America is facing a growing crisis in senior care—one that millions of families are already living through. Adult children are caring for aging parents while balancing careers, raising children, and managing rising costs. For many families, the combined costs and demands are simply unmanageable.
In-home care—which most seniors strongly prefer—is becoming harder to access. Full-time support can cost tens of thousands of dollars a year, and even part-time help is often out of reach. To make things worse, rigid regulations have made it more difficult for families to find options that fit their needs.
As a result, families face impossible tradeoffs and are often forced into undesirable choices. Some leave the workforce. Others piece together off-the-books arrangements that lack legal protection and leave both families and caretakers vulnerable. Still others turn to institutional care—not because they think it’s the best option, but because it’s the only one available.
Over the past several months, through the AMAC/Independent Women joint “Aging at Home, Living with Dignity” storytelling campaign, we’ve heard directly from families navigating these challenges. A social worker who left her job to care for a loved one. A daughter in a rural community struggling to find any reliable help at all.
It’s important to recognize that seniors with significant medical needs should be cared for by trained medical professionals. But a large—and growing—number of older Americans don’t require intensive medical care. They simply need help with daily activities, companionship, and the ability to remain safely in their homes.
Too often, the rigidity of the system pushes these families toward more expensive or less desirable options. We can, and should, take a more practical approach.
Recent efforts to revisit the 2013 Home Care Rule are an important step in the right direction. By narrowing the “companionship exemption” under the Fair Labor Standards Act, the rule has made it harder for families to find flexible, in-home help. Restoring the exemption to its previous scope would expand access to the kind of support many seniors actually need.
Congress is now considering competing approaches. Legislation introduced by Alexandria Ocasio-Cortez would effectively lock in the existing Obama-era framework, cementing a system that has already made care less flexible and more expensive for many families. By contrast, legislation led by Mary Miller would roll back those restrictions and codify reforms proposed under the Trump administration to expand access to affordable, in-home support.
Regulatory reform, while important, cannot fully address the challenges families face in caring for loved ones. In addition to these policy changes, we also need to expand the pipeline of caregivers and rethink how we connect them with families who need help.
One promising path is to build on a model that already works: the au pair program. Today, it connects young people from abroad with American families to provide childcare in exchange for room, board, and cultural exchange. There is a strong case for adapting this model to support seniors who need non-medical, in-home assistance.
An “au pair for seniors” approach could expand access to live-in companionship, provide families with more flexible and affordable options, and allow more older Americans to age in place with dignity. It would also offer participants a meaningful experience rooted in community and service.
At the same time, policymakers should pursue domestic solutions that build on the successful elements of the au pair program while adapting the model to expand its reach. An American Caregiver Program—modeled on similar principles—could connect U.S. caregivers with seniors in need of support and enable them to exchange a place to live for companionship and care work. In addition to expanding care options, this approach could help address another pressing challenge: housing affordability. These are practical, testable ideas. Pilot programs—run through states, universities, or private partners—would allow the model to be refined, evaluated, and scaled.
We should also give families more flexibility in how they pay for care. Expanding access to tax-advantaged tools like health savings accounts and flexible spending accounts for caregiving expenses would provide meaningful relief and allow families to make decisions based on their needs.
Earlier this year, AMAC and Independent Women hosted a national webinar to discuss these challenges and explore solutions with engaged members across the country. The response was clear: Families are looking for options, not a one-size-fits-none mandate.
Building new layers of bureaucracy will not address America’s senior care challenges. Rather, we must remove barriers that limit access to care. We must expand the range of care available and trust families to make the decisions that are right for them.
That means finalizing and codifying sensible regulatory reforms, expanding proven models like the au pair program, and launching pilot programs that can grow into scalable solutions. Most of all, it means continuing to support families directly, rather than routing support through systems that often fall short of the highest-quality care.
America’s seniors deserve dignity. Families and caregivers deserve flexibility. And policymakers have an opportunity—right now—to deliver both.