Photo by National Cancer Institute on Unsplash
This week The New York Times published political correspondent Michelle Cottle’s harrowing personal account of the challenges her Family faced in caring for her Aging father. It is a story shared, in its broad outlines, by 63 million Americans – one out of four American adults – who care for another adult or child. It is a story about systems that are failing families, endangering the physical Health, Mental Health, and financial health of the caregivers, the overwhelming majority of them unpaid. “The need crosses nearly all demographic lines: age, race, geography, politics, religion,” Cottle writes. “In our fragmented society, it is as close to a universal concern as you can find.”
Public policymakers have done nothing yet to address this “universal concern.” On the contrary, the Trump administration has taken steps that are making the crisis worse.
Policy wonks and talking heads who warn that a Caregiving crisis is coming are wrong. The crisis is already here.
The bottom line: The American Economy depends upon the free labor of 63 million family caregivers – 59 million of whom care for adults – whose services have a market value of more than $600 billion annually. But “free care” comes at a steep price, and it is being paid by those same family caregivers.
The 2025 edition of Caregiving in the US, a report compiled by AARP and the National Alliance for Caregiving, outlines the dimensions of the crisis for caregivers:
70% of family caregivers are employed. Many of them receive no supportive benefits from their employers.
On average, family caregivers provide 27 hours per week of services.
25% have taken on debt because of caregiving.
20% are in poor health themselves.
20% cannot afford their own basic needs.
40% are performing complex medical tasks (for which only 22% have been trained).
But perhaps the most shocking damage is to caregivers’ mental health. “The rate of active suicidal ideation [thoughts of suicide] in the last 30 days for people not in any caregiving role is 4.5%,” says Alexandra Drane, CEO of Archangels, a firm that helps companies use data to reduce costs and increase wellbeing. “If you’re caring for one or more children under 18, it doubles to 9%. For those caring for one or more adults over 18, it’s 10%. And for the sandwich generation – those caring for both – it’s 52%.”
Having suicidal thoughts at more than double the normal rate is a serious indication of the massive stressors burdening the lives of caregivers.
Some caregivers are reluctant to seek help. They feel caring for a family member is their obligation and handing off responsibility to anyone else smacks of disloyalty. However noble the sentiment, sacrificing one’s health and financial Security to care for another is likely to lead to bad outcomes for everyone. Many family caregivers would benefit from even a brief respite – a weekend or a week off – by relinquishing their responsibilities to professionals.
That said, the truth is that help is hard to find now, and it will be even harder in coming years. Studies show that 70% of adults who are 65 and older today will need some form of long-term care support. The demographic reality of the baby boom dictates that the number of older adults will continue to swell, and demand for care services is projected to increase 40% by 2035. But there has been an acute shortage of direct care workers for two decades.
Existing policies are worsening the crisis. Foreign-born workers are the backbone of the personal care services industry, in large part because low pay and demanding working conditions do not make the jobs appealing to native-born Americans. Current policies that sharply limit immigration and target both legal and undocumented immigrants exacerbate the shortage. And massive cuts to Medicaid spending undermine the program that provides what limited reimbursement is available to aid family caregivers.
Other nations have found ways to alleviate the care crisis. Germany made long-term care insurance mandatory in the 1990s and funded it through payroll taxes (the same way we fund Social Security). In 2000, Japan required all citizens aged 40 and older to pay into a national pool that covers their care when they need it. “These systems aren’t flawless,” writes Connie Garner, CEO of Garner Public Policy Strategies, “but they spread risk across society, treat care as a collective responsibility, and make it possible for families to stay families, instead of collapsing into unpaid, unsustainable labor forces.”
Garner also points out that “it’s about all of us, sooner or later. We will all need care, or provide it, or pay for it.”
There has to be a better approach than putting the burden of care – and the attendant burdens of financial pressures, physical exhaustion, and mental distress – on 63 million unpaid workers.
