| Q&A with Michael Lepore and Tara McMullen

| Shalini Kathuria Narang

| The new Public Policy & Aging Report 2026 by the Gerontological Society of America, on caregiving policy aims to inform policymakers, researchers, and advocates on the need to support policy advances. Michael J. Lepore, PhD, Editor-in-Chief, University of Massachusetts Amherst, and Tara McMullen, PhD, MPH, Associate Editor and Independent Research Consultant, edited the report. Here, they reflect on the challenges and opportunities of the present moment.

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Can you share something about the report theme for this edition?

Michael Lepore: This issue is on caregiving policy. What’s so important is that policies impact people of all ages, people who are receiving care or giving care. Part of what motivated our enthusiasm to bring this topic is that it impacts everybody in all of the world. In all of history, there has been caregiving taking place. And for carework—paid or unpaid, to be devalued, is one of the challenges that our society faces, largely women who do this work, it’s often not paid for. And even for women and some men who are doing the work for pay, that pay is often very low. And yet we see these jobs as essential, and that came to light during COVID, that these are critically important jobs for the health and well being of our entire society, and yet, we pay them so little. The tensions that it creates are part of why we wanted to highlight the topic within this issue.

Tara McMullen: There are federal and state policies that do touch on these (caregiving) areas, but to move them forward, where we have actionable progress, is one of our goals in highlighting and publishing these papers [in the report], talking about the diversity, the frameworks, the practices in policies that exist, and the need for policymakers, researchers and decision makers to read the report and say, “There’s more to this than just people need support.” These issues are multifaceted. I hope what comes out in this edition is that caregiving is not a black-and-white issue, especially since federal policymakers have been discussing it for decades. Yet we see progress, not to where it should be. Our authors have offered a lot of insights into state action plans and different research projects that offer practices and frameworks. 

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Any specific sub-topic within the theme that particularly stood out to you? 

Tara McMullen: It’s aging and caregiving in rural America, or vulnerable populations in underserved areas. This is such a definitive policy issue. It cuts across the board. Now we are working on an issue on environmental policy. One of the main things coming out of that issue, or the caregiving issue, is that we have these pockets in America of individuals in underserved rural areas who may be seeking and needing more, and are not getting that full attention. The resources are not there. That was a theme that cut across, that resources are needed, and how do we get them to these areas.

Michael Lepore: There were quite a few examples of how other high-income countries are approaching long-term care. There’s some common themes like support for services, for people to stay in their homes and in their communities rather than older people needing to move to a residential care setting or a facility. Seeing those trends internationally could be inspiring for federal or state-based lawmakers and policymakers in the U.S. What I think the journal contributes is a global lens toward global issues, approached in many different ways in different nations and states.

The recent challenges with new immigration regulations and enforcements have a huge impact on the caregiving economy. Your thoughts?

Tara McMullen: Immigration and caregiving do belong in the same sentence and should be interwoven into one narrative. It’s part of the same discussion, knowing who’s providing formal care in America. Our direct care workforce, when you look at the skill mix, and who’s a part of it, we have a lot of immigrants working in home care settings, nursing homes, and as CNAs [Certified Nursing Assistants], and they are truly the lynchpins to our system. A few states have done a lot of efforts in the policy area to build career ladders, or base wage policies, to support our direct care workers. The federal government has not moved as some of these more progressive states have. When we begin to talk about immigration and we talk about our staffing crisis, the need to retain and recruit our skilled workers has to be at the forefront of that discussion. 

It is essential that we talk about this over and over and over and over, and all of us in our field are kind of getting tired of hearing it, but the reason we’re getting tired of hearing it is because it has not progressed. 

Michael Lepore: There is a heightened challenge that the people in their [direct care workforce] care and their employers are facing now. I’m at the University of Massachusetts Amherst, and I end up meeting with a lot of providers in the northeast for my work. Struggles with hiring workers, and then with losing workers due to immigration enforcement, is something I’ve seen bring providers to tears on public panels because these are people who are actively caring for some of the most vulnerable people in our country, and they’re losing their rights to be here and are being removed forcibly.

Any specific area or paper in this edition that you want to highlight?

Tara McMullen: For me it’s Susan Reinhard’s paper about the policy impacts on family caregiving. It’s not giving you all the solutions. It presents a very effective and distinct background on the topic. This paper was intentionally added into the report, because it supports Dr. Laura Gitlin’s paper about historical lookback of policies. These two papers framed the topic really well, because not only did they talk about the gaps, which persist, but they’ve also highlighted the multiple efforts to try to close these gaps. We just haven’t been able to get to where we are in America, with the demographic realities that we’re in, to support better policies. Those two papers in tandem are must-reads, especially for someone who’s just walking into these topics and may not know everything about formal and informal caregiving. It’s more educational. We should understand these topics in a diverse way, and in plain language. 

Michael Lepore: What I want to emphasize is the international comparisons of current policies across many nations. Recognizing and understanding the history of our own policies is really important, so we know how we got to where we are, but there’s lots of other countries who are in very different places with very different policies, but maybe some similarities as their populations are also aging. They also have some mix of residential long-term care that’s maybe paid for by the government and some home-based care. We mainly could learn lessons from other countries or other communities that have done things differently. It opens us up to fresh new ideas that we might not have considered. Heightening support for individuals who are aging to receive home- and community-based services, and decreased emphasis and policy on the residential, or institutional settings. There were a few countries that have made or are making that shift. It’s a trend that aligns with what I hear people talking about wanting for themselves—to stay in their homes and communities, and the idea of moving to a nursing home being something they’d rather die than experience. 

Any final thoughts?

Tara McMullen: Caregiving is important because it’s a fundamental human activity. We were trying to put it in a greater spotlight knowing it’s millions and millions of Americans who are receiving some form of caregiving. It’s probably us and our neighbors or our family members. It is so central to everything we do, yet policy efforts in these areas lag. It doesn’t make sense as a citizen and a voter, because it’s so central to what we do. It’s wonderful when we are able to highlight these topics, because these topics are interwoven into each of our narratives, as human beings. I’m hopeful that raising awareness of the topics within this report could help caregiving and care be seen as a sort of social infrastructure that we can’t exist without. Raising awareness of these different policies impacting people who are the end users of these policies, whether as caregivers, care recipients or they will be at different times in their 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.