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The caregiving leave gap: More access, but unmet needs remain

Access to leave is expanding.

 

 

Special report

 

October 21, 2026

The United States does not guarantee paid family and medical leave at the national level. Though some states have enacted paid leave laws and some employers have expanded leave benefits, access does not always translate into usable time off. Millions of workers cannot use the leave available to them when caregiving needs arise. Millions more need leave but do not take it. 

That mismatch is the caregiving leave gap. It is becoming a growing economic challenge as the population ages, demand for family care increases and the paid care sectors come under strain.

When workers cannot step away to care for children, aging relatives or family members with medical needs, the effects extend far beyond the household. Employees miss work, reduce hours or leave the labor force entirely. Employers face coworker burnout, turnover costs and lost productivity. The economy loses labor supply, as more workers are sidelined by care responsibilities. 

States enact paid leave laws

The Family and Medical Leave Act (FMLA) is the main federal law guaranteeing eligible workers job-protected leave, but that leave is unpaid. Its eligibility rules exclude nearly one-half of all workers.1 As a result, many workers cannot afford to take leave. 

States have increasingly filled that gap. As of April 2026, 14 states and Washington, DC have mandatory paid leave laws; another nine have voluntary paid leave through private insurance.2 California was the first state to enact a paid leave law in 2002. Only seven states had enacted paid leave by the end of 2018. 

The result is an expanding but fragmented system in which access, eligibility, wage replacement and allowable use vary by location and employer. “Paid leave” can include paid time off (PTO) or vacation, paid sick leave, paid parental leave and paid family and medical leave. 

Those benefits are often not interchangeable. A worker may have paid time off but lack leave for childbirth or eldercare.

Employers expand access to leave and care benefits

More employers provide access to leave and care benefits compared to a decade ago. According to the National Compensation Survey (NCS), which surveys establishments, 83% of workers had access to paid sick leave in 2026, up from 70% in 2016.3

Yet access is uneven. Full-time workers, unionized workers, workers earning higher wages and those at larger companies all have greater access to different types of leave and care benefits.

In 2026, 90% of full-time workers had access to paid sick leave compared with only 59% of part-time workers. Similarly, 85% of workers in the highest wage decile had access to paid time off, compared with 44% of workers in the lowest decile of earners.4

Employers have expanded benefits that help workers manage care costs. Among private-sector workers, 43% had access to a dependent care flexible spending account in 2025, up from 37% in 2016. These accounts allow workers to use pre-tax income for certain childcare and dependent eldercare expenses, which reduces tax burdens. 

Recent federal policy changes could support future expansion. The One Big Beautiful Bill Act (OB3) raised the maximum limit for those pre-tax accounts to $7,500 from $5,000. That was the first increase in nearly 40 years. If the limit had been continuously adjusted for inflation over that period, it would be $15,157.5

OB3 also sought to encourage employers to expand paid leave and childcare benefits. The law permanently increased the tax credits and annual credit caps for Section 45S (paid family and medical leave) and Section 45F (childcare).6

More workers have access to paid leave

The American Time Use Survey’s (ATUS) Leave and Job Flexibilities Module reveals that more workers have access to paid leave. The ATUS first asked supplemental questions about paid leave in 2011. It redesigned the questionnaire in 2017-2018 and ran a similar one in 2024-2025. That provides a unique dataset about leave from the perspective of households, whereas the NCS only shows what employers are offering.

The share of workers with access to paid leave increased to 71% in 2024-25 from 66% in 2017-18. It was only 60.2% of workers in 2011. The increase reflects both state and employer expansions to paid leave. 

There are stark differences in access by educational attainment. In 2024-25, 82.9% of those with a BA+ had access to paid leave compared to only 42.5% of those with less than a high school diploma.7

Income influences access. In 2024-25, 90.9% of the top quartile of earners had access to paid leave whereas only 62.6% of those in the bottom quartile of earners did.8 (See Chart 1.) 

Between the 2011 and 2024-25 surveys, access across all income groups increased. However, the percentage point change was largest among the bottom quartile of earners. Their share jumped 12.5 percentage points to more than 62%. That likely reflects state laws on paid leave; they cover a wider range of workers than typical employer-provided benefits, which tend to skew towards higher-earning workers.

The largest gap for paid leave is between the bottom quartile of earners and the upper three quartiles. Those who need paid leave the most have the least access to it. They are the group least able to afford to take unpaid leave and even risk their jobs by taking leave. 

A breakdown by industry shows a similar story, with those with more education and pay getting more access to paid leave. Public administration had the largest share of workers with access to paid leave at 91.8% in 2024-25. That is due to the outsized role that unions and collective bargaining agreements play in setting public contracts.

In the private sector, the highest share was in financial activities with 86.1% of workers covered. The lowest share, 38.7%, occurred in leisure and hospitality.9

Flexible work arrangements were associated with access to paid leave. Among workers able to work from home, 85.6% had access in 2024-25; that is 22.9 percentages points higher than the 62.7% who were unable to work from home.

Chart 1: Access to paid leave has increased along the earnings distribution, but large gaps remain, 2011 to 2024-2025

Percent of workers with access to paid leave, by earnings quartile

Source: KPMG Economics, Bureau of Labor Statistics, American Time Use Survey (ATUS); Note: Usual weekly earnings of full-time wage & salary workers, single jobholders only.

More workers take leave of any kind, especially for care activities

On an average week, more workers took leave, paid or unpaid, in 2024-25 compared to 2017-18. In 2024-25, 32.5 million workers (21.4% of 151.5 million) took some type of leave during any given week. That is up from 29.9 million workers (20.7% of 144.3 million) in 2017-18. The average hours absent rose to 14.4 from 13.7.10

In 2024-25, 38% of workers said they took leave for vacation. Another 20.3% were off due to their own illness or medical care, and 18.1% took time for errands or personal reasons.11

Nearly 14% of all leave during an average week was for care reasons in 2024-25; that is up from 12.5% in 2017-18. Family medical care accounted for 8.3%. Childcare or eldercare other than for illness comprised 3.7%, and birth or adoption of a child accounted for less than 2%.12 That translates to around 4.5 million adults who took leave because of caregiving. 

Among workers who took leave, caregiving accounted for the largest share of those aged 35-44, nearly one in five. (See Chart 2.) These are Millennials in prime working age shouldering caregiving responsibilities. Many are in the sandwich generation caring for both their own children and aging parents or relatives.

A larger share of workers aged 15-24 cited caregiving as the main reason for taking leave compared to 25-34-year-olds (13.2% vs. 11.6%). That may be because more younger adults are providing unpaid eldercare, especially men.13

Workers aged 45-64, mainly Gen X, were most likely to cite family medical care as the main reason for taking leave. Gen X accounted for nearly one-half of workers providing unpaid eldercare in 2024.14 That means the type of eldercare for which they took leave was more likely to be medical care compared to non-medical routine eldercare.

Chart 2: Workers ages 35-44 are most likely to cite caregiving as their main reason for taking leave, 2024-2025

Among those who took leave, percent citing a caregiving-related reason as main reason

Source: KPMG Economics, Bureau of Labor Statistics, American Time Use Survey (ATUS)

More workers take paid leave

Not all workers who took leave were paid during their time off. Among workers who took leave, more used paid leave in 2024-25 (69.4%) compared to 2017-18 (64.5%), including for family medical care.15

A similar share of workers used only paid leave in 2024-25 for both family medical care (65.6%) and own illness or medical care (65.8%). The outlier was vacation: 79% of leave taken was paid, while only 18.3% was unpaid.16

Paid leave usage rises with age: only 34% of 15-24-year-olds used only paid leave versus 85.8% of those aged 55-64.17 Older, higher-earning workers use more paid leave than younger, lower-earning workers, as that is where access is most prevalent.

Some workers with paid leave cannot use it for caregiving

The share of workers with access to paid leave who could use it for childcare increased to 73.7% in 2024-25 from 64.7% in 2017-18. Similarly, those who could use it for eldercare rose to 70.5% from 64% over the same period.18

Yet broader access to paid leave has not closed the caregiving gap. Among workers with paid leave, more than one in five could not use it for childcare (22.4%) or eldercare (21.9%). That is more than five times the 4.2% who could not use it for their own illness or medical care. (See Chart 3.)

This mismatch between the leave workers have and the leave they need defines the caregiving leave gap. Chart 3 shows that most workers with paid leave can use it for vacation or their own illness, but coverage drops for other needs. Notably, 10.9% cannot use their paid leave for the birth or adoption of a child.

Eldercare had the smallest share of workers who could use their leave (70.5%). It had the largest share of those who did not know if they could use it. More Americans are set to have eldercare responsibilities in the years ahead as the population ages and people face more challenges obtaining quality and affordable paid care.

Chart 3: Many workers with access to paid leave cannot use it for family medical care, childcare or eldercare, 2024-2025

Among workers with access to paid leave, percent by ability to use leave for each reason

Source: KPMG Economics, Bureau of Labor Statistics, American Time Use Survey (ATUS)

Millions of workers need leave but do not take it

In an average month in 2024-25, 12.3 million workers, or 8.1% of all workers, needed leave but did not take it.19 That was only slightly below the 12.5 million workers, or 8.7%, recorded in 2017-18.20 Despite the expansion of state- and employer-provided leave over the past decade, a sizable share of workers still could not take the time off they needed.

Women accounted for 58.2% of these workers (7.1 million) in 2024-25; men were 41.8% (5.1 million). This gender distribution was little changed from 2017-18. Women were nearly twice as likely as men to cite childcare or eldercare as the reason they needed leave (12.2% versus 6.7%), underscoring their disproportionate caregiving responsibilities.21

Prime-age workers, those aged 25-54, accounted for 70.4% of workers who needed leave but did not take it, or 8.6 million of the 12.3 million total.22 Caregiving was a leading reason across all three prime-age groups. (See Chart 4.) Adults aged 35-44, Millennials often balancing work with multiple caregiving demands, had the highest share citing caregiving at 44.8%.

Unmet needs evolve across the life cycle. All prime-age workers have unmet needs for paid sick leave, especially those aged 25-34. Caregiving needs become much more important for workers aged 35-44. Workers aged 45-54 have a larger unmet need for leave for errands or personal reasons, while family medical care remains elevated.

Medical caregiving responsibilities are a major source of unmet leave. Each age group has a larger unmet need for family medical care compared to more routine childcare and eldercare. Family medical events are often less predictable and harder to schedule around work than routine care. More flexible leave policies could help workers respond to these events without sudden absences or presenteeism, both of which hurt business performance. 

Chart 4: Reasons prime-age workers needed leave but did not take it, 2024-2025

Among workers who needed leave but did not take it, percent citing each reason

Source: KPMG Economics, Bureau of Labor Statistics, American Time Use Survey (ATUS); Note: Respondents could select all that apply so sums do not add to 100%.

Bottom Line

Access to leave has expanded over the past decade. More workers are taking paid or unpaid time off. Yet millions still cannot take the leave they need, with large gaps concentrated around caregiving.

Those gaps will become more consequential as the population ages and strain in the formal care sectors shifts more responsibility onto families. Without more flexible and usable leave, caregiving demands will continue to constrain labor force participation and productivity, especially among prime-age workers. That creates a growing headwind for employers and the broader US economy.

Footnote

  1. Bipartisan Policy Center. “The Family and Medical Leave Act (FMLA): The Basics.” February 19, 2026.
  2. Wielk, Emily. “State Paid Family Leave Laws Across the U.S.” Bipartisan Policy Center. April 23, 2026.
  3. National Compensation Survey. Haver Analytics. Bureau of Labor Statistics. The share of workers with access to PTO ticked higher to 77% from 73% over the same period.
  4. National Compensation Survey.
  5. U.S. Bureau of Labor Statistics. “CPI Inflation Calculator.” That is as of August, 2026.
  6. FamTech.org. “From Policy to Practice: 45S & 45F Playbooks.” February 19, 2026.
  7. U.S. Bureau of Labor Statistics. “Access to and Use of Leave - 2011 Data from the American Time Use Survey.” August 16, 2012; U.S. Bureau of Labor Statistics. “Access to and Use of Leave -- 2017-2018 Data from the American Time Use Survey.” August 29, 2019; and, U.S. Bureau of Labor Statistics. “Access to and Use of Leave - 2024-2025 Data from the American Time Use Survey.” August 26, 2026.
  8. BLS, “Access to and Use of Leave, 2011.”; BLS, “Access to and Use of Leave, 2017-2018.”; and, BLS, “Access to and Use of Leave, 2024-2025.”
  9. BLS, “Access to and Use of Leave, 2024-2025.”
  10. BLS, “Access to and Use of Leave, 2017-2018.” and BLS, “Access to and Use of Leave, 2024-2025.”
  11. BLS, “Access to and Use of Leave, 2024-2025.”
  12. BLS, “Access to and Use of Leave, 2017-2018.” and BLS, “Access to and Use of Leave, 2024-2025.”
  13. Nestler, Matthew. “More young men providing unpaid eldercare.” Care Economy Insights. LinkedIn. November 12, 2025.
  14. Nestler, Matthew. “Gen X nearly one-half of workers providing unpaid eldercare.” Care Economy Insights. LinkedIn. April 28, 2026.
  15. BLS, “Access to and Use of Leave, 2017-2018.” and BLS, “Access to and Use of Leave, 2024-2025.” More workers who took leave for family medical care took only paid leave over that period (65.6% vs. 52%).
  16. BLS, “Access to and Use of Leave, 2024-2025.”
  17. BLS, “Access to and Use of Leave, 2024-2025.”
  18. BLS, “Access to and Use of Leave, 2017-2018.” and BLS, “Access to and Use of Leave, 2024-2025.”
  19. BLS, “Access to and Use of Leave, 2024-2025.”
  20. BLS, “Access to and Use of Leave, 2017-2018.”
  21. BLS, “Access to and Use of Leave, 2024-2025.”
  22. BLS, “Access to and Use of Leave, 2024-2025.”

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