Millions of middle-aged women struggle to care for ailing older relatives, and the crisis is only getting worse. So why is no one talking about it?

Baden-Mayer, a freckled forty-five-year-old, put her house on Airbnb three years ago and moved with her husband and two kids into her parents’ home in Alexandria, Virginia. Her mom, who has Alzheimer’s disease, was no longer able to take care of her dad, who had suffered from heart failure. “I didn’t really have a good idea of what I was getting into, quite honestly,” she said, reflecting on what a truly frank conversation with her husband would have sounded like: “What do you think of living with my parents for about ten years while their health declines and they die?” 

Baden-Mayer is one of about thirty-four million Americans providing unpaid care to an older adult, often a family member. Most of these caregivers are middle-aged, and most are women. They are individually bearing most of the burden of one of America’s most pressing societal challenges: how to care for a population of frail elders that is ballooning in size. 

Most people assume that Medicare will cover the type of long-term personal care older people often need; it does not. Neither does standard private health insurance. And the average Social Security check can only make a medium-sized dent in the cost of this care, which can easily exceed $100,000 a year if provided in a nursing home. Medicaid, unlike Medicare, does cover long-term care, but only for patients who have exhausted their savings, and coverage, which varies from state to state, can be extremely limited. So the safety net you thought would catch you in old age is less like a net and more like a staircase you get pushed down, bumping along until you’ve impoverished yourself enough to hit Medicaid at the bottom. 

Meanwhile, the cost of hiring a home health aide to take care of a frail parent can add up to $50,000 or more per year. So tens of millions of individual women across the United States wind up providing the care themselves for free, and bearing its cost in the form of stress, lost wages, and lost opportunities to nourish their other needs, and their families’. When we talked on the phone, Baden-Mayer wondered aloud, “Why is it that we don’t have a good system that we can plug into when our parents need care?”

Why indeed? You might expect that a problem that affects so many people so profoundly would become a major political issue.

Yet even though American women today are politically organized and running for office in record numbers, elder care remains widely viewed as a purely personal matter.

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