Child Welfare and Aging Programs: HHS Could Enhance Support for Grandparents and Other Relative Caregivers
Fast Facts
Grandparents, other relatives, and family friends often step in when parents cannot care for their children. In 2018, about 2.7 million children lived with such caregivers—mostly outside of foster care.
The Department of Health and Human Services (HHS) has established programs to help these caregivers with the financial, legal, or other challenges they face. However, many states are not using these optional programs, and some state and local officials told us they would like more guidance.
We recommended that HHS regularly share information and best practices with states on using these programs to better support caregivers.
Older woman holding a baby
Highlights
What GAO Found
In 2018, an estimated 2.7 million children lived with kin caregivers— grandparents, other relatives, or close family friends—because their parents were unable to care for them. Most of these children were cared for outside the foster care system, which can affect the types of services and supports available. While children did not live with parents for a variety of reasons, parental substance abuse and incarceration were often cited in data and in interviews with program officials.
Most Children Living with Kin Are Not in Foster Care, 2018
Challenges faced by kin caregivers include having limited financial resources and needing legal assistance, particularly when caring for children outside foster care, according to survey data and studies GAO reviewed. This is, in part, because licensed foster parents generally receive foster care maintenance payments and other services. Officials in selected communities said they have addressed some challenges by, for example, providing temporary payments or legal representation to eligible kin caregivers. However, officials also said that program eligibility criteria or insufficient funds can limit availability or result in waiting lists.
The Department of Health and Human Services (HHS) provides technical assistance and other support to help states use federal programs and initiatives established to serve kin caregivers. HHS officials said that these programs are optional, so they mainly provide assistance in response to states' requests. However, this approach has not led to widespread use. For example, 23 states used the option under the National Family Caregiver Support Program to serve older relative caregivers with 1 percent or more of their fiscal year 2016 funds (spent through 2018). State officials said they would like more guides or tools for using these programs. By not proactively sharing information and best practices, HHS may be missing opportunities to help states better support kin caregivers.
Why GAO Did This Study
Grandparents and other kin often step in to provide stability and security when parents cannot care for their children. Taking on this responsibility can lead to significant hardships, especially for older caregivers. GAO was asked to study the challenges faced by grandparents and other older kin when becoming primary caregivers.
This report examines (1) what is known about the numbers of grandparents and other kin serving as primary caregivers for children, and the reasons for that care; (2) challenges kin caregivers face and how officials report addressing them in selected communities; and (3) the extent to which HHS has supported states' efforts to use relevant federal programs and initiatives. GAO analyzed U.S. Census Bureau survey and HHS administrative data; reviewed relevant literature, federal laws, regulations, guidance, and other documents; and interviewed officials from HHS, national organizations, and in four states (Mississippi, New Mexico, New York, and Ohio) and communities, selected for their relatively large numbers of grandparent caregivers and to reflect geographic and demographic diversity.
Recommendations
GAO is making two recommendations to HHS on sharing information and best practices with states about federal programs that serve kin caregivers. HHS did not concur, stating that the agency already provides ongoing support. GAO maintains that implementing these recommendations would be helpful.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Administration for Children and Families | The Assistant Secretary for the Administration for Children and Families (ACF) should establish an ongoing process to proactively share information and best practices with states about programs it administers that are available to serve kin caregivers, especially in states with a relatively large share of grandparent caregivers. This could be achieved, for example, by leveraging regional office staff to provide additional assistance and information sharing, particularly related to kinship navigator programs. (Recommendation 1) |
HHS officials did not agree with this recommendation and stated that the agency already provides sufficient ongoing support to states. HHS noted the technical assistance, information sharing, and other efforts provided by ACF and its contracted technical assistance provider to share information and best practices. For example, in February 2021, HHS noted that its contracted technical assistance provider, the Capacity Building Center for States, is now convening a community of practice for kinship care state managers to support kin caregivers and assist states in developing support for this population--an initiative that had not begun at the time of our report. As we noted in the report, use of federal programs established to serve grandparents and other kin caregivers is not widespread across states--including among states with relatively high shares of these caregivers--and state officials we interviewed said they would like more assistance in using these programs. Moreover, state officials may not always know what questions to ask, making a proactive approach from ACF more important. We continue to believe that HHS could do more to proactively share information and best practices for using these programs with states and, as of August 2023, await further agency progress. This is consistent with goals in the National Strategy to Support Family Caregivers to increase awareness of and outreach to family caregivers, and strengthen services and supports for family caregivers, including grandparents and other older relative caregivers.
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| Administration for Community Living | The Administrator for the Administration for Community Living (ACL) should establish an ongoing process to proactively share information and best practices with states about using National Family Caregiver Support Program (NFCSP) funds to serve older relative caregivers of children, especially in states with a relatively large share of grandparent caregivers. This could be achieved, for example, by leveraging regional office staff to share information from states and area agencies on aging that have successfully used this program to serve older relative caregivers. (Recommendation 2) |
HHS officials did not agree with this recommendation, stating that it is overly prescriptive and ACL continues to achieve the goals through the actions the agency is already taking. As of November 2023, ACL officials noted that staff continue to maintain close working relationships with state agencies and use a variety of mechanisms to communicate, share information and innovative practices, and provide technical assistance. This continuous engagement with state agencies, according to officials, has created a relationship where states continue to seek information and assistance from ACL staff on issues associated with supporting grandparents and older relative caregivers. Officials also noted that states are now aware of the elimination of the 10-percent cap on the use of National Family Caregiver Support Program (NFCSP) funds for older relative caregivers of children. In addition, officials said that considerable progress has been made on implementing the requirements of the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act and the Supporting Grandparents Raising Grandchildren Act. The reports to Congress for these initiatives contain information, resources, and best practices to further enable states and communities to support this population. However, as we noted our report, use of the NFCSP and other federal programs established to serve grandparents and other kin caregivers was not widespread across states--including among states with relatively high shares of these caregivers--and state officials we interviewed said they would like more assistance in using these programs. Moreover, state officials may not always know what questions to ask, making a proactive approach from ACL more important. We continue to believe that HHS could do more to proactively share information and best practices for using the NFCSP to serve older relative caregivers of children. This is consistent with goals in the 2022 National Strategy to Support Family Caregivers to increase awareness of and outreach to family caregivers, and strengthen services and supports for family caregivers, including grandparents and other older relative caregivers.
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