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

Older woman holding a baby

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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

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.

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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 1. 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)
Open
HHS officials stated that it already provides sufficient ongoing support to states and this recommendation is duplicative of its current efforts. HHS summarized the technical assistance, information sharing, and other efforts provided by ACF to share information and best practices. However, while the ACF regional officials we interviewed confirmed they provide various types of technical assistance and other support, such as when they review states' strategic plans for providing child welfare services overall, they frequently noted that they did not share best practices specifically related to serving kin caregivers. Use of these 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 believe that HHS could do more to proactively share information and best practices for using these programs with states.
Administration for Community Living 2. 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)
Open
HHS officials stated that it already provides sufficient ongoing support to states, this recommendation is overly prescriptive, and the agency is already meeting the goals of this recommendation. HHS summarized the technical assistance, information sharing, and other efforts provided by ACL to share information and best practices. However, the ACL regional officials we interviewed said they generally provide a round of technical assistance and support when programs are new, and they provide additional support later if agency leadership changes that the state level. But they said the technical assistance related to serving grandparents and other older relative caregivers through the National Family Caregiver Support Program is generally provided in response to states' requests. Use of these 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 ACL more important. We believe that HHS could do more to proactively share information and best practices for using these programs with states.

Full Report

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