The best places I've worked have had PTO policies, no rollover (but flexibility for longer trips), and (critically) managers who would gripe at you at the end of the year if you didn't use your PTO.
Expectations were clear, everyone was on an equal playing field, and PTO was sized to something the company could afford everyone making use of.
I am ambivalent on this. Some benefits are a bit like insurance, I don't mind not using them fully but I am glad its available when I need it.
The big issue is that it has to be available when I need it and it can't just be a scam.
"Unlimited PTO" just sounds like make believe land.
And if it's not an actual, usable, guaranteed policy that doesn't negatively impact your career... then why are we deluding ourselves and creating a policy vs culture mismatch?
Years ago, when I was first married (like several months after getting married), my husband needed surgery. The surgeon thought it might be pancreatic cancer.
The board gave me all the time I needed, no questions. And, the day of the surgery, a colleague from work spent the day at the hospital with me. A free day from the board and director.
Now it's true that I worked every day husband was in the hospital - I mean, he was sleeping most of the time so why not work? But they knew I would work since that's what I did. I delivered for years.
I was incredibly grateful they allowed me to take the time. Am still grateful. But I was also in a position where I could take an unpaid leave or quit. Neither optimal, but family comes first.
Would the organization have done the same for other staff? I don't think so. I had been there the longest and busted my ass for them, loving the work every single day.
Had saved enough that finances permitted, and I still feel great about the decision.
It's certainly a tricky thing to sort out, though. As you noted, "abuse" is possible, but defining what constitutes abuse is nearly impossible.
I'm sort of the same. I never had unlimited PTO, but I tend to save my time off for cases where I actually need it. Saved my bacon a bunch of times, before I started working remotely, with teams/companies that don't mind me taking off half a day to run some important errands, as long as my total work hours add up to the correct number each month.
When I was younger and working more junior roles and moving from role to role every year or 2 (generally headhunted) there was a use it or loose it mentality. You wouldn’t take the day off the moment you had a sniffle / didn’t feel 100%.
However once your older, have kids and are at the role for more then a few years, that sick leave is often “banked” for when the kids come down with whatever is going around the schoolyard this week