When I went to visit one morning in May, her day had started at 5 a.m. Hair still wet from her shower, she steered her mother through a morning routine. She told her where to put her hands to wash herself, then placed her mom’s feet through the leg holes of her adult diaper. Without Baden-Mayer’s kind but firm instructions, her mother would start staring into space, seemingly happy but unsure of where to go next. More than once, when her mother was smiling at me, perplexed, Baden-Mayer explained my presence. (“She’s a journalist. She’s working on a story about family caregiving.”) The long dining-room table was a laundry-folding assembly line, piled with six people’s clothes.

Baden-Mayer is one of about 34 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-size 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 people thought would catch them in old age is less like a net and more like a staircase they get pushed down, bumping along until they’ve impoverished themselves enough to hit Medicaid at the bottom.

Private long-term-care insurance exists, but it’s the designer bikini of insurance: too expensive, skimpy coverage. Since people tend to buy it only when they know they’ll soon be making a claim, there are never enough healthy people paying into the plans to keep them affordable. Insurance companies have realized this and jacked up premiums—or stopped selling policies altogether.

Meanwhile, the cost of hiring a home health aide to take care of a frail parent can add up to $50,000 or more a 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? One might expect that a problem that affects so many people so profoundly would become a major political issue. Recent years have seen other issues, including ones that disproportionately affect women in their personal lives, become highly politically salient—from sexual harassment and pay equity to the push for universal pre-K education and improved access to child care. 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. Even a news junkie, following the 2020 race closely, could have heard nothing about it.