For millions of Americans, watching a parent grow older now comes with another fear: How are we supposed to afford to take care of them?
The price of caring for aging and disabled adults has climbed to levels that can overwhelm even middle-class households. For poorer Americans, there may be no realistic way to purchase full-time professional care at all.
In 2025, the national median cost of assisted living reached $6,200 a month, or $74,400 a year, according to CareScout. A private nursing-home room averaged $129,575 annually. Hiring a non-medical caregiver for 44 hours a week came to roughly $80,080 a year. (CareScout)
Those aren’t luxury prices.
They are the costs associated with helping people eat, bathe, dress, move around safely and continue living when age, disability or illness makes doing those things alone difficult or impossible.
And when a family doesn’t have $70,000, $80,000 or $100,000 a year to spend, the care doesn’t disappear.
Someone in the family usually has to provide it.
Families Are Becoming America’s Care System
The United States increasingly relies on an enormous workforce that rarely appears on a payroll: relatives.
AARP and the National Alliance for Caregiving found that 63 million Americans provided ongoing care for an adult or a child with a complex medical condition or disability in 2025 — nearly one in four adults and roughly 20 million more caregivers than a decade earlier. (National Alliance for Caregiving)
Among Americans caring for someone 50 or older, the average caregiver spends about 26 hours every week providing care. (AARP)
That can essentially amount to a second job.
Except it usually doesn’t come with a paycheck.
AARP estimates that 59 million people caring for adults provided approximately 49.5 billion hours of unpaid care in 2024. The economic value of that work exceeded $1 trillion. (AARP)
Families aren’t simply helping America’s long-term-care system.
In many communities, families are the system.
Being Poor Makes an Already Difficult Situation Worse
The consequences can be particularly severe for households that were struggling financially before a relative ever needed care.
A wealthy family may be able to hire someone to stay with an aging parent while everyone else goes to work.
A poorer family may have to decide which relative can afford to miss work.
That difference matters.
Research presented in 2025 found caregivers with household incomes below $50,000 were significantly more likely to experience all 13 financial problems measured in the national caregiving survey. (OUP Academic)
The problems extend far beyond paying a caregiver.
Among family caregivers overall, 47% reported at least one negative financial consequence from caregiving. About 31% stopped saving money, 24% exhausted short-term savings and 23% accumulated additional debt.
One in five left bills unpaid or paid them late.
And 14% reported being unable to afford necessities such as food because of the financial effects of caregiving. (Caregiving in the US)
For families already living close to the financial edge, there may be very little left to cut.
Someone Has to Stop Working
One of the hidden costs of America’s care crisis doesn’t appear on a nursing-home bill.
It’s lost income.
An adult child may start leaving work early to prepare meals for a parent with dementia.
Someone else may turn down overtime because their father cannot safely be left alone.
Another worker may move to part time because a mother recovering from a stroke needs help getting dressed and using the bathroom.
Eventually, some leave their jobs altogether.
That creates a brutal financial contradiction.
The family needs more money because someone needs care, but providing that care can make it harder for the family to earn money.
The consequences can continue long after the parent dies or enters professional care.
A worker who spends years earning less may also lose retirement contributions, Social Security earnings, promotions and career advancement.
What begins as an elder-care crisis can become the next generation’s retirement crisis.
Medicare Isn’t Long-Term-Care Insurance
Many Americans reach this stage assuming Medicare will take care of the problem.
That assumption can lead to an unpleasant surprise.
Medicare covers certain medically necessary skilled nursing and home health services under specific circumstances, but it generally does not pay for indefinite custodial care — the ongoing assistance with activities such as bathing, dressing and eating that many older adults eventually require.
Medicaid plays a much larger role in financing long-term services for people who meet eligibility requirements, including nursing-home services and, depending on the state and program, home- and community-based care.
But navigating eligibility rules and available services can itself become a challenge for families already dealing with a crisis.
The Middle Class Isn’t Safe Either
This isn’t exclusively a poverty issue.
A couple can spend decades building a retirement account only to encounter care expenses exceeding $100,000 a year.
A $300,000 nest egg sounds substantial until one spouse needs years of intensive care.
Even assisted living at the 2025 national median would consume nearly $75,000 every year. (CareScout)
For middle-income families, the process can become a gradual financial descent: use retirement income first, then savings, then investments and other assets while relatives increasingly contribute their own money and labor.
The difference is that poorer families often arrive at that crisis with little or nothing available to spend down.
The “Sandwich Generation” Is Getting Squeezed
The timing can be especially difficult for adults caring for parents while still raising children.
About 29% of family caregivers are part of this so-called sandwich generation, simultaneously supporting children and adults. (AARP)
Their money is being pulled in opposite directions.
College tuition or Mom’s home-care aide?
Retirement savings or Dad’s assisted-living payment?
Work overtime or stay home because a parent can’t be left alone?
There may be no financially good answer.
America’s Care Crisis Is Also an Inequality Crisis
Long-term care exposes a basic economic divide.
Families with money can purchase someone else’s time.
Families without money often have to provide their own.
That means the cost of care for poorer households isn’t measured solely in dollars. It can be measured in missed shifts, abandoned careers, depleted savings, unpaid bills and years spent performing demanding physical and emotional work without compensation.
And America’s dependence on those families is enormous.
The estimated $1.01 trillion value of unpaid adult caregiving in 2024 was greater than total federal, state and local Medicaid spending that year, according to AARP’s analysis. (AARP)
That should change the way the country talks about elder care.
This isn’t simply a private problem families are supposed to figure out behind closed doors.
America has built a substantial portion of its long-term-care system around an assumption that when professional care becomes unaffordable, a daughter, son, spouse, sibling or other relative will somehow make it work.
For millions of families, “making it work” increasingly means sacrificing their own financial security.
As America’s population continues aging, the question will become harder to avoid:
What happens when the people who need care can’t afford it — and the relatives expected to care for them can’t afford to stop working?
