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A Milken Institute publication says shortages of paid caregivers and Medicaid cuts threaten access to home-based care and could shift more responsibility to families. That can mean reduced work hours or leaving jobs, affecting household income and future retirement benefits. The report calls for stronger payment systems and coordination; the scale of future care gaps is not specified.
The Milken Institute’s Future of Aging and Longevity team published a report on Oct. 20 warning that caregiver shortages and Medicaid cuts threaten access to home-based care and could leave families filling more of the gap. The report’s contributors say relatives may have to cut paid work or leave jobs to care for older adults, putting household income and future financial security at risk.
The publication, titled A Decade of Progress, A Decade to Act, brings together essays and practitioner perspectives on systems needed to support longer lives. Diane Ty, managing director of the institute’s Future of Aging and Longevity team, said paid-care shortages are particularly acute in some areas, even for households able to afford a caregiver. As a result, family members are taking on care when paid help is unavailable.
Ty said the federal government’s immigration crackdown has exacerbated existing workforce shortages. The source report does not provide a national count of unfilled home-care positions or quantify how much the crackdown contributed. It also says Medicaid cuts could intensify difficult choices for families already facing affordability pressures.
When relatives scale back employment, the effects can extend beyond lost wages. Ty said leaving a job can reduce retirement contributions and future Social Security benefits. She also said fewer people working could mean less tax revenue for governments. These are risks described by Ty, not quantified outcomes in the publication.
Care Gaps Reach Beyond Older Adults
The pressure on families can affect work, income and long-term financial security, not only the person receiving care. A caregiver who reduces hours or leaves employment may lose current earnings and face lower retirement savings or Social Security benefits later. Employers and public finances may also be affected if more people withdraw from paid work.
The publication also points to younger caregivers. An essay by National Alliance for Caregiving President and CEO Jason Resendez and Vanderbilt University School of Nursing Assistant Dean for Student Affairs Feylyn Lewis says approximately 4 million U.S. children under 18 are family caregivers, while another 5 million young people balance caregiving with postsecondary education. Those figures describe the groups presented in the essay; the source does not provide a time series or a breakdown of the care they provide.
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A Call for Coordinated Home Care
The report’s authors argue that aging care should be treated as essential public infrastructure. In an essay, Sarita Mohanty, president and CEO of The SCAN Foundation, and Kapil Dhingra, a physician leader at Kaiser Permanente, call for affordable, available long-term care at home and better coordination for people enrolled in both Medicare and Medicaid.
They cite the Program of All-Inclusive Care for the Elderly (PACE) as an example of linking health care with community support. The federal program provides nursing-home-level care to eligible older adults in their homes and communities. Mohanty and Dhingra say participants live longer, healthier and more meaningful lives; the supplied report does not include supporting outcome data or details on how broadly PACE could be expanded.
The authors say integrated home- and community-based care needs payment frameworks that reward whole-person outcomes rather than service volume, better data sharing between health systems and community organizations, and meaningful involvement for families and caregivers 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
How Large the Care Gaps Could Become
The supplied report does not quantify the number of older adults who could lose or have reduced access to home-based care, the expected effect of Medicaid cuts, or how many family members may change their work arrangements. The timing and scope of the cuts are not specified in the source material, nor does it give local estimates of worker shortages. The degree to which immigration enforcement has affected the care workforce is presented as Ty’s assessment, without a numerical estimate. The publication makes a case for policy and payment changes but does not set out a confirmed implementation plan or funding commitment.
Policy Changes Remain the Next Test
The report’s authors call for coordinated action on payment, data sharing and community-based services, while Ty argues that proven approaches such as integrated care need to be scaled over the next decade through systems and policy changes. The source material does not identify a scheduled government decision, a specific legislative proposal or a timetable for expanding PACE. The next developments to watch are whether federal and state policymakers change Medicaid funding or home-care support, and whether health systems and community organizations put stronger coordination arrangements in place.
Key Questions
What did the Milken Institute report warn about?
It warned that shortages of paid caregivers and Medicaid cuts threaten access to home-based care and may shift more responsibility to family members.
How could families be affected?
Diane Ty said relatives may need to reduce work hours or leave jobs to provide care. That could affect household income, retirement contributions and future Social Security benefits; the report does not quantify how many families may face those choices.
What does the report recommend?
Its contributors call for payment systems that reward whole-person outcomes, better data sharing between health systems and community organizations, and a role for families and caregivers in shaping services.
What is PACE?
The Program of All-Inclusive Care for the Elderly is a federal program that offers eligible older adults nursing-home-level care in their homes and communities. The report’s authors cite it as an example of connecting care delivery with community support.
Are specific policy changes already scheduled?
The source material does not identify a scheduled decision, legislative proposal or timeline for expanding home-based care programs. It describes recommendations and risks, not a confirmed policy implementation plan.
Source: homehealthcarenews.com
