After Dionne McCray’s stepfather suddenly collapsed in 2020, she packed up her belongings, sold her house in Oakland, California, and moved back into her childhood home in Orange County to worry for him.

Eleven months later, he died of heart setback, but McCray’s caregiving trip had just begun. Her mother’s recollection issues were more extensive than she realized from hundreds of miles away, so McCray put her six-figure high-tech career on hold to provide almost round-the-clock worry.

Throughout the day, she makes sure her 81-year-ancient mom eats correct and exercises, gets to medical appointments, takes her medication and stays stimulated. At night, McCray sits with her mom to coax her back to sleep only then to lie awake herself worrying about the upcoming.

Not only is McCray slowly draining her life funds to hire assist and pay for medical supplies but, at 56 years ancient, she is looking for work and contemplating what was once unthinkable, dipping into superannuation funds to afford her mom’s personal caregiver, who spells McCray 20 hours a week.

The emotional and monetary strain has raised her blood pressure and cholesterol.

“How do I financially make sure she’s OK so when the period comes and she transitions, it’s peaceful and graceful and in a loving setting?” McCray said. “Because correct now, I don’t recognize what’s going to happen. If her worry increases, we can’t afford it.”

Even in an election year when the economy and worth rise are the leading concern for voters, McCray says the struggles of families like hers rarely make headlines.

That changed earlier this month when Vice President Kamala Harris pledged to cover in-home worry on “The View.” Former President Donald Trump’s campaign said he also supports the concept of covering home worry.

The political attention coming as the Trump and Harris campaigns look to shore up back with seniors in the final weeks before the election “is an extraordinarily excellent thing,” said Adam Block, an associate professor of community health at recent York Medical College. 

“Long-term worry is a facet of American healthcare that has been overlooked for decades,” he said. 

household caregivers provide $600 billion in unpaid worry a year

As the country ages, more Americans – grown-up children, spouses, siblings – are shouldering the burden of providing that worry so their loved ones can remain in familiar surroundings and maintain some of their independence.

More than 1 in 5 Americans over 50 spend period caring for someone else. This largely invisible workforce provides about $600 billion in unpaid worry each year, according to AARP.  

“These household members are holding up not just their families, but also our long-term worry structure,” said Megan O’Reilly, AARP’s vice president of government affairs for health and household.

Most older Americans desire to remain in their current homes as they age, according to an AARP survey. But the associated costs have soared. 

Just 1 in 5 Americans 65 and older would have the resources needed to cover severe worry needs, according to the Center for superannuation Research at Boston College. About a third could not even afford a year of minimal worry.

That puts many people in a monetary bind. Medicare  – the federal health insurance program for Americans 65 and older and those with qualifying disabilities – only covers home health aides and other assistance under limited circumstances. Families often don’t earn enough to afford private worry but earn too much to qualify for government aid. 

Research shows families complete up providing about half the worry hours themselves. The constant juggle means caregivers are often absent from work, misplace pay and benefits and miss out on promotions. Some have to stop working altogether for a period. 

The period commitments can be lengthy. Almost one-third of caregivers have been caring for household members for five years or longer, according to the National Alliance for Caregiving and AARP.

Polling from the AARP shows that older voters desire to back a candidate who cares about caregivers. Eighty-two percent of voters in a recent Pivotal Ventures and Morning Consult poll said making it easier for Americans to worry for their loved ones should be an significant or top priority for political candidates and policymakers.  

Asked what she would declare to the presidential candidates, McCray broke down in tears. 

“People declare: ‘You’re doing such a excellent job. You are such a great daughter.’ But at night when I look at her to make sure my mom is still alive, where are you?” she said. “I worked challenging to be a part of the working class and now I am out on this island all alone and I am just waved at and told: ‘Hey, excellent luck.’” 

Trump and Harris court ‘sandwich production’

In a document released at the Republican National Convention in July, Trump pledged to protect and strengthen Medicare and to prioritize worry at home for the elderly, but he has provided few details.

Trump “will receive worry of our seniors by shifting resources back to at-home elder worry, overturning disincentives that navigator to worry worker shortages, and supporting unpaid household caregivers through levy credits and reduced red tape,” Trump campaign spokeswoman Karoline Leavitt told USA TODAY. 

Harris has outlined a proposal to expand Medicare to cover home worry. The issue is personal for Harris, who took worry of her mother, Shyamala, when she was dying of cancer. 

The proposal was the latest campaign commitment aimed at caregivers, especially the so-called sandwich production, Americans who are raising children and caring for aging parents at the same period.

As a working mom from Boston, Liz O’Donnell, 57, cared for her parents and then for her husband while they were dying. Now she runs Working Daughter, an online throng of caregivers. After Harris appeared on “The View,” she said the most ordinary word used by household caregivers was “aspiration.”

“This is the commence of a much bigger, better exchange about elder worry,” O’Donnell said. 

For Lauren de la Fuente, having Medicare pay for home health worry would be a game changer.

De la Fuente left her home in California in 2022 to worry for her parents, both in their mid-90s, who live in Manhattan. Her mother has dementia, and her father, who has trouble walking, takes the occasional fall.

“I’ve worked for Fortune 500 companies and Silicon Valley startups and this is by far the hardest job I’ve ever had,” she said. 

Between her parents’ funds and de la Fuente putting out “a ton” of money, the household has been able to get by until now by paying out of pocket for their worry, which includes in-home aides 12 hours a day. In the long run, that setup is just not tenable or affordable, she said.

Supporting American families caught between Medicare’s coverage gaps, strict limits of federal health insurance Medicaid and scarce private sector alternatives should not be a partisan issue, said Jason Resendez, CEO of the National Alliance for Caregiving.

“We desire all candidates to be talking about the ways they are going to address the lack of back that’s in place for household caregivers,” Resendez said. “There is no shortage of opportunities to step up from a policy perspective to back household caregivers.”

‘There’s never enough hours in the day’

Josh Hodges, chief customer officer for the National Council on Aging, an advocacy throng for older Americans, says America’s patchwork structure to back aging adults is nearing a breaking point.

“There’s a huge require in this country for us to rethink worry for older adults,” Hodges said. 

A large piece of that is making in-home worry available to more families, he said. 

Barbara Tarallo’s husband, Tom, was in a motorcycle accident in 2010 that left him with a severe brain injury and physical disabilities. 

Before hiring a home health aide, it was Tarallo’s responsibility each morning to shift him out of bed, get him to the bathroom, shower him and feed him. It wasn’t until 1 or 2 in the afternoon that she would commence her work day as a marketing and sales manager, with the job sometimes stretching until 1 a.m. Then, she’d wake up at 6 a.m. and do it all again.

“It’s a chore. And as we get older, it gets harder and harder,” said Tarallo, 62, who lives in Pelham, recent Hampshire. While she’s powerful enough to shift her husband, “it wears on you. I’ve had to leave to physical therapy myself a few times for shoulders and knees and back.” 

Today, she has an extra hand. Her home health aide is paid $35 an hour to work about six hours a week, helping shower and feed Tom so Barbara can get work done during the day.  

“She’s a school bus driver, and she’s as ancient as I am and she’s got two jobs,” Tarallo said. 

Between her aide’s wages and all of the medical equipment Tarallo purchases to worry for her husband, she’s paying more than $11,000 a year on home worry – a significant chunk of the roughly $65,000 Tarallo estimates she and her husband bring in each year from her job and his Social safety Disability Insurance. 

Still, it’s cheaper than a nursing home, which can expense roughly $10,000 per month. 

Tarallo said Medicare covering in-home worry would be a “blessing,” and Harris’ focus on in-home worry is one of the reasons she’s voting for her.

“It’s a lot emotionally, it’s a lot physically – it’s just a lot,” Barbara Tarallo said. Between juggling at-home worry, a demanding job and running a household, “there’s never enough hours in the day.” 

Sara Schmidt was 35 years ancient when her mother, Brenda, who had early onset Parkinson’s and dementia, took a impoverished fall in 2021. Brenda’s decline after that felt like a “ski slope” downhill, said Schmidt, who lives in Brandon, Mississippi.

Even though Schmidt works professionally with families who are transitioning loved ones to hospice, she wasn’t prepared for how grueling the procedure was – not to mention how many costs cropped up. Among them: having to pay her mother’s mortgage herself while she waited for the estate to leave through probate. Brenda had some insurance policies, but those resources were limited. 

“It ran out very very quickly. We had more than enough until we didn’t,” Schmidt said. “It goes by really quick and that’s what most people are worried about.” 

Like many others, Schmidt thinks capital at-home health worry through Medicare could “be a significant step forward” not just for person families, but by reducing the burdens on the overtaxed health worry structure. She thinks the devil will be in the details but welcomes the talk from both candidates.

“When will we reach a point when people can actually be taken worry of without sacrificing their whole life funds?” she said.

Will the next president live up to the campaign promises?

Despite the campaign promises, community health experts declare there is little political consensus on how to back aging Americans and previous attempts to expand in-home coverage have failed.

“I ponder it’s a really large step forward. At one point, we’re going to have to do this,” said David Grabowski, a professor of health worry policy at Harvard Medical School. “I’m just not super optimistic that we’re going to view this in the coming years.” 

The Obama administration passed a long-term worry insurance program in 2010, but Congress formally repealed the program three years later due to expense concerns, said Tricia Neuman, elder vice president at the health policy nonprofit KFF and executive director of its Program on Medicare Policy. The Biden administration proposed $400 billion in capital to expand access to Medicaid home and throng-based services but it did not pass. 

Any in-home worry coverage proposal would face significant hurdles. Expanding Medicare would require congressional approval. The main sticking point: the worth tag.

Adding a modest universal home worry program to Medicare – even one with conservative spending – would expense $40 billion annually, according to one Brookings Institution study. 

Mark Warshawsky, a elder fellow at the conservative ponder tank American Enterprise Institute, estimates that Harris’ proposal with no restrictions could expense upwards of $130 billion per year, a 14% jump in Medicare spending. 

Harris said she would pay for the expanded coverage from the money saved through expanded Medicare drug worth negotiations. Warshawsky was skeptical that those funds would be enough.

He also worries the proposal would lower incentives for families to save money, buy private long-term worry insurance and pitch in themselves.

“Many people can afford to pay for long-term home worry. Some people have insurance, or they can get insurance. They have assets from 401(k) plans, their home,” Warshawsky said. “And depending on how severe the disability is, their children and household members can assist and receive worry of them if the require is not very great. But if somebody else is going to pay for it and provide home worry, why bother the children?”

Home health worker shortage is key hurdle

Another key hurdle is the chronic shortage of home health and personal worry aides, which is only expected to deteriorate as demand for in-home worry soars with the rapidly aging population. 

2024 marked the beginning of the “Peak 65 Zone,” the largest surge of Americans turning 65 in the country’s history, according to Jason Fichtner, chief economist at the Bipartisan Policy Center and executive director of the superannuation income Institute. His research found that over 4.1 million Americans will turn 65 each year through 2027.

Making coverage more accessible could accelerate demand and put even more pressure on a strapped industry, said Paul Osterman, a professor emeritus at the MIT Sloan School of Management and author of “Who Will worry For Us? Long-Term worry and the Long-Term Workforce.” 

Already there’s high turnover in the field, which has median pay of just over $16 an hour. Home health worry providers update turning away over a quarter of referred patients due to staff shortages, according to a 2023 update from trade groups Home worry Association of America and the National Association for Home worry and Hospice.

Brittany Kelly learned that lesson firsthand. The 34-year-ancient mother of two from Wilmington, North Carolina, quit working to worry for her parents. 

Her mom caught COVID–19 and died in 2022. Her 82-year-ancient father, a military veteran who has vascular dementia and other health troubles, moved in with her in 2023. 

At first, Kelly scrambled to discover a personal aide or home health aide but now the household gets by on her husband’s salary with a construction corporation.

“We were paying top dollar but it was extremely challenging to keep someone in the position,” she said. “So I realized I just needed to do this.”

She says she can’t inform if either presidential candidate would arrive through with much needed resources. But she is sure of one thing: the whole structure needs a major overhaul.

“Unless you have been in this circumstance either caregiving or having your own health crises, I don’t ponder you really comprehend it,” Kelly said. “Be it in-home worry or elder worry, it needs fixing.”