Use of Paid Family Care in the Community: National Trends Among Older Adults With Functional Impairment, 2011–2022

Objectives

Paying family caregivers (eg, children, friends) is an innovative approach to support older adults in the community and ease direct care workforce shortages. Yet, data about the receipt of paid family care are lacking. In this study, we used a nationally representative sample of Medicare beneficiaries to (1) identify characteristics associated with receipt of paid family care in 2022, and (2) describe national trends in receipt of paid family care between 2011 and 2022.

Design

Cross-sectional study and time trend analysis.

Setting and Participants

Community-dwelling participants in the National Health and Aging Trends Study (NHATS) who reported receiving help with self-care and mobility tasks between 2011 and 2022.

Methods

We compared characteristics among those who received paid family care (vs paid nonfamily care) in 2022. We examined trends in use and hours of paid family between 2011 and 2022 using the Mann-Kendall Trend test.

Results

Of the 941 older adults who reported help with self-care or indoor mobility tasks in 2022, 30% received paid care. Of those, 28.8% received paid family (8.1% of the overall sample). This group was more likely than those with paid nonfamily care to be Medicaid-enrolled (62.5% vs 33.1%, P < .001) and have more living children (3.36 vs 2.53, P > .001). There were no significant trends in the proportion of older adults receiving paid family care between 2011 and 2022 (range from 5.9% to 8.8%). Yet during this time, hours of paid care received decreased among those with paid nonfamily care (P = .005).

Conclusions and Implications

A substantial subgroup of older Medicare beneficiaries, including both those with and without Medicaid, received paid family care between 2011 and 2022. Especially given direct care workforce shortages, evidence-based expansion of models of paid family care is an important approach to meet the care needs of older adults living in the community.