“In 2020, an estimated 26 million Americans provided unpaid care to a family member or friend.” So begins a paper that appeared late last year in the Milbank Quarterly, a journal focused on health equity and policy—and that number continues to rise each year as the population ages.
Titled “The Landscape of State Policies Supporting Family Caregivers,” the paper gets seriously wonky about the patchwork of state and federal policies that support family caregivers and the patients they serve. While federal law provides some important benefits (including the Family and Medical Leave Act, or FMLA), healthcare policy is largely written at the state level—and, as with most aspects of our health system, the states vary widely in the level and extent of services they offer. “Although the landscape of state policies supporting caregivers has improved over time,” the paper concludes, “few states provide supports as recommended by the National Academy of Medicine, and benefit restrictions hinder accessibility for all family caregivers.”
How well does your state support family caregivers? Below we’ve reproduced the Milbank Quarterly’s ranking of the 50 states plus the District of Columbia. We’ve listed the states in reverse order, starting with the least generous in caregiver benefits. Scores are based not only on which services are offered but also the extent of each benefit; e.g., two weeks of paid leave gets a higher score than one week. A perfect score would be 24.0 points; the median state scored just 5.3 points. Ooof. Lots of room for improvement. Write those legislators.
If you click any state’s name, the drop-down will tell you which of the most common state-level benefits it provides to family caregivers, including:
- Paid family leave for caregivers
- Extended unpaid leave beyond the FMLA mandate of 12 weeks
- Assessment and training resources for family caregivers
- Paid sick days or flexible sick days
- Tax credits or deductions for caregiver-related expenses
- Unemployment insurance for caregiver-related job interruptions
Milbank‘s full analysis is available at this link. Off we go:
Available services: Caregiver training
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Spousal impoverishment protections
Not available: Caregiver training; paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver assessment
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver assessment
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver training; spousal impoverishment protection
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver assessment
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver training
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver training
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver training; spousal impoverishment protections
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Tax credits
Not available: Caregiver training; paid leave; extended FMLA; paid/flexible sick days; unemployment insurance
Available services: Caregiver assessment
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver training; spousal impoverishment protections
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Unemployment insurance; spousal impoverishment protections
Not available: Caregiver training; paid leave; extended FMLA; paid/flexible sick days; tax credits
Available services: Caregiver assessment and training
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits
Available services: Unemployment insurance; tax credits
Not available: Caregiver training; paid leave; extended FMLA; paid/flexible sick days
Available services: Caregiver training; spousal impoverishment protections; tax credits
Not available: Paid leave; extended FMLA; paid/flexible sick days
Available services: Caregiver assessment and training; unemployment insurance
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits
Available services: Caregiver assessment and training; unemployment insurance
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits
Available services: Caregiver training; tax credits
Not available: Paid leave; extended FMLA; paid/flexible sick days; unemployment insurance
Available services: Caregiver training; spousal impoverishment protections
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver assessment; unemployment insurance
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits
Available services: Caregiver training; spousal impoverishment protections
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits; unemployment insurance
Available services: Caregiver assessment; paid sick days; spousal impoverishment protections
Not available: Paid leave; extended FMLA; flexible sick days; tax credits; unemployment insurance
Available services: Caregiver assessment and training; tax credits
Not available: Paid leave; extended FMLA; paid/flexible sick days; unemployment insurance
Available services: Caregiver assessment and training; unemployment insurance; spousal impoverishment protections
Not available: Paid leave; extended FMLA; paid/flexible sick days; tax credits
Available services: Caregiver assessment; unemployment insurance; tax credits; spousal impoverishment protections
Not available: Paid leave; extended FMLA; paid/flexible sick days
Available services: Caregiver assessment; flexible sick days; unemployment insurance
Not available: Paid leave; extended FMLA; paid sick days; tax credits
Available services: Caregiver assessment and training; flexible sick days; tax credits; spousal impoverishment protections
Not available: Paid leave; extended FMLA; paid sick days; unemployment insurance
Available services: Caregiver assessment; tax credits; spousal impoverishment protections
Not available: Paid leave; extended FMLA; paid/flexible sick days; unemployment insurance
Available services: Caregiver assessment and training; extended FMLA; unemployment insurance; flexible sick days; spousal impoverishment protections
Not available: Paid leave; paid sick days; tax credits
Available services: Caregiver assessment and training; paid/flexible sick days
Not available: Paid leave; extended FMLA; tax credits; unemployment insurance
Available services: Caregiver assessment and training; unemployment insurance; tax credits; spousal impoverishment protections
Not available: Paid leave; extended FMLA; paid/flexible sick days
Available services: Caregiver assessment and training; unemployment insurance; paid sick days
Not available: Paid leave; extended FMLA; flexible sick days; tax credits
Available services: Caregiver assessment; tax credits; unemployment insurance
Not available: Paid leave; extended FMLA; paid/flexible sick days
Available services: Caregiver assessment; paid/flexible sick days; unemployment insurance
Not available: Paid leave; extended FMLA; tax credits
Available services: Caregiver training; paid/flexible sick days; tax credits
Not available: Paid leave; extended FMLA; unemployment insurance
Available services: Extended FMLA; unemployment insurance; tax credits; spousal impoverishment protections; paid/flexible sick days
Not available: Caregiver training; paid leave
Available services: Caregiver assessment; unemployment insurance; paid/flexible sick days; spousal impoverishment protections
Not available: Paid leave; extended FMLA; tax credits
Available services: Caregiver assessment and training; paid/flexible sick days; tax credits
Not available: Paid leave; extended FMLA; unemployment insurance
Available services: Caregiver assessment and training; extended FMLA; unemployment insurance; flexible sick days; tax credits; spousal impoverishment protections
Not available: Paid leave; paid sick days
Available services: Caregiver assessment; extended FMLA: paid/flexible sick days; tax credits; spousal impoverishment protections
Not available: Paid leave; unemployment insurance
Available services: Caregiver assessment; unemployment insurance; extended FMLA; paid leave; paid/flexible sick days; unemployment insurance
Not available: Tax credits
Available services: Caregiver assessment and training; unemployment insurance; extended FMLA; paid/flexible sick days; tax credits; spousal impoverishment protections
Not available: Paid leave
Available services: Caregiver assessment and training; unemployment insurance; paid leave; paid/flexible sick days
Not available: Extended FMLA; tax credits
Available services: Caregiver assessment and training; unemployment insurance; extended FMLA; paid leave; paid/flexible sick days; tax credits
Not available: n/a
Available services: Caregiver training; unemployment insurance; paid leave; paid/flexible sick days; tax credits; spousal impoverishment protections
Not available: Extended FMLA
Available services: Caregiver assessment and training; extended FMLA; paid leave; paid/flexible sick days; tax credits
Not available: Unemployment insurance
Available services: Caregiver assessment and training; unemployment insurance; paid leave; paid/flexible sick days; tax credits; spousal impoverishment protections
Not available: Extended FMLA
Available services: Caregiver assessment and training; unemployment insurance; paid leave; paid/flexible sick days
Not available: Extended FMLA; tax credits
Available services: Caregiver assessment and training; unemployment insurance;
extended FMLA; paid leave; paid/flexible sick days; tax credits; unemployment insurance
Not available: n/a
Available services: Caregiver assessment and training; unemployment insurance;
extended FMLA; paid leave; paid/flexible sick days; unemployment insurance
Not available: Tax credits
Source: Miller K.E.M., Stearns S.C., Van Houtven C.H., Gilleski D., Homes G.M., Kent, E.E. The Landscape of State Policies Supporting Family Caregivers as Aligned With the National Academy of Medicine Recommendations. Milbank Q. May 17, 2022. https://doi.org/10.1111/1468-0009.12567