Founded by Melinda French Gates, Pivotal Ventures accelerates social progress in the United States by removing barriers that hold people back.

Lorrie Casto, 59, hugs her grandchildren, who just returned from exploring a park in their small coal-mining town.

Photo by Maddie McGarvey

Lorrie Casto took in her four grandchildren, Sonya, Paige, Seth and Noah. Lorrie and her husband are doing their best to raise their grandchildren as their own but have spent their life savings to give their grandchildren a stable and loving home. In this photo Lorrie Casto, 59, hugs her grandchildren, who just returned from exploring a park in their small coal-mining town. Paige, 14, holds a turtle they found in a creek; Seth, 12, wraps his arms around the group; and Noah, 8, stands in front.

Why Must We Pick Between Paychecks and Caring for Loved Ones? We Need Paid Family Leave.

Carli Pierson, USA Today opinion writer
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This article originally appeared on usatoday.com


I knew that having a baby wasn't supposed to be easy, but I never imagined that it would be this hard. After a cesarean section that resulted in medical complications, however, I was in tremendous physical pain.

My partner had just finished his urology residency and often worked 14-hour days, so I was mostly alone and we didn't have any money at that time. I needed help to take care of the baby. I needed help to care for myself. But where was I going to get it? And how was I going to pay for it?

Before I had to take care of my own children, I often thought of caregiving as the formal work industry of assisted living centers for the elderly. But caregiving can also include caring for small children and people with injuries, disabilities or chronic illnesses, and it makes up a massive $648 billion economy.

Photo by Nicky Quamina-Woo

Kathleen Jones is a single mother who works more than 40 hours a week from home in Washington, D.C. Due to pandemic-related day care closures, she is now also the full-time caregiver to her 3-year-old son, Gabriel.

Average caregiver spends 45 hours a week on unpaid care

It is often informal work done in the person's home or in the home of a relative, and it isn't financially compensated. There are approximately 53 million adult caregivers in the United States, and an astonishing 5.4 million children and adolescents provide care for family members.

Morale among caregivers is low for obvious reasons. According to a new survey by Pivotal Ventures, the average American caregiver spends 45 hours a week on unpaid care, often in addition to a fulltime job, and 40% of unpaid caregivers report feeling isolated and unsupported.

When my second daughter, who has asthma, suffered second-degree burns after pulling a cup of hot tea down from the kitchen counter onto her face, I had additional care responsibilities that were difficult to manage as a working mother. And even as a writer working from home, a situation that gave me considerable flexibility, I still struggled to care for her during and after her hospital stay, while I worked to pay the bills.

Like so many women, I handled the majority of the caregiving my daughter required. I put my physical, mental and emotional needs on the back burner while I raised my kids and tried to move forward in my career. And I know my career took a hit with all the days I had to take off, or cut short, to care for my kids. I wasn't able to compete with many of my male counterparts who didn't have to shoulder all the domestic responsibilities their female counterparts (like me) faced, in addition to the professional ones.

My story isn't unique. Caregiving is a burden women often shoulder. According to the AARP, 2 out of 3 American caregivers are women.

During the pandemic, we saw both men and women drop out of the labor force, but a million women haven't returned. A reason could be that they're still providing unpaid care for loved ones.

Photo by Mikaela Martin

Ramona Peña is in her mid-90s and has Alzheimer’s disease. As her condition continues to worsen, she needs more and more assistance. Her daughter Johana stepped up to become her mother’s primary caregiver, after searching in vain for a qualified and affordable live-in professional. In this photo Johana pushes Ramona’s wheelchair during their weekly trip to a local park.

The sandwich generation

According to the Pew Research Center, 29% of U.S. adults have a child younger than 18 at home, and 12% of these parents are also unpaid caregivers for an adult.

My mom is still very independent and will probably be mad at me for saying this, but I began to prepare for how I will care for her after she broke her shoulder and her wrist this past year in two separate falls.

Phot by Ilana Panich-Linsman

Dana Jones, a single mother of two, works around the clock to care for her daughters, both of whom were born with sickle cell disease. In this photograph Dana worries over Kyra, and wonders if she’ll need to take tomorrow off from work to care for her.

I watched her care for my grandmother and me when I was younger and know that it can be tough. Multigenerational caregivers make up the sandwich generation and can spend on average more than 2 1/2 hours a day on unpaid care. Because women spend more time a day on child care on average than men, mothers providing multigenerational care spend 45 more minutes a day providing adult or child care than multigenerational caregiver dads.

Photo by Tailyr Irvine

Patty and Willie Stevens now raise their two great-nephews, a role they never anticipated taking on as they entered their 60s. But when the twins asked to come to live with them, Patty and Willie said yes in an instant and welcomed them with open arms.  In this photo Patty and Thomas leave to pick up Patty’s granddaughter, Erica, 23, from work. Erica also lives with the Stevenses, along with Thomas and Talon.

Caregiving solution in other countries

While other high-income nations devote more resources to a broad range of caregiving activities – from paid maternity leave to family medical leave to care for the elderly and infirm – it probably comes as no surprise that the United States gets low marks for that kind of government spending and support. We continue to be the only industrialized nation with no federally mandated paid leave. And as of 2020, only 20% of private-sector workers have access to paid family leave in the United States.

Despite an aging population, we spend only 0.5% of our gross domestic product on long-term care (Norway spends 3.3% and the Netherlands spends 3.7%).

In contrast, the United States spent about 3.5% of its GDP on defense last year.

Melinda French Gates, via her nonprofit Pivotal Ventures, has spearheaded calls for a generous national paid leave law that would help families access the economic support they need to be able to care for their loved ones from birth to illness and other situations where caregiving is needed.

The proposal has bipartisan support because many Americans, especially women, will need to care for someone they love at some point in their life, and that has nothing to do with which party you vote for.

In the richest country in the world, people shouldn't be forced to choose between caring for loved ones or their paycheck. A comprehensive paid national leave law is long overdue.

Images featured in this article are from Pivotal Ventures photo series “Caring for Each Other: Caregiving in America and the Need for Change"

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