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elder care
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.
Nov 29, 2025
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.
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Here's Why Harris and Democrats Are the Best Choice for Seniors
This election will determine whether current and future seniors—and their families—can count on the government to keep the promises of Social Security and Medicare and to improve eldercare.
Nov 03, 2024
For seniors and their families, the choice in this election couldn’t be clearer. Before Donald Trump took office, our organization did not endorse candidates for president of the United States. But Trump was such a four-alarm fire for us and our members (older Americans across the country), that we felt a duty to endorse Joe Biden in 2020, breaking with nearly 40 years of precedent. This cycle, we have endorsed Kamala Harris as the candidate who will genuinely protect seniors’ interests, including the two programs in our organization’s name, Social Security and Medicare. We have also endorsed scores of candidates for House and Senate as “champions” for older Americans.
From a policy standpoint, this is a no-brainer. Kamala Harris, like Joe Biden, has pledged to protect Social Security and Medicare from Republican proposals to cut both programs—by raising the retirement age, means testing, and reducing COLAs. But she also has endorsed the idea that the wealthy should begin contributing their fair share in payroll taxes, which would go a long way toward safeguarding the financial health of both Social Security and Medicare. With additional revenue flowing in—plus billions of dollars in savings on prescription drugs from the Inflation Reduction Act—we could not only strengthen, but expand, seniors’ earned benefits.
In October, the vice president laid out a plan to expand Medicare to cover long-term, in-home care for seniors (and people with disabilities). That is a historic proposal. Under the current system, seniors must impoverish themselves in order to qualify for long-term care under Medicaid—and may well end up in nursing homes. Otherwise, the main alternative is for families to provide home care, often at a high financial and personal cost.
Kamala Harris also wants to expand traditional Medicare to include hearing and vision coverage. We have been fighting for the enhancement of benefits for decades, because seniors’ health and safety depends on proper hearing and vision care. These coverages were part of President Biden’s original Build Back Better plan, a noble effort that can be revived with a new Democratic president and Congress.
On the other hand, it’s almost laughable that anyone would think Donald Trump is the better choice for seniors and their families. Trump is unserious about policy, except insofar as it helps him score political points. He knows that Social Security and Medicare are tremendously popular, so he claims he will protect them, while embracing proposals that could devastate both programs.
Many of Trump’s public statements over the years do not inspire confidence. He once called Social Security a “Ponzi scheme,” comparing America’s most successful social insurance program with a petty criminal enterprise. This year, he said he’d be “open” to cutting “entitlements,” a comment his campaign tried to walk back in the face of understandable backlash.
Each year that Donald Trump was president, he submitted White House budgets that would have cut Social Security and Medicare by billions of dollars. He recklessly suspended the FICA payroll tax during the pandemic and said that he hoped it would be “eliminated” entirely, never mind that this is Social Security’s main funding source. Now, he proposes to repeal taxes on Social Security benefits that were put in place during the 1983 reforms (signed into law by President Reagan) to help fund the program.
The Center for a Responsible Federal Budget, hardly a liberal group, estimates that Trump’s plans would cost Social Security up to $2.75 trillion over ten years—and would accelerate the projected depletion of the program’s trust fund reserves by three years. That’s just six years from now!
In the end, though, this election comes down to values. Kamala Harris and her running mate Tim Walz came from the middle class and understand the struggles of working Americans. Harris was raised by a single mother in a modest Oakland neighborhood and cared for her aging mom when she was dying of cancer. Tim Walz lost his father at age 19, and credits Social Security survivor benefits with keeping his family from falling into poverty. These candidates’ lived experiences inform their policies affecting seniors and families.
The Harris/Walz ticket reflects the preferences of most Americans across when it comes to seniors’ earned benefits. Public opinion surveys consistently show that bipartisan majorities of Americans oppose cuts to Social Security and Medicare, and agree that the wealthy should begin contributing their fair share. On the other side, the now-infamous blueprint for a second Trump term, Project 2025, calls for radical changes to Medicare that would end the program as we know it. Meanwhile, the Heritage Foundation, which authored Project 2025, has advocated raising the Social Security eligibility age and other cuts to the program.
Donald Trump has (unconvincingly) attempted to distance himself from Project 2025, but he is a member of an elite financial class that focuses on lining the pockets of the already wealthy and powerful. It’s no coincidence, perhaps, that the GOP has recruited millionaire candidates for Senate in key battleground states who, unlike their Democratic rivals, do not represent the interests of working people. Many of these candidates have supported raising the retirement age and privatizing Social Security, while championing more tax cuts for the rich. Their hostility to the interests of seniors is apparent. The GOP Senate contender in Wisconsin even suggested that nursing home residents aren’t truly capable of voting.
This election will determine whether current and future seniors—and their families—can count on the government to keep the promises of Social Security and Medicare and to improve eldercare. Growing old in America is increasingly costly. Without these bedrock programs, not only seniors, but their family members in the “sandwich generation” will find it even harder to navigate the cycles of life. In this clarifying light, the choices for President and Congress shouldn’t even be close.Keep ReadingShow Less
Climate Change Is a Current Crisis for Family Caregivers
It is imperative that adaptation strategies and emergency response plans include the unique needs of the elderly.
Dec 09, 2023
In discussions about climate change, we often gravitate towards those affected by devastating wildfires, catastrophic hurricanes, and vanishing coastlines. Rarely do we zoom in on the intimate, day-to-day ways it reshapes the individual lives of everyday people. As a caregiver for my elderly parents, I've experienced firsthand how climate change impacts the aging population, a narrative told less frequently but just as critical in weighing the costs of our inaction on climate.
In the blink of an eye, many of us went from sons and daughters to climate responders for our parents. During Michigan's infamous "Snowmageddon" in 2015, for example, my father, who was relearning to walk after a health scare, constantly fell into steep snow drifts. This meant he had to wear wet pants in the freezing cold and through doctor appointments, risking hypothermia. That same winter, my mom had to mail canned foods to my great aunt, who was trapped in her Grand Rapids home without groceries because relatives and even neighbors could not safely reach her due to the massive amounts of snowfall. These life-threatening situations, no different from what other families experience, were induced by our changing climate.
Living with these challenges means perpetual fear. I'm terrified of my mother slipping on black ice and breaking her hip, of my blind father's inability to detect and avoid ice patches, especially as snow-muffled sounds interfere with outdoor navigation. When a severe ice storm led to a power outage, ensuring my parents' safety in their unheated home was a logistical nightmare, from planning how to navigate slippery sidewalks and driveways in the middle of the night, to undriveable road conditions without traffic lights, to replacing the lost food. The situation was further complicated by the fact that their landline is tied to the internet, hampering their inability to make calls in a power outage. My own cell phone lost service because the cell tower was out.
Creating a rain garden to manage increased rainfall and flooding is a daunting task for someone with a bad back or severe allergies.
But the impacts of climate change extend beyond newly increased winter extremes. For my mother, who relies on walks with friends for mental and physical wellness, unpredictable weather patterns like poor air quality or extreme heat have imprisoned her indoors more frequently. Our lives now revolve around a complex choreography of scheduling doctors' appointments between forecasted weather extremes and finding ways to mitigate newfound environmental hazards.
These climate shifts bring new responsibilities for family caregivers. Each decision, from managing the heightened frequency of snow removal services to ensuring safe, accessible outdoor spaces, is a balancing act between health, safety, and financial constraints. Creating a rain garden to manage increased rainfall and flooding is a daunting task for someone with a bad back or severe allergies.
Climate change has subtly altered our natural environment, bringing unexpected challenges. Overgrown yards in our neighborhood release rampant pollen, aggravating my father's allergies. His thin and tearing sclera makes each sneeze a cause for anxiety. New growths of poison ivy near our porch, previously unheard of, threaten his sensitive skin.
Beyond the immediate environmental hazards, there are indirect, equally unsettling effects. The nutritional value of food is changing, with implications for elderly health. Delivery of essential prescriptions, like those from the VA, gets complicated with intense rainfall, heat, cold, and snow, risking delays or damage.
Often, people ask why family caregivers don't opt for institutional care. The answer is twofold. Culturally, my upbringing emphasizes family-based care. I believe that our elders should be surrounded by love and familiarity, and that caring for them is an honor. This perspective is reinforced by broader arguments for deinstitutionalization, which champions dignity and independence for the elderly and disabled in their communities.
Not that climate challenges are exclusive to home settings. Costly facilities also face power outages, complex evacuation challenges, and disrupted staff and supply chains due to extreme weather. Such instances further unveil broader systemic issues, pointing to the need to better support caregivers in the face of climate change.
As our population ages, our laws and regulations must acknowledge and address the unique hurdles of home-based elder care. We need infrastructure adaptations and proactive policymaking that accommodate a range of familial choices and take into account the changing environmental realities.
Organizations like Area Agencies on Aging and the Veterans Administration already offer comprehensive, hands-on training programs for family caregivers. To help caregivers effectively manage extreme weather risks, their curricula should be updated to provide at least 20 hours of focused instruction on how climate change affects vulnerable populations. Topics covered should include how to create detailed emergency plans and how to proactively prepare for environmental changes.
Beyond practical skills, these programs should also address the socioemotional impacts of climate emergencies on the elderly and disabled. Events like hurricanes, wildfires, heat waves, and drought can heighten feelings of vulnerability and anxiety, adversely affecting mental health. Caregivers, who often bear the brunt of these disruptions, risk burnout without adequate support. Training should therefore include emotional first aid strategies to help them maintain a reassuring presence, discuss fears and concerns, and foster resilience and security.
Last but never least, caregiver self-care is vital. Training needs to cover how to recognize burnout signs, stress management techniques, and the importance of a supportive community. A holistic approach to care safeguards the mental and emotional well-being of both caregiver and care recipient. This stability is crucial for sustainable caregiving in the face of climate change's challenges.
Climate change is not a distant threat for family caregivers; it's a current crisis reshaping the lives of millions. The experiences of caregivers like myself highlight the overlooked nuances in our response to this global challenge. It's imperative that adaptation strategies and emergency response plans include the unique needs of the elderly. Only then can we claim to be truly addressing the breadth and depth of climate change's impact on our society.
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