Family Caregiving, State programs

The cost of nursing home/assisted living care has continued to rise. The average daily cost of nursing home care in the United States is $235, with a high of $800 per day in Alaska, and a low of $147 in Oklahoma. The increasing cost of care for loved ones has placed burden on the federal and state governments, as well as the American people searching for cheaper alternatives.

Federally, in 2000, the National Family Caregiver Support Program, or NFCSP, was established to provide grants to states and territories based on their share of the population age 70 and over.  Administered through the United States Department of Health and Human Services, NFCSP aims to fund a variety of assistance to formal and informal caregivers, making it possible for more caregivers to care for loved ones in their homes as Medicare does not pay for in-home care or adult day care. NFCSP provides information to caregivers about available services, assistance to caregivers in acquiring access to other services, counseling, organization of support groups, caregiver training, respite care, and supplemental services. NFCSP works largely in conjunction with states and communities as the program has outlets across the nation. The U.S. Administration for Community Living houses the Administration on Aging, which provides different benefits depending on the county but sometimes offers stipends, reimbursement for caregiver supplies, training and respite care. There are no explicitly stated guidelines on their website, other than what the program can offer to caregivers and was authorized through the Older Americans Act.

In Connecticut, Massachusetts, Rhode Island, Ohio and Indiana, a local agency on aging can refer patients to receive structured family caregiving (Caregiver Homes). Structured family caregiving provides financial and supportive services to caregivers. Indiana’s program operates through a benefit associated with their Aged and Disabled Medicaid Waiver. The program justifies the waiver based on the condition of the patient and the level of care needed. In this model, the state of Indiana pays the caregiver as well as an oversight agency for care. Caregivers can earn compensation from $946.11 to $2,501.80 per month and the oversight agency, or Caregiver Homes, is compensated $315.37 to $1,250.90 per month. The aforementioned states have similar program structures as all use Caregiver Homes.

In 2017, Hawaii enacted the Kupuna Caregivers Assistance Act, HB607. The measure provides up to $70 per day worth of services for a caregiver who assists a loved one over age 60 and is employed at another job for at least 30 hours a week. Money flows directly to the providers for services such as respite care, adult day care, home-delivered meals, homemaker services, transportation and personal assistance. Recipients are not eligible if they live in a long-term care facility or they receive comparable help from Medicaid. No income criteria are established within this act. However, eligibility requirements based on condition of the care recipient were established. Hawaii’s program is administered through their executive office on aging and is being implemented through the area agencies on aging.

Washington, California, Rhode Island, New Jersey, New York and the District of Columbia require employers to provide paid family leave for employees who must take time off to care for sick or disabled family members.

Illinois and Georgia established flexibility for public- and private-sector employees to use existing paid leave to care for themselves or a loved one.

A variety of tax credits also exist for caregivers for elderly people with developmental disabilities. The federal Child and Dependent Care Tax Credit, or CDCTC, is open to individuals who pay a provider to care for their child or another dependent. Twenty-one states offer, or have offered, the credit. Four more states—Idaho, Missouri, Montana, and North Dakota—offer tax credits similar to the CDCTC however they focus on elderly individuals in a broad sense.

States are looking for ways to increase their citizen’s longevity while maintaining their financial wellbeing when they utilize a service that is not getting any cheaper. Unique and innovative solutions to the issue will only begin to increase in number as America’s population continues to age.