After a rough election in which Democrats used a government shutdown and the specter of lost health and food assistance benefits to hammer Republicans, conservatives should consider where the next attacks may come. One possible vulnerability is elder care, a very real and growing concern for millions of Americans, especially women.
By 2050, nearly 1 in 4 Americans will be over 65. Already, adults 65 and over make up about 18% of the U.S. population. Most want to stay in their homes, but many require assistance with daily activities such as meals, light chores, and transportation.
The financial burden is substantial. In-home care averages $80,000 annually, and nursing home care often exceeds $115,000. The cost of care has become unmanageable for even middle-income families, leaving many with few options as they juggle caring for aging parents and raising children.
During the 2024 campaign, then-Vice President Kamala Harris suggested expanding Medicare to subsidize in-home, long-term care services. While she did not provide details, such an approach would be astronomically expensive, divert resources from those who truly depend on a safety net, and overlook the impracticality of one-size-fits-all solutions. Seniors need more options that fit their circumstances, whether that means live-in companionship, part-time assistance, or another form of support.
There is already an existing model for affordable, home-based support that provides this kind of flexibility: the au pair program. For years, the State Department has facilitated this program, allowing young adults from abroad to live with U.S. families and provide child care in exchange for room, board, and a modest stipend. It’s a proven framework that connects household needs with capable companions.
This concept could extend beyond childcare and foreign participants. Policymakers could establish a U.S. companion program, adapting the model for citizens and residents to serve as in-home companions.
A college student could offset housing costs by living with an older adult who requires light assistance, or a widow living alone could offer companionship to a senior. Such arrangements could be budget-neutral and administered locally. Payment could follow the au pair model: free room and board, a modest stipend, and access to transportation or other in-kind benefits. At roughly $1,800 per month, the average cost of hosting an au pair, this structure would make live-in support far more attainable than today’s average $6,600 monthly cost for full-time home care.
The Department of Labor has acknowledged the limits of the current system and has proposed rescinding the 2013 Home Care Rule, returning to the previous interpretation of the companionship exemption. This change would again allow many in-home companions and caregivers to qualify for an exemption from overtime requirements and reduce compliance costs that deter families from hiring live-in support legally.
Currently, many caregiving relationships operate informally. Faced with high costs and burdensome regulations, many families and workers turn to “off the books” arrangements, leaving both seniors and caregivers without legal protections and exposed to potential tax and liability issues. They also risk violating complex wage-and-hour rules, which are notoriously difficult to navigate.
Therefore, while some may question whether an au pair-style model compromises standards and oversight, it’s the current system that creates the greatest possibility of abuse. The solution lies in simplifying and encouraging legal care arrangements. We need policies that make it easier for families to enter into legal caregiving relationships with safeguards against exploitation and other negative outcomes.
The State Department’s au pair program requires participants to undergo background checks, provide references and a physician’s report, and complete a thorough interview process before placement. A similar vetting process could be applied to host families and seniors, ensuring companions are placed in settings that match their skills.
As with the au pair program, sponsors could offer optional personal liability insurance for participants and have a responsible relative, such as an adult child, present during the companion’s initial days to ensure a smooth transition and then serve as the point of contact.
More than 40 million Americans provide unpaid care for aging relatives, often out of deep love and commitment but with limited support. Without meaningful policy changes, a growing number of seniors will be pushed toward costly institutional care they neither want nor can afford.
RESTORING AMERICA: REPEAL THE HOME CARE RULE AND RESTORE COMMUNITY-BASED CARE
With the 2025 elections behind us, the focus will soon shift to the 2026 midterm elections. This presents an opportunity for policymakers, particularly conservatives, to prioritize policies that bolster the workforce, help bring down housing costs, and support Americans in aging within their homes.
An American Companion model would transform how we care for our aging population, as well as create jobs and provide housing for younger Americans. The sooner these updates are made, the better prepared the country will be for the demographic changes already underway.
Heather Madden is policy staff director at Independent Women.
