Prevalence of Caregiving

Family caregivers provide support with daily activities like shopping, transportation, and meal preparation; they assist with personal care tasks like bathing and dressing; they help with medical and nursing tasks by giving medications or injections or dressing wounds; and they serve as care coordinators who arrange appointments, monitor the care recipient’s condition, and communicate and advocate with care professionals and service providers. Family caregivers are an integral part of the care recipient’s care team.

As table 1 shows, the number of family caregivers in the US continues to increase.

To see detailed prevalence statistics by demographics and for more information about the prevalence increase, see appendix B.

A family caregiver can be anyone, and each caregiving story is unique. The increase in prevalence of caregiving mirrors the face of caregivers. The number of caregivers has increased among all education levels, work statuses, genders, generations, and income levels and nearly all races and ethnicities. A confluence of factors may influence the increase in the prevalence of caregiving in the US, including the aging of the population, a lack of affordable paid long-term services and supports (LTSS), and an increase in the provision of HCBS that enable older adults to age where they overwhelmingly want to: at home (US Census Bureau 2023a; Reinhard et al. 2023; Binette and Farago 2024).

For the first time, the 2025 survey includes family caregivers who receive payment for care they provide to an adult family member or friend under Medicaid HCBS self-direction waivers, Veterans Affairs, or other state programs. These family caregivers are distinct from paid professionals, such as home health aides or other direct care workers. This update to the survey screening criteria reflects the shifting policy landscape of caregiving. Several policies have been introduced over the past decade and have accelerated in recent years, allowing family caregivers to receive payment for some of the care they provide. Access to these programs temporarily increased under the COVID-19 public health emergency when the federal government and states developed new flexibilities and mechanisms to support families navigating the pandemic. Although not all states provide the same opportunities for caregivers to receive payment via Medicaid HCBS, most states offer some avenues to payment. See Medicaid LTSS Programs That Pay Family Caregivers for more details on self-direction policies allowing family caregivers to be paid.

In total, 11.2 million family caregivers report they were paid for care in 2025. Most of these 11.2 million caregivers indicate they provided both unpaid care and paid care, suggesting that they were paid for only part of the care hours they provided. Only 1.9 million of 59 million caregivers are solely paid family caregivers. For this year, the Caregiving in the US total caregiver prevalence includes both paid, as described earlier, and unpaid family caregivers because the share of solely paid family caregivers is relatively small, does not represent a significant change in the prevalence trend for unpaid family caregiving, and is not performing tasks that differ completely from those of unpaid family caregivers.

Throughout this report, we include analysis of key differences between unpaid family caregivers and paid family caregivers. Note that these analyses compare family caregivers providing solely unpaid care to family caregivers who provide any paid care (those providing solely paid care and those who provide a mix of paid and unpaid care to a family member or friend). These cross-sectional data cannot be used to draw conclusions about the impact of programs that pay family caregivers on those caregivers, but they provide insights into who is incentivized to pursue programs that pay for care.

Medicaid plays a critical role in supporting family caregivers through self-directed long-term services
and supports (LTSS) programs that allow them to be paid for their care. As of 2024, 47 states and Washington, DC,^* allow payment to family caregivers for personal care services under various LTSS programs (Burns et al. 2025). These services typically include assistance with ADLs, such as bathing, dressing, and eating, and some IADLs, like meal preparation and medication management.

Payments to family caregivers are often authorized through self-directed care models, which are implemented via various Medicaid waivers—such as 1915(c) and 1115—or state plan options. These models allow care recipients to select, train, and manage workers—including friends and family members under some programs—offering both autonomy and flexibility in care delivery. Caregiver- inclusive self-direction programs are allowed for certain groups of LTSS beneficiaries and are most widely available for individuals with intellectual or developmental disabilities (IDD), followed by older adults and people with physical disabilities (National Alliance for Caregiving 2025). Legal requirements for participation as a caregiver differ across programs and are complicated.

The use of self-directed services markedly increased during the COVID-19 pandemic. In response to workforce shortages and safety concerns, the Centers for Medicare & Medicaid Services (CMS) granted states greater flexibility under self-direction waivers, allowing more family caregivers to be paid via these waivers. This allowed more families to safely meet care needs in home and community settings, and many of these flexibilities have remained in place after the pandemic (Burns et al. 2025; Murray et al. 2024).

Although most states allow payments to family caregivers, 46 states allow legally responsible relatives, such as spouses or parents of minor children, to become paid care workers (Burns et al. 2025). Payments to legally responsible relatives are subject to stricter federal and state regulations to protect the interests of the beneficiary. For example, a legally responsible relative cannot serve as a representative of the beneficiary and self-direct their care while also hiring themselves. Other states have sought to protect paid family caregivers from burnout by implementing recommended limits on the hours of compensated care or offering respite services.

Family caregivers are generally paid hourly wages comparable to those of other direct care workers. Thirteen states,^** however, have adopted structured family caregiving programs that offer family caregivers a daily stipend instead. These programs typically involve oversight of family caregivers by provider agencies, which offer training, care coordination, and support. Data on payments in all structured family caregiving programs are not available; however, payments to caregivers in those programs that have shared data range from $40 to $50 per day, depending on the state and program structure (American Council on Aging 2025).