Support family caregivers

Prevention, Early Intervention, & Youth
Parity, Coverage, & Equitable Access
social determinants of health
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Older Adults
People with Physical Disabilities
People with Intellectual & Developmental Disabilities (IDD)
Coverage & Standards
Federal department
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house committees
House Energy and Commerce Committee
House Ways and Means Committee
senate committees
Senate Finance Committee


Congress should pass legislation to help address challenges faced in the recruitment and training of family caregivers and direct care workers.


Unfortunately, high turnover and low wages have led to long-term staffing shortages among the direct care workforce, which includes home health and personal care aids, as well as certified nursing assistants who assist older adults and individuals with disabilities and other chronic conditions, including mental health and substance use disorders (MH/SUDs).[1] The direct care workforce is essential to help individuals and their families provide needed care and supports. To strengthen the direct care workforce, investments are needed in pay and benefits, education and training, and career advancement opportunities. Legislation such as the Supporting Our Direct Care Workforce and Families Caregivers Act would be a significant step in the right direction to addressing these challenges.[2]

Congress should also work to cover family caregiver supports in Medicare to allow family members or friends to receive modest assistance to allow them to care for individuals, particularly those who might otherwise be at risk of entering restrictive and expensive institutional settings. The Medicare Payment Advisory Commission (MedPAC), a nonpartisan, independent agency that advises Congress, previously reported that individuals who received more frequent care from informal caregivers, including family and friends, had fewer high-cost incidents that Medicare needed to cover.[3] While Medicaid allows states to reimburse for family caregiving through a range of different mechanisms, various agencies within the Department of Health and Human Services (HHS) could help improve family caregiver supports across states. Specifically, a recent report from the National Academy for State Health Policy recommended that HHS agencies identify and disseminate information about states’ family caregiver strategies; collect data relating to family caregivers who assist Medicaid beneficiaries; promote innovative state strategies; and provide technical assistance to states.[4]


1. “Sen. Kaine Leads Introduction of Bill to Support Direct Care Workforce & Family Caregivers.” 2023. Senator Tim Kaine. Last Updated April 26, 2023.

2. Supporting Our Direct Care Workforce and Families Caregivers Act. S. 1298 (Kaine), 118th Congress (2023-2024). Last Updated April 26, 2023.

3. Medicare Payment Advisory Commission. Home Health Services: Assessing Payment Adequacy and Updating Payments. Last Updated March 2005.

4. Kaye, Neva and Salom Teshale. Medicaid Supports for Family Caregivers. National Academy for State Health Policy. Last Updated October 2020.