When my partner’s best friend had eye surgery, he was in a bind: He couldn’t get home to recover by himself, and his family lives on the other side of the country. Luckily, my partner is self-employed and was able to take some time to be with his friend when he needed him. But what if my partner had needed to request time off from work to care for his friend? He’d likely be at the mercy of his employer.
At some point in our lives, nearly all of us will need to care for a loved one. But in the United States, whether you have the time and financial support for caregiving too often depends on whether you happen to work for a company that offers paid sick days or paid family and medical leave. It likely also depends on whether lawmakers or your human resources department decide your loved one counts as "family."
Caregiving doesn't always coincide with the kinds of family relationships that have historically been recognized by U.S. laws. One recent study found that approximately one-third of people in the United States, and more than 4 in 10 LGBTQ individuals and individuals with disabilities, had taken time away from work to care for a so-called chosen family member. While discussions of chosen family often focus on queer communities, many of whom have long relied on support networks outside their legal or “blood” family, "chosen family" refers to any person with whom you have a close relationship that isn't typically recognized in the law, such as a longtime neighbor who was like a mother to you or a close friend you served alongside during a tour of duty. And the need for policymakers to recognize chosen family is only likely to increase, given the growing need for elder caregiving and the shortage of direct kin to do it.
To help ensure that people can care for chosen family, paid leave and other caregiving policies need inclusive definitions of who can access time off and other support for caregiving. Yet policymakers also have to balance the need for inclusivity with the political reality that the more people a program covers, the more likely lawmakers are to have concerns about how much it costs. The White House’s most recent proposal would limit paid leave to new parents, which would exclude chosen family and many forms of caregiving. So how do we translate the complexity of family and caregiving relationships into the cold, hard language of a labor law—and how do we frame legislation so that it has a chance of passing?
The good news is that it can be done. Three policies in effect right now show the innovative approaches policymakers have been taking to help ensure that people can provide care to members of their chosen family. And these inclusive policies aren’t only coming from blue states and cities.
1. Paid Sick Day Laws Recognize “Equivalent of a Family Relationship”
Policies designed to support members of the military and veterans have been at the vanguard of U.S. social policy since the Civil War. One of the current standards for an inclusive definition of family originated in Vietnam War–era regulations permitting federal employees to take funeral leave for relatives who were killed in combat, including those related by "blood or affinity whose close association with the employee is the equivalent of a family relationship."
Much like the term chosen family, this language legitimates close nonfamily relationships by comparing them to relationships by "blood." Similar language is now being used in paid sick days laws in Arizona; St. Paul, Minnesota; Los Angeles; Chicago and Cook County, Illinois; and San Francisco covers leave for a “designated person.” These laws provide working people in the jurisdictions a job-protected right to earn and use paid sick days to care for chosen family.
2. Veterans Affairs Supports Anyone Providing Personal Care to a Post-9/11 Vet
Programs for veterans and military families continue to be a source of innovation in family policy today. The U.S. Department of Veterans Affairs Program of Comprehensive Assistance for Family Caregivers provides training, respite services, a monthly stipend, and other support to caregivers for veterans wounded in post-9/11 conflicts. Eligibility depends on the veteran's health status (a serious injury incurred or aggravated in the line of duty on or after Sept. 11, 2001), the level of assistance provided by the military service member’s caregiver, and either a family or residency relationship.
To be recognized as a "family caregiver," a person must either be "a member of the family of the veteran" (the law specifically names parent, spouse, child, stepfamily member, or extended family member) or an individual who "lives with the veteran but is not a member of the family of the veteran," and someone "who provides personal care services to the veteran."
Allowing nonfamily caregivers to be eligible for support leaves an opening for the approximately one-quarter of post-9/11 military caregivers who are not related to the veteran. Interestingly, this definition doesn't even require the caregiver to have a "familylike" relationship to the veteran. This innovative program is making a difference for veterans, and a proposal to expand coverage to pre-9/11 veterans even has bipartisan support in Congress.
3. In Hawaii’s Kapuna Care, “Friendship” Is Kinship
Earlier this year, Hawaii enacted a first-in-the-nation elder care program, "Kapuna Care," which provides a daily stipend to caregivers for older adults. Hawaii isn't new to the "innovative family policy" game either: In 1997, it became the first jurisdiction in North America to offer legal protections, including hospital visitation rights, to people unable to marry—such as siblings or other relations, as well as same-sex couples.
Kapuna Care defines eligibility around the health status of the care recipient and the level of assistance provided by the caregiver, and requires the caregiver to have a "personal relationship" to the care recipient. The law is remarkable in that it specifies "friend" as an eligible relationship.
As we continue to push for paid family and medical leave, paid sick days and other supportive caregiving policies, policymakers need to be pushed to consider policies like these that are already working as models for how to support diverse families and caregiving relationships. Designing policies with room for the complex ways Americans define family isn’t quite the hurdle it might seem.