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A Milken Institute publication says caregiver shortages and Medicaid cuts threaten access to home-based care and may shift more responsibility to family members. The resulting care demands could lead relatives to reduce paid work or leave jobs, with financial consequences for households and public revenue. The report calls for stronger payment frameworks and better coordination among health and community care providers.
The Milken Institute’s Future of Aging and Longevity team published a report on Oct. 20 warning that caregiver shortages and Medicaid cuts could make it harder for older adults to receive care at home and shift more work to family caregivers. The report’s contributors and Milken Institute managing director Diane Ty say that unpaid care can force relatives to cut their hours or leave jobs, affecting household finances and future retirement security.
The publication, titled “A Decade of Progress, A Decade to Act,” brings together essays and practitioner perspectives on systems needed to support longer lives. Ty told Home Health Care News that paid caregivers are not available everywhere, even when families can afford to hire them. She said the shortfall is more pronounced in some ZIP codes, leaving family members to fill gaps.
Ty said the federal government’s immigration crackdown has exacerbated existing labor shortages. The report’s contributors also warn that Medicaid cuts could intensify the pressure on families. The source report does not specify a particular cut or quantify its expected effect, so the extent of any impact remains unclear.
When relatives take on more care, some may reduce paid work or leave employment, Ty said. That can affect current income as well as retirement contributions and future Social Security benefits. She also said reduced employment could mean less tax revenue for governments. These are risks identified by Ty; the source does not provide estimates of how many families might be affected.
Caregiving Costs Reach Beyond the Home
The concern extends beyond whether an older adult can receive help at home. If paid care is unavailable, families may absorb the unmet need, and that responsibility can change work and education plans across generations. The report cites an essay by National Alliance for Caregiving President and CEO Jason Resendez and Vanderbilt University School of Nursing Assistant Dean Feylyn Lewis, which estimates that about 4 million U.S. children under 18 are family caregivers. It says another 5 million young people combine caregiving with postsecondary education.
For working-age relatives, reducing hours or leaving a job can create immediate income pressure and affect longer-term financial security. Ty also linked that choice to wider public effects, including potentially lower tax receipts. The report presents these as possible consequences of care gaps, not as measured outcomes of a specific Medicaid policy change.
Its central policy argument is that aging care should be treated as essential public infrastructure. The contributors call for affordable home-based long-term care, better coordination for people enrolled in both Medicare and Medicaid, and payment systems that reward whole-person outcomes rather than service volume.
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The Report’s Proposed Care Model
The publication was issued by the Santa Monica-based Milken Institute, a nonprofit, nonpartisan economic think tank. Its essays examine how care systems can respond as more people live longer. One contribution by Sarita Mohanty, president and CEO of The SCAN Foundation, and physician leader Kapil Dhingra of Kaiser Permanente argues for stronger connections between health care and community-based support.
Mohanty and Dhingra point to the federal Program of All-Inclusive Care for the Elderly (PACE) as an example. PACE provides nursing-home-level care to eligible older adults in their homes and communities. The authors say participants live longer, healthier and more meaningful lives; the supplied report does not give supporting outcome figures. They argue that expanding integrated care requires payment frameworks that reward outcomes, stronger data sharing between health systems and community organizations, and a role for families in shaping services.
Ty said the response should involve coordinated system and policy changes rather than piecemeal reforms. The publication frames the next decade as a period for scaling approaches that link care delivery with community support.
““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 Cuts and Care Gaps
The supplied report does not identify specific Medicaid provisions or reductions, provide a timeline for cuts, or estimate how many people could lose or lack access to services. It also gives no overall count of older adults affected by worker shortages and no measurement of how many family caregivers may reduce employment as a result.
Ty described shortages as uneven across ZIP codes and said the immigration crackdown has worsened existing labor challenges. The source provides no local workforce figures or data establishing the size of that effect. The report’s warnings about employment, retirement benefits and public revenue are potential consequences; their scale is not quantified.
Policy Changes and Care Coordination
The publication calls for stronger payment frameworks, improved coordination between health systems and community organizations, and expanded integrated home- and community-based care. It also recommends involving families and caregivers in shaping services. The authors identify PACE as one model, but the supplied material does not announce a specific expansion, funding decision or implementation schedule.
The next developments to watch are whether governments and health care providers adopt those recommendations, how Medicaid policy changes affect home-based services, and whether workforce measures improve paid-care availability in areas facing shortages. The report sets out a need for action over the coming decade, but it does not name a next policy milestone or deadline.
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, a collection of essays and practitioner perspectives on systems to support longer lives.
How could caregiver shortages affect families?
When paid caregivers are unavailable, relatives may take on more care. Diane Ty said that can lead some family caregivers to reduce work hours or leave jobs, with possible effects on income and retirement security.
Does the report identify specific Medicaid cuts?
No. The source says Medicaid cuts could intensify pressure on families but does not specify which cuts, when they would take effect or how many people could be affected.
What care approach do the report’s contributors recommend?
Contributors call for integrated home- and community-based care, payment systems focused on whole-person outcomes, stronger data sharing and a role for families in shaping services. They cite PACE as an example of linking care with community support.
Source: homehealthcarenews.com
