Oniqa and Sade Moonsammy as children with their grandfather, James Small.
Courtesy of Oniqa and Sade Moonsammy
By Abigail Abrams
Updated: March 23, 2018 11:34 AM ET | Originally published: March 19, 2018

When Oniqa Moonsammy, 33, brought her uncle home from the hospital in early February following his stroke late last year, she planned to help her mother care for the 62-year-old as he regained his strength, figured out how to brush his own teeth again and managed his medications. But when they opened the door to the Brooklyn, N.Y., home her uncle shared with his father, Moonsammy saw her grandfather slumped in a chair. He, too, was having a severe stroke.

Moonsammy used to work five days a week as a hostess at a restaurant in Brooklyn and often spent time with her boyfriend or went to bars with friends. Now her life revolves largely around caring for her family. She’s cut back to four days at the restaurant and spends two days helping her grandfather at his rehab nursing home. She spends the remaining day taking care of her uncle. “It kills me that I can’t help more, because it puts more stress on my mom, who also has ailments,” Moonsammy says.

In other countries, a young professional like Moonsammy might take a leave of absence from work and return to the office once the relative was safely cared for. But the U.S. is the only highly industrialized country that does not have a national policy offering paid family leave. While some states have started to propose policies on their own, 46 states still leave the decision up to employers. So far, that has not worked. Just 15% of workers across the country have access to paid family leave through their employers, and roughly 40% don’t even have access to job-protected unpaid leave through the federal Family and Medical Leave Act (FMLA).

While Moonsammy loves her family and enjoys listening to her grandfather’s jokes and stories, the heavy caregiving load is already wearing on her own finances and physical health. And her experience is becoming more common, too. As the Baby Boomers age, a growing number of millennials are being called upon to take care of aging family members. Nearly 25% of the 43 million adult caregivers in the U.S. are between the ages of 18 and 34, according to a report by the AARP and the National Alliance for Caregiving. Though many millennials face crushing student loan debt, uncertain job prospects and lower wages than previous generations, 86% of adults ages 18 to 29 told the Pew Research Center they view it as their responsibility to financially help aging parents. But many are struggling to balance these new duties with their own careers.

It’s been 25 years since the passage of the FMLA, and advocates say the time for comprehensive paid family leave in the U.S. has arrived. While Democrats have historically been more enthusiastic about the issue, some conservatives have embraced the topic. Ivanka Trump pushed the President to include six weeks of paid parental leave in his budget proposal. The Republican tax bill in December included a tax credit for companies that offer paid family leave. And Republican Senators Marco Rubio, Mike Lee and Joni Ernst have been discussing a plan that would allow people to draw on Social Security benefits to fund paid leave and then delay their retirement checks. A bill has not yet been introduced, but Ernst told TIME the group is working with White House to find a “path forward” on the issue.

“As a working mother and a grandmother, I believe our policies must reflect the evolving needs of our workforce and reduce barriers that pose challenges to parents balancing families and work,” she said in a statement. “That’s why I am encouraged to work to create a path forward for a voluntary, budget-neutral paid leave program rather than impose a new entitlement or mandate.”

But despite this emerging bipartisan support for the idea that families need time to deal with medical crises, bond with new babies and recover from pregnancy, there is no real consensus on how to offer this at the national level.

Experts say the tax credit is too limited to make much difference, and Democrats say a Social Security-based plan will hurt women and people of color, who depend on retirement benefits later in life and often take on greater caregiving duties. Many of them support the FAMILY Act, which would use payroll taxes to offer 12 weeks of paid leave to new parents and other caregivers — a plan Republicans say is too expensive to support.

“There’s the false perception that paid leave is expensive instead of thinking about what it’s costing us to fail to take action,” says Vicki Shabo, vice president for workplace policies and strategies at the National Partnership for Women and Families. Shabo says those costs come in the form of people re-admitted to the hospital because they don’t have anyone to care for them, employees who leave the workforce to care for family, employers that lose money when they have to replace those workers, and caregivers who suffer health consequences themselves after juggling so many responsibilities.

One month into caring for her grandfather and uncle, Moonsammy has lost sleep and developed a nagging cold. She lives in New York, which became the fourth state to offer paid family leave in January, but her busy schedule has left her no time to learn about her state’s program. In comparison, Moonsammy’s sister, Sade, gets paid family leave through her employer, Family Values @ Work, a network of state coalitions pushing for policies like paid leave. This has allowed Sade to travel from Washington, D.C., where she lives, to help her family coordinate care and navigate insurance processes. “I’ve been so grateful for the benefits,” Sade says. “But it’s also hard to see how my family is struggling to maintain the schedule when I’m not there.”

The sisters say they plan to look further into New York’s paid leave program, but right now, it replaces wages up to 50% of the state’s average weekly wage, which would likely not be sustainable. And while Sade’s job pays for the leave she takes in New York, the 32-year-old also has her own concerns to manage. “I’m also trying to start my career, I’m trying to pay off my $80,000 in student debt, and not lose money,” she says. “As a young, black, queer woman making it in the world, I have to work 10 times harder all the time.”

One positive aspect of so many millennials taking on caregiving responsibilities, experts say, is that it may force lawmakers and companies to start paying attention. Though family leave is generally considered a women’s issue, younger caregivers are equally likely to be men, according to the AARP. Studies have shown that millennial men want paid leave when they look for jobs, says Sherry Leiwant, co-founder and co-president of A Better Balance, a family-rights advocacy group in New York. States are taking notice. In addition to the four that already have paid leave policies in place, Washington state and the District of Columbia passed legislation set to go into effect in the next two years, and at least 30 more states have introduced legislation on the topic.

These changing priorities also mean that more young adults are getting involved in caregiving advocacy, says Jason Resendez of the advocacy group UsAgainstAlzheimer’s. While Alzheimer’s is a disease associated with older adults, about one in six millennial caregivers is helping someone with this diagnosis. This has led UsAgainstAlzheimer’s to start working with youth-focused groups to take advantage of millennials’ technology savvy and their drive to find caregiver solutions. “We need to look at how to empower and help young folks when it comes to caregiving,” says Resendez.

In the meantime, Oniqa Moonsammy still goes to her restaurant job and balances family responsibilities each day. She now wears a ring that belonged to her grandfather. “Every time I’m wearing this ring I’m putting positive energy into the ring and hoping it will help him,” she says. “I kiss my ring and I say, ‘Grandpa, stay strong, I love you, I’ll be there soon.”

Write to Abigail Abrams at abigail.abrams@time.com.

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