WASHINGTON — A new report from the AARP Public Policy Institute puts a number to something most families already feel in their bones: the unpaid labor holding America’s long-term care system together is now worth more than $1 trillion a year.
The report, “Valuing the Invaluable 2026,” found that 59 million Americans who care for adult family members, neighbors, or friends provided 49.5 billion hours of care in 2024 — work valued at $1.01 trillion annually. That’s the equivalent of about 23.8 million full-time workers, or roughly 17% of the entire U.S. full-time workforce.
To put it in context: that single number surpasses what the entire Medicaid program — federal, state, and local combined — spent that same year ($932 billion). It also exceeds total private-sector health care spending.
The Hidden Backbone of Long-Term Care
When a nursing home resident is discharged to a family member’s home, or when a spouse steps in to delay a family member’s admission altogether, that labor doesn’t appear on any balance sheet. But the AARP report makes clear it’s the reason much of the formal care system functions at all.
The average value of an hour of family caregiving rose to $20.41 in 2024, up from $16.59 just a few years earlier — driven by higher home care costs, rising direct care wages, and minimum wage increases in many states. Hourly values range from $14.12 in Louisiana to $27.05 in Washington.
More than half of today’s caregivers — 57% — now provide what researchers call “high-intensity care.” That means not just scheduling appointments and managing medications, but hands-on help with bathing, dressing, wound care, and injections. These are nursing skills, performed at home, for free.
“When you look at caregiving at this scale, it becomes clear that this is not just a personal responsibility,” said AARP CEO Dr. Myechia Minter-Jordan. “It is a foundational part of our economy and our care system.”
The Policy Push
AARP is using the report to press for federal legislation. The bipartisan Credit for Caring Act would give family caregivers a $5,000 tax credit. The Lowering Costs for Caregivers Act would let caregivers use health savings accounts and flexible spending accounts to offset caregiving expenses.
At the state level, 12 states have considered caregiver tax credit legislation in 2026. Oklahoma was the first to pass one in 2023, followed by Nebraska in 2024.
The labor shortage already straining skilled nursing facilities isn’t separate from this story. As the financial pressures facing operators continue to mount, nursing homes depend on a system where families absorb enormous unpaid care responsibilities — before admission, and increasingly, after discharge.
“Relying on families to juggle the responsibility alone is unsustainable,” said Rita B. Choula, senior director of caregiving at the AARP Public Policy Institute.
The full “Valuing the Invaluable 2026” report is available at aarp.org.
