Already Toast identifies several types of family caregivers: 

• Crisis caregivers are called into action as a result of a sudden illness or emergency.
• Long-term caregivers must sustain the caregiving over a period of months or years.
• Long-distance caregivers live far away and must manage care at a distance. 
• Sandwiched caregivers are also raising children or managing demanding jobs. 

These caregiving types are not mutually exclusive. For example, a parent who lives at a distance may have a health crisis that requires caregiving from an adult child who has a career and family of their own. 

Whether caregivers are providing eldercare or caring for the sick, there are several categories of caregiving activities: 

• Direct care involves providing physical care for the person’s basic needs, such as dressing, grooming, bathing, feeding, and getting them in and out of bed. Nearly all caregivers provide assistance with these activities of daily living (ADL). 
• Maintaining the immediate physical surroundings involves things like housecleaning, cooking, and doing laundry; this is provided by 72% of caregivers. 
• Sustaining social connections and relationships includes arranging visits, responding to texts, and keeping other family members and friends informed.

Caregivers may provide administrative care, which can involve hours each week spent dealing with medical providers, insurance companies, and billing departments. More than 60% of family caregivers do this work. Family caregivers are sometimes expected to do high-level nursing tasks, often with little or no training. If caregiving ends with a death, there is ongoing work related to all of the business matters related to a death, including logistics such as wills, death certificates, and financial accounts. 

Although caregiving for one person can be overwhelming, family caregiving occurs on a large scale across the United States. Data from AARP in 2020 reported that 53 million people served as unpaid family caregivers. This “invisible labor” is often done with little financial support. 

Washington details the financial inequities both for family caregivers and paid caregivers. Some programs allow family members to be paid to be caregivers for their own family members, but this is not consistent from state to state. Paid home-care workers earn near-poverty wages—with a median hourly wage of less than $10 per hour—and are typically excluded from labor protection and benefits.

In addition to the financial inequity related to caregiving, other inequities are present. Family caregivers and paid caregivers can also experience sexism and racism.

Among paid home-care workers earning the low wages described above, 91% are women, and 21% have the added responsibility of being single parents. Most family caregivers in the United States are women (75%). Among family caregivers, “female caregivers typically spend more time caring for their charges than males do, about 22 hours per week on average versus 17,” Washington says. Since many women are in the workforce, they work a “second shift” of domestic duties and caregiving, in addition to their paid jobs. Some leave the workplace to act as family caregivers, and this can have grave implications for their financial security.

Interestingly, the gender balance of caregivers is reversed in the LGBTQIA2S+ community, which makes up about 9% of caregivers. Since the beginning of the HIV/AIDS epidemic, gay men have stepped up as caregivers to members of their families of choice.

Racial inequities also have a long history in the caregiving space. Most paid caregivers earn very low wages, and 56% of them are BIPOC. A burden has been placed on Black women historically, since slaves in the South were required to be caregivers both to their enslavers and to other enslaved people. 

The book also addresses post-caregiving stress and its effects on the physical and emotional health of the caregiver. Weeks, months, or years of poor sleep, subpar nutrition, or lack of exercise can leave invisible scars. Washington points to major caregiver resource websites, such as AARP, The Caregiver Space, and the Family Caregiver Alliance, all of which address issues that arise after caregiving responsibilities end. There is also a $20, self-led, six-week webinar course called “Beginning Again After Caregiving Ends,” offered at CareGiving.com.

Washington notes, “We are all born needing care, and most of us die needing it, too.” But it is often an invisible issue for policymakers, and “even for people in the medical field, it’s hard to notice the importance of caregivers until you either need one or become one,” she says. The systemic solutions that are needed will require advocacy and changes to public policy, such as expanding leave policies, remedying the “patchwork of state policies,” or following the examples of other countries that offer paid leave for family caregivers, as well as pension and retirement benefits for full-time caregivers.

Already Toast is not a “how-to” book full of advice for caregivers on self-care and avoiding burnout. If you are completely immersed in your role as a caregiver and are experiencing burnout, this book is not what you need right now. Perhaps you can return to it later on. The author does, however, provide some resources for caregivers who need support. She recommends the wide variety of resources on AARP’s caregiving page (all of them are available in both English and Spanish). In addition, Washington provides the phone number for the Caregiver Help Desk (855-227-3640) operated by the Caregiver Action Network. These may be better sources for the support you need now.