| Caregiving Policy Advancements and Regressions

| Shalini Kathuria Narang

| The new Public Policy & Aging Report 2026 by the Gerontological Society of America  frames caregiving as a significant policy issue, providing a historic overview of caregiving policies, an assessment of current caregiving policies and frameworks across states and in other nations. The report also covers the effects of policies on care accessibility and quality, as well as novel caregiving regulation methods to strengthen systems of support.

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Here are some of the most compelling findings:

Looking Back at Caregiving Policy

Caregiving affects not just those needing care and those who provide care services at the moment but virtually everyone, in the long run. Recent federal budget cuts and policy revisions have destabilized this vital sector of society . Researchers emphasize learning how other high-income countries have created and built comprehensive coverage plans to support and stabilize the caregiving workforce.  

“Recent proposed federal budget changes could dramatically reduce funding to safety net programs and threaten to undermine recent gains, potentially stripping away vital services that millions of caregivers depend on,” caution researchers Laura Gitlin and Nancy Hodgson.

Families have and continue to be the primary long-term care givers to older adults in the United States. As caregiving is regarded as a normative role and primarily the ­responsibility of families, advocates have struggled to increase its salience as a policy issue, but many see progress in the last decade. 

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The push to age in place and to bring health care into the home has also led to place more health care responsibilities and burdens on families.

A number of factors have influenced the shift from caregiving as a personal obligation to one needing greater societal action. These include: longevity, declining fertility rates creating a smaller pool of available family members, caregiving responsibilities extending up to 10 or more years, individuals serving as caregivers on multiple occasions within their lifetime, a growing number of younger and long-distance caregivers, an increasing number of caregivers sandwiched between child care, employment, and/or schooling, and greater, expanded responsibilities including hands-on, medical, and nursing tasks previously provided by and reserved for trained health professionals. The rising public health concern for family caregivers is a historical and cultural pivot.

Policy Impacts on Caregiving

Family caregiving is a multilevel and multisector phenomenon affecting individuals, families, communities, and societies, impacting both the private and public sectors. 

According to the latest Caregiving in the US report by AARP & NAC, 2025, 63 million adults in America are family caregivers—a growth of 45% in the last 10 years. That means one in four adults (24%) are in this role, and one in four also cares for more than one person. Almost half of all caregivers under 50 years (47%) are known as the “sandwich generation caregivers” providing care for both an adult and a child under 18.

Caregiving remains one of the policy areas that draw bipartisan support in its relevance to all Americans. With a substantial portion of older adults in caregiving roles, the collective importance of caregiving has historically supported bipartisan policy progress, including the Family and Medical Leave Act and National Family Caregiver Support Program, Medicare reimbursement for caregiver training, advancing Veteran-Directed Home and Community-Based Services, and the enactment of the RAISE (Recognize, Assist, Include, Support, and Engage) Family Caregivers Act. 

Susan Reinhard highlights the enactment of 159 family caregiving policies across 44 states in a single year, and the passage of the Caregiver Advise, Record, and Enable (CARE) Act in 45 states and territories. 

Policy Threats to the Immigrant Direct Care Workforce

Direct care workers provide essential care for older adults and people with disabilities across care settings. Comprising nearly 5.4 million personal care aides, home health aides, and certified nursing assistants (CNAs), this workforce outnumbers every other occupation in the United States. 

The direct care workforce powered by immigrants is profoundly threatened by a constellation of federal policies that target immigrants.

The number of immigrants is much higher in some states and localities, such as Florida and California (46%), New Jersey (52%), and New York (57%). Because undocumented immigrants are under-represented in public surveys, these figures likely underestimate the full contribution of immigrant labor in long-term care. While the share of immigrants in this workforce has grown, more will be needed in the years ahead, as ­demographic changes drive up demand for care while reducing the supply of potential caregivers from within the U.S. population.

Yet even amid bipartisan support for caregiving policy, recent federal actions impede and threaten the immigrant direct care workforce. These impacts can be expected to ripple through the long-term care system, which has historically relied heavily on this workforce. 

Furthermore, because more than 30% of direct care workers rely on Medicaid, the cuts to Medicaid and other public programs advanced by the One Big Beautiful Bill Act of 2025 will negatively affect the direct care workforce, potentially exacerbating shortages of workers in long-term care settings, disruptions to care, pressure on family caregivers, and increased health care costs. 

To build a strong policy that supports all caregivers, one essay urges policymakers to examine other nations’ structure and support for long-term care. Examining long-term care policies in 19 high-income countries, researchers Comas-Herrera et al. find that most countries provide universal coverage with some copayments, a few countries offer some universal benefits, and several countries offer means-tested support for long-term care. 

Broader negative impacts on the U.S. economy also are anticipated because reductions in the direct care workforce are expected to push family caregivers into reducing or exiting employment to compensate for gaps in care. To overcome this cascade of caregiving challenges, researchers emphasize federal strategy with targeted efforts to recruit and retain workers in occupations such as direct care, an approach exemplified by Canada’s new immigration pathway for home care workers.

New Opportunity For Federal Regulatory Oversight

The quality of regulatory oversight of U.S. nursing homes remains a policy concern. Researcher Longobardi et al. detail how nursing home survey and certification processes are used to generate a statement of deficiencies and plan of correction,but this regulatory data may not easily indicate the specific nature of the citation nor the evidence the survey team used to arrive at it.

To overcome these limitations, the researchers tried a Natural Language Processing approach to examine the full texts of Statements of Deficiencies as detailed on the Centers for Medicare and Medicaid Services (CMS) paperwork to identify patterns related to a common citation. 

“The Plan of Correction in theory has a wealth of information about nursing home quality and areas for improvement, but it is not structured to make that information accessible to regulators, researchers, or community members. There’s a ton of great stuff in there. The question is how do you access it, organize it, and analyze it—such that it gains real public value as a dataset for ensuring nursing home quality and consistency of nursing home oversight across states,” says Isaac Longobardi.

The researchers recommend specific enhancements to the regulatory approach for American nursing homes including a proposal for CMS to develop a more rigorous framework for surveyor documentation and algorithms for reviewing and flagging patterns of concern in documentation that will allow surveyors and survey agencies to understand better and reduce variability in survey practices across states.

Policymakers, researchers, and advocates can discover policy advances in the new GSA report as well as the benefits for caregivers of continued dialogue and action.heir life course. It is part of our social world and it’s inevitable part of our social world. 

Shalini Kathuria Narang is a Bay Area-based independent writer and software professional. She writes about health, wellness, education and technology.