Caring for the woman who is holding the fort

By Chanua Johnson

It usually does not happen the way you would think. It is not a breakdown in the hospital corridor. It is a Tuesday night, eleven o’clock, you are standing at the sink with a sponge in your hand and you cannot remember if you took your blood pressure tablet this morning, and you start crying because your mother is calling from the room again and you have not sat down since six.

That is the moment. The one most care professionals never tell anyone about. If that is you, or someone you love, this is for you.

You are not imagining it, and you are not weak. In the United States, 63 million adults, nearly one in four, were caring for someone with a complex condition in 2025. That means nearly a quarter of them put in 40 or more hours a week of unpaid care, which is a second full-time job stacked on top of whatever else their life already contains.

In Trinidad and Tobago, the Dementia Awareness Research Group of Trinidad and Tobago (DARTT) study, using the Zarit care professional Burden Scale found that 55 per cent of care professionals carried a measurable burden. Most of them were middle-aged women caring for first-degree relatives. The pattern is the same across the region, and PAHO has flagged the long-term care gap across Latin America and the Caribbean as a regional concern, with millions of older adults relying almost entirely on unpaid family.

So, when you feel like you are doing this alone, the data agrees with you. You are not alone in feeling alone, which is a strange comfort but a real one. This is the part most caretakers do not get told. Caregiving stress is not just an emotional thing. It is a physiological state with measurable consequences.

The CDC’s MMWR analysis of 2021 and 2022 data found that care professionals had worse age-adjusted outcomes on 13 of 19 health indicators compared with non-care professionals. Depression prevalence was 25.6 per cent in care professionals, against 18.6 per cent in the rest of the population. Higher rates of obesity, asthma, arthritis, and cardiovascular disease followed.

Older research from Kiecolt-Glaser found care professionals carrying 23 per cent higher stress hormone levels and 15 per cent lower antibody response. Wounds heal slower. Colds last longer. The body is running a fever it never gets to break.

And a 1999 study by Schulz and Beach, still cited internationally, found that elderly spousal caregivers under strain had a 63 per cent higher mortality rate than peers who were not caregiving.

The short version: the body is keeping score. The sore back, the headaches you stopped noticing, the sleep that is never quite deep enough, the period that has gone strange, the test result that came back funny. These are not separate problems. They are one problem with many symptoms.

Here is another one that nobody talks about. You spend all day touching another person’s body. Bathing, dressing, lifting, turning, wiping. Your hands are on someone constantly.

And no one is touching you.

There is a term for this in the research literature: social touch deprivation, sometimes called skin hunger. A 2022 narrative review in Behaviour Change documented a meaningful link between reduced social touch and heightened loneliness in healthy adults. A 2025 randomised controlled trial found that even brief self-soothing touch (a hand placed firmly on your own chest, for example) reduced momentary stress and loneliness as effectively as a short meditation.

The caretakers’ paradox is that you give touch constantly and receive almost none. A hug from your own child does not always reach it because the child is asking, not giving. A hand on your shoulder from a friend at church can land harder than you expect, and you may find yourself unable to explain why.

If you are reading this and recognising yourself, the answer is not complicated. Get touched on purpose. A monthly massage. A standing hairdresser appointment where someone washes your scalp slowly. Holding hands with your partner watching a movie. Sitting next to a friend instead of across from her. Your body has been asking and you have been ignoring it. This part is practical. You do not have time for proper medical care for yourself. So, the routines you do keep need to do double duty.

The hairdresser. She has her hands on your scalp every six weeks. She notices the bald patch that started before you noticed. She notices the dry, flaky area at the back of your neck. She notices the texture change. Stress, thyroid, anaemia, vitamin deficiency, and scalp skin cancer all show up there first. A formal programme documented in JAMA Dermatology (2018) and PMC’s ‘Stylists saving lives’ study has trained hairstylists to flag suspicious scalp and neck lesions, because patients almost never check that area themselves and scalp melanomas are among the most lethal precisely because they are caught late. Your hairdresser is your second pair of eyes on the part of your body you cannot see.

The masseuse. Same logic, different surface. The American Massage Therapy Association notes that massage therapists see and palpate the back, which 37 per cent of people never check for skin changes. The 2014 Journal of Cancer Education study by Dyer et al argued that massage therapists are uniquely positioned to spot early-stage skin cancer because they cover the whole body methodically. She also feels lumps, swelling, muscle guarding, asymmetry. She is not your doctor. She is your alarm.

The walking buddy. A 2025 meta-analysis in PubMed (ID 40439199) on physical activity interventions for informal caregivers of people with cognitive decline found significant improvements in mental health, quality of life, and care professional burden. Beyond that, a regular walking partner notices when your breath is shorter than last month, when you are favouring a knee, when your mood has shifted. She is your weekly check.

These are not luxuries. The hairdresser, the masseuse, the walk are the practical infrastructure that keeps the person holding the fort alive long enough to keep holding it.

This is where it gets specific. The data and the experience say the load lands differently depending on where you are standing in the family.

Adult daughters provide an average of 12.3 hours of elderly parent care a month, against 5.6 hours for sons (Princeton sociologist Angelina Grigoryeva’s analysis of the University of Michigan Health and Retirement Study). A 2025 modelling study by Timothy Hunt confirmed it: sons reduce their caregiving when they have a sister, daughters increase theirs when they have a brother. Gender is the single largest predictor of who carries the load.

She is the default driver. Default cook. Default nurse. Default ear. Default everything. She works during the day or has had to step back from work. Her social life narrowed two years ago. She has not been on a date that mattered in longer than she can remember. Her brothers, who live in Toronto and Florida, call every fortnight to check in and tell her she is doing a great job.

What protects her. A written rotation, even when one sibling is officially ‘in charge’, so she has named days that are hers. Money flow that recognises her labour as labour, not just a duty of being the one who is there. Peer support from other women in the same shape, which the literature consistently shows women benefit from more than men. A coordinator who can say no on her behalf when the brothers in the diaspora want to add one more thing to her plate.

If you have read this far and recognised yourself in any of it, you have already done the hardest part, which is admitting the shape of the load.

It is a conversation with a coordinator. Twenty or thirty minutes on the phone, or in person if you prefer. We listen to what is happening in your house. We help you name what is yours, what is your sibling’s, what could move to a nurse, what is not actually anyone’s job and can be set down.

If a nurse is the right next step, we walk you through the arrangement, the rate, the rhythm, what is included, what is not. If a nurse is not the right next step, we tell you that too and help you think about what is.

You do not need to be at the wall to make that call. The whole point is to make it before you are. If you are reading this for someone else, the person holding the fort in your family, send this article to them. Then call them on Sunday and ask if you can come sit with their loved one for two hours so they can get their hair cut.

That is the help that matters.