Paid Family and Medical Leave: The Missing Piece in Supporting Working Caregivers and an Aging Workforce

A guide for C-suite and HR leaders: what new research on older adults and their caregivers means for leave strategy.

By Mary Beth Hartleb, J.D., SPHR — Founder & CEO, Prism HR Consulting

The caregiving conversation usually focuses on benefits, culture, and flexibility. New research compiled by the legal advocacy organization A Better Balance points to a piece of the puzzle that deserves equal attention from employers: paid family and medical leave. The data describe a workforce aging on both ends of the care relationship, and a leave system that has not kept up with either.

Two Populations, One Workforce

Aging touches an employer’s workforce twice. The first population is older workers themselves. Nearly one in five adults aged 65 and older was employed as of 2023, roughly double the rate of a generation ago, and many remain working out of financial necessity. Their health needs are real: per federal health data, nearly 93 percent of older adults have at least one chronic condition and 79 percent have two or more. Yet the workers most likely to need paid medical leave are the least likely to have it. About 38 percent of workers 65 and older work part time, and 80 percent of part-time private-sector workers lack employer-provided short-term disability or paid medical leave.

The second population is the employees caring for aging loved ones. The number of family caregivers in the United States has grown 45 percent in the past decade, to roughly 63 million adults, and about 44 million of them care for someone 65 or older. Seventy percent of family caregivers are employed. Among sandwich-generation caregivers, those supporting a child at home and an older adult at the same time, 86 percent are employed and 72 percent work full time. Two-thirds of employed caregivers say balancing the job and the caregiving is a genuine struggle. Both populations are already on the payroll of nearly every employer reading this.

The Access Gap

Here is the gap the research exposes: only 27 percent of private-sector workers in the United States have access to paid family leave to care for a family member. The federal FMLA provides job protection, not pay, and many workers either are not covered by it or cannot afford weeks without income. Access also tracks wages: in 2023, the highest-paid workers were ten times more likely to have paid family leave than the lowest-paid. The result is predictable. Employed caregivers are more likely than their nonworking counterparts to take on debt, deplete savings, and fall behind on bills, and the stress follows them to work. Nearly two-thirds of caregivers report moderate or high emotional strain, and almost one in four report feeling alone in the role.

The Evidence That Leave Works

The strongest finding in the research concerns what happens when caregivers can actually afford to take leave. After California implemented its paid family leave program, the proportion of elderly adults in nursing homes declined by more than 11 percent in relative terms. That is worth restating: paid leave for working caregivers kept older adults out of institutional care and in their homes, which is where 75 percent of adults over 50 say they want to age. Caregivers with access to paid leave also report lower caregiving stress and better well-being. Leave, in other words, is not merely an absence policy. It is functioning eldercare infrastructure, and it pays dividends to the employee, the family, and the employer who retains them.

What This Means for Employers

First, know the map. Thirteen states and Washington, D.C. now run comprehensive paid family and medical leave programs, each with its own contribution rates, definitions, and notice requirements; for multi-state employers, administering these correctly is a compliance obligation today, not a policy debate. Second, mind the definition of family. States are increasingly covering siblings, grandparents, extended family, and in some cases chosen family; company policies written narrowly around spouse-and-child will miss a large share of real caregiving relationships, including the 11 percent of caregivers supporting a friend or neighbor.

Third, for employers in states without a program, the 27 percent access figure is a competitive opening. A dedicated paid caregiver leave benefit, even a modest one, immediately distinguishes an employer in a market where nearly three-quarters of workers have nothing. Finally, pair the leave with the culture to use it. As covered previously in this series, a benefit that employees fear using is a brochure; leave works when leadership visibly supports it and disclosure is safe.

The Bottom Line

The workforce is aging, the caregivers of the aging are already employed, and the research now shows that paid family and medical leave measurably protects the health, finances, and independence of both. Employers do not need to wait for a federal program to act on that evidence. The ones that build leave and the culture to use it will keep experienced older workers and the caregivers who would otherwise leave to do this work unpaid, and they will be the employers those workers tell their friends about.

Sources: U.S. Bureau of Labor Statistics, National Compensation Survey (2023); Pew Research Center, “Older Workers Are Growing in Number and Earning Higher Wages” (2023); Arora & Wolf, “Does Paid Family Leave Reduce Nursing Home Use?” Journal of Policy Analysis and Management (2018); “Caregiving in the US 2025,” AARP and the National Alliance for Caregiving; A Better Balance, “Paid Family and Medical Leave Supports the Health, Well-Being, and Financial Security of Older Adults and Their Caregivers” (2026); U.S. Department of Labor; National Council on Aging.