One in Five U.S. Adults Are Unpaid Caregivers — and One in Five of Them Are in Poor Health

In brief

• Informal, unpaid caregivers support family members, friends and the health care system, and may sacrifice their own health to do it.
• In 2015–2017, about 20% of adults surveyed were caregivers.
• Nearly 20% of caregivers reported fair or poor health, from 11.7% in one state to 34.4% in another.
• As the population ages, caregiving is a growing public health issue, and caregivers' health needs attention.

Why it matters

An estimated 17.7 million people in the U.S. were informal caregivers in 2015, giving substantial unpaid help at home. Caregiving can strengthen the bond between caregiver and recipient, but it can also bring emotional and physical strain — more depression, lower quality of life and poorer health. The need for caregivers will likely grow as the population ages, yet there was little nationally representative information on them.

How the study was done

The Behavioral Risk Factor Surveillance System (BRFSS) is a telephone survey of noninstitutionalized adults. In 2015–2017, 44 states, DC and Puerto Rico asked all adults a nine-question caregiving module, starting with: "During the past 30 days, did you provide regular care or assistance to a friend or family member who has a health problem or disability?" Those who said yes were caregivers; those who said no were asked whether they expected to become a caregiver in the next 2 years. All were asked to rate their health from excellent to poor. The analysis covered 252,602 completed interviews.

Who the caregivers are

20.7% of respondents were caregivers — from 13.7% in Puerto Rico to 28.2% in Tennessee. The four states with the most, Alabama, Arkansas, Louisiana and Tennessee, are all Southern, with more than 25% of adults caregiving. Another 16.7% of non-caregivers expected to become one within 2 years.

Figure 1. Percentage of adults who were informal, unpaid caregivers, by state, 2015–2017. CDC, MMWR.

Caregivers' race and ethnicity largely mirrored each state's. Most were non-Hispanic White everywhere except California, DC, Hawaii, New Mexico and Puerto Rico; Black caregivers were 30% or more in Louisiana, Maryland and Mississippi and 57.2% in DC; Hispanic caregivers were most common in California, New Mexico and Puerto Rico. In Arkansas, 53.0% had a high school education or less.

Caregivers' health

After age adjustment, 19.2% of caregivers rated their health fair or poor, from 11.7% in Minnesota to 34.4% in Puerto Rico. In 19 states — Alabama, Alaska, Arizona, Georgia, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, West Virginia and Wyoming — it was 20% or more.

Figure 2. Age-adjusted percentage of unpaid caregivers reporting fair or poor health, by state, 2015–2017. CDC, MMWR.

What it means

About one in five adults caring for someone in a given month makes unpaid caregiving a common part of family life, and an important supplement to formal health care. Much of it falls on adults under 45, for whom it can limit work hours, income and job responsibilities; for older caregivers, its physical demands may become unsustainable.

The need will grow. The baby boomers, born 1946–1964, are reaching 65 and beyond, people 85 and older are the fastest-growing age group, and one in six non-caregivers expect to start soon. Yet there may be fewer caregivers per person: families are smaller, more women — who have historically done most caregiving — work outside the home, and families live farther apart. Many boomers want to stay in their homes, which will take family caregivers, and people with Alzheimer's disease are now more likely to die at home than 15 years earlier. Relying on informal caregivers may lower health care costs — but with 20% or more of caregivers in many states in fair or poor health, their own health needs support. It is also possible that some people became caregivers because poor health kept them from conventional work; this cross-sectional study cannot tell.

Caregiving also has benefits: the satisfaction of caring for a loved one, a sense of purpose, savings over institutional care, new skills and confidence. These are the first state-level estimates of caregivers' self-rated health, and states, health systems and federal programs can use them to tailor support to local caregivers — whose incapacity could otherwise mean more hospitalizations or earlier long-term care for the people they look after. CDC's Caring for Yourself page has resources for caregivers.

Limitations: caregiving was self-reported, subject to social desirability and recall bias; many people do not think of their help as caregiving; and BRFSS interviews one person per household, so caregivers may be undercounted.

Sources

Based on Valerie J. Edwards, Erin D. Bouldin, Christopher A. Taylor, Benjamin S. Olivari and Lisa C. McGuire, "Characteristics and Health Status of Informal Unpaid Caregivers — 44 States, District of Columbia, and Puerto Rico, 2015–2017," MMWR Morbidity and Mortality Weekly Report, volume 69, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's discussion says fair or poor health ran "as high as one third in Arkansas and Puerto Rico," but its results list Arkansas neither as the highest state nor among the 19 at 20% or more; this page follows the results.