Burden on Unpaid Family Caregivers Reaches Unprecedented Levels

A record number of Americans are now serving as unpaid caregivers for elderly friends or relatives. This crucial group is estimated to have reached 38.2 million people in 2024—representing about 14% of the adult population, according to the U.S. Bureau of Labor Statistics.

The pressure on caregivers is mounting due to a demographic and financial squeeze. The population segment requiring the most assistance—adults 85 and older—is projected to more than double, reaching 17.4 million by 2050. This massive increase, combined with the escalating cost of long-term care, places an unprecedented burden on family members.

As the ranks of unpaid caregivers swell, so too does the immense strain and demand on their time and resources.  In 2024, approximately 28% of caregivers provided eldercare on any given day, an increase from 24% a decade prior. Furthermore, the average daily time commitment has been increasing in both time and intensity, rising from 2.8 hours in 2014 to 3.9 hours today.

This upward trend underscores the mounting pressure on families as care needs expand and formal support systems struggle to keep pace. As life expectancy rises and the population of adults aged 65 and older grows faster than ever before, the responsibility for long-term care is increasingly shifting from professionals to family members.

The result is both a lifeline for millions of older and disabled Americans and a growing strain on those providing the care – particularly on older women, who make up more than one-third of caregivers for older adults.

Department of Labor data shows that nationwide, the average American woman aged 55 or older spends 182 hours per year tending to loved ones – the equivalent of a full-time job for five weeks of the year—but without pay or relief.

The human toll is steep. Research indicates caregivers are more likely to experience symptoms of depression and poor health overall compared to non-caregivers. Many are forced to reduce work hours or leave their jobs entirely, sacrificing wages, health insurance and retirement benefits in the process.

This burnout is more than a personal crisis – it’s a systemic one, threatening the sustainability of the informal care network that underpins much of the U.S. health care system. Economically, the stakes are immense: the value of unpaid family care is estimated at over $1.1 trillion annually, according to an analysis by the National Partnership for Women & Families nonprofit.

At the individual level, Americans over 50 can expect to receive the equivalent of $168,000 in unpaid family care as they age, Health and Human Services data shows.

Yet despite their vital role, family caregivers often receive little formal training, limited respite opportunities and uneven policy support across states. As demographic pressures intensify, these gaps are becoming more visible and more consequential.

To quantify this challenge, Seniorly, a CareScout company, analyzed state-level data to pinpoint where the burdens of family caregiving are heaviest and lightest across the nation.

By comparing factors such as caregiver prevalence, multigenerational households, access to respite services, home health affordability, and the availability of public support, the analysis reveals which states most rely on families to fill the caregiving gap – and where help is most urgently needed to sustain the nation’s invisible care workforce.

“The essential act of caregiving is one of the most profound responsibilities facing virtually every American family,” said Samir Shah, CEO of CareScout Services. “By mapping the geography of aging care strain, we can unlock the critical insight needed to strategically deploy the solutions and support that bolster independence and dignity for millions of older adults.”

Key Findings

• Washington Is the Most Burdened State: Driven by its high costs for adult day care ($193, #2 most expensive) and home health aides (annually, they cost 50% more than the median income for households with adults aged 65+). Montana, Oklahoma, New Mexico and Oregon round out the top five most burdened states.
• Delaware Is the Least Burdened State: Due in part to its highly affordable adult day care ($25, #1 cheapest). Missouri, Washington, D.C., Alaska and New Hampshire follow closely behind.
• None of America’s Biggest States Scored Well: Three of the five biggest states landed squarely in the middle of the pack: California (#27), Florida (#28) and Texas (#31), all of which have high numbers of multigenerational households. Caregivers bore an above-average burden in Pennsylvania (#8), where 79.8% of adults aged 50+ are caregivers, and in New York (#17), where adult day care is $113 per day.

Most Burdened States

Washington ranks as the most burdened state overall, followed closely by Montana in second place. Oklahoma comes in third, with New Mexico and Oregon rounding out the top five in fourth and fifth place, respectively.

In No. 1 Washington, hiring a home health aide for one year costs 50% more than the median income among households with people aged 65 or older ($96,096 to $63,963). It also has some of the most expensive adult day care in the country ($193 per day), second only to No. 5 Oregon ($202).

Meanwhile in No. 2 Montana, there are 2,776 people on the waiting list for Medicaid home-based services, compared to 7,100 enrollees – a ratio of 1:2.6, one of the lowest rates in the country.

No. 3 Oklahoma also has expensive adult day care ($171) and No. 4 New Mexico leans heavily on family caregivers, with 79.2% of adults aged 50 or older providing regular care.

Least Burdened States

Delaware ranks as the least burdened state overall at 51st, followed by Missouri in 50th place. Washington, D.C., comes in 49th, with Alaska and New Hampshire close behind in 48th and 47th place, respectively.

No. 51 Delaware has some of the most affordable annual home health aides – though those costs are still 19% higher than the median income for households that include someone aged 65 or older ($77,792 to $65,590). However, one day of adult day care is just $25, the lowest rate in the country.

In No. 50 Missouri, there is only one person on the waiting list for Medicaid home-based series for every 872.4 people actually receiving care, the best rate in the country by far (66,300 enrolled v. 76 on the waiting list).

Washington, D.C., is missing data for several metrics. However, it scores particularly well on both multigenerational households (just 2.2%) and home health costs relative to income among households with seniors (home health costs are 32% higher), which is why it landed 49th.

Top and Bottom States Across the Metrics

Compare how the top- and bottom-ranking states stack up across the five key metrics we used to determine the states that place the caregiving burden on families the most.

Family caregivers

The share of adults 50+ providing care shows how much unpaid caregiving families shoulder; lower is better, since a smaller share indicates the state provides more formal or institutional support.

Multigenerational homes

The share of households with multiple generations reflects how much families absorb care responsibilities at home; lower is better, suggesting less reliance on family networks due to stronger external support.

Home health aide affordability

 The ratio of home health care costs to seniors’ household income measures how financially accessible paid care is; lower is better, meaning home care is more affordable relative to income.

Respite care

The median daily cost of adult day care indicates how costly temporary relief for caregivers is; lower is better, as more affordable respite care eases the family caregiving burden.

Access to public services

 The ratio of people receiving Medicaid home-based care to those on waiting lists shows how effectively a state meets demand for public caregiving support; higher is better, since more people are actually getting services instead of waiting for them.

5 Tips to Support Family Caregivers

Plan for—and Schedule— Daily Respite Relief: Support caregivers to mandate a non-negotiable 30-minute daily reset. This time must be uninterrupted and dedicated solely to their mental and physical restoration. The responsibility for guaranteeing this coverage falls to family members, who must coordinate consistent backup support to ensure the 30-minute reprieve is never forfeited.

Leverage Community Support Systems: Connect caregivers with local respite programs, adult day care centers, or meal services before they are overwhelmed. The goal is to proactively reduce the daily care load using external, professional support structures.

Streamline the Administrative Load: The mental burden of managing logistics can be crippling, especially when paired with workforce demands and dependent caregiving. Set up a shared digital system (like a synchronized calendar or app) for appointments, medication schedules, and inventory tracking, and delegate the management of this system to a non-caregiving relative.

Enforce Structured Communication: Institute a mandatory, brief reguarly scheduled meeting (in-person or virtual) for the care circle focused on accountability. Use this time to clearly define roles, review financial burdens, and collaboratively solve problems, rather than letting stress accumulate.

Elevate the Caregiver’s Personal Health: The caregiver is part of the care plan. Schedule and protect the caregiver’s own routine medical, dental, and mental health appointments. Furthermore, ensure they schedule at least one social or recreational activity per week to maintain crucial social connections.

Conclusion

Understanding how caregiving responsibilities are distributed across the U.S. helps reveal where families need the most support – and could guide resources toward where they are needed most. For families, they highlight the everyday challenges and sacrifices involved in providing care, emphasizing the value of their contributions and the importance of ensuring those efforts are recognized and supported.

Methodology

We used the most recent data for five metrics to determine which states shift the caregiving burden onto families the most. We used a Z-score distribution to scale each metric relative to the mean across all 50 states and Washington, D.C., and capped outliers at +/-3.  We multiplied these scores by -1 if it was worse to have a lower rate, for example on waiting lists for Medicaid home-based care. A state’s overall ranking was calculated by averaging its Z-scores across all available metrics. If data for a particular metric was missing, the state’s ranking was based on the remaining metrics. Here’s a closer look at the metrics we used:

• Family caregivers: Share of adults 50+ who provided care for a family or friend in the past six months (Centers for Disease Control and Prevention, 2022)
• Multigenerational homes: Share of households that are multigenerational (Census Bureau, 2023)
• Home health aide affordability: Ratio of median annual home health care costs (Genworth-CareScout Cost of Care survey, 2024) to median income in households with someone age 65+ (Census Bureau, 2023)
• Respite care: Median daily cost of adult day care, a proxy for the affordability of respite care for family caregivers (Genworth Cost of Care survey, 2024)
• Access to public services: Ratio of people receiving Medicaid home-based care, relative to the number of people on the waiting list (KFF, 2023)