By Mark Friedman

Part one of two parts

These words often define the experience of caring for an aging parent: privilege, obligation, burden, and trauma.

Privilege is the opportunity to do something meaningful for someone we love. It reflects gratitude, connection, and the desire to give back.

Obligation is a duty or responsibility that arises from personal ethics, conscience, or a sense of right and wrong.

Burden emerges when the demands of caregiving begin to exceed the time, energy, financial resources, and emotional reserves available to meet them.

Trauma develops when prolonged stress, uncertainty, fear, loss, and repeated crises overwhelm a person’s ability to cope.

Most family caregivers experience all of these at some point in their caregiver journey. Most enter from either a sense of obligation (56% of caregivers), meaning there is no one else and it has to be done, or privilege (44% of caregivers), meaning I can and I am willing. Regardless, at some point the positioning evolves into something more encompassing.

Whether entering through the door of obligation or privilege, caring for an aging loved one can be one of life’s most meaningful responsibilities. Few people regret spending time helping the people who raised them. The challenge is that caregiving rarely stays the same. Needs increase gradually. One doctor’s appointment becomes several. A medication reminder becomes medication management. A minor fall becomes a trip to the emergency room. A quick daily check-in becomes a constant concern.

What begins as an act of love can slowly become a source of exhaustion.

The progression is often so gradual that caregivers fail to recognize how much their lives have changed until they are already overwhelmed.

Family caregiving has become one of the largest invisible forces affecting the American workforce. Bob Stephen relates that according to the 2025 AARP/National Alliance for Caregiving report “Caregiving in the U.S.,” nearly 59 million Americans provide care to an adult family member or friend, and more than 60% of those caregivers are employed. Millions of people begin each workday carrying two full-time jobs: the one that pays them and the one that waits for them when they leave the office.

Research consistently shows that caregiving affects workplace performance. Employees adjust schedules, reduce hours, turn down promotions, take leaves of absence, and sometimes leave the workforce altogether. Calls from physicians interrupt meetings. Lunch breaks become opportunities to coordinate transportation, refill prescriptions, or speak with insurance companies. Vacation days become caregiving days.

According to Dr. Tara Kfoury, a leading Boston-area expert in trauma, “Being a full-time employee and/or a stay-at-home parent while acting as a caretaker can lead to physical, emotional, and mental exhaustion. It is important to highlight that the ongoing demands of caring for a chronically ill, disabled, or aging loved one can have significant burnout effects on not only the caregiver, but also the caretaker’s immediate family members.”

The financial impact can be equally significant.

Many caregivers spend thousands of dollars each year on transportation, home modifications, medical supplies, supplemental care, and services that help an older parent remain at home. Others sacrifice career advancement opportunities or reduce work hours to accommodate increasing demands. National research shows that roughly half of caregivers experience negative financial consequences from caregiving, and many take on debt to help support a loved one. Per Stephen, as of 2020, those who spent their own money were contributing 25% of their income to care. This means sacrificing their own savings, reducing expenses including their healthcare, and even putting themselves in financial peril, with more than eight million unable to afford basics like food or housing. [AARP Out-of-Pocket Cost Survey, 2020, and Caregiving in the U.S. 2025]

The emotional toll often receives less attention. Relationships become strained. Exercise routines disappear. Sleep becomes fragmented. Social lives shrink. Caregivers begin to neglect their own health while focusing on someone else’s. Over time, their world becomes smaller. Says Kfoury, “This causes emotional burnout and happens when a caregiver devotes the majority of their time, energy and resources to taking care of their loved one. With a stretched emotional and physical bandwidth, they begin to neglect, forget or aren’t able to take care of him/herself. A direct causation of not caring for this physical, emotional and mental health can severely impact the way the caregiver feels, acts and directly impacts their ability to complete their personal responsibilities.”

Many people do not think of caregiving as a trauma experience, yet the similarities are striking. Unlike a single traumatic event, caregiving often involves years of chronic stress. Caregivers live with uncertainty. They witness physical and cognitive decline. They navigate difficult conversations about safety, independence, finances, healthcare decisions, and end-of-life wishes.

Many describe feeling as though they are always waiting for the next phone call. The next fall. The next hospitalization. The next crisis.

Researchers have linked prolonged caregiver stress to higher rates of anxiety, depression, emotional exhaustion, burnout, and declining quality of life. Dementia caregivers are especially vulnerable because the demands often intensify over time while the emotional losses accumulate long before a loved one is physically gone. Dr. Kfoury says: “Caretakers for loved ones with dementia often experience a unique form of grief called anticipatory grief. Though the demands of their loved one’s care often intensify over time, the caretaker experiences losing the loved one they once knew. Each day that passes, the caretaker is forced to grieve the loss of their loved one while he/she is still present while also continuing to provide daily physical, emotional, and medical support.”

These pressures frequently appear in ways that are easy to miss.

  • • Difficulty concentrating
  • • Persistent worry
  • • Sleep disruption
  • • Emotional fatigue
  • • Reduced resilience
  • • A feeling that no matter how much is done, it is never enough

Working caregivers experience another challenge known as presenteeism. They show up for work, but part of their attention remains focused elsewhere. They are thinking about a parent who lives alone, a medication that needs to be taken, a physician who has not returned a call, or a situation that feels increasingly fragile. The body is at work. The mind is somewhere else.

Employers feel the impact through absenteeism, reduced productivity, turnover, and burnout. Families feel it through strained relationships and declining well-being. Caregivers feel it everywhere. Dr. Kfoury adds: “Most significant is that the demands of caregiving often leave little opportunity to process their own emotions, resulting in chronic stress, exhaustion, anxiety, sadness, and feelings of isolation. Many caregivers report experiencing conflicting emotions, including grief, frustration, guilt, resentment, and profound love and commitment toward the individual in their care.”

The reality is that caregiving is no longer just a family issue. It is a workforce issue, a healthcare issue, and an economic issue.

America’s family caregivers provide nearly 50 billion hours of unpaid care annually, work valued at more than one trillion dollars. Without them, the healthcare system would struggle to function.

Yet many caregivers continue to suffer in silence. Recognition is often the first step toward relief.

Understanding that caregiving naturally evolves from privilege or obligation to burden helps families prepare for changing circumstances. Recognizing the signs of trauma allows caregivers to seek support before reaching a breaking point. No caregiver should feel obligated to do everything alone. Asking for help is not failure. Setting limits is not selfish. Protecting your own health is not abandoning the person you love.

The most sustainable caregiving plans are built around support, communication, and realistic expectations. Families that acknowledge challenges early are better positioned to preserve careers, strengthen relationships, and improve outcomes for older adults.

Most importantly, they remember a truth that caregivers often forget. Providing care for someone you love should never require sacrificing yourself in the process.

Sources:

  • • AARP and S&P Global, Working While Caregiving Research (2024)
  • • AARP, Caregiving in the U.S. 2025 Report
  • • AARP Employer Caregiving Research
  • • Family Caregiver Alliance, Caregiver Health Research
  • • National caregiver burden and mental health studies
  • • AARP, Valuing the Invaluable Report (2026)
  • • Mental Health America, Caregiver Trauma: Why It Happens and What You Can Do About It (2026)
  • • Cleveland Clinic, Caregiver Burnout (2023)
  • • American Psychiatric Association, Center for Workplace Mental Health, Best Practices for Caregivers in the Workplace (2026)

About the Authors: Mark Friedman is the owner and Chief Education Officer of Senior Helpers Boston and South Shore. Passionate about seniors and healthcare, the goal of his agency is to change the trajectory of aging for his clients and their families first by delivering an exceptional homecare experience in a combination of highly trained and high-touch caregivers, and second by providing education and guidance with and connection to resources and services in the 43 communities his company serves. Contact Mark at MFriedman@SeniorHelpers.com or visit www.SeniorHelpersBoston.com. 

Dr. Tara Kfoury is the founder of Boston-based RIVER Educational Consulting, and a transformative behavioral specialist dedicated to supporting the mental emotional, and therapeutic well-being of children, adolescents, veterans, and first responders and their families. She helps individuals recognize and overcome mental health and behavioral challenges that hinder success in daily life, empowering them to navigate their experiences, build resilience, and create a meaningful path forward.

Bob Stephen has more than 30 years of experience with healthcare and family caregiving and supported millions of family caregivers through his role leading family caregiving efforts at a leading aging-focused nonprofit.