Each year in late November, we gather around the table to show gratitude. But underneath the soft light lies another story, one that rarely fits the frame of celebration. November is National Family Caregivers Month, and last week, the New York Times published a searing essay about a daughter navigating the slow decline of her father. It was raw, heartbreaking and true. And yet the larger truth is harder still: America’s care crisis does not pause for holidays, sentiment or declarations of thanks. It tightens.
Across the country last week, adult children drove home carrying casseroles in one hand and pill organizers in the other. They set alarms for 2 a.m. to help an aging parent to the bathroom. They tried to keep watchful eyes on wandering dementia while pretending to savor pumpkin pie. They felt the familiar tug between loyalty and exhaustion, between duty and despair. On Monday, they returned to work more tired than when they left.
For all the speeches about “family values,” our care system survives mostly because of what families provide in silence. More than 63 million Americans now provide unpaid care to an older adult, contributing an estimated $600 billion in labor that the market conveniently treats as free. The number is so large that it becomes abstract, until you understand that every dollar in that figure represents an hour stolen from someone’s sleep, income, health or hope.
Data shows that long-term care options are shrinking. Nursing homes in rural counties continue to close at alarming rates. Assisted living costs now surpass $70,000, well beyond the reach of the average American family. Home care is buckling under a severe workforce shortage.
And yet in the public imagination, caregiving remains a private matter, a domestic inconvenience handled primarily by daughters and daughters-in-law. James Baldwin once wrote that “not everything that is faced can be changed, but nothing can be changed until it is faced.” This crisis, too, depends on its invisibility. Policymakers will not reform what they do not see. Voters will not demand what they do not recognize. And so the crisis grows.
Thanksgiving is when the gap between myth and reality grows hardest to ignore. The result is a country that is rapidly aging into a “caregiving desert.” Within a decade, adults over 65 will outnumber children under 18. Meanwhile, the supply of direct-care workers is projected to fall short by hundreds of thousands. Families now rely on a workforce that doesn’t exist, financed by a system that doesn’t pay, to manage a level of need the country has never seen before.
I write this as someone who has lived this personally and now works every day with families navigating similar terrains. Through CareYaya, we’re trying to expand the care workforce by building a domestic talent pipeline of 50,000+ pre-health college students — trained, supported and paid to provide in-home care to older adults. But even this is a patch on a much larger wound. America needs a national care strategy: better wages for care workers, new financing models, expanded immigration pathways and a public reckoning with what it means to age in a nation that has outsourced the burden to families by default.
Thanksgiving offers a mirror. Some households see abundance. Others see what the holiday obscures: the fatigue, the loneliness, the absence of any safety net beneath them. If we are to honor caregivers, we must do more than applaud their strength. We must redesign the world they are forced to hold up on their own.
The holiday ends. The caregiving does not. Will we finally build a care system worthy of the families who have been carrying it all along?