Never just a caregiver

Caregivers are the backbone of aging care in America

From Nancy Healey

On February 21 we celebrated the life of a dear friend in exactly the way she wanted at Broad Beach in Malibu California. It was a perfectly beautiful sunny day like it had been made especially for her. She would have loved it.

When we arrived, everyone started introducing themselves and discussing how they had known her. Some people knew her from her job at a large catering company, some had volunteered with her at the Senior Concerns Boutique, and others like me simply knew her as a friend.

I wrote about Linda D. last week. She had had a stroke in 2026 when she was 71 and was never able to live independently after that. She had spent the last several years in a 6-bed board and care home. Four of her caregivers from the home came to share in her celebration. I visited Linda frequently and had gotten to know and appreciate the care staff. They were standing together during the introductions; the first one who introduced herself said, “We were just Linda’s caregivers.” I did not say anything until we were at lunch when I asked them to please never think of themselves as “just” caregivers. Linda had been unable to walk during her years in the care home so would not have been able to survive without her “just” caregivers. Their importance for her and many other residents in nursing and assisted living facilities can never be underestimated.

Why are caregivers so critically important to our growing senior population? Caregivers, including family and paid, are the backbone of aging care in America. This includes caregivers in seniors’ homes and in care facilities.

Caregivers can allow seniors to safely age in place in their homes, remaining more independent and connected to the community. They provide the daily support that prevents hospitalization, delays nursing home placement, and preserves dignity. Even a few hours of help with meals, bathing, transportation, and medication can significantly extend their years living at home.

The national median cost of hourly in-home care in the US in 2025 was $33/hour. According to the 2025 Cost of Long-Term Care and Senior Living Report, these costs vary according by state according to location, cost of living, rural or urban, and the level of care required.

Live-in care is when the caregiver lives in the home. It is typically more cost-effective than hourly care. Daily live-in costs are on average $250-$350 a day or $400+ a day through an agency. Monthly rates for standard live-in care range from $6000 - $10,500/month. If the caregiver is required to provide care around the clock, the average rate in CA is $27,300 monthly and the national average is $23,839 monthly based on national data. If medical or skilled support is needed, the costs will vary based on certifications, medical skills required, and agency or private hire.

Caregivers hired through an agency are generally more expensive than private hire caregivers. Agencies handle background checks, training, scheduling, and backup care. They provide liability and workers’ compensation insurance and can handle insurance company billing when applicable. The caregivers receive only a percentage of the fee charged.

Private-hire caregivers are often more affordable and allow for more flexibility and personal choice. It is important to realize that no liability or workers’ compensation protections are provided. The family must provide payroll, taxes, vetting, and backup coverage when needed. This type of care is better for families familiar with managing employment responsibilities.

Caregivers are essential in care facilities, ensuring the safety, health, and emotional well-being of seniors who are unable to live safely at home. They are essential in these facilities because many residents require daily help with mobility, personal care, medication, or cognitive support. A skilled care team ensures a rehabilitation stay is productive and positive, not frustrating.

Caregivers help residents with intimate tasks like bathing, dressing, and toileting; the skill and compassion they use in dealing with these personal tasks can go a long way toward protecting the residents’ dignity and self-esteem. They are critical for ensuring residents’ safety, monitoring their health changes, and providing an emotional connection to reduce loneliness. Consistent daily care and routines are vital for individuals living with dementia and chronic illnesses.

There has always been a need for caregivers, so why is this even more important now? Caregivers have become the linchpin of our entire long-term care system. This has resulted from several national trends, which have made their role indispensable.

The biggest factor is the aging of America. Baby Boomers are now in their 60’s, 70’s, and early 80’s; by 2030 every Baby Boomer will be 65+. The number of Americans needing long-term care is projected to nearly double by 2050. Our growing elderly population means more chronic illness, more dementia, more mobility limitations, and the need for more hands-on care.

Another issue is that we are now living longer but not necessarily healthier, resulting in more years requiring daily support either at home or in a care facility. The demand for professional caregivers is outpacing supply. The positions entail considerable physical effort, offer modest compensation, and experience a high rate of employee turnover. Many care agencies report turning away 25 percent of referrals due to lack of staff.

Families now have fewer adult children to share caregiving responsibilities. More households have two working adults, many seniors live by themselves, and adult children are often distant. This leaves professional caregivers as the primary support system for our aging population.

Caregiving can be rewarding, meaningful work, but it can also be emotionally difficult. Research shows that family or professional caregivers experience high levels of stress, burnout, and emotional strain. It is critical that we show our caregivers how much they are valued. Acknowledge the importance of their work, either in your family or in a care facility. Invite them into care planning, which will validate their insight and experience. Small gestures of appreciation can boost morale and reduce burnout.

From working with caregivers in our home and in care facilities, I believe the most important message caregivers can receive is letting them know that their work matters and that they matter. Professional caregiver pay is very low, few have health insurance or paid sick days, and there are often no paths for advancement. Advocacy at state and local can hopefully make a real difference for the future.

Many caregivers at home or in facilities feel undervalued despite their critical importance. Respect for caregivers becomes respect for the people they care for. The two are inseparable.