: relatives may take on more of it. That can put pressure on a caregiver’s earnings, job stability and retirement security, while also affecting children and students whose time is divided between school and family responsibilities.
The issue also has consequences beyond individual households. Ty said reduced employment among family caregivers could mean less tax revenue for governments. The report frames aging care as an essential part of public infrastructure and argues that supporting care at home requires systems that connect health services with community support, rather than relying on families to bridge gaps alone.
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Report Calls for Coordinated Care
The Milken Institute is a Santa Monica-based nonprofit, nonpartisan economic think tank. Its Oct. 20 publication gathers proposals and perspectives on how systems can support people living longer. One essay, by Sarita Mohanty, president and CEO of The SCAN Foundation, and physician leader Kapil Dhingra of Kaiser Permanente, argues that long-term care should be affordable and available at home, with better coordination for people enrolled in both Medicare and Medicaid.
Mohanty and Dhingra cite the Program of All-Inclusive Care for the Elderly, or PACE, as an example of linking nursing-home-level care with services in people’s homes and communities. They say participants can live longer, healthier and more meaningful lives. Their proposed direction includes payment models that reward whole-person outcomes, better data sharing between health systems and community organizations, and a role for families in shaping services.
““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
Scale of the Care Gap Remains Unknown
The publication describes risks from workforce shortages and Medicaid cuts, but the supplied report does not quantify the projected effect of specific Medicaid reductions on home-care access, family caregiving hours or employment. It also does not identify which states or communities could face the greatest changes, or provide a timeline for when families might experience them.
Ty’s account of immigration enforcement worsening labor shortages is an attributed assessment; the source material does not provide workforce figures that measure the effect. The figures on young caregivers are cited in an essay, but the underlying survey dates and definitions are not included in the supplied material. The report’s proposals are recommendations, not announced policy changes.
Policy and Payment Changes Ahead
The report’s next step is a policy and systems agenda, not a specific legislative timetable. Ty said the response should be coordinated and sustained over the next decade. Mohanty and Dhingra’s proposals point to changes in how home- and community-based care is paid for, how providers share information, and how caregivers participate in service planning.
Whether governments or health systems adopt those recommendations, and how any Medicaid changes affect local care availability, remains to be seen. For families, the central near-term question is whether paid support will be available where they live and whether care programs can coordinate services before relatives have to make difficult choices about employment.
Key Questions
What did the Milken Institute publication report?
It warned that home-care worker shortages and Medicaid cuts could threaten access to care for older adults and shift more responsibility to family caregivers. It calls for stronger payment frameworks and better coordination among health care and community organizations.
How could family caregivers be affected?
Diane Ty said relatives may have to cut work hours or leave jobs when paid care is unavailable. That could affect current income, retirement contributions and future Social Security benefits, though the report does not quantify those effects.
What is PACE?
The Program of All-Inclusive Care for the Elderly is a federal program that provides older adults nursing-home-level care through services in their homes and communities. The report’s authors cite it as an example of linking care delivery with community support.
Are the report’s recommendations already policy?
No. The publication presents proposals for policy and system changes, including payment models focused on whole-person outcomes and better data sharing. The source material does not say those recommendations have been adopted.
Source: rss
