Caring for Elderly Parents

hand of a young and an old person Nearly 25 million American workers provide informal care for an elderly family member or friend who needs help with basic personal needs and daily activities. This number will probably grow as the post-World War II baby boomers – all 76 million of them – continue to age. Yet cobbling together time off from work is a real challenge for many caregivers. Some don’t have sufficient leave or the ability to take it when they need it. Others simply can’t afford to take leave without pay. Without job protections, others risk losing their jobs if they take time off to deal with these common caregiving demands. Three states – California, New Jersey and Rhode Island – have paid family leave programs for workers who are temporarily disabled, or bonding with new children (sometimes called parental leave), and for workers caring for elderly parents and other family members. New York will join them in 2018. These are important policies: workers receive more financial security, and employers could benefit from, lower staff turnover or other business factors. Chart showing comparison of paid family leave programs in California, Rhode Island and New Jersey, as well as what is permitted under the Family and Medical Leave Act (unpaid) The Department of Labor has released two research briefs from ongoing commissioned studies examining these programs and how they are working, especially for workers caring for elderly parents. One brief reports that more than 230,000 workers a year receive paid leave benefits in these three states under the programs. The researchers also explain that family leave benefits for eldercare comprise a small share of overall family leave. For example, in California, 90 percent or more of those receiving state paid family leave benefits do so for bonding with a new child, and less than 10 percent are caring for a family member. This is surprising given the number of working Americans who report caring for an elderly parent, and an issue on which additional research is needed. The surprisingly low take-up may be related to a general lack of awareness. A second brief, based on discussions with working caregivers in several communities in California, New Jersey and Rhode Island, explains there is low awareness of paid family leave programs, and confusion about the benefits provided and how they interact with other kinds of leave. For example, many workers in the discussion groups didn’t understand the differences between an employer’s leave benefits, the state paid leave programs, and the federal program Family and Medical Leave Act, which provides for unpaid, but job-protected, leave. These findings confirm those from earlier research, which found that over 50 percent of California workers did not know about the program two years after it started. And a nationwide survey in 2011  found that while about two-thirds of U.S. workers had heard of the FMLA, many were not sure about eligibility and benefits. While program awareness and understanding seems relatively low, when caregivers in the discussion groups heard about what the programs offered, nearly all said the benefits would be valuable to them and their families. One person quoted in the brief said, “It’s hard enough to know you have to take care of someone, and now you won’t have to have the worry of losing your job or losing money.” Several workers in the group who were caring for an elderly parent also mentioned their reluctance to tell employers they were taking time off to provide eldercare, let alone apply for paid family leave benefits, because they worried about repercussions at work. The experiences in states that have made paid family leave a reality provide an important policy lesson: The number of workers using the benefits is growing, but the programs may be underused in part because many workers don’t know about them. Getting the word out more broadly could have short and long-term benefits for both workers and employers. Dr. Demetra Smith Nightingale is the department’s chief evaluation officer. Dr. Christina Yancey is a senior evaluation specialist. For more information on the latest research on worker leave from the department’s Chief Evaluation Office, see

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I have read about how the program works in these different states. Far from being a hand out, employees pay into an insurance plan much like paying for disability insurance or life insurance or cancer policies through work. Leave time and plan payouts are capped like with other types of safety net insurance plans. Employees return to their jobs when able or when the plan caps are reached. Employers get to retain their employees instead of starting over from scratch finding the right talent to fulfill the employer's work. Often times small businesses with fewer than 20 or even 100 employees are exempt from labor rules that apply to larger businesses. For example, businesses with fewer than 20 employees do not have to provide COBRA when an employee has a qualifying event that triggers COBRA.

What do businesses of all sizes do when employees are sick or unable to work temporarily? Employment agencies exist for filling employer needs in either temporary help, contractual help, or long term permanent positions. I have worked a few jobs as a long term temp employee covering for people who were out on disability, extended leave or off serving our country in the military. In these cases I knew I was replacing an employee on a temporary basis. I benefited from a paycheck and they benefited from knowing they were returning to their job rather than unemployment. It's cheaper in the long run to retain trained and experienced employees even if there is a temporary leave of absence.

Thankfully now, I'm a permanent employee now with benefits. In the past year I've been in and out of the hospital numerous times with both my elderly parents, once for 30 days. At first I was blowing through my paid time off which concerned me and my employer. My employer offered the option to work remotely so I could stay looped in. It benefited them and it saved me from using all my time off. I'm thankful the nature of my job allows this as I can stay on top of work while in the hospital with my parent(s), get paid my full salary, and be available to advocate for my parent(s) as they lie in hospital beds often unable to clearly communicate to medical staff. However, it has been the MOST draining experience mentally, emotionally, and physically. If I could have even just taken 3 weeks of paid family leave, it would have alleviated some of the stress.

Employees pay into plans and programs for a reason. If ever needed, we know we can get unemployment pay when in between jobs because we paid into the system. We pay our share of Medicare while working so it's there for us when we need it later in life when we need to use it. We pay into Social Security while working so it's there for us when we need it to supplement our income in our old age (I won't say retirement because many of us won't be able to retire). We pay into health insurance, life insurance, cancer policies, auto insurance, home insurance etc... so it's there when we need it. Paid family leave where employees pay a share out of their paycheck to have a plan in place in case they need no different.

Patty, I can understand your loss as I lost my Dad to Cancer and stayed with him during the final month. I am also a caretaker for my Mom. But I must disagree with your philosophy that all states should adopt programs like California. Do you not see the problem and discrimination? You CAN'T provide leave for every working American because small business CAN'T replace it's workforce with temps, or other experts. Have you not examined the stats for small business in the US. Sure a large company or government entity can give paid leave, but you can't arrange for that in small business throughout the US - that frankly is unworkable. And if that is the case you are building a group of elitists - those with weeks of paid leave against those without it. You create unfair competition among large and small business, and you create basically an impossible situation for small business (over 20M workers in the US). So as nice as it is for you to have paid leave, and maybe others in your situation... that is elitist benefit and if you want to have that than you must see the problems that will create in the US.

How about tax credits as an incentive for any size business? The tax credit would have stipulations requiring job protection and a provision for lost wage benefits to the employee/caregiver. The tax credit would also offset the cost for the employer to hire temporary help during the caregiver's absence. Therefore, no need for FMLA/CFRA and that would be a happy solution for everyone, including overworked, understaffed HR departments! .

Buisness not running well is most common phenamona.but if security for elderly parents without minding buisness is best care.elderly wants very little ,that care can be affordable if Labour commission make a rule for elderly care.

Did you read the brief on the California experience? It has a section about effects on employers, and specifically addresses effects on small businesses.

Here it comes... the continued mass attack on small business and the way of life in the US. Elitists such as Smith Nightingale and Yancey somehow think that all of this leave can work for business in America. They somehow miss the data from their own census bureau 20M people working in companies with 10 or fewer employees, or other pertinent facts about small business. I've asked this question on this blog at least 3 times. In a small company with 3-5 employees (let's say it's a plumbing shop) and the plumber, book-keeper and plumber's assistant want to go out on some paid leave, how does that business stay in business. The reason people like Smith Nightingale, Yancey, and others don't respond to this very question is because leave for these people is unworkable. And it would threaten millions of small business in the US. But I actually they don't care about those businesses. They mean nothing to these people. They see the US through some governmental, big company, large entity glass that doesn't reflect the real world of working. They don't see the local hard ware store, the local restaurant, the local artisan contractor. And I could go on for paragraphs on why this whole leave thing for small business is a waste of discussion. I'm preparing for the Elitists to go full force on paid leave in the years to come and with it we will see America transform away from the small business values that have built this country. Goodbye America - we will miss you.

The Paid Family Leave program in California actually does not cost businesses any money. It is run like a state disability insurance program with the employee paying in a percentage of their wages to underwrite the cost. So the program does not cost the employer, or the state, anything, other than the protected time off for the employee. Now we could have conversations about all the other costs California and the Federal government has burdened large and small employers with, but Paid Family Leave is not one of those.

Leeana, with respect to your cost comments in California - I appreciate and agree with you. My point is less about the cost of a paid leave program, and more about an elitist attitude towards small business and this program. Some (Rebecca) suggest finding "temporary workers." That's easy to say... but when you have one or two employees who are specialists at what they do. Rebecca, where do you just pick up a qualified Butcher, or Cook, or Carpenter, or Electrician, or specialty Machinist, or any number of thousands experts in a particular geographic area that participate in small business. And I'm not even getting into small towns in the US. Again, this paid leave might work in the elitists' mind because they haven't experienced the US... the small towns, the small business, and I could go on. Again, if you make a law for employees that work at a company with "50 or more employees," you are discriminating against those that work for companies less than 50 employees. Therefore you can't put a law into place for 12 weeks of paid leave for every US worker. And if it's unworkable for most small businesses, you can't make a national law that allows it for some people and not others. And since it's unworkable for small business... well I hope some here get my point.

Sure you could patch something together in a small company to make it work, but that instantly puts the small business at a disadvantage to larger companies. You see (Rebecca), hiring temporary experts costs a lot of money and time. And you have to train people to do things as they are at a particular small business. My point to anyone talking about the costs of paid leave, and the "lack of impact on small business" obviously has zero real small business experience.

People making decisions in a bubble are blind to the 20M plus workers in this country that work in small business, small towns, and other like environments. For those of you that think that small business is "exempt" from the law... think hard about what you are suggesting. A law for 12 weeks of paid leave for Americans should be for everyone - not just those that work at employers with 50 + employees. And if you can't actually give 12 weeks of time off for everyone, you are discriminating against a huge block of Americans. Wake up people - this is completely unworkable for most small businesses.

I'm unsure of your argument. Are you saying that the Federal government should abolish FMLA, because it might destroy small businesses that employ specialist?

Temporary workers may be an option for small businesses.

The benefits seem to be available to employees of employers that have 50 or more employees, or are public sector.

Hopefully it won't affect small business. Currently it only applies to employers with 75 or more employees. i don't see it going away. Having had to care for both my parents (now both deceased) we are seeing more and more with people living longer, it is needed for many more people. I am lucky to have an employer that is very flexible so it wasn't a hardship. I can't imagine worrying about my parents AND possibly losing my job in order to care for them.

Wow. Where are you moving to? Seriously. Do you really think a state like South Dakota cares enough about its older citizens or its employees to pass something like this and if it did, it would apply to businesses with 3-5 employees? I think not.

Amen, I am in the same situation. I work as full charge bookkeeper in a small company with 10 people. As wonderful as this company is, they can't afford to pay me for "leave". They try to work with me when I have to be off with my husband, and they give me vacation and sick time. But, when that runs out, they need me there on the job. In my position, they can't just get a temporary to fill in. I love where I work. Small Businesses are the back bone of America.

Who is going to pay for those taking the leave? It is easy for Washington bureaucrats to mandate to business what they can and cannot do. Each mandate eventually causes someone to either be let go or not hired because of the expense.

I don't know about New Jersey and Rhode Island laws but in California your scenario about the plumbing company with only 3 employees is incorrect since FMLA and CFRA only apply to a business with at least 50 or more employees. Further, the employee must have worked 1250 hours in a 12 month period to receive this benefit.

CA HR, with respect, I'm not discussing the laws as they exist or will exist for 12 weeks of paid leave or some effort by the government to institute. I'm talking about whether it's workable for small business. If you haven't worked in a small business or have friends, family, or know others in a small business, why don't you ask them about something like this. How about the three person deli that all of sudden one of the employees wants 12 weeks or paid leave, or what if two ask at the same time. That is unworkable! And no matter how you share the legal (50 employees issue), you are not actually discussing the discrimination against the 20M workers in small business who WILL NOT receive this fantasy, socialist agenda 12 weeks of paid leave for ALL Americans. Unless you are suggesting that we eliminate small business?

How is it a socialist agenda when the employee pays for it out of their paycheck like they pay for disability, social security, medicare, and other insurance programs? Also, the exemption for small businesses are in place not to discriminate against some Americans but to protect small businesses from having to shoulder burdens that larger employer groups can adequately afford. Often religious organizations are exempt too and sometimes non-profit. I'm sensing this argument is not about the true goal of helping as many Americans as possible but rather just whining about "Elitists" (I'd like the definition of this bad bunch of folks please). I'm getting confused by the argument because on one hand it's unfair for small businesses (who are exempt) but then it's unfair because being exempt means the elitist are discriminating against small business owners and their employees?

I learned that my mother had several diseases including dementia which caused her death. I learned that in 2010. I could not return to work for doctors appointments, chemo treatments, dialysis treatment, and other medical conditions. I continued to do so until February 2016 when she expired. Now that she is gone employers view my resume, and the answer I received is that the problem with my resume is that I've aged out. Meaning that since being employed for over 19 years, they would be paying for health insurance more than a salary. Not old enough to retire (59), and too old to hire. All my resources were sponged away caring for my mom and my own medical expenses. Reside in the great state of Florida. No medical assistance, no Medicaid, practically sleeping on the streets.

Sorry to hear that.. That's really sad deal I don't understand why anyone would do that to someone that needs to go back to work.. It's all because they want these younger people to be there and the younger ones don't even want to work. SHAME ON THEM!!!!

"Nearly 25 million American workers provide informal care for an elderly family member or friend who needs help with basic personal needs and daily activities."

I'm curious to know where the writers of this article are getting their statistics.

The Family Caregiver Alliance (as well as AARP and the National Alliance for Caregiving) estimate the number of unpaid (i.e., informal) caregivers in the United States to be 43.5 MILLION (

This blog post, like the underlying research brief, ignores the fact that CA, NJ, and RI have their own family leave laws, which do provide job protection. The NJ Family Leave Act provides 12 weeks of job-protected leave in a 24-month period, requires only 1,000 hours of service in the past year (FMLA requires 1250) and covers employers with 50 employees worldwide, not just within a 75-mile radius.

The creeping ruin of the American Dream! Wake Up America and become the hard working nation that refuses a hand out before it's too late!!

ESBLO. congratulations on being a permanent employees. I too have had to deal with multiple hospitalizations for my Mom and I am her caregiver. I admire your dedication to family. However, I must disagree with your interpretation of providing 12 weeks of paid leave. You are missing the most important point of this. A temp agency can't just replace experts or others that are specific for small business. I'm afraid it is different for small business and if you want Americans to have 12 weeks of paid leave then you have to have it for everyone. And I'm sorry to disagree, small business can't just turn to a temp agency for a highly qualified Butcher, or Chef, or any list of thousands of experts needed in small business.

I understand some employees are too skilled to be replaced by temps. However, there are a lot of skilled people out there looking for work who would be willing to take a temp assignment if the opportunity presented itself. What would an employer do if the highly skilled butcher or chef had to actually quit to take care of family? Or the highly skilled plumber or contractor or carpenter or mechanic? Wouldn't a small business prefer to know their highly skilled employee - who they invested time and energy in - will return to their business at the end of a set time-period? Don't assume everyone would take 12 weeks - maybe someone needs just 3 weeks or 4. Or would it be better for the employer to just hire someone new and retrain that person and hope they get up to the level of the highly skilled employee who is on temporary leave? There's no one-size fits all answer as life is complex. Either way the small business owner is screwed if the highly skilled employee quits to be a caregiver. Seems to me it's better in the long run for both the employer and the employee and quite possibly, the other person out there who could step in and provide needed support even if for a short time. What about those workers? As a previous temp worked, I was highly skilled person looking for a permanent job. It was extremely frustrating that I couldn't find it for a long time. In my experience, the two employers hired lots of temps because in one case, it was cheaper and they didn't have to pay insurance for us and in the other case, two employees were out on disability (under fraud I might add). I worked in a pharmaceutical plant and product lab testing company - we worked in highly skilled environments and had to follow ISO regulations. We weren't stuffing envelopes, filing, or dishwashing.

I work 50 to 60 hours a week, care for two aging parents, as well as my younger brother, since he suffered a stroke last March. I will, at some point, need to take a break. I haven't used any family leave yet, but I'll sure be grateful it's there when I need it.

The California Paid Family Leave replaced part of my salary for six weeks while I cared for my dying mother in 2014. My sister from Tennessee came to California to help care for mom when my six weeks of PFL ended until mom's death about a month later. My sister suffered financially because she was eligible only for Federal FMLA. I think all states should adopt programs like California's Paid Family Leave which is paid for by employees through a small payroll tax.

I am sad to see the adversarial content of some of the posts. This is not an effective way to find solutions to a difficult problem. SDVeteran writes as though the problem is someone else's.
The truth is, we all age, most of us face the death of our parents as they age and sometimes we have family members who need care. Family caregivers save the economy Billions of dollars each year in costs of care that would usually be otherwise paid by medicaid (ie the taxpayers) . This is a reality that we all should be contributing our efforts to finding a solution for. No one should have to lose a job because of the hard moral choice between caring for a loved one or not. No one should have to lose benefits, seniority or should end up poor because they have chosen to care for a family member in need. But the truth is, this is happening all over the country.
It is true that the backbone of the economy is small business, and living in a small rural community and running a small business, I agree that a paid family leave can be hard for a small employer. But we are all in this reality together. surely we can work together to come up with fair, dignified alternatives that work for everyone if we just put our minds to it! Surely we can support small businesses AND help caregivers to do what they need to do. Certainly a hostile tone that points fingers as if this is your problem and not mine is going to fail. TeamMD

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