The coming years will bring drastic changes in the composition of the U.S. population. Not only will we be more racially and ethnically diverse, but, as the baby boom generation ages, we will have many more very old and frail people among us. The aging of America will be experienced first and foremost in the families who love, support, and care for older relatives and friends. Along with adapting our health care delivery and financing systems to respond to the needs of an increasingly older population, we will need to promote the broader public policy goal of supporting family members and through them, our communities. So how can public policies support families in their roles as caregivers? We at The John A. Hartford Foundation and the Milbank Memorial Fund believe that to address this question--as with many other pressing public issues--there is much to be learned from the responses of leading state governments. States, after all, are closer to the population they serve than the federal government and thereby able to respond in ways that meet the particular needs of their residents. With this in mind we commissioned a team of researchers from Johns Hopkins University to identify and examine a diverse set of states that have developed policies that support family caregivers. We invited the researchers to ask: In what kind of environment were these policies developed? What have these states done and how did they do it? And what are lessons for other policymakers? The report that follows captures the lessons garnered from states that range geographically and culturally from Maine to Hawaii. The report underscores the importance of considering community context, of being attentive to the experiences of caregivers and caregiving, and of persistence in policy adjustments. It gives examples of how attention to these elements is reflected in resulting state policies. An implication is that these elements are foundational for considering family caregiving issues and precede concerns that often arise about financing additional services. Stake-holders in Washington state, for instance, have long worked to build a community-based system for long-term services and supports. Only since this report was written have lawmakers there passed landmark legislation, the Long-Term Care Trust Act, to establish a fund that residents can use to support family caregivers.
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