Caregiving Decision Support Engine

How this engine works

You enter your own figures; the engine models two scenarios side by side and shows the twelve-month difference between them. The outputs are estimates built from your inputs and documented assumptions — not predictions, and not advice. Mood and stress are self-reported context that adjust the wording of the summary, nothing else. Inputs are processed in your browser. The full methodology, including what the engine does not claim, is on the Decision Center.

Step 2: Decision Forge — compare assumptions

Decision scenarios with reflection prompts

Each scenario in the tool above presents two options drawn from this event and models them side by side from the figures you entered. Before the comparison, the page names a cognitive-bias concept as an educational reflection prompt. It is a general prompt attached to the scenario rather than a finding about you: the page does not test whether the concept applies to your situation, and it does not indicate which option you should choose.

Self-reported context at decision time

The page does not create a psychological profile. Mood and stress may tailor wording and general next-step suggestions. They do not change the entered financial values or scenario math. They do not establish decision readiness. The named bias concept is a general reflection prompt; the page does not detect bias, assess decision capacity, diagnose a condition, or predict outcomes.

The clocks a family finds out about late

Caregiving has few decisions that must be made on a particular day, and four that must. One of them reaches five years backwards into decisions already made, and one of them is measured in hours.

There is no federal caregiver tax credit. Here is what actually exists.

The Credit for Caring Act has been introduced in Congress repeatedly and has never been enacted. Pages describing it as available are describing a bill. What exists is a set of narrower provisions, and knowing which one fits your situation is worth real money.

The medical expense provision worth knowing in detail: you may deduct medical expenses you paid for someone who would be your dependent except that they failed the gross income test or filed a joint return. That is the rule that actually reaches most people caring for a parent with modest retirement income, and it is far less publicised than the credits above.

One more point on dependency, because it surprises people: a parent does not have to live with you to be your dependent. Parents are specifically exempt from the household-member requirement. A parent can also make you eligible for head of household status without living with you, provided you pay more than half the cost of maintaining their home.

Medicare does not pay for long-term care

This is the most consequential misunderstanding in the whole area and it is worth stating without qualification. Medicare lists long-term and custodial care as not covered: help with bathing, dressing and toileting; home-delivered meals; adult day health care; transportation; and residence in a nursing home. Medigap does not cover it either.

What Medicare does cover is a limited skilled nursing benefit, and the conditions on it are strict.

Medicaid, the five-year look-back, and protections for the spouse at home

Medicaid is the programme that actually funds long-term care for most people, and reaching it involves a 60-month look-back on asset transfers, set by the Deficit Reduction Act of 2005. A penalty period from a disqualifying transfer begins on the date of the transfer or the date the person is institutionalised and otherwise eligible, whichever is later — which is why transfers made shortly before an application can be far more damaging than they appear.

The spousal impoverishment rules exist so that the spouse remaining at home is not left destitute. For 2026 the community spouse resource allowance runs from a federal minimum of $32,532 to a maximum of $162,660, and the minimum monthly maintenance needs allowance is $2,705 effective 1 July 2026, with higher figures for Alaska and Hawaii. These are federal floors and ceilings; your state sets its own figures within them, so the state number is the one that governs (CMS).

FMLA for caregiving covers fewer relationships than people expect

The Family and Medical Leave Act protects leave to care for a family member with a serious health condition, but the definition of family member is narrow and closed.

Covered: your spouse, son or daughter, or parent. “Parent” includes someone who stood in loco parentis to you, but it expressly excludes parents-in-law. Not covered at all: siblings, grandparents, grandchildren, aunts and uncles, and in-laws generally. “Son or daughter” means under 18, or 18 and over if incapable of self-care because of a disability.

So the adult child caring for a mother-in-law with dementia, or the sibling who is the only family member in the state, has no FMLA entitlement for that care — a gap that surprises people at the worst possible moment. Check your employer’s own policy and your state’s leave law, both of which may be broader than the federal floor.

One entitlement is much larger and much less known. Military caregiver leave provides 26 workweeks in a single 12-month period to care for a covered servicemember or veteran with a serious injury or illness, and it is available to a spouse, son, daughter, parent or next of kin — a wider circle than ordinary FMLA. It is a once-per-servicemember, once-per-injury entitlement, and the 26 weeks is a combined cap with other FMLA leave in that period (DOL).

The documents to put in place while capacity is not in question

This is the part of caregiving that costs nothing to do early and a great deal to do late, because the alternative to a signed document is a court proceeding.

A durable power of attorney for finances and a health care proxy or durable power of attorney for health care both require the person granting them to have capacity at the time of signing. Once capacity is genuinely gone, those instruments are no longer available and the route becomes guardianship or conservatorship — a state court process that is public, adversarial in form, takes months, costs legal fees, and often comes with ongoing reporting obligations to the court.

A separate HIPAA authorisation is worth having alongside them. A financial power of attorney does not by itself entitle you to medical information, and being told a provider cannot speak to you is a common and avoidable obstacle.

All of these are creatures of state law and the forms are not interchangeable across states. If the person you care for moves, or owns property in another state, the documents should be reviewed rather than assumed to travel.

The cost that lands on the caregiver’s own retirement

Caregiving budgets usually account for what is spent. What they rarely account for is what stops being earned, and the effect is structural rather than merely a pause.

Social Security retirement benefits are calculated from your highest 35 years of indexed earnings. If you have fewer than 35 years of earnings, the missing years are entered as zeros. A caregiver who leaves the workforce for three years does not simply lose three years of pay; those years may enter the benefit formula as zeros, permanently lowering the average the benefit is computed from. Reducing hours rather than stopping, where that is possible, keeps the year in the record.

Employer retirement contributions stop at the same time, and so does the match, at an age when compounding has the least remaining time to recover. None of this argues against caregiving. It argues for costing it honestly — the engine above models the near-term cash position, and the long-term figure belongs in the same decision.

What caregivers actually provide, from a source that measures it

The figures that dominate this subject — 53 million caregivers, hundreds of billions in unpaid care — come from AARP and the National Alliance for Caregiving. They are serious pieces of work, but they are advocacy estimates rather than federal statistics, and they are frequently cited as though a government agency produced them.

The federal measurement is the American Time Use Survey: 38.2 million people provided unpaid eldercare, about 14 percent of the civilian non-institutional population aged 15 and over. Among those providing care on a given day, the average was 3.9 hours, and 28 percent provided care on any given day (BLS, reference period 2023 to 2024).

VA caregiver support, and what is not yet law

The Program of Comprehensive Assistance for Family Caregivers provides a monthly stipend to a primary family caregiver, health coverage through CHAMPVA where the caregiver is not otherwise eligible, at least 30 days a year of respite care, training, mental health counselling, and travel and lodging support. A secondary caregiver receives training, counselling and travel benefits but no stipend.

Eligibility requires a VA disability rating of 70 percent or higher, enrolment in VA health care, and a need for personal care services for at least six continuous months. The programme is open to veterans of all service eras.

A proposed rule published in December 2024 would loosen several of these requirements, including replacing the stricter activities-of-daily-living test. It remains proposed; no final rule has been issued. Apply against the rules in force, not the ones that may arrive.