West Virginia’s caregiving system is built on women — and it’s breaking

by Ellen Allen. Originally published May 28, 2026 in West Virginia Watch.

 

More than one in four adults in West Virginia — about 375,000 people — are family caregivers, providing care to aging parents, spouses and loved ones, often without pay or formal support. This is not a small contribution. Family caregivers in West Virginia provide more than $3 billion in unpaid care each year — care that allows older adults to remain in their homes and communities instead of entering costly institutional settings.

But who is carrying this system? The answer: overwhelmingly women.

Across the country, women make up the majority of caregivers — about 61% — and that reality holds true in states like West Virginia. These are not women with time to spare. They are working full-time jobs, raising children and then coming home to manage medications, coordinate appointments, prepare meals and provide hands-on care late into the night.

They are living two, and often three full-time lives at once. This is the reality of caregiving in West Virginia: it is unpaid, it is essential and it is being carried largely by women who are already stretched thin. And the cost is real.

In West Virginia, 80% of family caregivers report paying out of pocket for care-related expenses, spending an average of more than $7,000 a year — roughly a quarter of their income. More than half report serious financial setbacks, including taking on debt or draining savings just to get by.

At the same time, many are trying to hold onto jobs. About 57% of caregivers are working while providing care, and nearly one-third are delivering the equivalent of a full-time job — 40 hours a week or more — on top of that employment.

And the strain is only growing.

We are on a demographic collision course in this country. Birth rates are falling, while the so-called “Silver Tsunami” is rising. The United States is aging rapidly, and within the next decade, older adults are projected to outnumber children for the first time in U.S. history — a historic shift with profound consequences for families, the workforce and our healthcare system.

In West Virginia, that future is already here. We are one of the oldest states in the nation, with a shrinking working-age population and growing demand for long-term care. The pressure on families — and on the systems meant to support them — is intensifying.

This is where policy matters.

Medicaid is the largest payer of long-term care in West Virginia. It is the backbone of how older adults and people with disabilities receive care, especially through Home-and Community-Based Services, which make it possible for people to remain in their homes rather than enter nursing facilities. But HCBS in West Virginia is under strain.

Workforce shortages, low reimbursement rates and limited service capacity mean that even when families qualify for help, it isn’t always available. Across the state, caregivers are stepping in to fill those gaps, often with little support, little training and no compensation.

When the system falls short, the burden doesn’t disappear. It shifts. It shifts onto daughters, working mothers, women already balancing careers, children and households.

We cannot build a sustainable care economy on invisible, unpaid labor. If we fail to modernize Medicaid, invest in HCBS and strengthen the direct care workforce, we will continue forcing women to absorb a crisis that belongs to all of us.

At the same time, 75% of older adults say they want to age in place — remaining in their homes, connected to their communities and maintaining their independence. In West Virginia, that’s not just a preference. It’s a way of life. But aging in place requires more than family devotion. It requires infrastructure.

That means fully funding and expanding HCBS, so services are available statewide. It means raising wages and building career pathways for direct care workers so there is a workforce to meet demand. It means supporting family caregivers with respite care, training and financial relief — because without them, the system collapses.

Right now, those supports are not keeping pace with need. If we do nothing, the consequences will not be abstract. They will show up in lost workers, strained families, worsening health outcomes and higher costs as more people are forced into institutional care.

In West Virginia, we pride ourselves on taking care of our own. That value is real — but it cannot be the only thing holding this system together.

If we want a future where people can age with dignity — and where women are not forced to choose between their jobs, their children and their parents — we must invest in the systems that make care possible. Because right now, those systems are underbuilt, underfunded and leaning heavily on women to make up the difference. And they are carrying far more than their share.