The 2022 National Strategy to Support Family Caregivers provides a roadmap for states to better support family caregivers. This overview highlights policy strategies and promising practices for states.
The Challenge
The pandemic heightened reliance on family caregivers and the shortage of direct care workers who provide care. States are being called upon to address these crises.
A Historic Solution
The National Strategy to Support Family Caregivers, as required by the RAISE Act, was presented to the U.S. Congress in September 2022. The strategy lays out actions — by federal and state governments, communities, employers, and others — to increase recognition and support for family caregivers.
State Roadmap
To inform the National Strategy, the National Academy for State Health Policy (NASHP) created the RAISE Act State Policy Roadmap for Family Caregivers. The roadmap helps states interested in expanding supports for family caregivers by offering the following policy strategies and promising practices.
Public Awareness and Outreach
To increase outreach and identification of family caregivers, who often do not self-identify as caregivers or know where to turn for information, states can…
- Launch public outreach campaigns for family caregivers
- Specify outreach targeted to family caregivers in regulation, policy, procedure manuals, and state plans on aging
- Create and engage state family caregiving taskforces, councils, and commissions
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Explore more recommendations, strategies, and state actions to build public awareness and reach out to caregivers
State Examples
From 2014 through 2019, 12 states created family caregiving task forces. Explore the map to learn more.
Engaging Family Caregivers in Health Care Services and Systems
To ensure person- and family-centered care, where providers listen to and engage family caregivers, states can…
- Engage family members as part of the care team, especially during care transitions and hospital discharges
Assess family caregivers for their own needs - Ensure that family members receive the information they need to care for the individual
- Measure family caregiver engagement for quality improvement and payment
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Explore more recommendations and state strategies to engage family caregivers in health care systems
State Examples
From 2014 through 2019, 12 states created family caregiving task forces. Explore the map to learn more.
South Dakota incorporates caregiver assessments for its structured family caregiving service within its Medicaid waiver. Qualified agencies are required to conduct a comprehensive caregiver assessment and establish a plan for educating, coaching, and supporting the caregiver.
Illinois recently expanded the use of an evidence-supported tool to assess family caregivers’ needs, with area agencies on aging in 12 of the 13 regions of the state using or planning to utilize it.
Services and Supports for Family Caregivers
To help caregivers obtain services that enable them to provide care in the home, states can…
- Blend and braid federal and state funding for services such as home and respite care that can give family caregivers a needed break
- Leverage new Medicaid funding and flexibility
- Rebalance toward more home and community-based services
- Pay family caregivers through Medicaid self-direction options
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Learn more about how states can fund training and support for family caregivers, including state strategies and promising practices
State Examples
Explore how states are educating, training, and counseling family caregivers through Medicaid home and community-based services waivers.
The Direct Care Workforce
To ensure that a well-trained direct care workforce is available to family caregivers, who often struggle to find qualified aides to provide care, states can…
- Coordinate workforce policy and resources across agencies
- Develop career pathways
- Improve and streamline training and working conditions
- Create registries to match workers with clients and credential portability for aides to work in various settings or as a career ladder
- Collect data on turnover rates, tenure, full-time/part-time status, vacancy rates, wages, benefits, and recruitment and retention
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Explore more recommendations, examples, and state strategies to strengthen the direct care workforce
State Examples
Tennessee’s Medicaid agency worked with the Quality Improvement in Long-Term Services and Supports (QuILTSS) Institute to develop a career and education pathway for direct care workers that allows them to “learn and earn” while acquiring credentials that will increase their wages.
The Oregon Home Care Commission operates a statewide registry and referral system, which combines a registry of work credentials with a portal for matching direct care workers with people in need of care.
Financial and Workplace Security
To prevent financial hardship and destitution, states can…
- Enhance family leave requirements
Establish tax credits for caregiving expenses - Establish protections against workplace discrimination based on family responsibilities
- Include family caregiving in unemployment insurance eligibility
- Promote financial education and planning for family caregivers
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Learn more about state strategies and approaches to assure the financial security of family caregivers
State Examples
- New Jersey and Washington implemented paid family leave programs
- Arizona and Nevada mandate paid sick leave
- Illinois and New Mexico mandate allowing the flexible use of sick leave
- Hawaii expanded Family and Medical Leave Act coverage and benefits
Research, Data, and Evidence-Informed Practices
To promote data and research on family caregivers, which is needed to inform policies and evidence-based practices, states can…
- Use broader definitions of family caregiver that go beyond blood relatives
- Collect family caregiver data and outcomes — for example, through family caregiver assessments, plans of care, or a Centers for Disease Control and Prevention (CDC) caregiver survey
- Compile state inventories of family caregiver services
- Develop state evaluations of family caregiver programs
- Implement evidence-supported programs for family caregivers
Get the Roadmap.
Learn more about how states can use research, data, and evidence-informed practices to support caregivers, including state strategies and approaches
State Examples
Washington has demonstrated cost savings and improved outcomes from supporting family caregivers, based on data from family caregiver assessments combined with data on emergency department visits, inpatient admissions, 30-day readmission rate, nursing home admission rate, and mortality rate.
California used national caregiver data as a comparison for state-level outcomes from its Caregiver Resource Centers. The evaluation found that the caregivers served by the resource centers were at high risk and were highly satisfied with the services.
For more information and state examples, read the RAISE Act State Policy Roadmap for Family Caregivers, funded by The John A. Hartford Foundation and the RRF Foundation for Aging, in collaboration with the U.S. Administration for Community Living.