November is National Family Caregivers Month, which focuses attention on the unpaid care work of family members.

The care provided by families often is enabled and supported by state-funded wrap-around services.

Over the last few decades, Missouri and other state governments around the nation have funded Home and Community Based Services - or HCBS - as a cheaper alternative to nursing-home care.

The turn towards HCBSs has meant that aging Americans are more often able to stay in their homes.

The kind of support they provide is broad, and includes visiting and live-in nursing care, in addition to other services such as transportation, home repair, and remodeling to ensure accessibility.

Recent state budget cuts to these programs threaten the availability of in-home care. Jay Hardenbrook, advocacy director with AARP Missouri, said funding HCBS sufficiently benefits all involved.

"It winds up saving the state a lot of money," said Hardenbrook. "It makes families stronger, especially if it's an unpaid family caregiver who's doing that, and it keeps that person receiving the services in the place that they want to be."

Hardenbrook said in Missouri alone, unpaid family caregivers are providing more than $8 billion worth of care. He called them an essential part of the system that doesn't get enough attention.

Funding for HCBSs in the state has declined over the last decade, with the nonprofit Missouri Budget Project reporting a 40% cut in community-based programs in 2018.

Last year the General Assembly injected $200 million from the American Rescue Plan into the system as a one-time payment to support care workers' wages.

Hardenbrook said the state needs to fully fund these programs.

"The state decides how much money goes into these programs," said Hardenbrook. "And if we let them stagnate for a long time as we did until last year, then fewer and fewer people will provide those services. Now that we've done this increase, if we can just keep it up, really we'll have a larger workforce and we'll have more people who are able to stay in their homes because they're able to get the services they need."

Hardenbrook said when aging seniors can't get the care services or home repairs they need, the state often ends up paying more for them to live in a nursing home.

He said while some people utilizing HCBS programs are doing so daily, others may only need occasional help.

"One of the things that has been very helpful, especially among our dementia enrollees, is that a family caregiver can get a day off," said Hardenbrook. "One day of respite is what we call it. But really, 'Can I just have a day where I don't have to be a caregiver all day long?' "

The Missouri Budget Project reports that on average HCBS support costs less than one third of institutional care.

Family caregivers provide valuable work to Washington state - even if they don't get paid. A new report puts a value to the unpaid work they do.

In 2021, the state had 820,000 family caregivers, according to a new AARP analysis. They provided an estimated $16.8 billion in economic value that year.

Cathy MacCaul, advocacy director for AARP Washington, said this report quantifies how important family caregivers are to the state.

"It really calls out and sings the praises of an unrecognized workforce that is so pivotal to our overall long-term care system," she said.

The report found that the value of that care provided to family members increased by $4.8 billion between 2019 and 2021 in Washington state.

Dana Allard-Webb manages Washington's Family Caregiver Support program, which offers services to help caregivers with their duties and to cope with the stress of the job, such as through respite care. She said it's hard for many to ask for help, but support from the program can be good for everyone involved.

"The calmer, more mentally and physically healthy a caregiver is, and the more educated they are," she said, "the better they're going to be able to care for that care receiver, and they'll be able to hopefully care for them longer."

According to the report, people age 65 and up will outnumber those younger than age 18 by 2034. MacCaul said it's important for policymakers to recognize the state's population is aging rapidly.

"There's really no way," she said, "that Washington state or the federal government would be able to compensate people or provide this level of care that unpaid family caregivers currently provide."

Every Missourian knows property values and property taxes have risen dramatically in the past 15 years, as well as the cost of rent.

State lawmakers are now looking at increasing what's known as the "circuit breaker" as well. The Missouri Property Tax Credit has not changed since 2008. It was designed to help low-income seniors and Missourians with disabilities, both homeowners and renters, stay in their homes longer.

House Bill 1351 would raise both the amount of tax credit and the income eligibility limit.

Juli Jordan, director of marketing and community engagement/wellness for the SeniorAge Area Agency on Aging, says the update is long overdue.

"The very people that this credit was designed for are being left out now, with inflation and rates going up; housing rates and renters' rates going up," Jordan contended. "It's leaving out those people who need it the most."

The maximum tax credit has been $750 for renters and $1,100 for homeowners since 2008. The bill would raise the maximum tax credit for renters to $1,055, and for homeowners to $1,550 in 2024, and includes an annual adjustment based on inflation. The income eligibility level would also increase and be adjusted annually based on inflation.

Jordan noted in 2021, the average credit was $602, and only Missourians earning less than $14,300 a year qualified for the full credit. She pointed to the challenges many seniors and people living with disabilities are facing, especially in light of inflation.

"Some seniors, they have to decide, 'Can I buy groceries, or am I going to pay my utility bill?' " Jordan observed. "Or even having to decide, 'Can I get my life-altering medications this month?' "

Jordan stressed increasing the "circuit breaker" limits would not impact the amount of tax money available for schools or other tax-dependent services. The bill is not currently on the Missouri House legislative calendar. It was introduced by Rep. Marlene Terry, D-St. Louis County.

Many Nebraskans know how crucial a family caregiver is to one of their family members. Now AARP research has put a dollar value on that unpaid care - $2.8 billion dollars in 2021. Nearly 180,000 Nebraskans provided family caregiving that year. The organization has calculated the value on a state-by-state basis in the latest report of their "Valuing the Invaluable" series.

Todd Stubbendieck AARP Nebraska director said these caregivers are often making it possible for their family members to "age in place."

"Because without the support of those family caregivers, many people would be forced to go into a long-term care or an assisted-living situation," he said. "In addition, not being able to live more independently - which we know is what people want - many of the costs of that care would then get shifted to taxpayers. "

Stubbendieck added it is important for Nebraska family caregivers to learn about the support programs available to them, including the statewide Aging and Disability Resource Center. Since 2021, Nebraskans who leave work to care for a family member are eligible to collect unemployment insurance if they meet certain requirements.

This session, state Senator Machaela Cavanaugh (D-Omaha) introduced The Paid Family and Medical Leave Insurance Act, LB-57, which would provide paid leave to Nebraskans who must leave work to care for themselves or a family member.

Stubbendieck said often people do not consider themselves a family caregiver.

"They're supporting a grandparent or a parent or even a child because that's what we do. And because they don't know that they are a family caregiver, sometimes they don't access the support and help they need," he said.

AARP estimates the value of family caregivers nationwide in 2021 was more than $600-billion dollars - up more than $200 billion in just five years.

The report's recommendations include implementing more of the 350 actions in the U.S. Department of Health and Human Services' 2022 National Strategy to Support Family Caregivers.

It also highlights the need to strengthen the Family Medical Leave Act and make sick leave more widely available for workers who need to take family members to medical appointments and procedures.