Family caregivers are the foundation of our system of care for older adults and younger people with physical or cognitive limitations. But they often provide that care with great love but little skill. The result: Preventable injuries to both care recipients and their family members, more emergency department visits and hospitalizations, and an overall lower quality of life for everyone involved.

Starting in 2024, the Centers for Medicare and Medicaid Services began paying doctors and certain other Medicare providers extra money to train and support caregivers. Physicians, nurses, and therapists, for example, can do this work in their offices or in settings such as hospitals or nursing homes prior to a patient’s discharge.

But a new report by AARP and the consulting firm ATI Advisory concludes that while the number of providers taking advantage of the new billing opportunities is slowly growing, overall participation remains vanishingly small.

Little Take-up

There are, depending on who is counting, somewhere between 20 million and 60 million family caregivers in the US. Yet, the report calculated that from the program’s beginning in 2024 through the first half of 2025 (the most recent data available) original Medicare paid about 26,000 caregiver training claims for 9,622 beneficiaries. You read that right: Fewer than 10,000 out of 20 million-plus caregivers received help. Over 18 months.

Medicare also pays providers for completing a health risk assessment of their patients’ caregivers. Curiously, the AARP study found that providers who perform that assessment don’t often follow-up with the new training.

Those in Medicare Advantage managed care aren’t much better off. While MA plans are allowed to offer caregiver support as supplemental benefit, the report found only 6% did so.

The plans do not report how many members and their families took advantage of the training when it was offered. And since many plans have been trimming their supplemental benefits over the past year, the number offering caregiver education may be even smaller than what the government has reported.

Impediments

The AARP/ATI authors analyzed Medicare claims data and interviewed providers, advocates, and other stakeholders to find out why participation is so low. They found, not surprisingly, that lack of information about the new billing codes, confusion about the rules, limited training skills, and high start-up costs often were to blame.

How complicated is the billing? Take a look at this flow chart that tries to explain to providers how it works.

A related problem: While Medicare will pay, state Medicaid programs may not. And it is not known which private insurance pays. That forces providers to set up separate billing systems depending on what insurance a patient has.

Payment is modest at best. Medicare pays providers about $53 for the first 30 minutes of one-on-one training and about $25 for each additional 15 minutes. Providers get about $22 for each participant in group training.

While the system makes it complex for doctors and other providers to participate, it also is difficult for patients and their families to navigate. For instance, there is no organized way for them to learn which providers in their communities offer training.

Caregivers desperately need this practical, hands-on coaching. How do you lift a loved one who cannot stand on their own, especially if they outweigh you by 100 pounds? How do you respond to agitation by a family member who is living with dementia?

Meeting these challenges is difficult enough for licensed aides who have formal training. It often is impossible for family members. How can this gap be filled?

How To Increase Participation

Time will help. Physicians often are slow to accept new ways of providing care, even when they are accompanied by new billing codes. Eventually, they will hear colleagues talk about it. And, if past experience with other Medicare payment changes is typical, they’ll gradually adapt.

Unfortunately, a problem with Medicare payments for services such as this is that providers sometimes will overbill. But that’s not a concern now.

Physicians, especially, may not have these caregiving skills themselves and even those that do may not know how to teach them to others. But they can partner with those who do. For example, physical and occupational therapists help patients learn how to manage their limitations. And they may be better equipped to show their family members how to assist their loved ones.

Non-profit community-based organizations also may have this expertise. An organization that provides adult day services for people with dementia may know how to train family members in necessary caregiving skills. Physicians should take the opportunity to partner with them.

In its report, AARP identified another key issue: The importance of integrating this training as a routine part of the care model. This could be especially valuable at times of care transitions, for example when a patient moves from a hospital or nursing home to home.

Culture change has become something of a cliché. But it is critical that health care providers recognize the value of family caregivers for frail older adults as well as younger people with disabilities.

Adjusting the payment system to provide a financial incentive for them do so is a modest first step in that direction. But it is a step that more providers should be taking.