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A Milken Institute publication says workforce shortages and Medicaid cuts threaten access to in-home care, potentially leaving more care responsibilities to family members. The report’s contributors call for stronger payment systems and coordination across health care and community services; the scale and effects of proposed cuts are not detailed in the source report.
The Milken Institute’s Future of Aging and Longevity team published a report on Oct. 20 warning that home-care worker shortages and Medicaid cuts could make it harder for older adults to receive care at home, shifting more responsibility to relatives. The report’s contributors call for stronger payment frameworks and better coordination among health systems, community organizations and families.
The publication, titled A Decade of Progress, A Decade to Act, gathers essays and perspectives on systems needed to support longer lives. Diane Ty, managing director of the institute’s Future of Aging and Longevity team, said that even people able to pay for a caregiver may have difficulty finding one, with shortages particularly acute in some areas. She said those gaps are leaving families to provide more care.
Ty said family members may have to reduce paid work hours or leave jobs when paid care is unavailable. That can affect current household income, retirement contributions and future Social Security benefits. She also warned that Medicaid cuts could intensify those choices. The source report does not specify the amount, timing or provisions of the cuts it discusses.
One essay in the publication, by The SCAN Foundation President and CEO Sarita Mohanty and Kaiser Permanente physician leader Kapil Dhingra, argues that aging care should be treated as essential public infrastructure. Their proposals include making long-term care more affordable and available at home and improving coordination for people enrolled in both Medicare and Medicaid.
How Care Gaps Affect Family Finances
The strain described in the report extends beyond the immediate work of caregiving. When relatives fill gaps in paid services, some may lose wages or reduce the time available for their own careers. Ty said leaving employment can also reduce retirement contributions and future Social Security benefits, creating financial effects that may continue after a period of intensive care.
The report also points to potential consequences for public finances. Ty said that if family caregivers cut back on paid work, governments could collect less tax revenue. These are risks described by the report’s contributors, not quantified projections: the supplied source gives no estimate of how many workers might leave jobs or how much revenue could be lost.
Caregiving responsibilities can reach younger people as well. An essay by National Alliance for Caregiving President and CEO Jason Resendez and Vanderbilt University School of Nursing Assistant Dean for Student Affairs Feylyn Lewis says about 4 million U.S. children under 18 are family caregivers, while another 5 million young people balance caregiving with postsecondary education. The figures are presented in the report’s essay; the source does not provide further detail on how they were measured.
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The Report’s Proposed Care Model
The institute’s report brings together essays and practitioner perspectives on how systems can respond to longer lives. Its central policy argument is that care at home depends on more than the availability of individual workers: it also needs payment arrangements and coordination that connect clinical services with support in people’s communities.
Mohanty and Dhingra cite the Program of All-Inclusive Care for the Elderly (PACE) as an example. The federal program provides nursing-home-level care to older adults in their homes and communities. The two authors say participants can live longer, healthier and more meaningful lives. That is their characterization of the program; the supplied report does not provide outcome data or comparisons.
For broader home- and community-based care, the authors call for payment systems that reward whole-person outcomes rather than service volume, better data sharing between health systems and community organizations, and greater involvement of families in shaping services. Ty said an immigration crackdown by the federal government has exacerbated existing labor shortages. The source does not quantify that effect or provide a breakdown by region or occupation.
““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
Details on Cuts and Shortages
The source report does not specify which Medicaid provisions or reductions are meant, when they would take effect, or how many people’s services could be affected. It also does not quantify the size of the home-care workforce shortfall or identify which locations face the greatest difficulty finding paid caregivers.
The publication presents risks and policy recommendations rather than a measured forecast of how many families will take on additional care, reduce their work or lose access to services. The figures on young caregivers are cited in an essay, but the supplied material does not explain their underlying data or methodology. The extent to which proposed changes would ease access to care is also not established.
Policy Changes Remain Ahead
The report’s recommendations call for coordinated action across payment policy, health systems and community services. Mohanty and Dhingra advocate better data sharing and payment models that account for outcomes across a person’s care, while Ty said the goal should be to expand such approaches over the next decade.
The source material does not identify a specific bill, agency decision or implementation schedule tied to these proposals. The next developments to watch are how Medicaid policy changes are defined and carried out, whether states and providers expand home- and community-based services, and whether new funding and coordination systems address the workforce gaps described by the report.
Key Questions
What did the Milken Institute report say?
The report said caregiver shortages and Medicaid cuts threaten access to home-based care and could shift more responsibilities to families. It calls for stronger payment frameworks and better coordination among care providers and community organizations.
How could families be affected?
According to Diane Ty, relatives may need to provide more care when paid workers are unavailable. Some caregivers could reduce work hours or leave jobs, affecting wages, retirement contributions and future Social Security benefits.
Did the report specify the Medicaid cuts?
No. The supplied source refers to Medicaid cuts but does not identify the provisions, amounts, timing or number of people who could be affected.
What solutions did the report’s contributors propose?
They called for affordable home and long-term care, improved coordination for people enrolled in Medicare and Medicaid, better data sharing, and payment systems that reward whole-person outcomes.
Source: homehealthcarenews.com
