Caregiving can feel like mourning someone while they are still present.

Every time my mother is hospitalized, I wonder if this is it. The doctors don't always have answers, which means I won't either. I'm her healthcare proxy now. I'll be the one making decisions if that moment comes. Last September, on my birthday, I thought that moment had arrived.

***

$873.5 billion. 

That's the market size for caregiving in the United States.

Is that too much? Too little?

Quantifying care for our loved ones is complicated. The number sits there, distant, removed from reality. At our house, that reality was furniture pushed against walls to make room for a walker. The kitchen counter surrendered to prescription bottles. Dialysis machinery running through the night.

Being the eldest son meant this responsibility was always going to be mine, less a choice than an inheritance. I grew up watching the architecture of caregiving: my grandmother buying the house next door to her mother, friends with three generations under one roof, and my own bedroom reassigned when family needed it. Spaces reorganized around need.

Some states will compensate you close to $3,000 per month for caregiving. The money helps; bills don't bend to cultural expectations. But payment creates dissonance. You're being paid to do what you were raised to believe was beyond transaction.

***

Why does putting a number on caregiving feel wrong, yet necessary?

When I think about care, I see three distinct layers:

• The bond: holding onto who they were and who they are, even as both shift.

• The system: navigating a healthcare system that doesn't speak your language, literally or culturally.

• The reversal: helping someone who once helped you, a shift nobody prepared you for.

These layers coexist. The boundaries blur constantly.

The caregiving economy exists in the shadows. Normalized culturally but invisible structurally.

Family becomes the infrastructure by default, filling the gap where policy and systems fall short.

Siblings trading shifts. A grandfather bringing food to his sick daughter. A support system that understands the routine, the emotional toll because they're carrying it, too. And still, caregiving can feel lonely. Being a healthcare proxy means more than medical decisions. When the moment comes, I'll be navigating what she would want, what others hope for, what's actually possible. The weight of choosing for someone else.

A revolving carousel of decisions. Which treatment path to take. When to escalate care. Whether to move forward with a procedure despite its risks. Who to trust when specialists disagree. What questions to ask and when. 

Millions are doing the same. According to AARP's 2025 report:

• 63 million Americans are family caregivers, nearly one in four adults

• $600 billion annual economic value of unpaid family caregiving

• 50% report negative financial impacts (debt, depleted savings)

• 20% of caregivers report fair or poor health due to caregiving

Family infrastructure isn't supplementing formal systems. It's replacing them, at tremendous cost.

Solutions are emerging: companies helping family caregivers become Certified Nursing Assistants (CNAs) to get paid, employers offering caregiver support benefits, states piloting paid family leave programs. But these remain exceptions, not the norm.

The caregiving economy won't emerge from the shadows until we stop treating it as a private family matter and start building public infrastructure around it. Policy has to catch up. Employers have to adapt. Innovation has to meet caregivers where they are, in the gap, trying to do what's expected with resources that don't exist. The cultural weight isn't going anywhere. The question is whether we'll finally build systems strong enough to hold it.