Earlier this year, AMAC and the Independent Women (IW) launched a national storytelling drive to highlight the need for increased freedom and flexibility for in-home elder care arrangements. In just a few days, hundreds of stories poured in from throughout the country that reflect both the heartwarming compassion of everyday Americans and the heartbreaking failures of the current rigid regulatory structure.
The policy problem is clear. In-home elder care costs have surged nearly 10 percent in the past year alone, far outpacing overall inflation. Full-time assistance now averages close to $80,000 annually. Assisted living and nursing facilities can exceed $100,000 per year. By 2030, more than 73 million Americans will be 65 or older.
Yet even as demand skyrockets, federal labor rules and outdated regulations have made flexible, lawful, affordable in-home arrangements difficult to structure and more expensive to sustain.
But statistics only tell part of the story. The real picture comes into focus through the families living this reality every day.
Jane Moore of Pennsylvania described what so many middle-income families quietly endure. Her late father left her mother enough of a death annuity to disqualify her from many assistance programs, but not enough to comfortably afford full-time private care. “This annuity amount puts mom in the frustrating position of not making enough to fully self-pay for any type of care but making like 100 or 200 dollars too much for literally any program designed to help seniors be cared for, physically or financially,” Jane wrote.
For years, the family kept her mother at home. Jane’s sister even took a four-year hiatus from nursing to care for her full-time so that their mother could remain in familiar surroundings. When 24-hour care became necessary, they tried hiring help themselves.
“We 1099’d the caregiver because I was afraid I’d get thrown in jail as my mom’s power of attorney if we did not,” Jane explained. Agency care proved unreliable and unprofessional. Adult day programs either refused self-pay clients or demanded that they switch doctors and insurance plans.
“Before my sister made the huge move to bring my mom into her own home, we were forced to consider ‘under the table’ arrangements while making a valiant attempt to keep her in her home,” she said.
Now Jane’s family has been forced to sell their mother’s house and is paying an elder care attorney thousands of dollars just to navigate the Medicaid “paydown” process. “I don’t understand how there can be such a large gap for people who planned financially for their future, but it is not enough and yet, it’s still too much money,” she wrote. “There has to be a better way.”
Her frustration is echoed across the country.
Linda from Pennsylvania is facing the difficult realities of in-home care with her 99-year-old mother. Since her father’s death in 2001, her mother has lived independently in the same home. “Her greatest wish is to remain there in the place where she feels safe and most comfortable,” Linda says. The family has redesigned the first floor to make it safer and more accessible. They have stepped in wherever possible.
But love and commitment cannot substitute indefinitely for structured support. Linda recognizes that family and friends will not be able to fill the caregiving gap forever. “If we believe in personal responsibility, family commitment, and dignity at every stage of life,” she says, “then we must also address the structural weaknesses in our long-term care system.”
Josephine, a 76-year-old New Yorker, is still caring for her 99-year-old mother. She sees the math clearly. “Finding a caretaker for what she can pay is virtually impossible,” she says. “My situation is not unique. There are many elderly people here in Mom’s complex who need assistance but can’t afford it.”
Josephine also sees untapped potential. “Assisting seniors is a good job for younger seniors to make a little income while serving those in need.” Her experience aligns directly with what AMAC and IW are arguing is necessary – flexible, mutually beneficial arrangements that connect seniors who need light assistance with individuals who could provide it in exchange for room, board, or modest compensation. But today’s federal regulations make such common-sense arrangements legally complex and financially prohibitive.
Kim, a patient care assistant from the Midwest, sees both sides of the crisis. She meets seniors “every week” who “have a new health issue that makes it necessary for them to have help to stay at home.” At the same time, she works alongside aging healthcare workers who would make excellent companions for seniors but cannot afford to give up their salaries or insurance.
“Many of these coworkers would make wonderful helpers for seniors wanting to stay at home, but they cannot afford to lose their insurance (or their salary),” Kim says. “It would be wonderful if we could figure out a way to match these two groups of people together.”
That simple idea captures what overregulation has blocked – the ability of willing people to help one another in flexible, human-scale ways without being punished by red tape.
For Donald Webb of Washington, the cost of institutional care changed the course of his final years with his wife. “My wife and I had been married for 52 years when Alzheimer’s took her life back in 2019,” he said. Years earlier, she had suffered a fall that left her in a wheelchair.
“In those 20 years, our financial resources were severely strained,” he explained, detailing how he had to place his wife in an assisted living facility because he could not afford in-home care. To do that, he was forced to liquidate his retirement savings.
Today, at 86, Donald is still living in the home he once shared with his wife, but he still carries a mortgage. “I have a small emergency fund. Medical bills… are my biggest challenge financially,” he says. The financial strain of long-term care did not end with his wife’s passing. It lingers in monthly bills and limited options – including for his own care, should he need it.
Marlene from Texas described a similar crossroads. After her mother passed away last summer, her 93-year-old stepfather expressed his strong desire to remain at home. The family agrees. They do not need round-the-clock medical supervision – just someone to stop in a few times a week. Yet even that modest level of support is extremely expensive.
“I would love to see something for those elders who want to stay in their home and keep their independence,” Marlene says. “I would love to see them have options for that occasional visit when family can’t do that for them.”
Across hundreds of submissions, the stories differ in detail but share a common thread. Seniors want to remain in their homes. Families are willing to sacrifice – financially, emotionally, physically – to make that possible. Many have remodeled homes, drained savings, paused careers, or sold property. Some have quietly contemplated informal arrangements because the legal options available to them are simply unaffordable.
These are not people asking D.C. bureaucrats to take over elder care. They are not demanding another trillion-dollar taxpayer-funded entitlement. They are simply asking for relief from rules that treat private households like corporate employers and make it nearly impossible to structure flexible, lawful, live-in or part-time assistance arrangements.
The 2013 Home Care Rule narrowed the longstanding companionship exemption and imposed wage and overtime structures that may make sense for institutions but often fail inside private homes. The predictable result has been higher costs, reduced flexibility, and a system that forces families to make impossible choices.
The men and women who submitted their stories are some of the most selfless, unsung heroes in this country. They are spouses honoring decades-long vows. They are sons and daughters juggling careers and children. They are seniors caring for parents in their late nineties. They are families who saved responsibly only to discover that the system punishes the middle – too much money for assistance, too little for private care.
Government should be bending over backward to help these families, not boxing them into narrow, bureaucratic pathways that drain assets and dignity alike.
That is why AMAC and IW remain committed to elevating these voices and advancing reforms that expand lawful, flexible caregiving options. That includes exploring innovative models that allow room and board to count toward compensation where appropriate, encouraging vetted shared-living arrangements and restoring the flexibility that once made in-home companionship accessible to ordinary families.
Aging at home is not about convenience. It is about preserving identity, memory, and independence. It is about ensuring that the final chapters of life are written in familiar rooms. The stories pouring in from across America make one thing unmistakably clear: There is deep love in these families. There is sacrifice. There is resilience. What is missing is a system that works with them instead of against them.
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