Lance Robertson, Former Assistant Secretary for Aging, Discusses Caregiving Policy

We sat down with  Lance Robertson, a partner at the global consultancy Guidehouse and former Health and Human Services Assistant Secretary for Aging, to discuss how lawmakers are addressing caregiver support and what opportunities exist. Lance is one of the country’s foremost experts on aging and caregiving policy and we were so excited to hear his thoughts!

What trends are you seeing related to caregiving?

There’s currently a higher water mark for supporting caregivers than we’ve historically seen due to several factors. First, there’s  a growing number of caregivers and there are many elected officials who have now gone through the experience of caregiving themselves. Another big driver of the attention we are getting came out of the Recognize, Assist, Include, Support, & Engage (RAISE) Family Caregivers Act, which is starting to come to fruition. There is greater visibility and support from Congress. And another variable is the workforce crisis and how people recognize that family caregivers sometimes have to leave the workforce. Employers need to figure out how to support a working caregiver because that loss is damaging to all. There is acknowledgement of how we are not supporting the working caregiver. We don’t have control over getting people into the workforce, but you can control in a big way the number of people already in the workforce who may have a caregiving responsibility and the support they need to continue working. Employers can offer a flexible workday, remote opportunities, whatever a company can do. Companies must acknowledge caregiving situations; the situation can be temporary like six months to a year. But if someone makes a  directional decision to leave the workforce and you could have helped them patch things together for a year and still have that person, it would make a big difference and everyone wins.

How does this compare to the past?

RAISE has created a roadmap and has put out on the table a national strategy. In the past, it wasn’t a failure in this respect but not everyone was on the same page. RAISE was a chance to put everyone including them on the same page.  And, the combination of a growing number of caregivers and a broadening number of people having this experience is culminating to better shape our commitment. 

What’s changed over the past few years?

The RAISE Act and visibility of caregivers. Another reality is that Mrs. [Rosalynn] Carter’s passing brought elevated attention to the work she did in the space of caregiving advocacy through the Rosalynn Carter Institute for Caregivers. There is an understandable uptick in caregiver support because of her legacy. 

Did the COVID pandemic bring attention to the work family caregivers do?

The verdict is mixed. Logically it put an extra strain on caregivers. What waters it down is the strain it put on everyone. Social isolation has been a problem for a long time. This became more realized across the country and world because everyone started feeling a bit socially isolated. It generally didn’t affect the caregiver role or create more family caregivers.

Who and what should we be watching?

It’s going to be important for all of us to watch what happens for policy and program changes for caregivers on state and federal levels. I would be surprised if we didn’t see more money appropriated on the federal level in coming years. We will probably see more and more states adopt small and large measures. We will likely see tax credits on a state by state basis. RAISE has 350 recommendations [about how to support caregivers on the local, state, and federal levels in its National Strategy to Support Family Caregivers]. People shouldn’t just watch things on the federal level; they must watch states too. 

Another trend would be what role does technology play? It will play a much more enhanced role for caregivers in the future. How is it supporting remote caregivers? How is artificial intelligence (AI) factoring in?

What state(s) should we keep an eye on?

AARP puts out the Long-term Services and Supports (LTSS) scorecard and found that Minnesota ranked the highest for family caregiver support. [Other top states included: Colorado; the District of Columbia; New Jersey; Oregon; and Washington]. This is one resource to explore as a way to watch states moving in positive directions. 

What are you most excited about?

I think it’s just the final fruition or development of our RAISE Act effort. We started working on it in 2017. In the near future we will see real fruit from that and that excites me.

What are the shortcomings and what needs to be improved?

The biggest thing is a longstanding struggle: We have to quit talking the talk. We need to walk the walk at all levels. How will we significantly fund and support family caregivers? That to me is the biggest challenge we have long had. No one on Capitol Hill would argue caregivers don’t need support, but we need people to get behind it and back it at all levels. 

Also, we need to be able to better track impact. We need stronger data. And that’s part of the RAISE Act. How do we get data to better support impact and ROI? We do have quite a bit of data on the impact of a working caregiver. A space we don’t have enough data for is the caregiving impact on caregiver health and how do we measure the negative impact on health, placing the caregiver in physical jeopardy as well.

How can people advocate for better caregiver support?

They can advocate with their own story because it strengthens the conversation. People should be action-focused. They can say, as an example, “Because of my experience, I suggest we put attention toward a tax credit for family caregivers because my out-of-pocket expenses per year are X.” There can be advocacy at all levels, even at the municipal level. People must be purpose-driven, clear, and concise.