America’s Unpaid Caregivers: The Hidden Workforce

According to the AARP-National Alliance for Caregiving in the U.S. 2025 report, about 63 million Americans, roughly 1 in 4 adults are caring for older parents, spouses, or other loved ones. Family caregivers provide approximately $600 billion in unpaid care each year, helping their family members live independently at home and stay connected to their communities.

One of the most striking truths about caregiving today is that older adults are just as likely to be caregivers as younger adults. According to a statistic shared on the West Health Mosaic—citing data from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS)—22% of adults age 65 or older provide ongoing caregiving, a rate nearly identical to the 20% observed among younger adults.

Despite the essential role caregivers play, the burden they carry remains largely invisible. Data from AARP, the CDC, and West Health Mosaic paint a vivid picture of emotional, financial, and physical strain but also reveal areas where thoughtful policy, such as Maryland’s caregiver support model, is beginning to offer relief.

For Many, Caregiving Is Long-Term — Not a Short Burst of Help

Caregivers provide regular care or assistance to a friend or family member with a health problem or disability. [AH1] [AH2] [MM3] While younger adults tend to care for parents or children, older adult caregivers are more likely to be caring for a spouse—often someone aging alongside them. And this care is rarely short-term. Although the available data come from only a handful of states, they make clear that the burden on caregivers is significant. Data posted on the West Health Mosaic  show that for many, family and friend unpaid caregiving typically extends for years rather than months, creating a prolonged responsibility that heightens the risks of burnout, financial strain, social isolation, and worsening health for caregivers themselves. This long duration of care underscores the critical need for formal respite programs, yet most caregivers receive little to no structured support or relief, leaving them to shoulder these challenges largely on their own.

The Intensity of Care: Most Caregivers Are Doing Both Personal and Household Care

According to the West Health Mosaic National Aging Readiness Dashboard, most family and friend caregivers are responsible for both personal care and household support. This means caregivers may be helping with intimate daily tasks such as bathing, dressing, feeding, or administering medications, while also managing essential household responsibilities like cleaning, preparing meals, and overseeing finances. What stands out is how common this dual-role caregiving is, particularly among adults in their 50s, 60s, and 70s. These older caregivers are consistently carrying the full weight of both personal and household care, often without formal training, reliable paid support, or respite services to ease the burden.

The Workforce Gap: When Paid Care Isn’t Available

Even when families want to rely on paid caregiving, that support is often difficult to secure. Insights from the National Aging Readiness Dashboard, show that the direct care workforce does not have sufficient capacity to meet the growing needs of older adults. As a result, many communities face long waitlists for home care, high turnover among direct care workers, limited availability in certain regions, and rising costs that put paid support out of reach for many families. Overall, the workforce remains too small and unstable to keep pace with the level of assistance older adults require. The result? Unpaid family caregivers, especially those 50+, become the safety net of last resorts.

How Maryland Is Reimagining Caregiver Support

The National Family Caregiver Support Program (NFCSP) is a federal initiative that all states, including Maryland, use to support unpaid family caregivers. While often associated with aging services, the program serves a broader group: adults caring for someone age 60 or older, caregivers of any-age individuals with Alzheimer’s or related dementias, and older relatives raising children or supporting adults with disabilities. States receive federal funding to provide services like respite care, counseling, training, case management, and in some places, modest financial assistance. Maryland stands out for offering annual stipends that caregivers can use for essentials like respite, supplies, or home modifications which can be a practical help that can ease burnout and stretch limited household budgets.

Maryland offers a particularly promising model for how states can meaningfully support unpaid caregivers. Under the NFCSP, Maryland delivers a full continuum of services including information and outreach, counseling, training, case management, respite care, and supplemental assistance. These supports address core challenges that caregivers routinely face high levels of burnout, limited access to training, and persistent financial strain.

A distinctive strength of Maryland’s approach is its financial assistance program, which provides annual stipends (typically $300 to $600) that caregivers can put toward respite, medical supplies, home modifications, or other essential needs. Though modest, these funds help older caregivers manage tight budgets, avoid crises, safeguard their own health, and continue providing care safely and sustainably.

Toward a Nation That Supports Its Caregivers

As the nation confronts a deepening caregiving crisis, we must recognize caregiving as the national infrastructure it truly is. Policies such as caregiver tax credits, expanded respite programs, flexible workplace benefits, enhanced training opportunities, and scalable models like Maryland’s can help ease the immense burden shouldered by millions of older Americans. In May 2025, this momentum was reinforced by the Administration for Community Living (ACL), which expanded federal support through $2 million in new demonstration grants and released fresh resources through the National Caregiver Support Collaborative to strengthen coordination, elevate best practices, and improve family caregiver programs across states, tribes, and communities.

That commitment to innovation was further underscored in November 2025 when the U.S. Department of Health and Human Services (HHS) and the Administration for Community Living (ACL) announced the new Caregiver AI Challenge—a national competition offering up to $2 million in first-round prizes for AI-driven tools that reduce caregiving strain through predictive health alerts, task coordination, safety monitoring, and streamlined administrative work. As these federal efforts move forward, it remains essential that we continue to elevate the voices and lived experiences of caregivers, especially those 50 and older whose unpaid labor sustains families, communities, and the healthcare system itself.