I'm one of 48 million unpaid caregivers. Health care collapses without us.

Tonight, I was too exhausted to take a shower after work. I stood in my bathroom, looking at the tub that wouldn’t drain, knowing I still had to be up at 6 a.m. for another shift. My body ached. My mind was foggy. And all I wanted was 10 minutes of quiet. Instead, my phone lit up again. It was my mother.

I’ve been a registered nurse for over 30 years. I’ve cared for patients through emergencies, chronic illness and end-of-life transitions. I thought I understood what caregiving meant. I didn’t – not until I became responsible for my own parent.

I never planned to leave New York City and return home to take care of my mother. My father died suddenly after a delayed cancer diagnosis. By the time they found it, it was already stage 4 with metastasis. Six months later, my mother survived a near-fatal car accident. I had a new job lined up. Instead, I gave it up and stepped into a role I wasn’t prepared for: full-time caregiver.

What followed were surgeries, rehabilitation and a slow, uncertain recovery. Then came more setbacks – and eventually, significant vision loss. The appointments became constant. The driving alone began to wear me down.

Caring for a parent is not just physical – it is emotional, relentless and often invisible. My mother is still functional in many ways. She can walk, she can use the bathroom independently and her mind is sharp. But her vision is severely impaired. Simple tasks – like cooking – have become dangerous. This is where caregiving often lives: not full dependence, but not true independence, either. It is a constant state of vigilance, where you are always anticipating risk while trying to preserve dignity.

What makes it harder is how alone it can feel. When you ask for help and receive silence instead, the burden doesn’t just stay the same – it grows heavier. What I’ve experienced is not unique. It is part of a much bigger, largely invisible crisis.

A massive unpaid workforce of caregivers

According to AARP, almost 63 million Americans – almost 1 in 4 adults – are caregivers and nearly 48 million of them are unpaid. If they were compensated, it would amount to an estimated $600 billion in care each year.

For many families, the financial reality makes outside help impossible. As AARP noted, nursing homes cost an average of $108,000 a year for a private room. Assisted living can range from $4,000 to $11,000 a month.

My mother is not eligible for Medicaid. If she were, the state would provide some level of support to a caregiver. But because she has what is considered “good” insurance, she falls into a gap millions of families face – too resourced for public assistance, yet not covered for the care she actually needs. Her insurance does not cover in-home health aides for ongoing support.

We attempted to file claims through her extended policy. She was denied – three times.

Supporting caregivers needed to stabilize health care, economy

This is not just a personal struggle – it is a structural one. It is a massive, unpaid workforce sustaining a system that would otherwise collapse.

If that workforce were supported – through Medicare coverage, caregiver stipends or structured respite care programs – it would not only relieve the emotional and physical burden on families, but also put money back into the economy rather than quietly extracting it.

Instead, families are left to absorb the cost – financially, emotionally and physically – while the system continues to rely on their labor without recognizing it.

Even my mother's supplemental insurance for in-home care falls short. Coverage is only triggered when a patient can no longer stand or perform basic functions independently. In other words, support is only available once someone has already reached a point of severe decline. In practice, the system waits for people to fail before it helps them.

When I entered nursing school in 1990, one of my professors warned us that the United States would face a caregiving crisis within 30 years – that there would not be enough people to care for an aging population. At the time, it felt like a distant concern.

Now, we are living in that reality. At the same time, the United States is facing a rapidly aging population. The U.S. Census Bureau reports that by 2030, 1 in 5 Americans will be older than 65 – a demographic shift that is already reshaping families and the health care system. Yet the system has not evolved to meet this reality.

There are solutions within reach. Expanding access to in-home care through Medicare and state programs would allow seniors to remain safely in their homes. AARP has commended some states that are already providing tax credits. Those credits or stipends to family caregivers would recognize the essential labor already sustaining the system.

Further, insurance policies must be required to cover long-term in-home support – not just acute medical care.

Supporting caregivers is not just compassionate policy – it is essential to the stability of our economy and health care system. We can no longer afford to treat family caregiving as an invisible responsibility – it must become a visible priority in public policy. The 48 million American adults providing unpaid care are not just individuals – they are a workforce, a constituency and a signal that the system must change.

Christine Villabona-Kuntz has been a nurse for 31 years and lives in Delaware. She's working on a book about health care.