Written by: Angela Derrick, Ph.D. & Susan McClanahan, Ph.D.
Date Posted: August 1, 2025 9:59 am
We recently watched the incredibly compelling documentary “Caregiving” and were moved by both the personal stories and the well-researched history of caregiving in the United States. The film places personal stories within a broader context by tracing the evolution of caregiving and policy in the U.S., from the Social Security Act under FDR’s Secretary of Labor, Frances Perkins, to the caregiving demands spurred by wars, economic changes, the pandemic, and other factors. “Caregiving” argues that this work is a sacred calling and deserves systemic support.
In midlife, typically between 40 and 60 years old, many people find themselves in what is often referred to as the sandwich generation. They’re caring for aging parents while still supporting children or young adults at home. At the same time, they’re in what should be their prime earning years, building careers, saving for retirement, and navigating major life transitions. For women, this burden is even heavier: midlife often coincides with menopause, workplace ageism, and the cumulative effects of a lifetime of invisible labor.
Almost all my clients in this age range are bringing in issues related to their caregiving responsibilities. Many feel guilty for struggling with aspects of the work or their sense of obligation to a loved one. They don’t realize that a whole range of feelings about this experience are very understandable, and also the norm.
~Dr. Angela Derrick, SpringSource co-founder and co-owner
The pressure for the sandwich generation is intense, and the system provides little relief. There’s rarely paid family leave, affordable eldercare, or flexibility in most jobs. As a result, midlife caregivers face higher rates of burnout, financial struggles, and mental and physical health declines, as their own needs go unmet. Despite doing most of the unpaid care, they remain overlooked in public policy and lack support at work.
In times of crisis, a country’s real priorities are revealed. For the United States, both World War II and the COVID-19 pandemic exposed a truth we keep ignoring: America depends on unpaid, unseen caregiving, and we still don’t recognize it as the essential system it truly is. Caregiving isn’t just emergency relief. It’s infrastructure.
Some argue that the lack of value and resources assigned to caregiving is reflective of how our society sees those who are doing the work, often women of color from lower economic backgrounds. Thus, there is discrimination in what jobs are considered valuable and who is performing the work. Often, the work goes unacknowledged and is almost invisible, as well as the caregivers themselves.
When American men went off to the battlefields of World War II, the era of Rosie the Riveter began, with women taking their places in factories and shipyards across the country. To support this large-scale entry into the workforce, the U.S. government took an extraordinary step: it invested in federally funded, high-quality child care initiatives. Under the 1941 Lanham Act, child care centers were built near defense plants, staffed by trained educators, and subsidized by the government.
These centers weren’t just band-aids; they were bold, effective institutions, and deeply appreciated by working families. But as soon as the war ended, so did the support. The prevailing message was clear. Women should return to domestic life, and caregiving once again becomes a private, unpaid matter.
Nearly 80 years later, the COVID-19 pandemic forced the country to face a different kind of frontline. Millions of caregivers, mostly women in the sandwich generation, juggled elder care, child care, home-schooling, and full-time work, often without any support.
Once again, temporary measures were introduced, including expanded paid leave, stimulus checks, work-from-home accommodations, and a monthly child tax credit. For a short period, these measures significantly reduced child poverty. However, similar to World War II, these programs were seen as emergency aid rather than a permanent fix. As political support shifted, most of them disappeared along with progress in reducing childhood poverty.
The country leaned hard on caregivers when it needed them most, and then walked away.
Globally, women perform over 75% of unpaid caregiving, work that supports the entire economy but isn’t reflected in GDP. In the U.S., the value of unpaid caregiving is estimated at more than $600 billion annually (AARP). Many women hold a paid job only to return home to a second shift of caregiving and domestic responsibilities.
This labor is essential, but because it isn’t monetized, it remains invisible to policymakers, employers, and even many families. When women leave the workforce to care for others, they lose income, retirement benefits, and long-term financial security—yet society often treats this as a personal choice rather than a structural failing.
Care work is emotional, physical, and logistical labor—encompassing tasks such as feeding, bathing, advocating, scheduling, and soothing. It’s often dismissed as natural or what good people do, especially in relation to women. But that logic keeps it devalued and unsupported.
This labor is invisible not because it lacks value, but because it is performed quietly, behind closed doors, mostly by women, although men also perform caregiving. And as long as it remains invisible, it remains uncompensated and unprotected.
While unpaid caregiving remains the silent norm, paid caregiving is also undervalued and often racialized. Home health aides, nannies, and elder care workers are disproportionately women of color and immigrants, and they are among the lowest-paid workers in the country. Most lack access to basic labor protections like paid sick leave, health insurance, or retirement benefits.
This workforce forms the foundation that enables others to go to work, yet they face economic vulnerability and political marginalization. Their labor is vital and personal, but it is consistently undervalued.
Women’s caregiving responsibilities are a major driver of the gender pay gap. When women cut back hours, decline promotions, or leave the workforce to care for family, they face financial setbacks, not just temporarily but throughout their lives. The pandemic worsened this issue, reversing years of progress toward gender equality.
Ignoring caregiving means ignoring one of the root causes of economic inequality.
Caregiving takes a toll not just on finances, but on mental and physical health. Caregivers experience higher rates of depression, anxiety, stress, and chronic illness. They often neglect their own medical needs, lack sleep, and feel isolated.
Caregiving is love in action. But without support, it becomes unsustainable.
As Baby Boomers age, America is facing a caregiving cliff. By 2030, 1 in 5 Americans will be over 65. Long-term care facilities are understaffed and expensive. Families are unprepared, and the unpaid caregiving labor force is shrinking.
We are running out of time to build a sustainable care infrastructure. The need is not coming. It is already here.
Care is not just a personal virtue; it’s a public necessity. If we redefine caregiving as vital infrastructure, we could create a more humane and equitable society. One that honors not just the labor that builds bridges and roads, but the labor that sustains lives.
As the PBS documentary Caregiving powerfully demonstrates, the stories of those who care, often silently and at great personal sacrifice, are deeply human. It argues that it is long overdue for a permanent, structural change—treating caregiving as essential infrastructure, not just emergency aid. From World War II to COVID-19, we have repeatedly seen that caregiving isn’t a crisis fix. It’s the foundation of everything.
As mental health professionals, we are acutely aware of the stress our clients face in providing care for aging relatives, growing children, and/or individuals with specific disabilities. We find therapy to be uniquely helpful in providing a space for caregivers to address compassion fatigue and burnout, feel less alone and more supported, and to process the ways in which their lives and sense of identity are impacted by the shifting roles. No matter what is going on in their lives, therapy is a time when the caregiver can get individual and personal attention to their emotional world, which is often ignored or lacking in their day-to-day experiences as they prioritize the needs of others.
Stream Caregiving on PBS here: https://www.pbs.org/show/caregiving/
#ShareYourCaregivingStory — You can share your own caregiving story or check out others and find community through this hashtag.
Caregiving Resources at Well Beings
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