As our societies age, employers need to understand the hidden risks created by employees’ obligations as caregivers
Writing: Diane Ty
I reached my breaking point after years of juggling full-time work, raising three children, navigating care for my father with Alzheimer’s, and supporting my mother, who was burnt out after years as my father’s primary caregiver.
Instead of quitting altogether, a former boss offered me flexible, project-based work. This sustained me financially and professionally as my father neared the end of his life and during the years that followed, until my children left for college. I was lucky; too many are not.
In the US, 63 million people are family caregivers. Seven in 10 of that group also hold paid jobs, and about a third are part of the sandwich generation, caring for both children and adult family members. One in four US caregivers puts in hours the equivalent of a full-time job.
The US is not unique. Similar patterns are emerging across Asia and Europe. Longer lives, smaller families, urban migration and rising dementia rates are placing unprecedented strain on working families.
Caregiving, whether episodic or sustained, is no longer a private matter to be quietly managed. Rather, it is a growing reality for today’s workforce – one that requires thoughtful leadership.
The rise of caregiving
Over the past century, global life expectancy has more than doubled, adding roughly 40 years to the human lifespan. In the US, as in much of Europe and Asia, population aging is accelerating as large cohorts move into older age and birth rates decline. By 2030, the share of adults 65 and over is projected to be about 21% in the US, 23–25% in Italy and Germany, and over 30% and 20% in Japan and South Korea, respectively.
While longer lives are a remarkable achievement, many of these additional years are lived in poor health. Globally, the gap between lifespan and healthspan – years lived in good health – is 9.6 years, while the US faces a striking 12.4-year gap. Americans turning 65 today have an 80% chance of needing long-term care during their lifetime. Who provides that care lies at the heart of today’s caregiving crisis and growing employer risk.
A decade of poor health in later life, combined with shifting family structures, shortages of professional care workers, and the lack of coordinated long-term care systems, means that an increasing number of employees, from frontline workers to executives, are managing complex elder caregiving responsibilities alongside their jobs.
The distinct demands of eldercare
Most of us understand how care for children works, with daycare and early education organized around clear age milestones. Eldercare is fundamentally different, as needs emerge unevenly, unpredictably and with no roadmap.
It often begins without warning: with a phone call, a diagnosis that spirals into crisis, or the growing realization that a parent may be experiencing cognitive decline. These moments disrupt the lives of workers worldwide, with care responsibilities starting episodically and increasing to more than 20 hours per week. It can encompass hands-on care, care coordination, and financial tasks, such as bill paying and insurance claims management. For many families, caring for a loved one with dementia eventually becomes round-the-clock.
A leadership imperative
As C-suite leaders grapple with mental health, return-to-office policies, talent shortages, and AI-driven transformations, caregiving emerges as a core challenge, intersecting with and exacerbating each of those pressures.
Family caregiving costs US employers as much as $35 billion annually in lost productivity and turnover. Replacing an employee can cost between 50-200% of the annual base salary, depending on role, tenure and organizational context. The impact tends to fall most heavily on mid-career employees, especially women, who disproportionately shoulder eldercare responsibilities during their peak earning years. Many reduce hours, turn down promotions, or exit the workforce altogether.
Caregiving also takes a measurable toll on mental health, sleep, financial security and productivity, compounding over time to affect long-term career trajectories. There are financial sacrifices, with the out-of-pocket expenses incurred by US family caregivers averaging $7,200 annually, and dementia caregivers report outlays exceeding $9,000. All told, 45% of caregivers report a negative financial impact.
Employers as levers for change
Despite its growing scale and its significance to employees, caregiving often remains largely invisible inside organizations. Yet employers can be powerful catalysts for broadscale change by adopting practical strategies to support working caregivers and advocating for policy reform.
At the Milken Institute Future of Aging, we see employers as underleveraged but well positioned to support win-win policies and practices. It starts by implementing a range of measures.
- A care-aware culture where leaders share their experiences balancing work and family responsibilities, including eldercare, and normalize caregiving as a shared life experience. Conducting an anonymous survey to understand the prevalence of caregiving and unmet needs is a low-cost way to get started
- Employee affinity or resource groups to foster peer support and connection
- Flexible work arrangements including remote options, job sharing, and part-time or adjustable hours
- Transitional retirement strategies that honor experience, retain expertise and support evolving caregiving needs
- Paid leave that is separate from vacation or sick leave and can be used intermittently
- Education and support on financial, legal and care planning topics, including advance care directives, powers of attorney, and (in the US) Medicare and Medicaid navigation
- Specific caregiving benefits such as pooled long-term care insurance, care concierge platforms, or backup care.
Employers can further extend their impact beyond the workplace by advocating for policies that include tax incentives and reforms to support caregivers. Examples include expanding eligible uses and contribution limits for health savings accounts and dependent care accounts to cover eldercare – without requiring the older adult loved one to be claimed as a dependent.
Caregiving can no longer be treated as a private issue happening outside the workplace. It directly impacts workforce productivity, retention, leadership pipelines and long-term competitiveness. The organizations that will thrive in an era of longer lives and tighter labor markets will be those whose leaders recognize caregiving for what it is: a shared life experience that transcends seniority, gender and job function. It starts with actions that enable flexibility without penalty, create psychological safety, and – ultimately –normalize caregiving.
Diane Ty is managing director, future of aging, at the Milken Institute
