TL;DR
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A Milken Institute publication says home-care workforce shortages and Medicaid cuts threaten older adults’ access to care at home and could leave families filling gaps. Caregivers may reduce paid work, affecting household income, retirement savings and tax revenue; the publication calls for coordinated policy and payment reforms.
A Milken Institute publication issued Oct. 20 warns that shortages of paid home-care workers, combined with Medicaid cuts, could leave more families responsible for supporting older adults at home. The report’s contributors say the gaps may force relatives to cut back on paid work or leave jobs, with consequences for household finances and access to care.
The publication, A Decade of Progress, A Decade to Act, brings together essays and perspectives from people working in aging and care. Diane Ty, managing director of the institute’s Future of Aging and Longevity team, said shortages affect some areas more severely than others, limiting access even for households able to pay for help. She said family members are already absorbing some of the unmet need.
Ty said gaps in paid care can require relatives to reduce their hours or stop working. That can affect current earnings as well as retirement contributions and future Social Security benefits. She also warned that Medicaid cuts could intensify these choices for families facing affordability pressures. These are risks described by the publication’s contributors; the source material does not quantify how many households would be affected or the size of any resulting employment changes.
The report also highlights caregiving by young people. An essay by National Alliance for Caregiving President and CEO Jason Resendez and Vanderbilt University School of Nursing Assistant Dean Feylyn Lewis says about 4 million U.S. children under 18 are family caregivers, while another 5 million young people combine caregiving with postsecondary education. The figures are presented in the essay; the source material does not specify a measurement date or methodology.
How Care Gaps Affect Family Finances
The issue reaches beyond the availability of home-care visits. When paid services are unavailable or unaffordable, family members may take on more hours of hands-on support, potentially changing whether they can keep full-time work, maintain income or contribute to retirement plans. Ty also said reduced employment could mean lower tax revenue for governments, though the report does not estimate the fiscal effect.
For older adults, the availability of coordinated home and community services affects whether living at home is a workable option. The report argues that care systems need to support both older people and the relatives who help them. Without that support, families may face difficult trade-offs between caregiving and employment, while young caregivers may be balancing those duties with school or further education.
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The Report’s Proposed Care Framework
The Milken Institute is a nonprofit, nonpartisan economic think tank based in Santa Monica, California. Its Future of Aging and Longevity team published the report on Oct. 20, 2026, collecting essays on systems needed to support longer lives. The source report identifies workforce constraints and Medicaid cuts as threats to home-based care, while Ty said federal immigration enforcement has worsened existing labor shortages. That assessment is attributed to Ty; the material provides no workforce figures or separate analysis of the policy’s effect.
In an essay in the publication, Sarita Mohanty, president and CEO of The SCAN Foundation, and physician leader Kapil Dhingra of Kaiser Permanente argue that aging care should be treated as essential public infrastructure. They point to the federal Program of All-Inclusive Care for the Elderly (PACE), which provides nursing-home-level care in home and community settings, as an example of connecting health services with community support. The authors say participants live longer, healthier and more meaningful lives; that is their characterization in the essay.
Mohanty and Dhingra call for payment systems that reward whole-person outcomes rather than the volume of services, stronger data sharing between health systems and community organizations, and a role for families in shaping services. Ty argues that addressing the pressures requires coordinated policy and systems change rather than isolated reforms.
““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 the Coming Care Gaps
The publication warns of potential effects but does not provide a forecast of how many older adults could lose or lack home-based services, how many family members might reduce their work hours, or how large the impact of Medicaid cuts would be. The supplied material also does not detail the specific Medicaid provisions or their implementation timelines. It is therefore unclear how the risks described will vary by state, community or household.
Ty attributes part of the workforce pressure to federal immigration enforcement, but the source material does not quantify that contribution or establish how it compares with other causes of staffing shortages. The report’s cited figures for young caregivers are not accompanied in the supplied material by a survey date or methodology. The authors’ claims about PACE outcomes are also not paired with specific outcome measures here.
Policy Changes and Care Access
The publication’s proposed direction is expanded home- and community-based care, payment models tied to whole-person outcomes, better information sharing among health and community providers, and meaningful input from families. Ty said the task is to scale such approaches over the next decade through systems and policy changes. The source material does not identify a specific legislative timetable, funding commitment or government action tied to the report.
Whether those proposals advance, and whether they offset worker shortages or Medicaid-related pressures, remains to be seen. Further details about Medicaid changes, local staffing levels and access to programs such as PACE would help show how the risks differ across communities.
Key Questions
What did the Milken Institute publication say?
It warned that home-care worker shortages and Medicaid cuts could threaten access to care at home and shift more responsibility to families. The publication calls for stronger payment frameworks and better coordination of care.
How could family caregivers be affected?
According to Diane Ty, relatives may need to reduce work hours or leave jobs when paid care is unavailable. That could affect household earnings, retirement contributions and future Social Security benefits.
What role do young caregivers have?
An essay in the report says about 4 million U.S. children under 18 are family caregivers and another 5 million young people balance caregiving with postsecondary education. The supplied material does not give the figures’ measurement date or methodology.
What changes do the report’s contributors propose?
They call for payment approaches that reward whole-person outcomes, stronger data sharing between health systems and community organizations, and greater family involvement in service design. They also point to PACE as an example of combining care at home and in the community.
Are the effects of Medicaid cuts already quantified?
No. The source material describes possible pressures but does not quantify how many families may be affected, specify the Medicaid provisions at issue or give a timeline for their effects.
Source: homehealthcarenews.com
