Unpaid caregiving is reaching unprecedented levels nationwide, but a new analysis suggests Missouri may be less burdened than most states — even as advocates warn many families are still falling through the cracks.
About 38 million Americans — roughly 14% of the adult population — provided unpaid care to an older family member or loved one in 2024, according to the U.S. Bureau of Labor Statistics. Caregivers now spend an average of nearly four hours a day providing eldercare, up from less than three hours a decade ago, reflecting rising demand as the population ages.
Against that national backdrop, a study by Seniorly, a service providing subsidiary of CareScout, ranks Missouri as the second-least burdened state in the country for unpaid family caregiving. Delaware ranked first.
The analysis evaluated factors including caregiver prevalence, affordability of home care, access to respite services and availability of public programs. Missouri also ranked among the top states for access to Medicaid-funded home care, with fewer people stuck on long waiting lists.
Marlena del Hierro, CareScout’s director of operational growth, said stronger access to Medicaid services helps ease pressure on families.
“When you look at the population of folks using those Medicare and Medicaid services, they’re actually able to use that service,” del Hierro said. “There’s not the waiting list barrier you see in many other states, and there’s strong availability.”
Missouri also scored well for having fewer caregivers living in multi-generational households — situations where adults care for aging parents while also raising children, a dynamic that research shows can increase financial and emotional strain.
Still, advocates caution the rankings do not capture the full picture.
Stacy Morse, executive director of the Missouri Council on Aging, said strict Medicaid income limits leave many older adults without formal support, even when they need care.
“If Medicaid eligibility were raised to a living-wage level — so people could actually have some money left over — the waiting lists would grow because more people would qualify,” Morse said. “So when we say there’s no wait list, it’s partly because eligibility requires people to be extremely poor to begin with.”
As a result, many Missourians do still rely heavily on unpaid family caregivers, often at significant personal cost.
A 2025 report from the Alzheimer’s Association estimates Missourians provided about $9.5 billion worth of unpaid caregiving in 2024 alone. Nationally, the economic value of unpaid family care is estimated at more than $1.1 trillion annually, according to the National Partnership for Women & Families.
The burden is expected to grow as the population ages. Federal projections show the number of adults aged 85 and older — the age group most likely to need long-term care — will more than double by 2050. At the same time, rising costs for home health aides and adult day care are placing added strain on families.
Women shoulder much of that responsibility. Department of Labor data show women 55 and older spend an average of 182 hours a year caring for loved ones — the equivalent of more than a month of full-time work — without pay.
Advocates say Missouri’s relatively strong ranking should not obscure the need for broader support, particularly for middle-income families who earn too much to qualify for Medicaid but cannot afford private care.
“Even when someone is in a nursing home or receiving home- and community-based services, it’s still critical to have an advocate,” Morse said. “Someone has to help manage prescriptions, doctor’s appointments and other living expenses to ensure that person is safe and able to live well. Caregiving doesn’t stop just because formal services are in place.”
