In the US they do have a policy in most companies that allow husbands/wives to take a 'medical' leave if their SO is ill, and they have to take time off for appointments, care, etc. It is unpaid, but there is no consequence of losing your job or seniority. There is also a savings plan for medical care in some companies in the US, (sorry, can't remember the name of it) where you can put money aside for medical bills, and therefore is tax free. As for vacation days or time off in the US, depends mostly on the job you have and whether you are salary or hourly. If you are salary, quite often you have so many days in a year, and if you do not take them, they are lost, whereas for hourly, they carry over to the next year.