The number of family caregivers has grown from 53 million Americans in 2020 to 63 million as of 2025. This number is expected to increase as the baby boomer generation ages and faces the limitations of our current health and social services systems.
A family caregiver is an unpaid individual who provides assistance to a family member who needs support due to illness, disability or aging.
The population of metro Pittsburgh is one of the oldest in the country, according to U.S. Census Bureau data. This means an increasing proportion of the local population will require care from family caregivers as they age. In Allegheny County, the number of residents age 65 and older is projected to grow by 50,000 by 2050.
Despite their critical role in supporting the aging population, however, family caregivers are not often provided with medical training or help with navigating the health and social services systems. This puts them at significant risk of experiencing physical and mental strain that can lead to burnout and leaving the workforce before retirement age. Caregivers and those they support can also develop health complications based on these factors.
This is particularly true for women, who provide a disproportionate amount of care in the U.S.
I study ways to improve the quality of life for aging adults and their care partners. My work centers on how family caregiving can improve mental health for families. I also examine the toll that caregiving takes on families navigating serious illness and decline.
Sandwich generation caregivers
The “sandwich generation” refers to adults – typically in their 40s and 50s – who are simultaneously caring for their aging parents while raising their own children. They are “sandwiched” between two generations of dependents and often face significant financial and emotional pressures as a result.
Rep. Jennifer O’Mara/Instagram
These caregivers often find themselves caught between work and unpredictable caregiving demands. Without formal protections like paid leave, they may feel forced to reduce hours, turn down promotions or leave the workforce altogether. These decisions can add to the financial strain they’re already under.
Where the law falls short
Several national and state programs exist to support older adults.
The federal Older Americans Act funds services like meal delivery, transportation and caregiver support, and Medicaid Home and Community-Based Services helps older adults receive care at home rather than in a facility. But systemic barriers – from eligibility gaps to access issues – limit their reach.
Federal initiatives like the RAISE Family Caregivers Act offer some hope for family caregivers. It outlines specific actions the government can take to help caregivers, including making it easier for them to balance caregiving with their jobs.
In addition, several states have implemented paid family leave policies. California, for example, offers up to eight weeks of paid family caregiving leave – replacing up to 90% of wages for lower earners. Washington and Massachusetts both provide up to 12 weeks, with wage replacement rates of 90% and 80%, respectively, and include job protection so caregivers don’t have to choose between their loved one and their livelihood.
Pennsylvania may be next. Legislators are currently debating the Family Care Act, paid leave legislation proposed by state Rep. Jennifer O’Mara. The bill, approved by the Pennsylvania House in March 2026, would allow employees to take up to 12 paid weeks off after the birth of a child or to care for a family member during a serious illness. Spotlight PA reports that the House-approved bill proposes employers cover the cost, with grants available for small businesses.
The state Senate’s version of the Family Care Act, pending in the Labor & Industry Committee as of May 2026, would fund benefits through employee payroll deductions of up to 1% of their income. This addresses a critical gap in existing federal law, which guarantees only unpaid leave.
Even if passed and signed into law, the proposal may fall short for sandwich generation caregivers, who face simultaneous, overlapping demands on both ends of the age spectrum. Many of these caregivers have already reduced hours or left the workforce entirely. A benefit tied to employment may never reach the people who need it most.
Pittsburgh’s generational tug-of-war
Pittsburgh-based sandwich generation caregivers face competing demands: securing reliable, affordable childcare – a growing problem in Allegheny County driven by staffing shortages and limited spots – while simultaneously managing eldercare responsibilities. Without a state or federal paid leave mandate, many Pittsburgh workers, like those in lower-wage or part-time roles, have no guaranteed access to the time off they might need to meet either obligation.
Paid leave policies vary by employer, and without a universal federal mandate, coverage is uneven – often weakest for lower-wage workers, part-time employees and people at small businesses.
Research has shown that sandwich generation caregivers already use most of their paid time off for caregiving tasks. This means they have limited time to take care of their own health. The proposed Family Care Act caps paid leave at 12 weeks per year. While this is an improvement from having no mandatory paid leave, it’s designed to supplement – not replace – standard sick days. The Family Care Act would cover intermittent leave for singular events, like childbirth or surgery. But sandwich generation caregiving is chronic, overlapping and resource-intensive in ways the bill isn’t designed to address.
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In addition, the act proposes a partial wage replacement – 90% of wages for a weekly benefit cap ranging from $573 to $995 per week, depending on the individual’s earnings.
Caregivers who step back from work to care for a child or an aging parent are disproportionately lower- and middle-income workers. A 90% wage replacement rate at a lower-wage tier means those workers don’t have to choose between a paycheck and showing up for their family.
Yet this coverage is still likely insufficient for caregivers who often face significant financial strain related to caregiving, such as out-of-pocket expenses for care.
While the Family Care Act – whether it is funded through employee and employer payroll contributions – is a step forward, it still falls short for sandwich generation caregivers. What this population needs is the ability to take flexible time off as needs arise, not just in one block. However, intermittent leave presents administrative challenges for employers, like scheduling disruptions and paperwork burdens that could make it harder to put into practice.
