A Caregiving Agenda is Long Overdue

Family caregivers are the backbone of our society but have long been neglected in terms of supportive public policy. In recognition of National Family Caregivers Month, this post examines what it would mean to have a policy agenda that truly supports those caring for young children, and youth with disabilities or chronic or complex medical conditions. Current efforts in Congress to pass the Build Back Better Act could do a great deal to meet the needs of family caregivers but will leave work to be done to advance and make permanent the interconnected policies that support millions of Americans who serve in this role. 

Improving the physical and mental health of caregivers also supports the health of those they care for. Family caregivers often suffer economic, physical and emotional health effects from serving in this role. For instance, women who are caregivers are more likely to have health problems as compared to non-caregiving women. 

The financial impact of caregiving can be equally severe—nearly half of family caregivers report losing income to take time off to fulfill responsibilities at home. Caregiving responsibilities are also linked to social isolation and lower psychological well-being. Research from PolicyLab’s Intergenerational Family Services Portfolio has shown that poor mental health among adult caregivers can have wide-ranging effects on children, including lower utilization of preventive health services and increased school absence.  

Providing greater support to family caregivers is also vital to ensuring racial and gender equity. Among families in which unpaid care is provided to one or more family members, Black and Latino families are more likely than White and Asian American families to have a lower household income. Almost 1 in 7 women provide care to family members or friends. During the COVID-19 pandemic, a record 1.8 million women dropped out of the workforce, highlighting disparities in access to policies such as paid sick leave. The pandemic also posed unique challenges for grandparents serving as caregivers to young children. 

Against this backdrop, the Biden administration’s focus on “a caregiving agenda,” including expressed support for child care, paid family and medical leave, and putting unconditional cash transfers in the hands of families is very welcome. In fact, President Biden is credited as the first president to use the term caregiving in a public speech. While far from perfect, including the potential absence of paid family and medical leave, the Build Back Better Act is likely to make big investments in caregiving and caregivers. 

A robust policy agenda that supports family caregivers includes many interconnected components. While recent efforts to detail a policy framework that specifically addresses the needs of family caring for the elderly is critical, this post highlights three policy areas that are of long-standing importance to PolicyLab, and which research shows are essential to supporting caregivers and meeting the needs of children and families. 

Paid leave

Paid time off to care for oneself or a family member has proven to be an essential public health tool during the COVID-19 pandemic, particularly when it comes to the safe functioning of schools and child care centers, but it is also an issue of health equity and is vital to the health and well-being of families. Only half of low-wage workers (those in the bottom 25% of earnings) in the U.S. have access to paid sick leave. Certain industries (such as retail and food services) have particularly limited paid sick leave policies, and immigrants are especially likely to lack access to paid sick leave.

Paid maternity leave is associated with improved physical and mental health among both mothers and children, including a decrease in postpartum maternal depression and intimate partner violence, improved infant attachment and child development, and reduced infant mortality. Countries that also have paid paternity leave have seen improved personal and economic family well-being. 

PolicyLab researchers have emphasized the importance of paid family and medical leave, particularly for caregivers of children with autism and children with complex medical needs. Our researchers are currently working on studies that consider the financial impact of caring for children with complex medical needs, and explore caregiver perspectives on how to support workforce participation, including through more flexible paid family, medical and sick leave policies. 

With federal progress on paid leave policy still uncertain, the U.S. may remain the only country among its peers in the Organization for Economic Cooperation and Development without a national paid parental leave policy. And even if paid family and medical leave is included in the final version of the Build Back Better Act it will be much more limited in scope. Thus opportunities for advancing this policy in the near-term will be at the state level (13 states already require paid sick leave, while 8 states and the District of Columbia require paid family and medical leave), and PolicyLab will continue to bring its research and expertise into this ongoing discussion. 

Affordable, quality child care 

Families struggle to find child care that they can afford and meets their needs, and the system itself is greatly in need of investments to increase capacity, improve infrastructure and raise wages. The COVID-19 pandemic exacerbated these issues and affected the ability of working parents, particularly those who are low-income and lack job flexibility, to remain in the workforce. This issue also disproportionately affects women. In one survey, more than three-quarters of mothers of children under age 10 say child care has been among their top three challenges during the pandemic.

We know that quality and safe child care is a pathway to economic stability, can play a role in promoting equity, and is essential to all children’s health and development. Yet families face many well-documented challenges in accessing high-quality child care, including: 

In a recently published issue brief, PolicyLab’s child care experts lay out these issues and some specific problems that merit further attention. For instance, our experts emphasize the importance of child care navigation for families, and of training and support to help child care providers address the needs of children with behavioral challenges and medical needs. 

The Build Back Better Act offers important investments in child care and early childhood education, including increased subsidies to families, a cap on the maximum proportion of income a family should have to pay for child care, universal preschool and investments to improve child care facilities. Some commentators have called the legislation potentially revolutionary for the child care system and for working families. We will be working to ensure that the investments in the system help to move the needle on the priority areas mentioned above.

Direct cash transfers 

Policies such as the Child Tax Credit and the less-discussed Child and Dependent Care Tax Credit, as well as important interventions like ensuring all families access the Earned Income Tax Credit, put money directly into the hands of families that are grappling with the high costs of child care, food and other essential items. 

While the Child Tax Credit has been around for many years, it notably excluded families with the lowest incomes given that a family had to earn enough to file federal taxes to access the credit. The 2021 American Rescue Plan Act addressed this issue, making the Child Tax Credit fully refundable, and also increased (temporarily) the amount of money that families are eligible for through the Child Tax Credit. 

The expanded Child Tax Credit is projected to cut child poverty nearly in half. In its first month, data suggests it kept 3 million children from poverty, reducing the monthly child poverty rate from 15.8% to 11.9%. In addition, economic hardship declined in families with children as Child Tax Credit payments arrived. Other research found that payments strongly reduced food insecurity, and that these effects are concentrated among families with lower income. This work also concluded that increasing the uptake of the Child Tax Credit among eligible families will be required in order for material hardship to be reduced further. 

PolicyLab has called for the expanded Child Tax Credit to be made permanent. As it currently stands, the Build Back Better Act would only extend it by one year, but the legislation would also ensure that it remains fully refundable. The growing body of evidence on the impact of the expanded Child Tax Credit may prove pivotal for the future of this policy, and PolicyLab is currently exploring how we can contribute to this discourse.

In the debate around the Build Back Better Act, there has been pressure to “pick the most important family policy" of those outlined here (as well as others like universal pre-k), but this approach fails to acknowledge how these policies all work together to support families, and in particular caregivers. As we recognize family caregivers this month, let us also reward all of their hard work with public policy that supports their intersecting and diverse needs and those of their families.