As America Faces a Caregiving Catastrophe, We Need to Name the Real Villains
I can tell you from firsthand experience that we’re not in a “sudden” caregiving crisis. It’s a catastrophe 50 years in the making.
If you want to understand how deeply broken America’s caregiving system is, consider this: The New York Times just published a sprawling 4,000-word essay America’s Caregivers are in Crisis about one family’s elder care crisis – a daughter juggling two increasingly fragile parents, a shattered leg, a ruptured tube, a father disoriented from chemo and dementia – and somehow still came away blaming the collapse mostly on the latest round of Medicaid cuts and immigration restrictions. Convenient targets, for sure. But focusing there is like pointing at the last flake of snow on an avalanche and calling it the cause.
To be clear, I think the Times story is heartfelt, beautifully written, and painfully familiar to millions of families. My own caregiving experiences have been challenging, leading me to leave behind my career to become a full-time caregiver due to the guilt, strain, and lack of care support.
But the framing in the Times essay? It’s exactly the kind of superficial diagnosis corporate America loves, because it distracts from decades of bipartisan neglect, profiteering, demographic denial, and policy choices that handed the future of eldercare to private equity chains, insurance middlemen, and unpaid women.
I can tell you from firsthand experience that we’re not in a “sudden” caregiving crisis. It’s a catastrophe 50 years in the making. And it didn’t happen by accident. It happened because political leaders, both Democrats and Republicans, were too busy pleasing donors and protecting corporate interests to address the unavoidable math of an aging nation.
It didn’t happen by accident. It happened because political leaders, both Democrats and Republicans, were too busy pleasing donors and protecting corporate interests to address the unavoidable math of an aging nation.
The truth is that America is aging into a care desert, and the institutions that should have warned us spent decades looking the other way—or cashing in.
The Real Story Isn’t an Individual Tragedy but a Systemic One
Michelle Cottle’s piece captures the emotional chaos of caregiving: the 2:00 am hospital sprints, the disorientation and fear, the immigrant home-care aide who becomes the anchor of a failing system. Anyone who has ever cared for an aging parent read that and said: Yes, this is my life too.
But the Times presentation turns a structural collapse into a tear-jerker about one unlucky family. It gestures briefly toward Medicaid cuts and immigration policy, both real issues, but never asks the deeper question: Why is eldercare so fragile in the wealthiest nation on Earth? Why are millions of families just one fall, one bad diagnosis, one staffing shortage away from ruin?
Here’s what the Times doesn’t say:
- The U.S. fertility rate has collapsed over the past 50 years from 3.5 to 1.6 births per woman, the lowest ever recorded, per the CDC.
- Life expectancy at 65 has risen to nearly 20 additional years, according to the Social Security Administration.
- We now have fewer siblings, fewer adult children, fewer caregivers, and more older adults than any generation before us, per the U.S. Census Bureau.
- The U.S. will be short 1.2 million direct-care workers by 2035, per PHI National.
- Medicaid home-care waitlists top 700,000, with decade-long waits in some states, per KFF.
- And the annual cost of home care for an older adult is now $77,000 per year, according to Genworth.
I think it’s clear that caregiving is not a “family problem” but a deep national design failure—engineered through privatization, austerity, and the magical thinking that daughters and sons would always pick up the slack.
The Villain is the Corporate Model of Care America Chose.
Here’s the part you won’t see above the fold in the Times: America handed long-term care to “the market,” and the market did what it always does: cut corners, extract profits, and leave families to hold the bag.
For decades:
- Private equity bought up nursing homes and slashed staffing ratios to maximize returns – resulting in higher mortality rates and worse outcomes.
- States quietly underfunded Medicaid home care, knowing daughters would fill the gaps.
- Long-term care insurance executives mispriced the risk, made their money, and walked away as the industry collapsed.
- Corporations lobbied Congress to avoid a public long-term care program that might compete with their profits.
- And both parties treated caregiving like a sentimental issue, not a critical economic one.
The current administration’s Medicaid cuts? Bad. The immigration crackdown harming the frontline care workforce? Also bad.
But this crisis didn’t begin in 2025. It began when America decided that caring for our parents should be a private burden while corporate profits remained a public priority.
We are now living with the consequences.
If We Want to Fix This, We Must Name the Real Enemies
And they are not overwhelmed families, or immigrant caregivers, or some abstract “strain on the system.” I think it’s clear that the real enemies are:
1. Corporate chains that treat eldercare as an asset class. Private equity now controls huge swaths of nursing homes, assisted living, and home-care agencies. Their business model is simple: raise prices, cut staff, extract profit, and pray no one looks too closely until the quarterly numbers hit.
2. Politicians who refuse to fund actual care infrastructure. We have social insurance for retirement (Social Security) and for medical care (Medicare). But long-term care? Nothing. Just vibes, wishful thinking, and a 700,000-person waitlist.
3. A culture that pretends family caregiving is an infinite resource. Women lose $320,000 in lifetime income caring for aging parents, per the MetLife caregiver study. But politicians treat this unpaid labor as if it costs nothing.
4. A workforce treated as disposable. Nearly 30% of direct-care workers are immigrants. We rely on them to keep our parents alive, then subject them to the threat of deportation. Instead of calling this “policy”, let’s call it for what it is: hypocrisy.
And the Times, for all its emotional clarity, still can’t bring itself to fully name these forces. It focuses on the pain, but not the power. On the collapse, but not the architects.
What Would a Real Solution Look Like?
I think a real caregiving solution for America would look like this:
- A national long-term care insurance program—publicly funded, like every other advanced nation.
- A federally backed caregiving workforce pipeline, not a patchwork of $14-an-hour gigs.
- Caregiver visas to stabilize the frontline workforce.
- Social Security credits and stipends for family caregivers.
- Technology that augments human care and helps train caregivers for the enormous burden that lays ahead.
These things are possible and within reach, but they require political courage, not billion-dollar corporate lobbyists whispering in the ears of Congress.
It’s why I built CareYaya: a social enterprise that brings tens of thousands of healthcare students into care, at fair wages, offering families support that Washington refuses to provide. It’s not a replacement for real policy, but it is real-world evidence that America could rebuild caregiving if it actually wanted to.
The Care Collapse Wasn’t an Accident But a Choice
What didn’t make it into the pages of the Times is that we aren’t witnessing a tragic accident, but rather, the result of decades of political decisions that protected profits over people.
America is aging. Families are breaking under the weight. And unless we name the real villains – the corporations, the profiteers, the policymakers who looked away – we will keep reading stories like Cottle’s for the next 50 years.
The care collapse is here. And until we stop letting the wrong people take the blame, we’ll never build the system every aging American deserves.
