Increasing Access to Caregiver-Friendly Workplaces: Stakeholder Perspectives

Abstract

In the U.S, the roughly 70% of family caregivers who are employed face challenges balancing work and family responsibilities—which can threaten their longer-term financial well-being. Thus, the National Strategy to Support Family Caregivers (2022) focuses on increasing the availability of workplace protections and supports. This study provides stakeholder perspectives on caregiver-friendly workplace policies, drawing on data collected to support the development of the Strategy. Data were collected from qualitative interviews and focus groups with stakeholder organizations, comprising 34 individuals, aiming to identify key issues in encouraging caregiver-friendly workplaces. Respondents supported the need for systematic approaches in support of that shift and offered ideas for catalyzing it, stressing the importance of supportive workplace environments. They highlighted employer variation in capacity to adopt practices and the need for a range of options that accommodate employer and employee heterogeneity. Furthermore, they described the role of data in informing employers and policy.

Keywords

workplace policy caregiver-friendly workplace policies employee benefits working caregiver

What This Paper Adds

• This paper provides information on the views of stakeholders (representatives from employers, human resources, employer intermediaries, and caregiver advocates) on how American workplaces can become more caregiver-friendly

• It identifies a range of issues that are critical for advancing the adoption of caregiver-friendly workplaces, such as broad differences among employers and the need for supportive workplace environments

• It identifies areas where research is lacking that would speak to the issues seen as critical by study participants

Applications of Study Findings

• The paper suggests key strategies for encouraging workplaces to become more caregiver-friendly

• It stresses that the range of practices is broad enough to enable different employers to adopt at least some practices

• It finds that efforts to encourage caregiver-friendly workplaces can take place at many levels: within organizations, across firms, and at different levels of government

Introduction

Unpaid caregiving is increasingly common: in the United States more than 63 million adults provide care to an older adult or an adult with a disability (AARP National Alliance for Caregiving, 2025). Most of these caregivers (approximately 70% of those aged 18-64) are employed full- or part-time while providing care (AARP National Alliance for Caregiving, 2025). Balancing employment and caregiving responsibilities has well-documented consequences for caregivers’ well-being, including elevated stress, work–life conflict, and adverse financial impacts (AARP National Alliance for Caregiving, 2025; Burch et al., 2019; Calvano, 2013).

As the population ages, the number of working caregivers will continue to grow. Yet public policy in the United States remains limited. The primary federal policy, the Family and Medical Leave Act (FMLA) of 1993, provides up to 12 weeks of job-protected unpaid leave for eligible workers—but applies only to employers with 50 or more employees, thus covering only about 60% of the workforce (Chen, 2016). Consequently, workplaces play an important role in supporting employed caregivers. However, it remains unclear how and why employers adopt caregiver-friendly workplace policies (CFWPs) and what factors facilitate their diffusion.

This study draws on the perspectives of key stakeholders to identify strategies supporting a shift toward caregiver-friendly workplaces. It provides a more in-depth analysis of qualitative data collected to inform the development of the National Strategy to Support Family Caregivers (RAISE Family Caregiving Advisory Council, 2022), under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act of 2018. The Strategy’s recommendations included Goal 4: Ensure financial and workplace security; and Outcome 4.2: Increase access to caregiver-friendly workplaces.

Background

Family caregivers face difficulties combining employment and caregiving. This tension is often conceptualized as work–life conflict, rooted in Role Theory, which posits that competing demands across roles generate stress and other negative outcomes (Feeney & Stritch, 2019; Kahn, 1964). Among caregivers, work–life conflict has been linked to psychological strain (e.g., guilt, burnout, anxiety) as well as adverse physical and financial outcomes (Burch et al., 2019; Clancy et al., 2020). Prior research identifies caregiving intensity and type as primary drivers of conflict, alongside individual characteristics such as gender (Burch et al., 2019; Clancy et al., 2020).

Employer practices can mitigate work–life conflict through CFWPs. These practices build on family-friendly workplace practices focused on parental needs, and include flexible work arrangements (e.g., flexible schedules, remote work, paid time off), employee assistance programs (EAPs) offering resources, and supportive organizational cultures that normalize caregiving responsibilities and encourage managerial and peer support (Butts et al., 2013; Crain & Stevens, 2018; Ireson et al., 2018). Employers are increasingly offering such benefits (AARP National Alliance for Caregiving, 2025), and a growing body of research demonstrates their positive effects (Chung, 2020; Çivilidağ & Durmaz, 2024).

Research on employer outcomes associated with CFWPs has attempted to quantify its return on investment (ROI), under the assumption that demonstrated savings will motivate adoption. This literature is limited, reliant on gray sources, and differs in rigor (de Menezes & Kelliher, 2011; Kelly et al., 2008). More consistent evidence links CFWPs to proximal outcomes such as turnover, absenteeism, job satisfaction, and productivity (Burch et al., 2019; Wong et al., 2020).

Notably absent from the peer-reviewed literature are analyses of what motivates the adoption of CFWPs. Some insight comes from studies examining employer characteristics associated with adoption (Chung et al., 2022; Lorenz et al., 2021) and from gray literature indicating that many employers underestimate both the prevalence of caregiving employees and the range of options for supporting them (Fuller & Raman, 2019). To address these gaps, this study draws on Diffusion of Innovations theory (Rogers, 2003) and Bronfenbrenner’s ecological model (Bronfenbrenner, 1979) to explore multilevel influences on CFWP adoption to identify stakeholder perception of the critical factors shaping CFWP adoption.

Methods

Data for this analysis were drawn from a larger multi-phase qualitative study conducted in support of the RAISE Family Caregiver Advisory Council involving 153 organizations from across the United States. Phase I involved six stakeholder strategy sessions, including one focused on caregiver financial and workplace security. A two-hour listening session focusing on caregiver financial and workplace security was held in December 2020, involving nine representatives from stakeholder organizations identified by the Council.

Phase II expanded on Phase I findings through six key informant interviews and three stakeholder focus groups designed to identify concrete actions to advance CFWPs in late 2021. It included 25 employers, employer intermediaries, labor market researchers, and caregiver advocates, totaling 34 participants. While employer respondents represented a limited range of large to mid-sized firms, the other respondents were recruited to provide broader perspectives on the issues. Recruitment for Phase II is described in detail elsewhere (Tell et al., 2022). Appendix A lists participants and quote identifiers.

A semi-structured interview protocol was used across interviews and focus groups and adapted to participant roles (e.g., employer, intermediary, researcher, advocate). Topics included the role of government in promoting workplace security for caregivers; employer priorities and practices; strategies to encourage adoption of CFWPs; and data and research needs. Participants were encouraged to identify strategies they viewed as effective, feasible, and actionable.

Analysis built on an existing coding framework developed for a broader analysis of the same dataset. That framework, created through an iterative process by a five-member research team, included a parent code related to workplace issues, with subcodes such as employer practices and employer incentives. For the present study, two researchers (the first and third authors) revisited the data using an open coding process to identify recurring patterns (Glaser & Strauss, 1967; Miles et al., 2014). The analytic approach combined deductive coding based on the a priori codes, inductive refinement and generation of new codes, and abductive reasoning through iterative engagement with our theories about the phenomenon and the data (Charmaz, 2014).

Authors 1 and 3 met regularly to review, revise, and reach consensus on the evolving coding scheme. Each independently applied the revised codes to the transcripts, followed by team discussions to resolve discrepancies and identify themes and subthemes (Thornberg & Charmaz, 2014). NVivo 12 was used to manage and analyze the qualitative data.

Findings

Several strong themes emerged. Respondents emphasized the importance of promoting caregiver-friendly workplaces, particularly through the creation of supportive organizational cultures. They identified multiple strategies for catalyzing this shift and highlighted the role of data in supporting it. However, they also stressed that employer heterogeneity determines the feasibility of caregiver-friendly practices, necessitating differentiated approaches.

Workplaces have many options for becoming caregiver-friendly

Respondents discussed the wide range of options for supporting family caregivers. They highlighted the critical role of a supportive work environment, stressing that its absence may mean that CFWPs are underutilized. Lastly, respondents noted the importance of widespread awareness of caregiving issues and benefits.

A wide range of practices can support family caregivers

A respondent discussed the many employer practices that support family caregivers:

When you talk about policies, do we have policies for flex time? Do we have policies for use of your PTO?... There’s lots of things I think that employers could look at. (FG2-5, Public Sector Employer)

However, as one respondent noted, “…there’s not one answer for how you can create the right benefit. There’s not just one benefit.” Moreover, they commented, “…no caregiver journey is alike. And so, it’s really hard for employers to figure out there is no one package for an entire workforce” (KI-1, Employer Intermediary).

Respondents also noted caregiving employees’ needs for information, advice, and emotional support. As one employer intermediary said,

Even though you offer more PTO or FMLA or more time off, like people still need help with the challenge at hand…. [An employee is] still trying to figure out how to help my mom and my dad and help my family. (FG4-3, Private Sector Employer)

Another commented,

We need to make it so much simpler for our employees, for people in general to get the services they need, understand what’s available to them. It’s really a complex system to maneuver through when you’re stressed too. (FG1-4, Caregiver Advocate)

However, it was acknowledged that these practices might be costly and that employers could choose lower-cost options:

There’s also these smaller lower-hanging fruit things that you could do. So we’ve been trying really hard to push caregiver ERGs [employee resource groups] and like lunch and learn and other smaller bites of the apple to get people into the space. (FG1-6, HR Director)

Because many companies (and HR departments) lack expertise in caregiving, some rely on “employer intermediaries:” businesses that offer service packages that employers can offer. As one participant mentioned:

Many [larger employers] are using EAP [employee assistance programs] work-life services type benefits to connect. Even if they don’t have a caregiving program [these] folks will connect them with community resources. (FG3-1, Researcher)

A supportive workplace culture is critical in enabling caregivers to claim benefits

Respondents discussed the importance of caregivers feeling able to talk with managers and utilize benefits without fear of repercussions. Organizational culture can support caregiver self-disclosure or create a climate of fear: as one participant remarked, “...just because benefits are available doesn’t mean employees are going to seek it out…that’s related back to the stigma issue” (FG3-2, Business Consultant). Participants frequently mentioned employee distrust of managers and HR departments. As one participant said, “there’s a concern about confidentiality” (KI-6, Employer Intermediary). Another participant stated that some managers openly discourage use of benefits: “A manager announced, ‘Here’s this new maternity policy we’re putting in place. God forbid anyone who makes use of it.’ That was said verbally” (KI-4, Researcher).

The respondent also reflected on her own positive experience of a supportive workplace:

We all worked together to make sure I got time off to do what had to be done. Work priorities were maintained, it was an open conversation… We’re not having those conversations with HR … most HR in the last decade has not, has gone from not being the care provider, but the rule keeper, how you fire people, how you hire people, that type of stuff. (KI-4, Researcher)

Leadership, management, and workers need to be aware of caregiving issues and benefits available to support caregivers

Respondents discussed the importance of organization-wide awareness and noted its critical role in creating a supportive workplace environment. Employer and manager training is needed for better understanding of caregiver needs.

The education piece, I think, is key. Not only for the employees to recognize that they are a caregiver, but then use that same education piece and give it to the employer to recognize what a caregiver is. Because chances are there’s several people who are the employer who are probably caregivers and don’t even get it. (FG4-1, EAP Manager)

Training managers was seen as critical:

Are you training managers to assist and be able to have sensitive conversations with employees? If an employee comes to a manager and says, ‘You know, I’m really struggling. I have a child with autism,’ is that manager going to say, ‘Tough’? (KI-1, Employer Intermediary)

Another participant observed,

…there are companies out there teaching resiliency and empathy… If you go to your supervisor… and they don’t know how to talk to you about this, you’re lost right there. (FG3-1, Researcher)

CFWPs are not one-size-fits-all

Study participants stressed that caregiver needs vary—both across the workforce and for individuals over time—leading to a need for employer flexibility. Thus, workplaces need to understand their workforce and its needs, as well as how different CFWPs might fit into their organization. One respondent suggested that,

...it’s going to be the flexibility of an employer recognizing that success doesn’t mean the same for me as it does for [others]. Right? And it’s going to be having flexible benefit designs that include benefits that mean something to me today. So today I need caregiving benefits. Tomorrow, I may, may need long-term care benefits. (KI-1, Employer Intermediary)

A few respondents noted that supporting caregivers was a part of organizational commitments to diversity. Moreover, one noted that, “It doesn’t matter where you are on the spectrum. There’s something you can do… there are options” (FG1-5, Policymaker).

Ideas for catalyzing change

Respondents discussed how to catalyze the shift toward CFWPs, highlighting the potential of leadership, government, and business incentives.

Leadership at all Levels Is Needed

All kinds of leadership were seen as important. At the firm level, organizational champions are needed. Across firms, employer coalitions or organizations can provide leadership and diffuse best practices. As one respondent stated:

High-level executives have come out and really done a lot of leadership work….. if an executive is coming out and saying that they’ve had these caregiving challenges and they’ve faced these problems and they were afforded flexibility in their workplace…, that says a lot. (FG3-2, Business Consultant)

High-level support may come from personal experiences. As one respondent relayed:

A CEO… started crying and he said…, my mother got cancer. I didn’t miss a single day of her treatment, but it doesn’t even strike me that I have 300 or 1000 workers who come on my shop floor…. Three times you don’t show up at work, you’re fired…. And I think I’m a great employer, but it never even entered my head that I should think about this. (KI-4, Researcher)

Leadership from within the business community was also seen as critical. As one said, “Our most effective strategy was employer to employer. So we had some champions, we had a group of champions and they recruited other champions and they just kept reaching out” (FG1-4, Caregiver Advocate). Another respondent suggested,

I’d go after business groups. I’d go after big groups,… [the] things that most employers are familiar with. Going direct to employer…. You’re just going to beat your head against the wall... Once they understand that that information is out there and they don’t have to put it together themselves, they love that kind of stuff. (FG3-1, Researcher)

In partnership with business, government could also help: “someone high up in the government and high up in the public and or private sector needs to be a champion” (FG4-1, EAP Manager).

Role of government

Respondents frequently mentioned government policies supporting caregivers—particularly the FMLA. However, some saw the FMLA as an inadequate and short-term solution:

People use leave as essentially like, ‘I’m at my breaking point. My to-do list is so long. I’m about to burst otherwise I might quit… What families really need is just more infrastructure. (KI-3, Employer Intermediary)

Participants felt government could motivate employers by offering financial incentives. As one respondent noted,

It needs to be some sort of federal government assistance to organizations… Your organization may want to do it…. [but] they cannot afford to.… But if we had some sort of federal government… relief financially to the organization, I think you will see a lot more. (FG4-2, HR Director)

Another mentioned that “if we can have some sort of standards of caregiving... say, the employer is committed to creating X program, then we should have some sort of tax credit.” (FG4-4, Caregiver Advocate) This respondent also suggested federal government modeling of CFWPs:

The federal government is a very large employer. If they were to take their own medicine …. show a respect for and engagement of family caregivers, I think that would be a great first step. (FG4-4, Caregiver Advocate)

Other government roles mentioned included funding research, compiling resources, facilitating cross-sector partnerships, raising public awareness, and establishing best practices. Some participants suggested employer certification, while one focus group converged on the notion of a playbook:

The playbook could include, what data do you need to understand… your population and how it affects [it]?... Here are some successful best practices that other employers have employed …. How do you then measure success in your workforce? (FG3-1, Researcher)

A frequently mentioned model was the Massachusetts Caregiver Coalition, a business group supported by the Massachusetts government. As one participant said, “…the point was to have a multi-stakeholder group that focused on how employers can recognize, honor and support the caregivers in their workforce” (FG1-5, Policymaker). Others mentioned a Kentucky initiative (Canopy) that certifies businesses demonstrating good practices.

While some respondents felt strongly that CFWP adoption needs to be business-led, others felt that government needs to offer both sticks and carrots. At least one respondent felt that “it has to be from federal policy.” (LS-6, Caregiver Advocate).

Promoting the business case for CFWPs

Participants emphasized that evidence of organizational benefits is critical for CFWP adoption, particularly data demonstrating return on investment (ROI). However, they also noted the difficulty of rigorously establishing ROI, contrasting it with the more intuitive value on investment (VOI), which is reflected in outcomes such as absenteeism, morale, recruitment, and retention.

Despite its difficulty, establishing the ROI of CFWPs was seen as critical. As one participant said, “The reaction is going to be financial monetary first, and human second” (FG3-1, Researcher). If convincing evidence on ROI were available, one noted, “…there’s a huge audience that would be willing to take a look at something like that if we had some tangible measures, information, so that businesses can tie it back into their workforce.” (FG1-6, HR Director). As one respondent suggested,

What is really interesting about this whole conversation is the ROI versus VOI story… I get the whole VOI thing. It’s a great feel-good program, but… their first reaction is always… how much is it going to cost me? How much is it going to save me? (FG3-1, Researcher)

Another respondent noted that “It’s just really hard to show that it pays to care. It’s still vast. There’s so many different use cases and scenarios” (KI-2, Employer Intermediary).

Some respondents suggested that evidence on the costs of not supporting caregivers would be more meaningful:

It’s not the hard data on return on investment. It’s the hard data on this is how you are bleeding. Mr. CEO or Ms. CEO… the fact that productivity is being lost is not really tracked by organizations…. (KI-4, Researcher)

Some urged a focus on healthcare costs: “What are those healthcare costs for you the employer, if you don’t provide supports for your caregiving employees?” (FG3-2, Business Consultant).

Furthermore, establishing ROI is difficult if the workplace environment discourages benefit uptake. As one participant said, “…it’s really hard to fully understand what the ROI is and can be if people aren’t utilizing [benefits]” (FG3-2, Business Consultant).

In contrast to the difficulties of measuring ROI, respondents noted that the VOI case for CFWPs is intuitive: parameters such as recruitment, retention, and staff loyalty were repeatedly mentioned. One said, “The number one thing that business roundtables are telling us… is the issue of human capital. How do they get and retain employees?” (FG3-3, Business Consultant). Another said, “…if you want to compete, you’re going to have to be known as a place that caregivers want to work” (FG3-1, Researcher). This cluster of responses underlined the reputational advantage of being caregiver-friendly. In highlighting the loyalty CFWPs engender, one respondent mentioned

the lady… who was a wonderful employee, has a lot of tacit knowledge. “We will retain her. She will not leave the company. She will stay with us, she’ll be loyal to us…” So it’s a shift in the way from a loser mentality to a winner mentality. And when employers go through that shift, they actually don’t focus on counting the cents and dollars. They get it at a strategy level. (KI-4, Researcher)

Moreover, respondents noted that caregivers bring softer skills that could fit into a VOI framework:

But I also know that caregivers bring incredible negotiation skills and attention to detail and research skills.... maybe that’s a way to look at ROI and VOI. (FG3-4, Caregiver Advocate and Employer Intermediary)

Ultimately, one respondent suggested that firms consider not just the organizational but also the societal benefit of CFWPs:

But then when you make it a little bit bigger and you think, “Wow. If I’m taking care of my mother and I’m a supported caregiver, she’s going to end up in the ER less. She’s going to have less readmission.” So there’s that ROI. And then there’s the ROI for the caregiver and his or her own health costs too. So there’s so much, I think we could do if we begin to tie those government programs… and show a bigger global ROI. (FG1-1, Employer Intermediary)

The role of data in supporting CFWP adoption

A major theme was the role of data and research in supporting CFWP adoption. Participants discussed the importance of employers’ understanding of employees’ experiences and needs, the need for improved understanding of CFWP ROI and VOI, and government’s role in supporting CFWP research.

Employers need awareness of their employee caregivers

Participants stressed that employers often fail to realize how many employees have caregiving responsibilities, what their needs are, or the extent to which absenteeism or productivity are impacted. Indeed, one participant noted that a business they worked with was “stunned by the number of caregivers in their workforce… and it led to them making a lot of moves” (KI-4, Researcher). This lack of evidence limits employers’ ability to respond to employee needs. That respondent added,

What are the demographics of your organization? What is the age group of different employees within your organization? Each age group, each decade you have different needs. (KI-4, Researcher)

Participants commented that employers often lack understanding of the diversity of caregivers and caregiving responsibilities among employees:

One of the things that surprises a lot of businesses… is how many caregivers are not 50-year-old white women. When an employee base is all millennial men… [they] think, I don’t have to worry about caregiving because these people aren’t caregivers, they don’t fit the demographic. (FG3-3, Business Consultant)

Given this lack of awareness, participants noted that “You have to survey” (FG3-1, Researcher). Information can help reduce stigma and increase benefits uptake. One respondent said we need, “any kind of data that can help us normalize this, quite frankly -- so that people can use what is offered” (FG3-2, Business Consultant).

Companies also need to track benefit utilization. One respondent commented, “…companies are good at jumping at providing benefits. They’re not tracking who is using the benefit and how well is that benefit being used?” (KI-4, Researcher).

It was further noted that even if data on the ROI and VOI of CFWPs were desired, firms’ capacities to collect and analyze data varies.

Government’s Role in Research

Respondents felt that the federal government had a significant role in supporting CFWP research, although thoughts varied on the nature of that role. One respondent suggested that research about caregiving employees’ experiences should be collected “by an uninterested party like the government or someone, the Census Bureau” (FG 3-1, Researcher) and used to publicize working caregiver needs. As another commented, “…if there’s more research and data at the macro, it will be a driver to make certain programs for caregivers considered essential” (KI-1, Employer Intermediary).

Given the limited research capacity of many businesses, respondents felt that government should help with the expense and effort involved in ROI and VOI research and sponsor research comparing CFWP practices across firms.

There’s a lot of government funding that could go in, and there’s a lot of research you could do around the different organizations… and what that impact is overall on those organizations from a financial perspective (FG4-3, Private Sector Employer)

Respondents also commented on existing government data. Some mentioned that “...the problem is the data – getting it from the government and the census bureau and all the publicly available data, which is what we like to use for research – is tough” (FG3-1, Researcher).

Government also has an important role, some respondents suggested, in promulgating best practices and gathering resources. A caregiver advocate stated:

The federal government, I think can do some great research and make that available to employers: “Here’s something you can just share with your employees in your area, here on these resources. If you need tasks getting a nursing home, we’ll doing X, Y, and Z, elder rest, whatever it is.” It doesn’t cost the employer anything, but [employers can] make it easily and readily available… (FG3-2, Business Consultant)

One respondent stressed that the lack of guidance on effective strategies places businesses at a loss:

You’re very often just investing in stuff haphazardly and assuming it’s a one-size-fits-all. And that can be catastrophic because what happens is, you get companies with great intentions, they invest, but they don’t know how to invest. And then, there’s really no return on that investment…. And then, you’ve lost them. (KI-2, Employer Intermediary)

Differences Among Employers Impact the Ability to Establish CFWPs

Respondents frequently highlighted businesses’ differing abilities to invest in CFWPs, collect data, and determine which CFWPs best suit their organization. As noted, there is no “one-size-fits-all,” but “no matter where you are there is something that you can do.” (FG3-2, Business Consultant)

Small versus large employers

Respondents frequently discussed how firm size affects the ability to adopt CFWPs. One respondent remarked, “Size is absolutely a factor because the bigger you are, the more you can absorb” (FG1-1, Employer Intermediary). Larger firms can contract out for services. As one participant said, “Large employers, they’re depending on their consultants” or perhaps “using EAP work-life services type benefits.” This respondent continued, “…not every employer has the [employer intermediary service] not every employer has work-life services. Those are all front door things for pretty big employers” (FG3-1, Researcher).

In contrast, offering CFWPs is harder for smaller employers:

...we’re a relatively small company. We’ve had over 30 babies born, so it’s taxing on our other employees. And we I think are a very flexible company… it’s just tough. (FG1-1, Employer Intermediary)

Respondents noted that CFWPs are particularly important for small employers: “It’s left out of this conversation… that most employees are covered under small businesses that are exempt from [government] programs” such as FMLA (LS-6, Caregiver Advocate). One noted, “60% of the US workforce works for small or midsized organizations that even if you put a professional mandate… it’s ineffective because it doesn’t reach enough employees” (LS-5, Caregiver Advocate).

Industry Type

Respondents noted that differences other than firm size were important, as the ability to be flexible differs considerably within firms and across industries. For example, certain jobs are on-site—such as retail or manufacturing jobs—while others have fixed schedules—such as nursing. So,

The other thing is what type of workforce you have. So we have no one that is manufacturing or needs to go into the office. So we have a lot of flexibility built into just the way you can work. There’s other companies that can’t give that flexibility. So what do you do? (FG1-1, Employer Intermediary)

Respondents also noted that certain employees might receive more support than others:

In the case of their top C-Suite essential… employees… [In] many private equity funds when a female managing director has a baby, they will fly a nanny along with her worldwide… so that work can keep going and she can join work back, because she’s considered valuable, important. (KI-4, Researcher)

Another respondent remarked on the role of unions pushing for CFWPs, suggesting that workplaces with strong unions tend to be the “types of working environments and demographics, where family is important… when it comes to family care and caregiving, I think, there’s a real opportunity for unions” (KI-1, Employer Intermediary).

Discussion

Much has been demanded of working caregivers, resulting in well-documented negative outcomes. These pressures are only likely to increase as the population ages and the primary source of paid care—Medicaid—will likely be significantly cut. Employers will play an increasingly critical role in enabling caregivers to remain employed and financially secure. This study identifies stakeholder perspectives on strategies for promoting and implementing CFWPs.

Findings indicate that employers have multiple pathways to becoming caregiver-friendly and that change can be catalyzed through action at multiple levels, consistent with Bronfenbrenner’s socio-ecological model (Bronfenbrenner, 1979). Consistent with Diffusion of Innovations theory (Rogers, 2003), respondents emphasized that leadership is required within organizations, across employer networks, and through government policy. Suggested strategies included incentives such as certifications or tax credits, practical resources for employers (e.g., implementation “playbooks”), awareness campaigns to shift workplace norms, and employer coalitions that can act as opinion leaders within business communities (Dearing, 2009).

Respondents also highlighted that CFWPs constitute a bundle of practices varying in cost and complexity, allowing employers to tailor approaches to their organizational context as well as differing employee needs. This flexibility is critical for diffusion, particularly among employers unable to implement resource-intensive policies such as paid leave. There was broad agreement, however, on the need for creating caregiver-friendly workplace environments. Shifting social norms—especially among managers and coworkers—was consistently identified as a low-cost, high-impact strategy. This emphasis aligns with prior research linking perceived organizational support to reduced burnout, increased job satisfaction, and lower intent to leave (Crain & Stevens, 2018; Rhoades & Eisenberger, 2002), as well as with theory highlighting the protective role of social support in the stress process (Pearlin et al., 1990). Educational initiatives within organizations were seen as important for normalizing caregiving and disseminating supportive norms.

Data and research were also viewed as central to advancing CFWPs. Respondents stressed the need for better data on caregiving employees’ needs and experiences, as well as evidence linking CFWPs to organizational outcomes. While return-on-investment arguments were perceived as influential, participants acknowledged the methodological challenges of demonstrating ROI and emphasized alternative framings, such as impacts on recruitment, retention, and staff loyalty, or the costs of inaction. Given limited incentives and capacity within many firms, respondents saw a clear role for government in supporting data collection and research.

Employer heterogeneity emerged as another key theme. Firm size, industry, unionization, and workforce composition shape both whether CFWPs are adopted and how they are implemented. This is particularly salient for small employers, which employ two-fifths of the U.S. workforce (U.S. Chamber of Commerce, 2024) yet face distinct resource constraints; not enough is understood about feasible strategies for these employers. Participants also noted unequal access to CFWPs within organizations, with higher-status employees often benefiting more than frontline workers, echoing prior findings (Ireson et al., 2018).

Finally, respondents identified government action as an important catalyst, pointing to international and subnational examples. Initiatives such as Canada’s workplace standards for caregivers and the EU Work–Life Balance Directive illustrate how policy guidance can educate employers, accommodate organizational differences, and encourage uptake. In the absence of comprehensive federal action, state-level efforts demonstrate alternative pathways for promoting caregiver-friendly practices.

This study is limited in its relatively small participant pool, which may not reflect broader caregiving or employer circumstances, and in its inability to capture the full range of employer perspectives, particularly those of smaller employers; systematic data about participant characteristics were not collected. Future studies should more systematically examine how firm differences impact the ability to offer CFWPs.

Conclusion

This study highlights stakeholder perspectives on mechanisms for advancing caregiver-friendly workplace policies in the United States. Findings underscore that employers have multiple, adaptable options for supporting working caregivers; that diffusion of CFWPs can occur across organizational, inter-organizational, and policy levels; and that leadership, supportive workplace cultures, and credible data are critical to this process. At the same time, differences among employers shape both the feasibility and likelihood of adoption, pointing to the need for tailored strategies. Together, these findings suggest that while the diffusion of CFWPs is achievable, sustained progress will require coordinated leadership from employers, employer coalitions, and government actors.

Supplemental Material

Supplemental Material - Increasing Access to Caregiver-Friendly Workplaces: Stakeholder Perspectives

Supplemental Material for Increasing Access to Caregiver-Friendly Workplaces: Stakeholder Perspectives by Pamela Nadash, Eileen J. Tell, Maryssa Pallis in Journal of Applied Gerontology

Footnotes

Acknowledgments

This study would not have been possible without the stewardship of Greg Link from the Administration for Community Living. The support of Wendy Fox-Grage of the National Academy for State Health Policy has also been invaluable, as well as funding from the John A. Hartford Foundation (under a subcontract from the National Academy for State Health Policy) in collaboration with the Administration for Community Living. We also thank our colleagues at Community Catalyst for their help and advice, as well as those who assisted with the collection and analysis: graduate research assistants Taylor Jansen and Shan Qu.

ORCID iD

Pamela Nadash

Ethical Considerations

The research activities and research protocol were approved by the University of Massachusetts Boston Institutional Review Board. The authors acknowledge that this research project was conducted in full compliance with ethical standards.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Funding was provided by the John A. Hartford Foundation (under a subcontract from the National Academy for State Health Policy) in collaboration with the Administration for Community Living.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Research Involving Human and Animal Participants

This research involved human participants. All research activities and protocols were approved and regulated by the University of Massachusetts Boston Institutional Review Board. This was completed in compliance with standard research ethics for qualitative research.

Supplemental Material

Supplemental material for this article is available online.

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