4

Current Laws, Policies, and Practices to Support Family Caregivers

This chapter draws substantially from the research paper “Comprehensive Literature Review of Current and Promising Practices to Support Unpaid Caregivers in Science, Technology, Engineering, Mathematics, and Medical STEMM,” by Jessica Lee, J.D., Erin Frawley, M.Ed., and Sarah Stoller, Ph.D., which was commissioned for this study.¹

The current landscape of laws and policies that support family caregivers consists of a variety of piecemeal efforts that provide a degree of support for caregivers, but are neither comprehensive nor coordinated, resulting in significant gaps. These efforts exist at many different levels, from broad national laws to policies adopted by outside agencies, funders, and accrediting institutions that influence universities to individual universities themselves. This chapter provides an overview of the policies and practices that support family caregivers. It starts by describing the external forces that can shape and influence university policies, including federal and state laws, the policies of federal agencies and other funders, and accrediting bodies. It then turns to universities themselves, acknowledging that there is no one approach to work-family policies at U.S. institutions, but rather an array of different elements that can be implemented in a variety of ways. The goal of this chapter is to provide a clear understanding of current laws and policies by outlining the existing status quo for caregiving support. Chapters 6 and 7 build on this information to detail best practices and innovative ideas, respectively.

CURRENT FEDERAL AND STATE LAWS

In the United States, no single law establishes and defines the full set of rights and protections of family caregivers. Instead, a set of mandates and

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¹ The full paper is available at https://nap.nationalacademies.org/resource/27416.

regulations at the federal, state, and local levels provide legal protections and accommodations for family caregivers. These mandates and regulations are not coordinated nor are they connected, resulting in a complex patchwork that creates challenges for individuals seeking to understand what protections apply to them. This chapter summarizes key laws related to caregiving, including protections for university employees (see Table 4-1) and protections for students (see Table 4-2). Additional information is available in Appendix A.

TABLE 4-1 Federal and State Legal Protections for Employees

TABLE 4-2 Federal and State Legal Protections for Students

As summarized in Tables 4-1 and 4-2, the United States has a system of federal, state, and local protections that can be relatively comprehensive but piecemeal and inconsistent across locations. Multiple laws provide employees with leave, accommodations, and protection against discrimination; state and local laws provide additional protections. Faculty, staff, and other university employees in certain states have greater protections for caregiving responsibilities than those in others. For example, 12 states and Washington, D.C., have a law requiring paid leave for new parents and family caregivers, though even in these states, laws typically have caps on benefit amounts and are generally unable to replace a faculty member’s pay (A Better Balance, 2023). In contrast, caregiver protections for students fall largely under a single federal law, Title IX of the Education Amendments of 1972 (Mason & Younger, 2014). While Title IX affords a range of important protections, it is not comprehensive. For example, student leave under Title IX is provided and protected for pregnancy and related conditions, but Title IX does not provide the right to leave for other caregiving responsibilities, such as caring for a parent, a sibling, or an adult child.

Together, various laws and regulations provide some degree of support and protections for family caregivers and provide a set of minimum requirements that colleges and universities must meet and adhere to as they build their own practices. Still, current laws are a patchwork that can be

challenging to navigate, for faculty and university officials as well as employees and students. And current laws are incomplete, especially regarding coverage of caregiving responsibilities other than for children and regarding paid family and medical leave. Title IX does not consider caregiving responsibilities not related to pregnancy and parenting, and similarly, many laws regarding accommodations for both students and employees are maternity related, which does not consider accommodations people may require for other caregiving responsibilities. Additionally, the United States is the only Organisation for Economic Co-operation and Development (OECD) country that does not provide any form of federal paid family and medical leave. In contrast, on average across the OECD,² mothers are entitled to nearly 51 weeks of total leave time, with an average of 19 weeks of paid maternity leave and 32 weeks of paid parental and home care leave.³ Fathers or non-birthing parents are entitled to around 10 weeks total on average, composed of an average 2 weeks of paid paternity leave and 8 weeks of paid parental and home care leave (Organisation for Economic Co-operation and Development, 2022). Along with parental leave policies, more than half of OECD countries provide paid leave for the care of sick children or other family members, though the amount varies considerably (Organisation for Economic Co-operation and Development, 2020).

FEDERAL AGENCIES’ AND OTHER FUNDERS’ POLICIES SUPPORTING CAREGIVERS

Along with federal and state regulations, caregivers in academic science, technology, engineering, mathematics, and medicine (STEMM) may find support in the policies of federal funding agencies (e.g., National Institutes of Health [NIH], National Aeronautics and Space Administration [NASA], National Science Foundation [NSF], National Institute of Standards and Technology) as well as private funders and foundations (e.g., the Doris Duke Charitable Foundation, Henry Luce Foundation, American Cancer Society, Afred P. Sloan Foundation). For those receiving grants or fellowship money to support their work, federal agencies and other funders may implement a variety of policies to ensure flexibility for grant recipients with

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² These averages include the United States, which offers 0 paid weeks across all categories.

³ Parental leave refers to a leave of absence for employed parents that is supplemental to maternity and paternity leave. Home care leave refers to leave generally following parental leave to allow at least one parent to stay home and provide care to a young child under 2 or 3 years of age.

caregiving responsibilities as well as provide opportunities to use funding for purposes related to childcare.

Federal agencies and other private funders provide important resources in support of research, and this funding often supports the salaries of principal investigators, staff, trainees, and students. While it is earmarked for a particular project, individual, or group, some funders stipulate flexibility in use of funds for caregiving needs or provide access to additional resources to meet these needs. For example, the NIH (2021) has several caregiver-friendly initiatives, which include the following:

• Reimbursement of caregiving-related costs
• Additional funding awards to support caregiver leave
• Funds to offset the cost of childcare
• Reentry programs to support grant recipients who have taken time away for caregiving
• Extensions on timelines for early-stage investigator award eligibility

NIH has also recently undergone policy changes in response to pushback from postdoctoral fellows in a letter urging better family supportive policies to prevent women from leaving the academic workforce (Guo et al., 2023). This letter detailed (1) the lack of paid parental leave, (2) the lack of support during the transition back to work, and (3) the high cost of childcare as barriers to remaining at work. Accordingly, the NIH has implemented several reforms over the past 2 years. In particular, National Research Service Award postdoctoral fellows (F30, F31, F32) may now apply for up to $2,500 per budget period to defray the costs of childcare (National Institutes of Health, 2021). Notably, this amount would be expected to cover approximately 2 months of infant care at a childcare center (Child Care Aware of America, 2022).

Similar policies are also in place among other federal agencies. The NSF, for example, has a Career-Life Balance Initiative instituted in 2012 that has worked to organize and disseminate information on policies that provide flexibility for those caring for dependents. Through this initiative, individuals with family caregiving responsibilities are eligible to take leaves of absence, access no-cost extensions, or delay starts to grants, and can apply for supplements up to $30,000 to hire temporary support for those on leave (National Academies of Sciences, Engineering, and Medicine, 2023; National Science Foundation, 2015).

NASA similarly provides flexibility in support for grant recipients with family caregiving responsibilities. All grant recipients can make use of one

no-cost extension without requiring approval, though subsequent extensions do require approval. Though NASA does not have a centralized source of funding to provide supplements to support bringing on additional personnel for those on leave, they can consider these case by case. Other policies such as the use of award money for dependent care or to pay for leave are allowable only when a recipient’s host institution allows this (National Aeronautics and Space Administration, 2021).

Private funders have targeted grants for investigators with family caregiving responsibilities, and some have created programs specifically designed to support individuals with substantial caregiving responsibilities. The Doris Duke Charitable Foundation, for example, created its Fund to Retain Clinical Scientists (FRCS) in 2015. This fund provides grants to medical school recipients to establish an FRCS program that provides supplemental research support to early-career scientists with family caregiving responsibilities (Myers, 2018). The funds can be used to hire technicians and research coordinators and to buy back clinical obligations to provide more time for research (Jagsi et al., 2018, 2022).

While some federal and private funders provide easily accessible information dedicated to family-friendly initiatives,⁴ such as on well-organized web pages devoted to these policies, many funders only include information about policies aimed at caregivers within the pages of long handbooks on grant requirements, if this information can be found on their websites at all.

ACCREDITATION AND CERTIFICATION BOARDS

Accreditation and certification boards also play a role in shaping university policies. These boards set requirements that a university or program must meet to receive accreditation or certification. In recent years, key accrediting bodies have adopted policies that affect caregivers in medicine. For example, in 2022, the Accreditation Council for Graduate Medical Education (ACGME) began to require all accredited training programs to offer 6 weeks of paid leave to residents and fellows for parental and caregiving leave. This policy was essential given the heterogeneity and inadequacy of leave typically offered to resident physicians in training (Magudia et al., 2018). It allows medical residents to be able to afford the leave that they need (Ortiz Worthington et

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⁴ For example, the Office for Research on Women’s Health at the NIH provides a web page detailing the range of policies in support of caregivers. See https://grants.nih.gov/grants/policy/nih-family-friendly-initiative.htm.

al., 2019), and it reduces gender disparities in the process, as research shows that men are less likely to take leave when it is unpaid (Halverson, 2003).

The ACGME policy complemented an initiative of the American Board of Medical Specialties (ABMS) that took effect in 2021, requiring its member boards to develop written policies stating the time required for physician trainees to become eligible for board certification. That initiative further mandated that these eligibility requirements permit a minimum of 6 weeks of time away from training once during training for member boards with training programs of at least 2 years, for the purposes of parental and caregiver leave, without exhausting other forms of time off (e.g., vacation and sick leave) and without extending training (American Board of Medical Specialties, 2021). Prior to this, leave for resident physicians was often inaccessible, in practice, since taking time away from training could create cascading challenges that extended training time even further (Jagsi et al., 2007). The ABMS policy further supports the continued education of residents who take leave by encouraging the scheduling of subspeciality fellowships after July to allow those who must extend their training to have access to the fellowships.

INSTITUTIONAL POLICIES

Individual academic institutions often offer policies, programs, and practices intended to support employees, students, postdocs, and trainees with caregiving responsibilities. While compliance with federal and state laws and with accrediting bodies can drive some degree of convergence in the policies offered by various institutions, policies can still vary greatly between institutions and there is no universal approach to supporting family caregivers. The section below outlines the main types of policies commonly seen at academic institutions and the ways in which these policies may be structured. In general, policies can be thought of in four main categories: (1) policies providing caregiving leave, (2) policies providing accommodations and adjustments to regular responsibilities and timelines for caregivers, (3) policies providing direct care support, and (4) policies that aim to prevent or respond to discrimination and harassment based on a person’s caregiver status.

Policies Related to Leave

Caregiving Leave Policies

Today there is no single approach to caregiving leave across colleges and universities. Leave lengths, pay rates, and eligibility vary significantly

institution by institution (Riano et al., 2018), and policies can even vary within the same institution (Anthony, 2011). It is also not clear exactly how many U.S. academic institutions offer leave policies of any kind, and existing data have largely focused on a narrow set of institution types or departments. Additionally, existing data largely speak to parental leave policies following the birth of a child rather than broader caregiving leave. These data, however, provide some indication that a substantial proportion of schools may not offer leave, a significant gap that leaves many caregivers underserved and indicates a lack of compliance with federal policy in some cases. For example, a 2019 study of the top 25 schools of public health in the United States found that 80 percent had paid childbearing leave for faculty, but only 48 percent provided this leave for staff (Morain et al., 2019).⁵ These institutions averaged a leave term of 8 weeks, just slightly more than half of the 14 weeks paid leave recommended by the American Public Health Association. Further, although these schools had published policies, they were often unclear and difficult to understand (Morain et al., 2019).

Additionally, while most universities now have paid parental leave for faculty, this does not universally extend to postdoctoral fellows and graduate students in STEMM who may simultaneously hold positions as both students/trainees and employees of the university (Lee et al., 2017). There are significant gaps in our knowledge of how universities handle leave for students at the undergraduate and graduate level, but available data suggest that policies offering leave for students are rare. For graduate students, Mason and colleagues (2007) found that only 26 percent of universities in the United States had graduate student maternity leave policies in 2007. As with faculty data, more findings exist looking at specific departments. A 2008 study of sociology Ph.D. programs found that few official policies existed to support graduate student parents (Springer et al., 2009), while a separate examination of sociology programs noted that graduate students typically perceived leave policies as being designed only for faculty (Kennelly & Spalter-Roth, 2006). Given many graduate students do not qualify for the Family and Medical Leave Act (FMLA) due to their student status, in many instances taking a leave of absence may be the only option available (Springer et al., 2009). Additionally, the committee could not find national data on the prevalence of parental and family leave policies at the

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⁵ This distinction between availability of paid leave for faculty compared with staff aligns with general trends seen in leave across the workforce in which those with greater income are more likely to receive paid leave benefits than those with lower income (Klerman, Daly, & Pozniak, 2012).

undergraduate level. Given that institutions often do not have a continuous registration policy, the committee speculated that some institutions may expect students to simply fail to register when leave is needed, since maternity leaves are commonly addressed under standard medical withdrawal policies. Ultimately, there are strong indications that universities largely do not have robust policies in these areas and much more to learn and develop to better support graduate and undergraduate students who need leave.

Family leave tailored to the unique needs of medical students has been explored based on information on school websites. In a recent review of websites, Kraus and colleagues (2021) found that 33 percent listed some form of parental leave policy related to pregnancy, birth, and family at 199 medical schools granting M.D. (doctor of medicine) and D.O. (doctor of osteopathic medicine) degrees. Roselin and colleagues (2022) similarly reviewed the websites of 59 highly ranked allopathic medicine schools and found that 46 percent listed leave policies that mentioned “parental needs,” while only 14 percent referenced “parental and family leave policies.”

Another key gap in leave policies is the difference in access to and use of leave among men and women. Based on one analysis of the experiences of 741 postdoctoral scholars at 63 institutions across the United States, while many postdoc mothers lacked access to paid leave, fathers were at times left out of leave policies (Lee et al., 2017). The report also detailed the pressures fathers faced against taking leave and stereotypes about men and caregiving. In interviews conducted as part of the study, postdocs spoke to experiences of bias in the form of negative comments about taking leave or continued scheduling of meetings during leave periods (Lee et al., 2017). Among faculty, gender-neutral policies have become more common, but at the same time, research has shown the significant role of campus culture in discouraging use of these policies by men (Lundquist et al., 2012). This gender difference is especially consequential given evidence about the effect of parental leave for fathers on gender equality (Gonzalez & Zoabi, 2021; Kotsadam & Finseraas, 2011).

The committee notes that another challenging aspect of drafting a formal leave policy in an academic setting is establishing a leave length that matches the needs of the employee and institution. There is widespread consensus that a leave term of at least 12 weeks is beneficial for employees and their families (this is in alignment with the FMLA’s requirement to provide leave for 12 weeks annually for welcoming a new child or caring for a seriously ill family member (U.S. Department of Labor, 1993). But 12 weeks falls just short of a typical university semester, leading institutions to

offer leave in semester increments—which works so long as the pregnancies or family illnesses are well timed to the start and end of a semester, which is unlikely. Some universities have allowed employees to donate their sick time to colleagues who have exhausted their allotted leave benefits, such as a program at the University of Alabama at Birmingham (2018). It is not clear how common these programs are, and they still may not be sufficient to ensure faculty can take the full leave they require.

Policies Related to Adjustments and Accommodations

Stop-the-Clock Policies

Concerns about securing promotion and tenure can be a major barrier to academics taking the family leave they need. In a study of more than 1,300 faculty, 33 percent of women opted not to take their designated maternity leave because of concerns about tenure (Koppes Bryan & Wilson, 2015). Tenure clock extension policies have been used to allay concerns about having children and taking leave to support caregiving for children and adults in the pre-tenure years, but controversy persists regarding their efficacy and best practices.

Stop-the-clock (STC), or tenure extension, policies have been among the most widespread institutional interventions implemented to support caregivers in higher education. The first STC policy was introduced at Stanford University in the early 1970s for female faculty members who had babies prior to receiving tenure (Manchester et al., 2013). The aim of the policy was and remains to prevent penalizing birthing and caregiving faculty in the tenure process by accounting for time lost to leave periods and caregiving responsibilities. As of 2005, 86 percent of research institutions offered STC policies (Hollenshead et al., 2005). They range from policies that mainly apply to new parents—typically on a gender-neutral basis—to wider-ranging policies covering circumstances including the birth or adoption of a child, caring for a sick relative, personal illness, and other unforeseen research delays (e.g., Institutional Review Board delays) (Manchester et al., 2013).

While STC policies are now part of a suite of family-friendly benefits offered by a sizable majority of research universities, there is continued debate in the literature surrounding their effectiveness and impact. Most significantly, research has highlighted important implications for promotion. A recent study reported that women and men who used STC were equally disadvantaged in time to tenure; however, being a woman and

having taken a tenure extension negatively affected women’s promotion to full professor more so than men’s, even years later (Fox & Gaughan, 2021). And a 2018 study of economics departments found that STC policies increased the likelihood of men receiving tenure while decreasing women’s likelihood at their first academic institution (Antecol et al., 2018). In contrast, a 2013 study at a single university found higher rates of promotion among faculty who used STC policies, but also noted salary losses for these faculty (Manchester et al., 2013). And a 2022 study found that universal and opt-in stop-the-clock policies predict higher proportions of women and particularly women of color among tenured faculty (Gonsalves et al., 2022).

Overall, the findings on STC are mixed but do suggest there could be negative effects of STC policies depending on how they are structured. Importantly, as well, it is not clear what the true alternative should be when evaluating the effects of STC policies. STC policies may slow down tenure processes for those who use them compared with those who did not need or utilize them. However, in the absence of STC policies, faculty who would have used them may have instead left academia to manage their caregiving responsibilities. In Chapter 6, the committee discusses best practices aimed at addressing some of the potential negative consequences of STC policies.

Accommodations, Adjustments, and Duty Modifications

Caregivers in academic STEMM may need changes to how, when, and where work is performed to provide care to others. These changes can be captured by various terms, including reasonable accommodations, academic adjustments, active service modified duties, and workplace flexibility depending on who is accessing them and how they are structured.

Caregiving students who desire to take less leave, or who need ongoing changes to be able to stay enrolled while meeting their educational goals, may be entitled to family-responsive academic adjustments. Reducing course load is an example of a common academic adjustment for caregiving students. This could entail extending a student’s time to degree and prorating their stipend to match their reduced workload (Springer et al., 2009). At the undergraduate level, student parents often attend part-time to meet the demands of caregiving and work, especially while enrolled at community college (Huerta et al., 2022). For pregnant students, universities may offer accommodations to allow them to participate in classes virtually as well as required accommodations for lactation (The Pregnant Scholar,

2023). Workload flexibility for students is another space where student caregivers may require accommodations. Anecdotal evidence suggests that most institutions do not have formalized policies for allowing students to attend to family needs. Typically, attendance policies are managed at the level of individual faculty advisors.

For faculty, the concept of modified duties was designed to create flexibility in faculty members’ workloads by changing job responsibilities without any changes in pay. The most common modification is a reduction in teaching with the expectation that time devoted to the classroom will be reassigned to other responsibilities that allow for more flexible scheduling. Some universities reduce the work assignment for a set period. Others may offer modification on an open-ended basis. One study found that 18 percent of 255 institutions surveyed had implemented a formal modified duties policy (Koppes Bryan & Wilson, 2015). A shared laboratory with two principal investigators can be highly productive while allowing for flexibility (Oldach, 2022). (See Chapter 7 for a lengthier discussion of career and workplace flexibility.)

Research has consistently drawn attention to the benefits and potential of part-time work for academics (Drago & Williams, 2000). This may be offered as a temporary modification or as an ongoing program to support caregivers and diversity in STEMM. Higher education lags far behind industry in offering part-time options (outside the adjunct market, which has its own challenges) (Wilson, 2008). A study of family-friendly policies in higher education completed in 2007 by the University of Michigan, Ann Arbor, found that only 15 percent of the 189 institutions surveyed had a formal policy allowing professors to work part-time. In many other institutions, part-time work is negotiated on an ad hoc, case-by-case basis (Wilson, 2008). In academia, part-time work has in many instances taken the form of marginalized and contingent labor, but it does not necessarily need to be so. Instead, part-time work could be structured as a valued and viable alternative for those who need the flexibility that receives adequate pay and benefits and allows continued progress toward tenure and other goals. It is important to note that, much like STC policies, there is evidence suggesting potential stigma associated with the use of part-time work that can be harmful particularly to women’s career advancement (Durbin & Tomlinson, 2010; Van Osch & Schaveling, 2020). As with stop-the-clock policies, attention needs to be paid to implementation to ensure equitable outcomes for all who need part-time options. (See examples of part-time work from industry and academia in Chapter 7.)

Policies Related to Direct Care Support

Childcare and Adult Dependent Care

Universities and colleges may offer on-site childcare options, but rarely enough to meet the high demand for this resource. Across nine research universities, on-campus childcare was faculty members’ most requested family-responsive service in a 2005 study (Ward & Wolf‐Wendel, 2005). Still, existing research suggests that this is not a widely available benefit (Forry & Hofferth, 2011).

Access to on-site care is determined institution by institution and varies widely, as does the quality of care offered. Variation in access and eligibility has consequences for students and trainees. Typically, these centers, which also provide care for the children of faculty, have a limited number of childcare slots for the children of student and trainee parents and waitlists are common (Hill & Rose, 2013; Reichlin-Cruse et al., 2021). A national mixed-methods study of postdoc parents’ experiences found that only 29 percent of postdocs reported being eligible for on-campus childcare, and even fewer could use it (Lee et al., 2017). Postdoc survey participants noted that campus childcare facilities would not accept young infants, had waitlists longer than their postdoctoral appointment would last, and were unaffordable. Further, postdocs reported that the hours of childcare availability did not match their work schedules, which were longer than those worked by others on campus. More recent data from the National Postdoctoral Association’s Institutional Policy Report indicate that 40 percent of institutionally funded postdoc trainees had access to on-site childcare in 2019 and that 16 percent were eligible for subsidized childcare, a decrease from 2016 (Ferguson et al., 2021).

Childcare access has also been a central concern for many graduate students and has been raised as a key needed benefit in labor organizing efforts of graduate students across the nation. Individual university collective bargaining agreements may now cover such support on a growing but still small scale. For example, Harvard graduate students obtained a raise and funds to cover childcare arrangements as part of their union contract (Harvard Graduate Students Union, 2020).

Along with on-site childcare, some colleges and universities offer other policies and programs to support parents in caring for their children, including the following examples. Arizona State University offers faculty consultations with a childcare services coordinator, and the University of Pennsylvania provides a childcare resources web page that directs families to

resources and activities. At Brown University, faculty benefit from backup and emergency care, as well as financial support for the family-related expenses incurred with work travel. The University of Chicago offers travel grants of up to $500 per year for faculty needing to travel for work with their children. The University of Houston has developed summer camps for children, and the University of Pennsylvania provides backup care for snow days (Cardel et al., 2020). Rice University’s “Children’s Campus” provides childcare for faculty members, with participants reporting that it decreased their job stress (O’Brien et al., 2015).

Beyond childcare, some educational institutions provide services to support faculty and staff in caring for aging or disabled family members. The committee did not identify evidence of this type of care provision for students. Care services may be provided via third-party contractors off site or on site, paid for with university subsidies, or the institution may provide referrals and subscriptions to care-finding services. The committee could find little to no research examining these types of programs in detail and their prevalence at academic institutions, though the relative dearth of information on older adult care is likely suggestive that this is a less common benefit and in line with the greater attention that has been given to childcare compared with other caregiving situations.

Policies Addressing Bias and Discrimination

Colleges and universities have workshops and other initiatives to address bias based on race/ethnicity, gender, and other categories. While many of these measures are not specific to the potential for family responsibilities discrimination, general measures aimed at reducing bias in the hiring process have been employed and may have important implications for caregivers. Key measures universities have implemented to address bias and discrimination include ensuring diverse committees for hiring and promotion, providing training, and using rubrics for evaluation.

There is less information on current policies aimed at addressing the potential for family responsibilities discrimination in academic workplaces, but this type of discrimination is prevalent. Reports across the labor market in fact have risen over time. Between 1998 and 2012, for example, reports of family responsibilities discrimination increased by over 500 percent (Calvert, 2016).

Importantly, family responsibilities discrimination may also be different for different individuals. For example, in 8 percent of more than 4,000 cases, individuals also alleged racial discrimination, such as when

Black employees were denied leave or flexibility given to White caregivers (Calvert, 2016). As such, this is an important area for greater attention among universities, particularly for the potential for compounding forms of discrimination against those with intersecting marginalized identities.

SUMMARY OF FINDINGS FROM CHAPTER 4

A variety of actors shape the specific policies and practices that any caregiver in STEMM will find available to them. Federal and state laws form a patchwork of different policies that provide varying degrees of support and protection for university employees, but they may not provide the needed resources or support for all caregivers. Institutions themselves provide various forms of support for caregivers, ranging from leave to accommodations to childcare to protections against bias. There is, however, no universal standard across universities, and what this looks like in practice varies across institutions. The result of this patchwork of policies is that some caregivers can access the support needed to remain in STEMM fields and thrive, while others have little to no support during times when they are engaged in caregiving.

1. There is no single law that establishes the full rights of family caregivers in the United States. Instead, a disconnected set of mandates and regulations at the federal, state, and local levels provides legal protections and accommodations for family caregivers that can make it challenging for caregivers to understand their full rights and leaves significant gaps in the support caregivers can access.
2. Along with the federal government, other third-party actors influence the support caregivers have access to. Federal agencies and other funders may provide additional funding, no-cost extensions, and other resources to support caregivers. Accrediting agencies may also set caregiving-supportive requirements for universities to meet to receive accreditation or certification.
3. Though legal and accreditation requirements may create some degree of uniformity in policies, there is no universal approach to supporting caregivers at colleges and universities across the United States.
4. Colleges and universities have enacted a variety of policies to support different constituencies, including students, trainees, and employees.

5. The most common sets of family-friendly policies and programs across universities include caregiving leave, stop-the-clock and other extensions, educational accommodations and work modifications, and childcare provisions or subsidies, though how these are implemented vary across institutions.
6. While colleges and universities have done some work to address bias and discrimination based on gender and race/ethnicity in their admissions, hiring, and advancement processes, few if any measures are specifically designed to address family responsibilities discrimination.

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