PolicyLab

Editor’s Note: This blog post is part of a series recognizing National Family Caregivers Month, which takes place in November. The posts in this series explore research, policy, and programs that can support the health and well-being of caregivers and children so families can thrive. For more on this topic, check out our Intergenerational Family Services research portfolio.

In 2018, there were more than 2.7 million grandparents and an unknown number of other relatives in the United States caring for children whose parents are not able to do so. Known as “kinship care,” some of these arrangements are within the foster care system, but many more are informal caregiving arrangements outside of that system. The number of kinship caregivers has almost certainly grown during the COVID-19 pandemic and from the continuing substance use disorder crisis in the U.S., making it more important than ever to consider how we can support the needs of this population. 

To this end, during National Family Caregivers Month, we welcome efforts by the U.S. Department of Health and Human Services (HHS) to release the first National Strategy to Support Family Caregivers. The Strategy offers recommendations to build a support system for relatives caring for children whose parents are unable to do so, or those in need of long-term care. It also considers the needs of those caring for elderly relatives. Informed by two advisory councils established by Congress, the Strategy is an important step in recognizing the unique needs faced by kinship caregivers. 

PolicyLab’s work on kinship care, part of our Intergenerational Family Services Research Portfolio, has focused on supporting the health of caregivers for benefit across generations and on connecting kinship caregivers to services and supports. In this post, we summarize the feedback we submitted to HHS on the Strategy during the public comment period, highlighting areas to prioritize, as well as potentially strengthen, as the plan is implemented. 

Rooted in Research: Our Response to the Strategy

The expansive Strategy is organized around five overarching goals: 

• increase awareness of and outreach to caregivers
• advance partnership and engagement with caregivers
• strengthen services and support for caregivers
• ensure financial and workplace security for caregivers
• expand data, research and evidence-based practices to support caregivers

To deliver on these goals, the Strategy lays out actions that can be taken at the federal level, at other levels of government and by community groups. In our feedback, we identified the promotion of health support for caregivers, family caregivers’ connection to services and support, and public policy action on paid leave as priorities to focus on moving forward. 

PolicyLab research has examined the influence of caregiver depression on youth, comparing those in non-kin versus kin foster placements. This work found that youth in kin foster placements exhibited improved social, emotional and behavioral outcomes. Simultaneously, kinship caregivers were more likely to become depressed or remain depressed than non-relative foster caregivers. This study affirms the importance of allocating resources to support kinship caregiver needs and appropriately connect them with services.  

Kinship families outside of the child welfare system, who make up the majority of kinship arrangements, do not have access to the same supports as kinship caregivers within the system. Additionally, kinship families may face challenges accessing assistance available to other households with children. A new Generations United report suggests rates of food insecurity are 60% higher among grandparent-led households compared to all households with children. And yet, participation in benefits programs like the Supplemental Nutrition Assistance Program (SNAP) is low among this population for myriad reasons, including that grandparents simply may not know that they qualify. 

PolicyLab experts have advocated that health care providers have an important role to play in meeting the unique needs of kinship caregivers, including connecting families to community programs, safety net program enrollment and advocating with families in schools. Further, an American Academy of Pediatrics policy statement authored by PolicyLab experts recommends that pediatric providers should seek partnership with adult primary care and geriatric physician organizations to develop stronger intergenerational support for kinship families. Also, with disproportionate rates of uninsurance among children in kinship care, increasing awareness among pediatric providers of guardianship laws could serve to better connect families to health insurance coverage through Medicaid or the Children’s Health Insurance Program. 

As part of a holistic caregiving policy agenda, we seek to strengthen the Strategy’s suggested actions related to advancing access to paid leave. Paid leave, as the Strategy suggests, is a critical component of supporting kinship families. Yet in addition to the mention of how employers should do more in this area, it is also critical to look to federal and state-level policy change to move these efforts forward and in order to reduce inequities in access to paid leave. 

Following the release of the Strategy, the John A. Hartford Foundation released new polling on policies to help family caregivers, which showed there is strong support for these efforts regardless of political affiliation, race, age, gender, income and education. Notable findings include that more than 90% of those polled support providing paid time off for family caregivers to fulfill their caregiving responsibilities, and a similar percentage support guaranteeing unemployment benefits to cover family caregivers who need to leave their jobs to care for someone. 

The need to support kinship caregivers and families has never been more acute, and with public support for related policies, the new Strategy is an important step to raise these issues. We will be following its implementation and hope it delivers for children and families.

Aliyah Jones is a former policy intern at PolicyLab and a recent graduate of Rutgers University, where she studied psychology and social work.