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    Caring for the caregivers

    Caring for the caregivers: Rest and real help for the people who care for everyone else.

    63 million Americans care for a family member or friend, and the people who care for us at work are burning out. This chapter is about caring for them, too.

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    Ryan K. Hertel · heyitskenton

    The problem

    What we're up against.

    • A second job, unpaid.

      63 million Americans gave ongoing care to someone in the past year. Nearly one in four of them gave 40 hours or more a week, and only 11% have had any medical training.

    • Dementia, cared for at home.

      Nearly 13 million Americans care, unpaid, for someone with dementia: more than 19 billion hours in 2025, worth more than $446 billion. 59% say their emotional stress is high or very high.

    • Burning out at work.

      Health workers who felt burned out very often rose from 11.6% in 2018 to 19% in 2022.

    • Nurses leaving.

      More than 138,000 nurses have left the workforce since 2022, and 39.9% of registered nurses say they intend to leave or retire. Of those, 41.5% name stress and burnout as the root cause.

    • The people who care for animals.

      Suicide accounted for 3.5 times the expected share of deaths among women veterinarians, and 2.1 times among men. Veterinary technicians face a higher risk too, on a median pay of $47,380 a year.

    • Afraid to ask for help.

      Nearly 40% of physicians said they'd be reluctant to seek care for a mental health condition, for fear of what it could mean for their medical license.

    What works

    Proven, and ready to grow.

    • Coaching for dementia caregivers.

      In the REACH II trial, 12.6% of caregivers in the program had clinical depression, against 22.7% of those without it. When the VA offered it in its own medical centers, 96% of caregivers wanted the VA to keep offering it.

    • Help that keeps families together longer.

      Counseling and support for spouses caring for someone with Alzheimer's cut the rate of moves to a nursing home by 28.3%.

    • Fix the workplace, not just the worker.

      Across studies of physicians, burnout fell from 54% to 44% with the programs tested, and programs run by the organization worked better than ones aimed at individuals.

    • Protected time.

      In a Mayo Clinic trial, an hour of paid time every other week for small, guided groups of physicians improved how engaged and empowered they felt.

    What a family could fund

    Where the money goes furthest.

    • A proven program for every dementia family.

      The Tailored Activity Program cost about $1,707 a family in its trial, and REACH helps caregivers for less than $5 a day.

    • Real breaks.

      Medicare's GUIDE model pays up to $2,500 a year for respite for people enrolled in it. An initiative could reach the families outside it.

    • Grants for whole workplaces.

      The Dr. Lorna Breen Act authorized $35 million a year for programs that protect health workers' mental health. Private grants could add to that, for clinics, shelters and home care agencies too.

    • Help outside the chain of command.

      Free, confidential lines like the Physician Support Line, staffed by volunteer psychiatrists, for nurses, veterinarians, vet techs and home care workers as well.

    Honest limits

    What money can't promise.

    • Modest effects.

      Programs for physician burnout bring small reductions, and the ones aimed at individuals do least.

    • Apps and classes aren't enough.

      A large survey of workers found no evidence that mindfulness, resilience classes or wellbeing apps help employees on their own.

    • The root causes are time and respect.

      Health workers who had enough time to finish their work were far less likely to burn out. No grant replaces enough staff.

    • The evidence for respite is thin.

      A Cochrane review couldn't show that respite care helps or harms, though that may reflect too little good research.

    • Even the best dementia programs are modest.

      The National Academies found only low-strength evidence of benefit for the best dementia care programs, and the activity program didn't ease agitation.

    Hard questions

    Asked and answered.

    1. You might ask

      Isn't this the employer's job?

      Ryan

      Mostly, and the evidence agrees: programs run by the organization worked better. Private money does the most good where employers can't reach, like confidential help outside the workplace, and the license questions that keep doctors from seeking care.

    2. You might ask

      Do wellness programs actually work?

      Ryan

      The individual ones barely do. Changes to the work itself do better, like protected time and changing work schedules.

    3. You might ask

      Why help professionals who earn good money?

      Ryan

      Many don't. Direct care workers earn a median $17.36 an hour, and 49% rely on public assistance. For doctors, the barrier isn't money but fear for their license.

    4. You might ask

      Why not executives and lawyers too?

      Ryan

      Most can pay for their own care, and lawyers already have confidential assistance programs, like the one Texas runs. This chapter goes where help is scarcest.

    In the slider

    See what your fortune could do here.

    Caring for the caregivers

    The slider prices this cause with these numbers:

    • About $1,707 a family paid for the Tailored Activity Program, home visits from an occupational therapist that improved caregivers' wellbeing in a trial.
    • The whole need is everyone caring, unpaid, for someone with dementia: nearly 13 million Americans.
    • A trial's cost, and a modest benefit: it helped caregivers but didn't ease the agitation that comes with dementia.
    Try it in the sliderTalk to Ryan

    More of the Blueprint

    Keep reading.

    Back to Keep 100

    Sources

    Every number in this chapter, and where it came from.

    1. Source 1: New Report Reveals Crisis Point for America's 63 million Family Caregivers (opens in a new tab)

      AARP, 24 July 2025. Checked 22 October 2026.

    2. Source 2: Vital Signs: Health Worker-Perceived Working Conditions and Symptoms of Poor Mental Health, Quality of Worklife Survey, United States, 2018-2022 (opens in a new tab)

      CDC, Morbidity and Mortality Weekly Report, 3 November 2023. Checked 22 October 2026.

    3. Source 3: Alzheimer's Disease Facts and Figures (opens in a new tab)

      Alzheimer's Association, 2026. Checked 22 October 2026.

    4. Source 4: NCSBN Research Highlights Small Steps Toward Nursing Workforce Recovery; Burnout and Staffing Challenges Persist (opens in a new tab)

      National Council of State Boards of Nursing, 17 April 2025. Checked 22 October 2026.

    5. Source 5: Suicide among veterinarians in the United States from 1979 through 2015 (Tomasi and others) (opens in a new tab)

      Journal of the American Veterinary Medical Association, January 2019. Checked 22 October 2026.

      Written with researchers at the CDC's National Institute for Occupational Safety and Health.

    6. Source 6: Suicides and deaths of undetermined intent among veterinary professionals from 2003 through 2014 (Witte and others) (opens in a new tab)

      Journal of the American Veterinary Medical Association, September 2019. Checked 22 October 2026.

    7. Source 7: Occupational Outlook Handbook: Veterinary Technologists and Technicians (opens in a new tab)

      U.S. Bureau of Labor Statistics, 27 August 2026. Checked 22 October 2026.

    8. Source 8: Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions (Dyrbye and others) (opens in a new tab)

      Mayo Clinic Proceedings, October 2017. Checked 22 October 2026.

    9. Source 9: Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial (Belle and others) (opens in a new tab)

      Annals of Internal Medicine, 21 November 2006. Checked 22 October 2026.

    10. Source 10: Translation of a dementia caregiver support program in a health care system: REACH VA (Nichols and others) (opens in a new tab)

      Archives of Internal Medicine, February 2011. Checked 22 October 2026.

    11. Source 11: Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease (Mittelman and others) (opens in a new tab)

      Neurology, November 2006. Checked 22 October 2026.

    12. Source 12: Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis (West and others) (opens in a new tab)

      The Lancet, 28 September 2016. Checked 22 October 2026.

    13. Source 13: Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis (Panagioti and others) (opens in a new tab)

      JAMA Internal Medicine, February 2017. Checked 22 October 2026.

    14. Source 14: Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial (West and others) (opens in a new tab)

      JAMA Internal Medicine, April 2014. Checked 22 October 2026.

    15. Source 15: Economic Analysis of the Tailored Activity Program: A Nonpharmacological Approach to Improve Quality of Life in People Living With Dementia and their Caregivers (opens in a new tab)

      Journal of Applied Gerontology, 22 February 2023. Checked 22 October 2026.

      The cost in a research trial; delivered in a community it may cost more or less.

    16. Source 16: Impact of the REACH II and REACH VA Dementia Caregiver Interventions on Healthcare Costs (Nichols and others) (opens in a new tab)

      Journal of the American Geriatrics Society, May 2017. Checked 22 October 2026.

    17. Source 17: Guiding an Improved Dementia Experience (GUIDE) Model (opens in a new tab)

      Centers for Medicare & Medicaid Services, 11 August 2026. Checked 22 October 2026.

    18. Source 18: Public Law 117-105: Dr. Lorna Breen Health Care Provider Protection Act (opens in a new tab)

      U.S. Government Publishing Office, 18 March 2022. Checked 22 October 2026.

    19. Source 19: Physician Support Line (opens in a new tab)

      Physician Support Line. Checked 22 October 2026.

    20. Source 20: 'More ambition' needed to improve workplace wellbeing, research suggests (opens in a new tab)

      University of Oxford, Wellbeing Research Centre, 10 January 2024. Checked 22 October 2026.

      A survey of workers in the United Kingdom at one point in time.

    21. Source 21: Respite care for people with dementia and their carers (Maayan and others) (opens in a new tab)

      Cochrane Database of Systematic Reviews, 16 January 2014. Checked 22 October 2026.

      The review says this may reflect too little good research, not a lack of benefit.

    22. Source 22: Meeting the Urgent Needs of People Living with Dementia Requires Addressing Existing Disparities in Care, and Ensuring Future Research Prioritizes Inclusivity and Real-World Studies (opens in a new tab)

      National Academies of Sciences, Engineering, and Medicine, 23 February 2021. Checked 22 October 2026.

    23. Source 23: Effects of the tailored activity program (TAP) on dementia-related symptoms, health events and caregiver wellbeing: a randomized controlled trial (Gitlin and others) (opens in a new tab)

      BMC Geriatrics, 20 October 2021. Checked 22 October 2026.

    24. Source 24: Preventing occupational stress in healthcare workers (Ruotsalainen and others) (opens in a new tab)

      Cochrane Database of Systematic Reviews, 7 April 2015. Checked 22 October 2026.

    25. Source 25: PHI Report Highlights Record Growth in Direct Care Workforce, Warns Federal Policy Changes Threaten Job Quality and Stability (opens in a new tab)

      PHI, 22 September 2025. Checked 22 October 2026.

      A nonprofit that researches and advocates for direct care workers.

    26. Source 26: Texas Lawyers' Assistance Program (opens in a new tab)

      Texas Lawyers' Assistance Program. Checked 22 October 2026.