How has caregiving changed in the United States?

There are several reasons why caregiving has changed in our country; the biggest reasons are changing demographics, workforce and health care service delivery. 

Demographics  It is no secret that our population is aging.  What we don’t often discuss is that the number of people who are able to care for our aging population is not growing as fast; so there are, and will be in the future, fewer caregivers to support our growing aging population.  The Caregiver Support Ratio is the number of potential family caregivers aged 45-64 for each person aged 80 and older.  In 2010 this ratio was more than 7 potential caregivers for each person over 80.  In 2030 the ratio is projected to decline sharply to 4 caregivers to 1 older adult and this ratio will drop further still in 2050 (5 caregivers to 1 older adult).  This declining ratio is a problem, as the prevalence of chronic illnesses, such as dementia, increases as individuals age, which leads to increased dependence on caregiver support. 

Workforce A shift in American culture that has impacted family caregiving is the increase of women in the workforce.  As we discussed last week, the “typical” U.S. caregiver is a 49 year-old female who is employed full-time.  Roughly 60% of family caregivers are women; while 40% of caregivers are men. Women continue to provide most of the day-to-day personal and household care.  The dual responsibility of working and providing support as a caregiver can be a 60+ hour per week commitment.  Balancing these and other responsibilities, such as child rearing, can pose great stress on the caregiver making self-care incredibly important.  Some caregivers need to leave their job to provide care to a family member full-time.  These caregivers not only lose income and access to employer health insurance, but also future Social Security benefits, retirement income and job opportunities when caregiving ends.  An additional workforce issue is that there are not enough professionals or paraprofessionals trained to care for older adults. There is a need for career ladders and funding mechanisms to  encourage and support individuals, such as Certified Older Adult Peer Specialists, to provide care to older adults in home and community based settings as well as residential settings. 

Health Care Service Delivery Many people assume that long-term care takes place in nursing homes, but in fact, the majority of long-term care is provided at home by family members. Health care systems have been motivated by cost-containment efforts that move  hospital-based care to home and community-based care.  National policies also drive the growth of community long-term care.  The Olmstead Decision of 1999 was a crucial Supreme Court decision that said people with disabilities need to be cared for in the least restrictive environment appropriate to their needs.  The Olmstead Decision applies to all individuals who need Long Term Supports and Services (LTSS), including older adults.  With these changes in demographics, workforce and health care service delivery, caregivers need resources and support now more than ever.  

For inspiring caregiver stories, check out the Family Caregiver Alliance “Caregiver Connect” webpage.  To submit your own story, visit their online submission form

Check back next week for caregiver resources!  Also, if you would like to contribute to the COAPS Institute blog please feel free to e-mail us at!


The Family Caregiver Alliance National Center on Caregiving

The Hastings Center: Family Caregiving

Promoting Community Living for Older Adults Who Need Long-term Services and Support by Jane Tilly, DrPH