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A Milken Institute publication released Oct. 20 warns that shortages of paid caregivers and Medicaid cuts could leave families providing more care to older adults at home. That responsibility can disrupt caregivers’ employment and finances, while the report calls for stronger funding and coordination across health and community care.
The Milken Institute’s Future of Aging and Longevity team published a report on Oct. 20 warning that paid-care workforce shortages and Medicaid cuts could make it harder for older adults to receive care at home, shifting more work to relatives. The report’s contributors say families may have to reduce paid work or leave jobs, with consequences for household income and future retirement security.
The publication, titled “A Decade of Progress, A Decade to Act,” brings together essays and practitioner perspectives on the systems needed to support longer lives. Diane Ty, managing director of the institute’s Future of Aging and Longevity team, said shortages of paid caregivers vary by location and mean that family members are already taking on care that might otherwise be provided by workers.
Ty said gaps in paid care can force relatives to cut work hours or leave employment. That can reduce current earnings and affect retirement contributions and future Social Security benefits, she said. Medicaid cuts could intensify those choices for families already facing affordability pressures. The report does not quantify how many households may be affected.
An essay by Sarita Mohanty, president and CEO of The SCAN Foundation, and Kapil Dhingra, a physician leader at Kaiser Permanente, argues that aging care should be treated as essential public infrastructure. They call for affordable long-term care at home, better coordination for people enrolled in both Medicare and Medicaid, and payment systems focused on whole-person outcomes rather than the volume of services delivered.
Family Care Has Economic Costs
The burden described in the report extends beyond the hours spent helping an older relative. When a family caregiver reduces paid work, a household can lose income and the worker may accumulate fewer retirement contributions and Social Security benefits. Ty also said reduced employment could mean less tax revenue for governments, though the publication does not estimate the scale of that effect.
Care responsibilities also reach younger people. An essay by Jason Resendez, president and CEO of the National Alliance for Caregiving, and Feylyn Lewis, assistant dean for student affairs at Vanderbilt University School of Nursing, cites approximately 4 million U.S. children under 18 as family caregivers and another 5 million young people balancing caregiving with postsecondary education. The figures underline that care gaps can affect education and household responsibilities as well as older adults and working-age relatives.
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Proposals for Coordinated Home Care
The report presents the Program of All-Inclusive Care for the Elderly, or PACE, as an example of linking health care with community support. PACE is a federal program that provides older adults with nursing home-level care in their homes and communities. Mohanty and Dhingra say its model shows how services can be coordinated around a person’s needs; the report does not provide comparative outcome data in the source material.
The authors argue that wider integrated home- and community-based care would require payment frameworks that support whole-person outcomes, stronger data sharing between health systems and community organizations, and meaningful input from families and caregivers. Ty said the labor shortage was already a problem and that the federal government’s immigration crackdown had exacerbated it. That is her assessment; the source does not quantify the crackdown’s effect on the care workforce.
““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
Scale of Care Gaps Remains Unknown
The publication warns of risks but does not specify how many older adults could lose or have difficulty accessing home care, how much Medicaid cuts will reduce available services, or how those effects will vary across states and communities. The source also provides no forecast of how many relatives may reduce their hours or leave employment.
Ty links immigration enforcement to worsening workforce shortages, but the available material gives no figures separating that effect from other causes. It is also unclear which proposed payment, data-sharing, or caregiver-support changes policymakers will adopt, and on what timeline.
Policy Changes Will Shape Access
The report calls for coordinated action to strengthen payment systems, connect health providers with community organizations, and include families in designing care. It does not announce a specific legislative proposal, funding commitment, or implementation schedule. The next developments will depend on decisions by federal and state policymakers, health systems, and community-based care providers about whether and how to expand integrated home- and community-based services.
Key Questions
What did the Milken Institute publish?
Its Future of Aging and Longevity team published “A Decade of Progress, A Decade to Act” on Oct. 20, 2026. It collects essays and practitioner perspectives on supporting longer lives.
How could Medicaid cuts affect family caregivers?
The report warns that cuts could worsen pressure on families if older adults have less access to paid home care. Relatives may need to provide more care and, according to Diane Ty, could face difficult choices about reducing work hours or leaving jobs.
What is PACE?
The Program of All-Inclusive Care for the Elderly is a federal program that provides older adults with 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.
How many young people provide care, according to the report’s cited essay?
An essay in the publication cites approximately 4 million U.S. children under 18 as family caregivers and another 5 million young people balancing caregiving with postsecondary education.
What remains uncertain?
The source does not quantify how many people may be affected by Medicaid cuts or workforce shortages, or how impacts will differ by location. It also does not identify a specific policy action or timetable for the proposed changes.
Source: rss
