Financing long-term care is difficult partly because much of its cost never appears in a long-term care budget. In Mexico, an older person who develops significant dependency may receive medical treatment through a public health institution, a federal pension, daily assistance from a daughter, privately purchased help several times a week and occasional support from a community organization. Each contribution has a financial value, but the costs sit in different budgets—or, in the case of unpaid family care, largely outside public accounts altogether.
That fragmentation is becoming increasingly important as Mexico develops its Sistema Nacional y Progresivo de Cuidados. The country has begun making care expenditure more visible through a dedicated transversal budget annex and is building a territorial approach involving federal institutions, state DIF systems and women's institutions. These are significant developments, but they do not yet amount to a single long-term care financing system or universal long-term care entitlement.
This fifth article in the Mexico Aging, Long-Term Care & Community Support Knowledge Hub examines the financing question beneath the emerging care architecture. The central challenge is not simply how much Mexico spends. It is whether public expenditure, household resources and unpaid care can be organized so that increasing dependency does not automatically translate into increasing financial and caregiving pressure on families.
Mexico does not yet finance long-term care through one dedicated system
International discussions about long-term care financing often begin with recognizable institutional models: dedicated social insurance, tax-funded entitlements, compulsory insurance contributions or means-tested public programs. Mexico's present position is more dispersed.
Older people can benefit from several forms of public expenditure, but these have different purposes. Health services finance medical treatment and some home or community health activity. Social assistance institutions provide particular services. The Pensión para el Bienestar de las Personas Adultas Mayores provides income support. Other programs support people with disabilities or specific population groups. Federal, state and municipal institutions may operate or support care-related infrastructure. Families then contribute money, housing and substantial unpaid labor.
The distinction matters because a peso allocated to income support is not automatically a peso purchasing personal care. Likewise, expenditure on health services cannot simply be counted as long-term care capacity because clinical treatment and assistance with everyday activities perform different functions.
Mexico's financing architecture therefore needs to answer two related but separate questions: what public resources contribute to a broader society of care, and what resources actually enable a person with sustained dependency to obtain the support they need?
Those questions will become harder to avoid as the number of older people requiring assistance grows.
The 2026 budget makes care expenditure more visible
A major change in Mexico's public financing architecture is the creation of Anexo Transversal 31, “Consolidación de una Sociedad de Cuidados,” within the federal expenditure budget for 2026.
The annex identifies approximately MXN 466.7 billion across federal expenditure associated with the development of a care society. Government presented this as equivalent to around 1.21 percent of gross domestic product when the 2026 economic package was introduced.
Its significance lies partly in visibility. Care-related expenditure has historically been distributed across institutions and programs, making it difficult to see the aggregate public commitment or assess how different spending streams contribute to common objectives. A transversal annex creates a mechanism for identifying expenditure across administrative boundaries.
But the figure requires careful interpretation. Anexo 31 is not a MXN 466.7 billion long-term care fund for older people. It encompasses a much wider care agenda and includes expenditure directed toward children, people with disabilities, older people with dependency and caregivers. Major existing social programs appear within the annex alongside more directly care-related activity.
That makes the annex an important budget-governance instrument rather than evidence that Mexico has already established a comprehensive long-term care benefit.
The distinction is essential for international readers. Budget classification can improve transparency without changing an individual's entitlement to a service. The next stage is therefore to connect expenditure visibility with clearer evidence about what services, infrastructure and caregiver support the expenditure actually produces.
A care budget and a long-term care benefit are not the same thing
The difference can be illustrated through the Pensión para el Bienestar de las Personas Adultas Mayores. The pension is enormously important to household income security and is one of the largest federal programs associated with older people. It can indirectly help households meet care costs because money is fungible: a family may use income to pay for food, transport, medication, domestic assistance or a private caregiver.
But an income transfer does not guarantee that an appropriate care service exists.
An older person living in a rural locality may have additional income but no nearby home-care provider. A person with advanced dementia may require continuous supervision that exceeds the value of the transfer. A family may use the money for ordinary household expenses while continuing to provide all personal care unpaid.
Cash and services therefore solve different problems.
Income support can protect autonomy and reduce poverty. Service funding can create trained workforce capacity, respite, day services, rehabilitation, home support and residential provision. Sustainable long-term care policy may require both, but their effects should be measured separately.
This is where wider analysis of funding and payment models becomes relevant. The financing mechanism influences not only who pays but what kind of supply develops, who can access it and what evidence government can obtain about quality and outcomes.
The largest hidden care fund remains the household
Public expenditure captures only part of Mexico's real care economy. Households finance care through direct spending and, even more extensively, through unpaid time.
INEGI's Cuenta Satélite del Trabajo No Remunerado de los Hogares de México estimated the economic value of unpaid domestic and care work at approximately MXN 8 trillion in 2024, equivalent to 23.9 percent of GDP. Women generated 72.6 percent of that estimated value.
This measure covers domestic and care work more broadly rather than long-term care for older people alone. It should therefore not be interpreted as the cost of replacing Mexico's elder-care system. Its importance is different: it demonstrates the enormous economic scale of activities that conventional public expenditure measures leave outside the market economy.
Care financing analysis that ignores unpaid work consequently produces an incomplete picture.
A daughter reducing her working hours to support a dependent parent is financing care through lost earnings and time. A spouse providing overnight supervision is contributing labor that would be expensive to replace formally. A household adapting its home is making a capital contribution. When relatives pay another person directly to provide support, part of the cost becomes visible as household expenditure, although informal employment may still remain poorly captured.
The result is a financing model in which households absorb both explicit and implicit costs.
Operational scenario: the public benefit covers income, but not the care package
An 82-year-old woman receives the federal older-person pension and lives with her daughter in a medium-sized Mexican city. Following a stroke, she needs assistance with bathing, dressing, transfers and meal preparation. Public health services provide clinical follow-up and rehabilitation for a period, but the everyday assistance continues throughout the week.
The daughter initially provides that care around her employment. As the woman's mobility deteriorates, the family privately hires somebody for several mornings each week. The pension contributes to the cost but does not cover the full amount, and the daughter reduces her paid working hours to cover the remaining periods herself.
From one perspective, several public supports are present: pension income, health treatment and rehabilitation. From another, the household still finances most long-term support through direct payments and unpaid labor.
If policymakers measured only the woman's receipt of public programs, her support might appear comparatively comprehensive. If they measured the full care package, the financial exposure of the household would become visible.
This is why Mexico's emerging care system needs expenditure measures that distinguish income security, health care and long-term assistance while understanding how they interact in real households.
Unpaid care creates a gendered financing mechanism
Mexico's Encuesta Nacional para el Sistema de Cuidados has made the distribution of caregiving particularly visible. The survey was designed not only to identify who needs care and who receives it, but also to examine the consequences for caregivers, especially women, including effects on employment and economic participation.
This matters to financing because unpaid care is not financially neutral simply because no invoice is issued.
When women disproportionately reduce employment or leave paid work to provide care, the household bears immediate income loss and the caregiver may experience longer-term effects on savings, social security contributions and retirement income. The economy also loses paid labor capacity.
Care financing is therefore connected directly to family caregiver burden and gender equality. Expanding formal care can create expenditure for government, but it may simultaneously release caregiver time for employment and reduce other household costs.
A serious financing assessment needs to examine both sides of that ledger.
The care funding gap is partly a capacity gap
It is tempting to describe the long-term care financing challenge purely as a question of raising more money. Yet financing only becomes meaningful when it can purchase appropriate capacity.
Mexico has significant territorial variation in health infrastructure, formal care services, household income and provider markets. A new subsidy or benefit may improve purchasing power in an urban area with multiple providers while having much less effect in a rural or underserved community where formal home support is scarce.
The care funding gap therefore has at least three dimensions: insufficient resources for some households, insufficient formal services in some places, and insufficient workforce to convert funding into reliable support.
These dimensions interact. If government creates purchasing power faster than workforce supply, prices may rise or informal provision may expand. If infrastructure is built without sustainable operating funding, capacity may exist physically but remain underused. If wages are too low to attract and retain workers, allocated budgets may not translate into continuity.
Organizations and system partners examining these questions can use the Digital Twin Scenario Modeler to explore how changes in demand, workforce and service capacity can interact. It is not a model of Mexican public expenditure, but its scenario-based approach reflects an important planning principle: financing decisions should be tested against the capacity they are expected to create.
Federal financing must eventually connect with territorial implementation
Mexico's federal structure makes the financing question more complex. National government can establish programs, budget priorities and policy direction, but care is experienced locally. State and municipal institutions, state DIF systems, health services, nonprofit organizations and private providers all influence what is actually available.
During 2026, the Secretaría de las Mujeres and Sistema Nacional DIF began a territorial implementation process with the 32 state DIF systems and the Instancias de las Mujeres en las Entidades Federativas. The first stage includes state-level diagnoses intended to inform local strategies.
This is an important step because a national financing framework cannot assume that every state starts from the same baseline.
A useful territorial diagnosis needs to go beyond population numbers. It should identify existing services, workforce, infrastructure, unmet demand, unpaid caregiver intensity, rural access, provider availability and the capacity of local institutions to administer expanded programs.
Funding formulas will eventually need to respond to those differences. Equal per-capita allocation may not produce equitable access where the cost of delivering services differs substantially between dense metropolitan areas and remote communities.
The stronger objective is therefore territorial equity rather than identical spending.
Operational scenario: the same allocation buys different care in different places
Consider two local areas with similar numbers of older residents experiencing functional dependency. The first is within a major metropolitan area. It has hospitals, rehabilitation services, private home-care providers, transport and a relatively deep labor market. The second includes dispersed rural communities where travel times are longer and formal care providers are scarce.
If each area receives an identical amount of new care funding per eligible person, their capacity to translate that money into services may differ considerably.
The metropolitan area can potentially purchase additional hours from existing providers. In the rural area, there may be nobody available to purchase from. Creating equivalent support could require transport funding, mobile teams, workforce incentives, community-based infrastructure or digital links to specialist professionals.
The nominal funding may be equal while practical access remains unequal.
This is why rural and underserved communities need to be visible within care financing design. Allocation formulas should reflect the cost and difficulty of creating usable capacity, not only the number of people theoretically eligible for support.
Mexico faces a strategic choice about what should become an entitlement
As the Sistema Nacional y Progresivo de Cuidados develops, one of the most consequential questions will be what people can expect as a right rather than what happens to be available through existing programs.
A long-term care entitlement can take many forms. It does not necessarily mean unlimited free services. Systems internationally use combinations of assessed need, public subsidies, insurance, co-payments, income tests and service ceilings.
Mexico will need to determine its own approach in light of fiscal capacity, existing social protection institutions and constitutional arrangements.
The important principle is clarity. People need to understand whether assessment creates access to a defined service, a cash benefit, a contribution toward costs or simply referral to whatever local resources exist.
Without that clarity, a formal right to care can remain difficult to exercise in practice.
This distinction is especially important because legislative proposals concerning constitutional recognition of the right to care and a national care system have continued to be considered. Such proposals should not be treated as already enacted universal long-term care entitlements. Meanwhile, the federal government is advancing the Sistema Nacional y Progresivo de Cuidados administratively and through budget and territorial coordination.
Mexico is therefore in a transition in which policy architecture is advancing while the precise scope of future enforceable care entitlements continues to develop.
Progressive implementation creates both opportunity and governance risk
The government's description of the care system as “progressive” is fiscally significant. It acknowledges that a comprehensive system cannot be created immediately and that coverage, services and infrastructure will need to expand over time.
Progressivity can support realistic implementation. It allows government to build workforce, test delivery models and expand coverage within available resources.
But it also creates an accountability challenge: how will Mexico know whether progressive expansion is actually reducing unmet need?
A credible approach needs measurable baselines and transparent milestones. These might include service availability, caregiver support, geographic coverage, waiting times, workforce capacity and the proportion of people with significant dependency receiving adequate assistance.
Simply increasing the aggregate budget does not prove that the system is becoming more accessible.
This is where outcomes frameworks and indicators become essential. Financing should eventually be connected to changes in people's lives: whether they remain safely at home, whether caregivers experience less excessive burden, whether preventable deterioration is reduced and whether access gaps between territories narrow.
Funding home and community support can change the trajectory of demand
Long-term care financing is often discussed as expenditure required after dependency has already become severe. That overlooks the potential value of earlier support.
Home assistance, rehabilitation, accessible transport, assistive technology, fall prevention, caregiver respite and social participation can sometimes preserve independence or delay escalation to more intensive services.
The economic case should not be exaggerated. Prevention does not eliminate aging or guarantee that people will never require high-intensity care. Some interventions also create additional expenditure because they identify previously unmet need.
Nevertheless, a financing model focused exclusively on acute medical episodes and late-stage dependency can miss opportunities to support function earlier.
The relevant policy objective is not simply cost avoidance but better allocation across the care pathway.
Investment in reablement and restorative approaches, for example, may support recovery after illness or hospitalization and reduce unnecessary long-term dependence for some people. Such approaches require coordination between health services and ongoing community support rather than separate funding decisions.
Health financing and care financing meet at the hospital door
One of the clearest operational interfaces occurs when an older person leaves hospital.
A hospital may have completed the clinical intervention, but discharge can expose a new need for assistance with mobility, medication, nutrition or personal care. If no funded community support exists, the practical burden transfers immediately to the household.
This can create unsafe discharge, delayed recovery or avoidable return to hospital. The cost then reappears in the health system.
Long-term care financing therefore cannot be designed entirely separately from health financing. The two systems perform different functions, but they share people and consequences.
Strong coordination across health and social care requires a mechanism for identifying functional need, arranging support and clarifying who pays after a health episode ends.
For Mexico, this interface is particularly important because health coverage through institutions such as IMSS, ISSSTE, IMSS-Bienestar and other arrangements does not automatically create a comprehensive long-term personal-care benefit.
Operational scenario: hospital savings become household costs
A 76-year-old man is hospitalized following a fracture. Surgery is successful and the clinical team determines that he no longer requires inpatient treatment. Before the fracture he lived with his wife and managed most daily activities independently.
At discharge he needs help transferring, bathing and preparing meals. His wife is also in her seventies and cannot safely provide all physical assistance.
If community rehabilitation and temporary home support are available, the couple may manage the transition while his function improves. If those services are unavailable or unaffordable, the choices narrow: relatives provide unpaid care, the family purchases help privately, he remains in hospital longer than clinically necessary, or the household seeks residential provision.
The financing question therefore changes the care pathway itself.
A health budget may record a successful and timely discharge, while the household records new expenditure and unpaid labor. Conversely, modest expenditure on transitional support may protect recovery and reduce the risk of readmission.
Good system accounting needs to recognize those cost transfers rather than evaluating each institution in isolation.
Workforce funding is infrastructure funding
Expanding formal long-term care requires people. Financing policy must therefore address wages, training, employment conditions, supervision and career pathways rather than treating labor as a residual operating cost.
Mexico's existing care economy is strongly gendered and includes high levels of informal employment. If new public funding purchases services at prices that cannot support decent employment, formal expansion may reproduce the vulnerabilities already present in informal household care.
This has direct implications for quality. High turnover weakens continuity. Inadequate training increases risk. Poor employment conditions make it harder to attract workers into a sector that will need to grow substantially as the population ages.
Financing and care workforce development therefore need to be planned together.
Mexico's current care agenda includes professionalization as one of its emerging priorities. The financial test will be whether future reimbursement and service budgets genuinely support that ambition.
Operational scenario: a low service price creates a quality problem
A state-level program expands home support by purchasing services from local organizations. Demand is strong and initial coverage increases quickly. However, the amount available per hour of care is based primarily on maximizing the number of people reached.
Providers discover that the rate leaves little room for travel time, supervision, training or replacement staff. Workers are paid only for direct contact hours and begin leaving for other employment. Families experience frequent changes of caregiver and providers struggle to cover rural visits.
The program has technically purchased more care hours, but the financing mechanism is undermining continuity and workforce stability.
The response is not necessarily simply to increase every rate. Authorities need cost information showing what safe and sustainable delivery actually requires, including indirect operating costs. Payment can then be designed around realistic service models and accompanied by expectations for competence, continuity and reporting.
The scenario demonstrates why long-term care financing is also a quality issue. The price attached to a service shapes the workforce and infrastructure that can exist behind it.
Private spending will remain important, but financial protection matters
Even in countries with extensive public long-term care systems, households often contribute toward costs. Mexico is therefore unlikely to eliminate private expenditure altogether.
The more important question is what level of financial exposure is acceptable.
Long-term dependency differs from many ordinary consumer expenses because duration and intensity are uncertain. A household may manage several hours of paid help each week but struggle if dementia progresses to continuous supervision. Residential care can create recurring costs over several years.
Without risk pooling, those costs fall disproportionately on households unlucky enough to experience severe or prolonged dependency.
Mexico's future debate may therefore need to examine not only public expenditure but mechanisms for protecting households from catastrophic care costs. Options internationally include tax funding, social insurance, mandatory contributions, public subsidies and regulated co-payments. Each requires different institutions and creates different distributional effects.
No external model can simply be transplanted. Mexico has its own labor market, levels of informality, social security structure and fiscal constraints. A contribution-based system, for example, has different implications where large parts of the workforce move through informal employment than it would in a country with near-universal formal payroll coverage.
The transferable principle is risk pooling, not a particular foreign mechanism.
Financing reform needs to protect autonomy as well as solvency
Care financing decisions can also influence personal autonomy.
If public support is available only for institutional care, people may enter residential settings even when they would prefer to remain at home. If cash benefits are paid without accessible services, families may have nominal choice but no practical alternatives. If eligibility thresholds are too restrictive, households may receive support only after needs become severe.
Funding design therefore shapes the balance between institutional and home- and community-based support.
A person-centered system should ideally allow funding to follow assessed need across a meaningful range of settings, subject to appropriate safeguards and fiscal limits.
This does not mean every preference can be funded without constraint. It means that financial architecture should not unnecessarily determine where a person lives or who must provide their care.
The principle is particularly relevant in Mexico, where family care has historically absorbed gaps in formal provision. Expanding community alternatives can turn remaining at home from an expectation imposed on the family into a genuine choice supported by services.
Better data can reveal where public money is not reaching need
Anexo 31 creates a stronger foundation for tracking federal expenditure, while ENASIC provides evidence about care demand and caregivers. The next analytical opportunity is to connect spending, services and outcomes more systematically.
For example, authorities could examine whether states with higher estimated dependency have proportionately greater service capacity; whether public investment is reducing unmet care; whether caregiver burden changes as formal provision expands; and whether poorer or rural households obtain comparable access.
This requires data governance across institutions that have historically collected information for different purposes.
Organizations examining comparable evidence systems can use the Quality Dashboard Builder to consider how financial, capacity, workforce and outcome indicators can be viewed together. It is not an official Mexican reporting framework, but the underlying governance discipline is relevant: spending data becomes more useful when decision-makers can see what the expenditure is producing.
The same principle applies nationally. A future care financing dashboard should not celebrate budget growth in isolation. It should reveal the relationship between resources, coverage and lived outcomes.
Accountability must follow money across institutions
The cross-government nature of the Sistema Nacional y Progresivo de Cuidados creates a particular assurance challenge. When expenditure sits across many ministries and programs, no single institution may control every result.
That makes shared objectives and clear responsibility essential.
Mexico's interinstitutional work already recognizes the need for coordination between the Secretaría de las Mujeres, Sistema Nacional DIF and a wider group of federal institutions. Territorial implementation adds state-level actors to that architecture.
The next governance question is how expenditure will be traced from national allocation to actual care capacity and outcomes.
For each major funding stream, leaders eventually need to understand what population it is intended to support, what service or outcome is being financed, which institution is accountable for delivery and what happens when expenditure does not produce the expected result.
This is broader than financial audit. Funds can be legally and correctly spent while still producing limited improvement in access or quality.
Organizations considering similar multi-agency assurance arrangements can use the Governance Maturity Assessment to examine responsibility, evidence and escalation across organizational boundaries. Its role is analytical rather than regulatory, but the question it poses is highly relevant to care financing: who can see the whole system well enough to act when fragmented expenditure produces fragmented outcomes?
Financial sustainability requires a long-term demographic view
Mexico's care financing challenge will not be solved through one annual budget.
Population aging means the number of people potentially requiring support will continue to rise over coming decades. At the same time, smaller families, migration, changing employment patterns and increased female labor-force participation can reduce the availability of traditional unpaid care.
This produces a double effect: demand for care grows while the informal workforce historically relied upon to meet much of that demand becomes harder to assume.
Long-term fiscal planning therefore needs to model multiple variables together: dependency prevalence, healthy life expectancy, workforce participation, wages, service intensity, family structure and the balance between home and residential provision.
The objective should not be to predict one exact future cost. Demographic and service assumptions will change. The value of modeling lies in understanding the consequences of different choices early enough to respond.
Delaying formal investment can appear cheaper in a short budget cycle while increasing household burden and creating more expensive demand elsewhere. Equally, expanding entitlement without workforce and fiscal planning can create commitments that are difficult to deliver.
Sustainability requires sequencing.
The stronger financing model will combine resources rather than search for one perfect mechanism
Mexico is unlikely to solve long-term care financing through a single new program. Its existing institutional landscape and the breadth of the care agenda make a blended architecture more plausible.
That could involve continuing universal or categorical income supports alongside more explicit service entitlements, targeted subsidies, public provision, contracted services and household contributions calibrated to ability to pay.
What matters is how the components fit together.
A strong financing architecture would seek to achieve several things simultaneously:
- protect people from severe financial exposure when dependency becomes prolonged;
- reduce excessive reliance on unpaid family care without displacing valued family relationships;
- fund enough workforce and infrastructure to make entitlements practically usable;
- support home, community and residential options according to need and preference;
- respond to higher delivery costs and weaker markets in underserved territories; and
- connect expenditure to transparent evidence about access, quality and outcomes.
The balance between taxation, contributions, household payments and existing social protection programs is ultimately a political and fiscal choice. The operational requirement is that the resulting model works as a system rather than a collection of disconnected funding streams.
What Mexico’s financing transition offers internationally
Mexico's experience provides an important lesson for countries beginning to formalize long-term care: the first financing challenge is often visibility.
Before governments can redesign expenditure, they need to understand where care is already being financed. That means looking beyond departmental budgets to household payments and unpaid labor.
Mexico's transversal budget approach is interesting precisely because it attempts to make cross-government care expenditure visible. Its institutional conditions are specific to Mexico and the mechanism should not be treated as a universal template. But the underlying principle is transferable: fragmented expenditure is difficult to govern if nobody can see it collectively.
The second lesson is that budget identification is only the beginning. Governments need to distinguish expenditure that supports the broad care economy from funding that creates a defined long-term care service or entitlement.
The third is that public financing decisions should account for costs shifted elsewhere. A reduction in hospital expenditure may increase household care costs. Limited formal provision may reduce the public budget while reducing caregiver employment. Low reimbursement may purchase nominal capacity while undermining workforce stability.
The strongest economic analysis therefore follows costs across the whole system.
The next stage is to connect the care budget with the care pathway
Mexico now has better information about caregiving and a new mechanism for identifying federal expenditure associated with care. During 2026, the federal government has also moved from interinstitutional planning toward territorial diagnostic work with all 32 state DIF systems and state women's institutions.
The stronger opportunity is to connect these developments.
A territorial diagnosis should show where needs are concentrated. Budget information should show what resources are available. Service mapping should show existing capacity. Workforce data should reveal whether expansion is feasible. Outcome measures should then show whether investment is reducing unmet need and excessive caregiver burden.
This is the point at which a budget becomes a financing strategy.
Mexico does not need every state to develop an identical provider market. Geography, demography and existing infrastructure differ too substantially. But national policy can establish common financing principles while allowing territorial implementation to respond to local conditions.
The ultimate test will be whether a person experiencing dependency can obtain appropriate support without the entire financial and practical responsibility defaulting to the household.
Conclusion
Mexico is entering a consequential phase in the financing of care. The creation of Anexo Transversal 31 makes federal expenditure associated with a care society more visible, while the Sistema Nacional y Progresivo de Cuidados is beginning to develop a stronger territorial and interinstitutional architecture. These developments matter, but neither should be confused with the completion of a comprehensive long-term care financing system.
The central challenge is structural. Mexico currently finances sustained care through a combination of public programs, health and social-assistance institutions, household payments and a very large contribution of unpaid labor. Much of that unpaid contribution is provided by women. As population aging increases dependency and traditional family capacity becomes less certain, relying on households to close the gap will become progressively harder to sustain.
The strongest forward direction is therefore not simply a larger care budget. It is a financing architecture that distinguishes income support from services, connects national resources with territorial need, develops a viable formal workforce, protects households from excessive costs and makes home and community support genuinely available alongside residential care.
Mexico's policy ambition will ultimately be judged locally: by whether an older person can obtain support when functional need increases, whether a caregiver can continue caring without sacrificing their own health and economic security, and whether public expenditure produces measurable access, continuity and dignity. Financing is where the emerging right to care will either acquire practical substance or remain dependent on what families can provide themselves.