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A Milken Institute publication says shortages of paid home-care workers and Medicaid cuts threaten older adults’ access to care at home and may shift more responsibility to relatives. The report’s contributors call for stronger funding frameworks and coordination, while the scale and effects of any cuts remain unspecified in the source material.
The Milken Institute’s Future of Aging and Longevity team published a report on Oct. 20 warning that shortages of paid home-care workers and Medicaid cuts threaten older adults’ access to care at home and could leave families doing more. Contributors say relatives may have to reduce paid work or leave jobs, with consequences for household finances and future retirement benefits.
The publication, titled A Decade of Progress, A Decade to Act, brings together essays and practitioner perspectives on systems needed to support longer lives. Diane Ty, the institute team’s managing director, said worker shortages already leave some families to fill gaps in paid care. She said shortages vary by location and that federal immigration enforcement has worsened existing labor challenges; these are Ty’s assessments, not quantified findings presented in the source report.
Ty said family members who cut back their hours or leave employment can lose current income and reduce retirement contributions and future Social Security benefits. She also warned that Medicaid cuts could intensify the choices facing families already struggling with affordability. The source does not provide a dollar estimate, identify particular cuts, or quantify how many households would be affected.
An essay by Sarita Mohanty, president and CEO of The SCAN Foundation, and Kapil Dhingra, a physician leader at Kaiser Permanente, argues that aging care should be treated as essential public infrastructure. They call for affordable long-term care at home, better coordination for people covered by both Medicare and Medicaid, and payment systems that reward whole-person outcomes rather than service volume. They also call for stronger data sharing between health systems and community organizations and for caregivers to help shape services.
Families Face Work and Income Trade-Offs
The concern extends beyond the immediate hours spent providing care. If paid services are unavailable or unaffordable, relatives may have to rearrange work, take unpaid time off, or stop working. Ty said those choices can affect household earnings now and retirement security later. They may also reduce tax revenue if family caregivers leave paid employment, she said.
The report’s contributors describe effects on 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 cites approximately 4 million U.S. children under 18 who are family caregivers, and another 5 million young people who balance caregiving with postsecondary education. Those figures are reported in the essay; the source material does not specify their measurement date or methodology.
These pressures connect older adults’ access to care with families’ ability to maintain jobs and education. The report argues that planning for aging at home requires more than a supply of workers: payment arrangements and coordination also shape whether care can be delivered consistently.
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Report Calls for Coordinated Care
The Milken Institute is a nonprofit, nonpartisan economic think tank based in Santa Monica, California. Its Oct. 20 publication gathers perspectives on how systems can respond to longer lives. The source material presents the concern as a policy and service-access issue, rather than announcing a new program or a specific change to Medicaid.
Mohanty and Dhingra point to the federal Program of All-Inclusive Care for the Elderly (PACE) as an example of connecting care delivery with community support. PACE provides older adults with nursing-home-level care in their homes and communities. The authors say participants live longer, healthier and more meaningful lives; the report excerpt does not provide supporting outcome data or details on the program’s reach.
The authors argue that integrated home- and community-based care needs payment frameworks that support outcomes, information sharing across providers and community organizations, and a role for family caregivers in service design. Ty said piecemeal reforms are not enough and called for a wider systems and policy response over the coming decade.
Scope of Cuts and Shortages
The source material does not specify which Medicaid cuts are at issue, when they would take effect, or how they would change eligibility, benefits or provider payments. It also gives no nationwide measure of home-care worker shortages or estimate of how many older adults and families could lose or lack services.
Ty attributes worsening labor shortages in part to federal immigration enforcement, but the material does not quantify that effect or provide independent evidence separating it from other causes. The cited figures on young caregivers are not accompanied in the excerpt by a survey date or methodology. The scale of the resulting employment, income and care-access effects remains unclear.
Policy and Payment Changes Ahead
The report’s contributors are calling for broader policy and systems changes, including stronger payment arrangements for home- and community-based care, improved coordination for people enrolled in both Medicare and Medicaid, and better data sharing between health systems and community organizations. The publication does not announce a specific legislative proposal, funding commitment or implementation schedule.
The effects of Medicaid changes and workforce availability will depend on the policies adopted and local access to paid care. The source material does not identify a next official decision or report date. For now, the proposed direction is a longer-term effort to expand coordinated care and include families in planning services.
Key Questions
What did the Milken Institute report say?
Its Future of Aging and Longevity team said home-care worker shortages and Medicaid cuts threaten access to care at home and may push more responsibility onto family caregivers. The publication also calls for stronger payment and care-coordination systems.
How could families be affected?
According to Diane Ty, relatives may need to reduce paid work or leave jobs when paid care is unavailable. That can affect current household income, retirement contributions and future Social Security benefits.
Does the report identify specific Medicaid cuts?
No. The source material warns that cuts could intensify family pressures but does not name particular provisions, amounts, effective dates or affected groups.
What is PACE?
The Program of All-Inclusive Care for the Elderly is a federal program that offers older adults nursing-home-level care in their homes and communities. The report’s essay authors cite it as an example of linking care delivery with community support.
What changes do the report’s contributors recommend?
They call for payment systems that reward whole-person outcomes, stronger coordination and data sharing across care providers, and a role for family caregivers in shaping services. No specific policy proposal or implementation timetable is included in the source material.
Source: rss
