The financial, physical, and mental cost of family and friend caregiving in California


Soraya Marashi


On Monday, the UCLA Center for Health Policy Research released their findings from the 2020 California Health Interview Survey in a report titled “Who Is Caring for the Caregivers? The Financial, Physical, and Mental Health Costs of Caregiving in California.” 


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The report revealed that family and friend caregivers (individuals with caregiving responsibilities that do not practice professionally) in California are struggling financially, physically, and mentally.

According to the report, family and friend caregivers “… are the backbone of our long-term care system, providing the lion’s share of home and community-based care for people with chronic care needs and disabilities.” It goes on to say that these caregivers “… seek to avoid the emotional and financial costs associated with care in institutional settings, such as nursing homes, and instead choose to keep their family member or friend at home, where they prefer to be.”

The survey data revealed that California caregivers experience tremendous financial stress and receive little–if any–compensation for their caregiving. Nearly half of caregivers reported experiencing some level of financial stress due to caregiving, with about 20.5% reporting that caring for their relative or friend was “somewhat” to “extremely” financially stressful. Moreover, Black or African American (28%), Asian (23.4%), and Latinx adult caregivers (21.9%) were more likely than white adult caregivers (17.7%) to report this financial distress.


Image: UCLA Center for Health Policy Research.


Increased levels of financial stress among caregivers were also more likely to be reported by women than men. 

In 2020, 1 in 4 California caregivers provided 20 or more hours of care to a family member or friend in a typical week, yet only 1 in 11 received payment for any of the hours spent providing care. According to the report, “the value of these unpaid contributions is enormous, and in 2017 it was estimated at around $470 billion nationwide and $63 billion in California.”

The survey found that the intensity and time-consuming nature of family and friend caregiving also had implications for caregivers’ professional and social life. The report notes that time spent on caregiving often results in missed opportunities for educational or career advancement and less time spent on self care and social needs.

Survey data also revealed that caregiving significantly contributed to caregivers’ physical and mental health issues. In 2020, 13.5% of all caregivers reported suffering a physical or mental health problem due to caregiving in the past 12 months.

Women were also 50% more likely than men to report physical or mental health problems. Additionally, while the estimated proportions were statistically unstable, Native Hawaiian or Pacific Islander (NHPI) caregivers represented the highest proportion of caregivers reporting physical or mental health problems due to caregiving, and nearly double that of the overall caregiver population.


Image: UCLA Center for Health Policy Research.


The report also emphasized opportunities for positive change presented by key state legislation, stating:

“Since 2002, California has been a leader in spearheading policies that support family caregivers, beginning with the passage of the California Paid Family Leave Act (PFL),

which provides eligible caregivers with benefit payments for up to eight weeks in a 12-month period, with income replacement of between 60% and 70% of their weekly wages.”

However, these benefits are seldom used by family and friend caregivers. Among the 53.4% of employed caregivers working full-time, only 1.3% reported using paid family leave, as well as only 0.2% of employed caregivers working part-time. 

The report provided policy recommendations based on these findings to better address the financial, physical, and mental health needs of family and friend caregivers. The three recommendations included in the report are as follows:

    • “Increase awareness, make access easier for family caregivers, and encourage uptake of the paid family leave benefit in California—for example, by promoting it through the Employment Development Department, employers and human resource administrators, aging and disability resource centers, and community/ local media efforts.

    • Include a mandatory caregiver assessment as part of all health and social services intake processes. Engage health and social services providers to systematically identify and assess caregivers’ financial, health, and social care needs and connect them to appropriate benefits and resources.

    • Enhance and expand the reach of existing caregiver support programs—and introduce new ones—that help reduce caregiver financial stress and prevent or address their emergent physical and mental health care needs.”