More than 63 million Americans are caregivers for a family member with complex medical needs, a 20 million increase over the past decade, according to a new report.

But state policies, workplaces and the American health system haven’t kept up with this surge in family caregiving responsibilities, said Dr. Myechia Minter-Jordan, a physician and the CEO of the AARP, which released the report with the National Alliance for Caregiving, a nonprofit policy and research organization.

“Nearly half of caregivers say they face major financial consequences, draining savings, falling into debt or struggling to afford basic needs like food and housing,” Minter-Jordan told reporters on a call this week.

One of the biggest reasons for the surge in family caregivers is that Americans are living longer, yet they’re not necessarily healthier. There’s a 12-year gap between the average number of years that Americans live and the number of years they’re healthy.

The caregiving role typically involves helping a family member with daily tasks like bathing, dressing and eating. But more than half of caregivers also perform more complex medical tasks, such as managing catheters or administering injections, the report found.

A growing number of caregivers are so-called “sandwich caregivers” — parents caring for their children as well as for an adult family member, such as an aging parent. About 17 million people are sandwich caregivers, compared with 11 million a decade ago. And most caregivers are also working a job.

And while the bulk of caregiving still falls on women, 40% of American caregivers are men.

Some states have heeded the growing calls for action.

Earlier this year, Maine lawmakers created a state program to provide respite care, which includes services such as adult day care that give family caregivers a temporary break.

Also this year, Tennessee extended its pilot program that provides respite care for Alzheimer’s and dementia patients, and also passed a bipartisan bill that directs the state Medicaid program to develop guidelines to allow family caregivers to be paid for their work.

Last year, Nebraska passed a tax credit for family caregivers; Oklahoma passed a similar law the year before. And while the United States is one of few countries that doesn’t mandate paid family leave at the federal level, 13 states and the District of Columbia have established their own paid family leave rules.

Meanwhile, the historic cuts to Medicaid enacted as part of the GOP’s Big, Beautiful Bill Act will shift health costs to states, leaving experts worried that family caregivers could lose Medicaid-funded services they rely on.

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