Some older adults have diligently prepared for their future. They purchased long-term care insurance when it was still affordable, then paid the premiums each month, even as they continued to rise. This is not the norm. Many adults have no plan at all, or assume that Medicare, which currently kicks in at age 65, will cover their health costs. Medicare, however, doesn’t cover the long-term daily care — whether in the home or in a full-time nursing facility — that millions of aging Americans require. For that, you either need to pay out of pocket (the median yearly cost of in-home care with a home health aide in 2020 was $54,912, and the median cost for a private room in a nursing home was $105,850) or have less than $2,000 in assets so that you can qualify for Medicaid, which provides health care, including home health care, for more than 80 million low-income Americans. Even if you qualify, the waiting list for home care assistance for those with Medicaid tops 800,000 people and has an average wait time of more than three years.

A nursing home is too expensive; or, because of ongoing staffing shortages, there aren’t even open beds in the area. Over the past year and a half, many have also deemed them too risky because of Covid-19 concerns. In-home care seems more complicated, but it’s almost always what the care recipient wants, especially if it means the ability to stay in their own home. So the family decides to make it work, without a real understanding of the often-invisible costs that will quickly begin to accumulate.

Of those caregivers, 28 percent have stopped saving, 23 percent have taken on more debt, 22 percent have used up their personal short-term savings, and 11 percent reported being unable to cover basic needs, including food. The average age of someone providing care for an adult is 49, but 23 percent are millennials and 6 percent are Gen Z. Sixty-one percent are women, and 40 percent provide that care within their own homes, up from 34 percent in 2015.

A lot of these caregivers are really, really struggling. What’s required of them is more complex and time-consuming than just 10 years ago, as caregivers deal with overlapping diagnoses related to physical health, mental health, and memory loss as the elderly live longer. The work is much more than just clearing out the guest room or setting another place at the dinner table. Depending on the health of the care recipient, it’s monitoring medication, preparing special meals, changing diapers, and bathing, plus figuring out finances, providing transportation to and from medical appointments, and more. But only three in 10 have additional paid help, and 27 percent struggle to hire affordable care in their area. One in four caregivers find it difficult to take care of their own health, and the same percentage report that their health has deteriorated because of caregiving.

Read more in Vox.