The Impact of Paid Family Leave Policies on Working Caregivers and Older Adults

One in two older Americans needs assistance with functional limitations that affect their
ability to care for themselves. Functional limitations are associated with unmet self-care and social
needs, which can increase their risk of adverse events such as falls, hospitalizations, and nursing
home admissions. As older adults near the end of life, an estimated 74% need help with functional
limitations. In the US, access to publicly-funded programs that provide long-term care services are
limited; Instead, unpaid caregivers (primarily family members) serve as the backbone of long-term
care. Trends suggest a growing share of caregivers are adult children, who must often balance
employment and caregiving responsibilities for an aging parent. A potentially effective policy
solution is to provide working caregivers with access to paid family leave (PFL). PFL programs
provide access to paid leave for three distinct needs: i) when they are expecting a new child, as
parental leave; ii) when workers experience a serious health issue of their own, as medical leave;
iii) when caring for a family member with serious health issues, as caregiving leave. A handful of
states were early adopters of PFL, namely California, New Jersey, and Rhode Island. Since then, the policy has spread to a total of thirteen states and the District of Columbia, as of 2025, signaling
the salience of the issue for policymakers.
Despite working caregivers being a key goal of PFL policies, research on their utilization
and impact as a caregiving leave benefit remains scant. Using program administrative data and the
Health and Retirement Study, this dissertation evaluates the impact of PFL policies in the care of
older adults by working adult children. In Aim 1, I explore trends and characteristics associated
with PFL utilization in Rhode Island and Washington. In Aim 2, I examine the impact of PFL on
place of residence for worker’s aging parents. In Aim 3, I examine the impact of PFL on working
caregivers’ health and wellbeing. As the population continues to age, the results yield rigorous
evidence that can guide state planning decisions and inform ways to modify program benefits to
increase access to PFL benefits and support working caregivers.