Issues involving the care of vulnerable people are some of the few issues that still resonate across the political spectrum. In New York, Mayor Zohran Mamdani campaigned to victory on universal child care, among other affordability concerns. On the campaign trail in 2024, President Donald Trump’s stump speech included a pitch for a caregiver tax credit. And in September, a bipartisan group of senators introduced a bill intended to update the main federal child care law.
Yet the narrow focus of these proposals, whatever their individual merits may be, exemplify a persistent mistake: policymakers still approach caregiving in disconnected silos, which is far from how families experience them. It’s time for a comprehensive rethink.
The reality is that child care and care for sick, aging and disabled people are not separate policy challenges but an integrated part of a huge number of Americans’ lives. According to new research from the National Alliance for Caregiving and AARP, 63 million adults now provide care for adults and children with disabilities or serious medical conditions — a 46% increase since 2015. Combined with the 91 million Americans raising children (and accounting for duplication), approximately 130 million people are engaged in some form of complex caregiving.
The new data also reveals interconnected care that defies segmented policy approaches. Sixteen million Americans are “sandwich-generation” caregivers, simultaneously caring for both children and adults. Among family caregivers under the age of 50, nearly half fall into this category, compared to just 14% of older caregivers.
These statistics represent real people —such as a mother rushing from her daughter’s asthma attack at school to her father’s chemotherapy appointment, juggling insurance paperwork for both while struggling to keep her job. This reality hits communities of color particularly hard, with 36% of Black and 43% of Hispanic/Latino caregivers managing sandwich-generation responsibilities, compared to 23% of non-Hispanic white family caregivers.
These pressures will only intensify as demographics shift. By 2040, nearly one in four Americans will be over 65. By 2050, the U.S. may have as many people over 85 as under five. This sea change is happening gradually but steadily, and it will be far easier to act now than later. Indeed, population aging isn’t another policy issue to add to the list — we are approaching an era that will reshape every aspect of society. America can develop integrated solutions now or lurch from crisis to crisis as systems designed for a younger nation buckle under demographic pressure.
However, America’s policy infrastructure remains stubbornly siloed. Child care and elder care occupy different funding streams, fall under different congressional committees and mobilize separate advocacy ecosystems. While policymakers debate in these silos, families experience caregiving as a continuum— piling needless stress onto already overwhelmed households.
Caregiving is the invisible backbone of American communities. Families don’t face discrete “child care challenges” and “elder care challenges” —they face Tuesday afternoon, when the school nurse calls about a sick child just as dad’s medical transport arrives.
Moreover, American culture has normalized parenting as expected caregiving while treating care for older adults as something to avoid discussing or to outsource. This artificial distinction ignores how care needs flow naturally in both directions across generations.
Creating effective policies requires systemic thinking. For instance, workplace reforms must include paid family and medical leave, flexible dependent care leave, predictable scheduling and cultures that support all forms of caregiving — not just parenting. Community infrastructure needs intergenerational care facilities, updated zoning policies and co-located services that recognize families’ time and transportation constraints. Economic supports should recognize all caregiving work equally through tax credits and Social Security caregiving credits. Housing policy must prioritize multigenerational homes and aging-in-place accessibility as standard features, not luxuries.
Transformation begins with how we study and advocate for care. Research silos create policy silos. Child care and elder care researchers rarely interact, despite studying the same families at different life stages. Those 16 million sandwich-generation caregivers represent natural connection points for unified policy, yet we rarely study their integrated experiences.
We need research asking harder questions: How do families make trade-offs when competing care needs arise? What interventions create benefits across the caregiving spectrum?
The opportunity is massive. Those 130 million caregivers represent an enormous constituency for change — if they recognize their common cause. Policymakers must design with the full caregiving spectrum in mind, while advocates build coalitions across child, disability and elder care communities; efforts such as the Caregiver Nation Coalition and Care Can’t Wait are already pointing the way. Funders need to shift from categorical giving to ecosystem thinking, as the CARE Fund is demonstrating. And researchers should study these intersections, learning from those already navigating multiple responsibilities.
When we support caregiving comprehensively, we strengthen the invisible backbone holding communities together across generations. The choice is clear: We can continue pretending that care happens in silos or build systems reflecting the integrated reality millions already navigate daily. With demographic change inevitable, the time for artificial divisions has passed. America’s future depends on recognizing care as the continuous, interconnected and essential work it has always been.
Jason Resendez is the president and CEO of the National Alliance for Caregiving. Elliot Haspel is a senior fellow at Capita and author of “Raising a Nation: 10 Reasons Every American Has a Stake in Child Care For All.”