Caregiving Is Extremely Difficult in America. It Doesn’t Have to Be This Way.

For many immigrant families, caregiving is an act of love passed down through generations—yet in the U.S., the lack of paid leave, affordable elder care and basic support makes it nearly impossible to sustain.

For many Asian and immigrant families, caregiving is a way of life, with generations living and caring for one another under the same roof as part of daily life.

My Iranian grandparents lived in a multi-unit dwelling in Tehran, where they cared for each other through illness and aging, cooking and sharing meals with their children and grandchildren in what seemed to me a seamless synchronicity. When my Pakistani grandmother emigrated from Karachi to the U.K. in the 1970s, she moved in with my uncle’s family, sharing a bedroom with her youngest grandson until she died. Now, that grandson lives in the same house with his own children and aging parents. 

However, here in the U.S., caregiving takes on a very different form, even for families raised on the belief that caring for another is simply what we do. As the cost of living continues to climb and women shoulder impossible expectations, what was once a deep cultural value has become either too hard to maintain or comes without the structural and emotional support it deserves.

Already, American families shoulder some of the highest healthcare costs in the world. According to an AARP report, American caregivers spend an average of $7,242 per year out-of-pocket for caregiving-related expenses, including costs for home modifications, medical supplies, transportation and paid assistance.

For Asian American and Pacific Islander (AAPI) families, the cost increases to $8,378. 

Yet despite the costs, 80 percent of caregivers surveyed said their role has strengthened their relationships with their loved ones, with the large majority reporting feelings of personal fulfillment and gratitude from those in their care.

I can attest to this firsthand, having experienced it in my own family. When my mother immigrated to the United States last year, my siblings and I assumed the responsibility of caring for her. Sometimes she’s in my sister’s spare bedroom in Florida. Sometimes, she’s with my brother and his family in California. The rest of the time, we’re rooming together in my Brooklyn apartment. My brother handles my mother’s healthcare, my sister manages her immigration paperwork and I oversee her day-to-day finances. 

It’s not the most ideal setup, but it’s the best we can do for now, and forming a “community of care” with my siblings has had a profound effect on our relationships. Working together towards a common goal has made us kinder and more empathetic towards one another. We understand when one of us is overwhelmed and another needs to step in, and we’re more sympathetic to the challenges in each other’s daily lives.  

The “village” that sustains immigrants, queer people and working-class families rarely shows up in policy conversations. Care is an inheritance passed down through generations—but that doesn’t mean we should continue to allow it to come at the expense of our health or financial stability. Family caregivers in the U.S. provide an estimated $470 billion in unpaid labor each year—an invisible economy roughly the size of the country of Austria’s entire GDP and built almost entirely on the unpaid labor of mostly women. 

If we truly value the people who hold our families and communities together, we must finally treat caregiving as the essential labor it is. That means federally paid family leave, culturally competent eldercare and broader infrastructure that makes caregiving easier, such as language access in healthcare and workplace policies that respect the realities of family responsibilities.

While caregiving is often rooted in immigrant traditions, soon it will become a universal, shared reality across the country. Nearly half of Americans today are expected to become caregivers at some point in their lives, indicating that if we don’t build stronger community infrastructure for care, the nation could soon face a full-blown caregiving crisis as Baby Boomers continue to age into higher-need care.

Since my mother immigrated to the U.S., I’ve often thought about the instability of care and how it moves in quiet, fleeting ways through our communities. Sometimes it looks like friends pooling money for a plane ticket when someone is too homesick to keep going, or covering a bill when one of us falls short. This type of occasional care has been the difference between surviving and thriving, especially for immigrants without a safety net nearby. But not everyone has those networks to fall back on and has been so lucky. 

Care is an inheritance passed down through generations—but that doesn’t mean we should continue to allow it to come at the expense of our health or financial stability.

In the face of rising living costs and a looming retirement crisis, lawmakers should learn from the lived experiences of AAPI women. We are the daughters managing remittances across borders, the aunties raising nieces while siblings work night shifts, and grandmothers cooking and cleaning while navigating our own aging bodies. Caregiving is a beautiful act, rooted in security and love for others, but without real support, it becomes unsustainable.

It’s time to make caregiving a centerpiece of policy discussions and build the national and workplace policies and systems to honor the caretakers, namely women, whose labor has all too often slipped beneath the radar. A thriving country depends on care, and it’s past time we began treating it that way.