Caring for the caregiver

KonCite · Personal Investigation

Who Cares for the Caregiver?The Invisible Labor Behind Black Professional Success

At forty-four, I finally understand what my mother was carrying. Now I see friends reaching the height of their careers while quietly becoming the people their families cannot function without.

Kevin Ahmaad Jenkins, PhDCaregiving, Work & Black Health22–26 Minute Read

Editorial reconstruction: This image represents the intersection of professional responsibility, family care, and invisible labor.

The KonCite

The greatest hidden cost of Black professional success may not be the work itself. It is becoming the infrastructure that keeps everyone else functioning.

Lately, I have noticed something about my friends.

They are tired. Not vacation tired. Not the kind of tired that can be solved by sleeping late on Saturday and promising to drink more water on Monday. This is a deeper fatigue, the kind that sits behind professional titles, successful children, leadership roles, polished presentations, and the dependable answer, “I’m good.”

Somewhere between forty and fifty, many of us quietly became the people everyone calls. A parent needs transportation to an appointment. A prescription has been denied. A specialist used language nobody in the family understood. Someone fell. A bill arrived. A cousin needs advice. A child still needs help. Work still expects the presentation by noon.

Because we earned the degree, found the stable job, learned how institutions work, or developed a reputation for fixing things, the call comes to us. Competence becomes availability. Achievement becomes family infrastructure.

Caregiving is not my current journey. But I recognize it because I lived beside it when I was young. During middle school and high school, my mother carried responsibilities I did not yet have the language to name. As a child, I experienced that time mostly as love and proximity. I remember being with her. I remember how she kept moving. I remember feeling cared for.

At forty-four, I finally understand that what looked natural from the outside was labor. It was planning, worry, time, interrupted sleep, financial calculation, emotional restraint, transportation, paperwork, and the constant mental inventory of what could go wrong next.

Children experience caregiving as love. Adults learn to recognize it as labor.

That recognition is why I see my friends differently now. I see the colleague who answers a medical call between meetings and returns to the room as though nothing happened. I see the friend managing medications from another state. I see the daughter who knows every specialist’s name and every sibling’s excuse. I see the son who is trying to protect his mother’s dignity while quietly wondering whether he can keep doing this without losing his health, his marriage, or the career his parents sacrificed to make possible.

We describe these people as strong. We rarely ask what strength is costing them.

The labor children do not see. What looks like love from one side of the table may be logistics, vigilance, and sacrifice from the other.

The Expanding Circle of Responsibility After 40

Career

→

Children

→

Parents

→

Self becomes the smallest remaining space

Success often expands rather than reduces the number of people depending on one individual.

WHEN SUCCESS MAKES YOU MORE REACHABLE

American culture often treats success as separation from hardship. Work hard, earn credentials, move upward, and life is supposed to become easier. For many Black professionals, the reality is more complicated.

Upward mobility may improve income, insurance coverage, institutional knowledge, and access to information. Those gains matter. They may also make one person the family’s most reliable translator of systems. The lawyer reads the contract. The physician interprets the discharge instructions. The professor helps complete the application. The executive has the flexible credit card, the car, the retirement account, the reliable internet, or the ability to speak to authority without being immediately dismissed.

Success does not necessarily reduce obligation. It may increase the number of people who believe you can absorb it.

I call this the Success-Caregiving Paradox: the same achievements that provide greater personal security can increase the expectation that one person will stabilize the family around them.

This is not simply generosity. It is a transfer of administrative, emotional, medical, and financial responsibility into the hands of the relative most capable of navigating institutions. The person who “made it” becomes a scheduler, insurer, advocate, driver, researcher, translator, banker, emergency contact, and historian.

The paradox becomes sharper for people who are firsts. The first physician, first PhD, first attorney, first executive, or first person with a stable professional salary may already be managing imposter phenomenon, racialized scrutiny, and the pressure to represent more than themselves. They must appear calm in rooms where mistakes feel costly. They may also be coordinating a parent’s care from the hallway between those rooms.

The office sees the professional. The family sees the infrastructure. The caregiver has to be both.

America’s Caregiving Reality

Finding	Best available estimate	Why it matters
Number of family caregivers	About 63 million U.S. adults, according to the 2025 AARP/NAC report	Caregiving is not a niche condition. It is a central part of the country’s health and labor infrastructure.
Growth	Approximately 45% increase over the previous decade	More adults are entering the role, often earlier and with more complex responsibilities.
High-intensity care	About 40% report high-intensity caregiving	Many caregivers are effectively performing a second job without formal preparation or reliable relief.
Training gap	Only a minority report formal preparation for caregiving or complex medical tasks	Families are performing clinical and administrative work that would require training in formal settings.
Employment collision	Many caregivers remain employed while providing care	The burden appears as missed work, reduced hours, stalled advancement, presenteeism, and concealed distress.

Interpretation: Estimates vary by definition, reference period, and whether care is provided to adults, children, or both. The figures above use the 2025 AARP/National Alliance for Caregiving framework and should not be treated as a single clinical profile.

Two meetings before noon. One is on the calendar. The other begins when the family needs you.

WHY THE BLACK CAREGIVING BURDEN IS DIFFERENT

Black caregiving should not be described as merely the universal caregiving experience with a racial adjective placed in front of it. The surrounding conditions are different.

Black families often encounter caregiving after decades of unequal exposure to chronic disease, neighborhood disinvestment, occupational stress, fragmented healthcare, lower accumulated wealth, and discriminatory treatment. Those conditions can shape when care is needed, how complex it becomes, and what resources are available to purchase relief.

A family with substantial savings can hire transportation, home care, meal preparation, legal help, or a care manager. A family without those reserves converts unmet need into unpaid labor. The difference is not love. It is purchasing power.

This helps explain why racial comparisons can be deceptively simple. Some studies find that Black caregivers report equal or even lower subjective burden than White caregivers despite providing demanding care. That should not be interpreted as evidence that the work is easier. Cultural meaning, spirituality, family obligation, resilience, and expectations about care can influence how burden is reported. High commitment can coexist with high physiological strain.

Black caregiving also sits inside broader kinship networks. The person receiving care may not be a spouse or parent. Care may flow to grandparents, siblings, aunts, uncles, fictive kin, church members, or family friends. These networks are sources of survival and belonging. They can also make the boundaries of responsibility difficult to define.

Then there is the historical meaning of care. Black families have survived because relatives, neighbors, churches, and communities did what institutions refused to do. Informal care has been a strategy of endurance. The danger comes when society celebrates that resilience while using it as an excuse not to build formal support.

A strong family should not be treated as a substitute for a functioning long-term-care system.

The office celebrates your promotion. The family experiences your availability. Somewhere in between, you become everyone’s emergency plan.

Three generations, one system. Illness rarely belongs to one patient. It reorganizes the family around the person who needs care.

THE PSYCHOSOCIAL STRESS OF BEING THE PERSON WHO HANDLES IT

Caregiver burden is often reduced to the number of tasks performed. That misses the deepest part of the experience.

Psychosocial stress is the sustained mental, emotional, behavioral, and physiological demand created when people must repeatedly anticipate, interpret, manage, or recover from threats and obligations in their social environment, especially when they have limited power to remove them.

For caregivers, the stress is not confined to bathing, driving, cooking, or managing medication. It includes anticipation: Will the parent fall? Will the doctor call during a meeting? Did the prescription arrive? Can they be left alone? Will insurance pay? Which sibling will not answer this time?

It includes role conflict. The professional must be fully present at work while mentally tracking a family member’s condition. The parent must care for children while becoming responsible for a parent. The spouse must preserve intimacy while performing clinical tasks. The successful family member must remain generous while quietly resenting the assumption that competence equals infinite capacity.

It also includes concealment. Many Black professionals understand that vulnerability is not evaluated equally. The person already navigating racialized scrutiny may fear that disclosing caregiving demands will be read as unreliability, poor commitment, or an inability to handle leadership. So the crisis is managed privately and competence is performed publicly.

That performance has a physiological cost. Chronic vigilance can disturb sleep, elevate blood pressure, alter eating and physical activity, intensify depression and anxiety, and reduce the time available for preventive care. Caregivers may become what clinicians sometimes call the hidden or secondary patient: the person whose health deteriorates while attention remains fixed on the person receiving care.

The stressor affects the body. Then it affects how the body reaches care.

Caregivers postpone appointments because someone else’s appointment is more urgent. They ignore pain because the family cannot absorb another patient. They know exactly which medications their parent takes and cannot remember the date of their own last physical examination.

We should not romanticize this as strength. Strength may be present. So may untreated hypertension.

What Caregiving Can Do to the Body and Mind

Outcome	What research generally shows	Likely pathways	Important caution
Depressive symptoms	Higher burden and intensive caregiving are consistently associated with greater depressive symptoms.	Loss, isolation, sleep disruption, role captivity, financial strain.	Caregiving can also provide meaning and closeness; effects vary by intensity and support.
Anxiety and vigilance	Uncertainty and responsibility can maintain persistent worry and threat monitoring.	Anticipatory stress, medical uncertainty, fear of emergencies.	Anxiety symptoms should not automatically be dismissed as a normal part of caring.
Sleep disruption	Nighttime supervision, worry, and irregular schedules commonly reduce sleep quality.	Interrupted sleep, hyperarousal, nighttime care tasks.	Sleep disorders may require direct treatment, not only stress advice.
Cardiometabolic strain	High-intensity caregiving may worsen blood pressure, activity, diet, and metabolic risk.	Sympathetic activation, reduced recovery, missed preventive care.	Associations vary; caregiving is not a single exposure and does not determine disease.
Financial harm	Reduced hours, job exits, unpaid leave, and out-of-pocket costs can weaken long-term security.	Lost wages, missed promotions, retirement withdrawals, purchased services.	Financial effects are shaped by policy, wealth, workplace flexibility, and family structure.
Social isolation	Care demands may reduce time for friendships, worship, exercise, hobbies, and rest.	Time scarcity, embarrassment, mobility limits, emotional exhaustion.	Isolation is modifiable and should be assessed directly.

The weight nobody sees. Caregiving burden is not one task. It is the accumulation of tasks, anticipation, identity, money, and time.

The Success-Caregiving Paradox

Education

→

Career success and institutional knowledge

→

Greater family reliance

→

Psychosocial and health burden

Upward mobility can increase both resources and expectations. The pathway is a proposed synthesis, not proof that professional success causes caregiver burden.

WHY WE HIDE IT?

Professional culture rewards the appearance of uninterrupted capacity. Caregiving is interruption made visible.

The caregiver leaves early, turns the camera off, takes the call, reschedules the trip, misses the networking event, or arrives after spending the night in an emergency department. Even when workplace policies exist, access may depend on the manager, team culture, job classification, and whether the employee believes using the benefit will damage advancement.

For Black professionals, disclosure may feel particularly risky. Many already experience the minority tax: additional mentoring, service, representation, emotional labor, and proof demanded because they are among the few. They may also be managing imposter feelings—the fear that any sign of strain will confirm someone else’s doubt about whether they belong.

So they hide caregiving inside productivity.

They answer email from waiting rooms. They present from parked cars. They schedule procedures around major meetings. They call exhaustion discipline and grief professionalism.

This is not work-life balance. It is work-life concealment.

Employers often see the consequences only when performance changes. By then, the caregiver may have been operating at a deficit for months. The organization loses concentration, creativity, retention, and leadership capacity, while the employee loses sleep, health, income, and the feeling that any part of life belongs entirely to them.

The problem is not that caregivers are insufficiently resilient. The problem is that institutions often benefit from care remaining invisible.

Evidence-Informed Ways to Reduce Caregiver Burden

Intervention	Best use	Evidence signal	Limitation
Multicomponent caregiver programs	Education, skills, problem-solving, emotional support, and linkage to services	Meta-analyses generally find modest improvements in burden, depression, and coping, especially when tailored.	Availability, cultural fit, and caregiver time affect participation.
Cognitive behavioral approaches	Self-blame, catastrophic thinking, depression, insomnia, and coping	Supported for several caregiver populations, with effects varying by condition and delivery.	Therapy cannot substitute for money, respite, or safe formal care.
Respite and complementary formal care	Creating actual time away from direct care	Can reduce immediate strain and protect continuity, especially when reliable and acceptable.	Effects are mixed when respite is too brief, hard to access, or creates guilt and coordination work.
Care navigation and training	Medication, appointments, benefits, equipment, and complex medical tasks	Improves preparedness and may reduce avoidable confusion and crisis use.	Information without authority or resources can become another assignment.
Support groups and peer connection	Isolation, validation, practical learning, anticipatory grief	Often improves perceived support and coping; online options can increase access.	Not every group is culturally safe or appropriate.
Workplace flexibility and paid leave	Reducing the collision between employment and care	Strong practical rationale; flexible scheduling and paid leave protect employment and retention.	Policy effectiveness depends on affordability, eligibility, and freedom from retaliation.
Family care agreements and succession plans	Distributing tasks, money, authority, and backup responsibility	Evidence base is less standardized, but planning addresses known drivers of overload.	Family conflict, geography, and unequal resources can limit redistribution.
Brief restorative practices	Interrupting sustained activation and preserving identity	Positive emotion, mindfulness, creative activity, and short recovery periods may improve regulation and mood.	They are protective moments, not solutions to structural overload.

Caregiving becomes more sustainable when responsibility is discussed, documented, and shared. A family meeting is not proof of crisis. It is infrastructure.

Caring for the Caregiver

1. Become the architect, not the hero. Ask how care should be organized, not only how much you can personally absorb.

2. Distinguish love from indispensability. Devotion is not measured by exhaustion. Coordinating help is still care.

3. Build succession into the care plan. Someone else should know the medications, documents, passwords, appointments, and next steps.

4. Name the work at work. Use available leave, flexibility, employee assistance, and caregiver benefits without apologizing for having a family.

5. Protect the caregiver’s healthcare. Schedule their medical visits, sleep assessment, therapy, movement, and preventive care with the same seriousness given to the recipient.

6. Create culturally safe support. Faith, kinship, and community can be protective, but support must permit honesty rather than demand martyrdom.

FINDING NUGGETS OF PEACE

Caregivers are often told to practice self-care as though wellness arrives in uninterrupted afternoons. Most people carrying a family know better. Peace often appears in smaller units.

A nugget of peace is not an attempt to solve caregiving with a coloring book, a cup of coffee, or a playlist. It is a protected moment in which the nervous system receives evidence that the entire day is not an emergency.

Adult coloring books can help some people narrow attention and create a brief creative boundary around worry. A walk, prayer, stretching, sitting in the car, calling the friend who needs nothing, or listening to one favorite song may do the same. These moments are not trivial because they are small. They are useful because they are repeatable.

My nugget of peace is coffee and Lauryn Hill’s “Ex-Factor.” I do not need the ritual to become a productivity strategy. For a few minutes, nobody needs me to interpret, solve, schedule, or explain anything. The coffee slows me down. The song gives emotion somewhere to go. I remain a person before I become useful to anyone else.

Peace does not have to be profound to be protective.

Finding My Nugget of Peace

Coffee. Lauryn Hill. “Ex-Factor.”

For a few minutes, no one needs an answer. The responsibilities remain, but they do not occupy every inch of the day.

Ask yourself: What small, repeatable moment reminds you that you exist beyond what you provide?

AT 44, I UNDERSTAND

When I was younger, I thought my mother’s strength meant caregiving came naturally to her.

At forty-four, I understand something different.

Strength is often what burden looks like from the outside.

I am grateful for the time we shared. I am grateful for what her care taught me about love, loyalty, and showing up. Gratitude does not require me to pretend the work was effortless. In fact, loving her now means seeing more clearly what she gave then.

That clarity has changed how I see my friends. I recognize the pause before they answer, the phone placed face down during dinner, the cancelled trip, the new familiarity with pharmacies and specialists, the promotion accepted while a parent’s health declines.

We call them executives, physicians, attorneys, scholars, entrepreneurs, leaders, mothers, fathers, sons, and daughters.

We should also call them caregivers.

And recognition must lead to more than praise. Caregivers need time, money, training, competent navigation, flexible work, paid leave, reliable respite, culturally safe support, and families willing to distribute responsibility before one person breaks.

The question is not whether Black caregivers can continue carrying everyone. History has already answered that.

The harder question is why so many institutions have been allowed to depend on that carrying while treating it as private love rather than public infrastructure.

As a child, I experienced caregiving as love.

At forty-four, I understand it as labor.

Both are true.

And perhaps honoring the caregiver requires us to finally hold both truths at once.

Sources and Notes

01Caregiving in the United States, 2025

AARP and National Alliance for Caregiving. Caregiving in the U.S. 2025. National survey report.

02Caregiver burden: clinical review

Adelman RD, Tmanova LL, Delgado D, Dion S, Lachs MS. Caregiver burden: a clinical review. JAMA. 2014;311(10):1052-1060.

03Stress process model

Pearlin LI, Mullan JT, Semple SJ, Skaff MM. Caregiving and the stress process: an overview of concepts and their measures. Gerontologist. 1990;30(5):583-594.

04Allostatic load

McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med. 1993;153(18):2093-2101.

05Weathering

Geronimus AT. The weathering hypothesis and the health of African-American women and infants. Ethn Dis. 1992;2(3):207-221.

06Racism and health

Paradies Y, Ben J, Denson N, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138511.

07Discrimination and health

Williams DR, Mohammed SA. Discrimination and racial disparities in health. J Behav Med. 2009;32(1):20-47.

08Black veterans and healthcare racism

Jenkins KA, Keddem S, Bekele SB, Augustine KE, Long JA. Perspectives on racism in health care among Black veterans with chronic kidney disease. JAMA Netw Open. 2022;5(5):e2211900.

09Dementia caregiver interventions

Walter E, Pinquart M. How effective are dementia caregiver interventions? An updated comprehensive meta-analysis. Gerontologist. 2020.

10Remote caregiver support

Cochrane review: remotely delivered information, training and support for informal caregivers of people with dementia. Cochrane Database Syst Rev. 2021.

11Caregiving and employment

National Academies of Sciences, Engineering, and Medicine. Families Caring for an Aging America. Washington, DC: National Academies Press; 2016.

12Family caregiver health

Roth DL, Fredman L, Haley WE. Informal caregiving and its impact on health: a reappraisal from population-based studies. Gerontologist. 2015;55(2):309-319.

13Caregiver concept analysis

Liu Z, Heffernan C, Tan J. Caregiver burden: a concept analysis. Int J Nurs Sci. 2020;7(4):438-445.

14Black dementia caregiving

Alzheimer’s Association. Alzheimer’s Disease Facts and Figures. Current annual report; review racial and ethnic disparities sections.

15Workplace support

U.S. Department of Labor. Family and Medical Leave Act guidance; state paid-family-leave rules vary and should be checked before publication.