Georgia can no longer ignore its caregiver collapse
She sat in my exam room in Gainesville with a thick binder resting on her lap — the kind you build only when love becomes a second full-time job.
Inside were years of careful organization: business cards from specialists, medication lists, color-coded tabs and pages of neatly written notes that once gave her a sense of control over something uncontrollable.
But that morning, the binder told a different story.
A few cards were out of place. Tabs were bent. New lab results were missing entirely. She rested her hand on the cover as if steadying not just the binder, but herself.
“I used to keep this perfectly organized,” she whispered.
There was no shame in her voice. Only the quiet realization that she had reached the edge of what one person can carry.
That moment captures a crisis unfolding quietly across Georgia.
Caregivers — the spouses, adult children, neighbors, and friends who keep patients safe — are approaching a breaking point. We talk often about physician shortages or hospital closures, but we rarely acknowledge the most fragile part of our system: the unpaid caregiver now responsible for tasks that grow more complex every year.
Patients decline when caregivers reach their limits
In my practice, I see the consequences daily. Georgia has one of the fastest-growing older adult populations in the country, and Hall County’s 65-plus population continues to surge.
Families are managing medications, coordinating transportation, navigating insurance hurdles and juggling multiple chronic conditions — often while working full time and raising children of their own.
And when caregivers exceed their limits, patients decline.
Appointments are missed because no one can leave work. Medication lists become outdated as overwhelmed caregivers fall behind.
Treatments are deferred not out of doubt, but because the person organizing pillboxes and reminders simply cannot absorb one more task.
The unraveling begins quietly — until the moment it doesn’t.
We see preventable hospitalizations rise. We see chronic illnesses worsen because treatment plans were unsustainable. We see caregivers develop high blood pressure, insomnia, anxiety and burnout — a second wave of illness created by the first.
Some of my patients drive more than 40 miles across county lines because there is no home-health support near their rural communities.
And in many parts of northeast Georgia, families face monthslong waits for the state’s Home and Community-Based Services program. When the only caregiver becomes exhausted, there is often no one else waiting in the wings.
Four fixes to help alleviate the crisis
Here is the truth we rarely confront: Georgia’s health care system is being propped up by an invisible workforce we do not measure, support or even consistently acknowledge.
Physicians feel the limits, too.
There are days when I see the caregiver fading before the patient does — and I sympathize deeply with the struggle. I offer support where I can. I try to hold space for their exhaustion. But the reality is stark: I can diagnose caregiver fatigue, but I cannot test for it. I cannot bill for it. I cannot fix the structural forces bearing down on them. Their collapse is happening in a space beyond what I can control.
Because we don’t measure caregiver strain, we underestimate it. Because we underestimate it, we fail to support it. And because we fail to support it, caregivers are collapsing under responsibilities they were never meant to carry alone.
But this crisis is solvable.
- Georgia can expand respite care and streamline access to aging-services programs so families aren’t left deteriorating while they wait.
- Insurers can reimburse clinicians for caregiver assessments.
- Clinics can adopt caregiver-strain screenings as a standard part of care.
- Employers can create flexible leave options for workers caring for aging parents or spouses — not as a perk, but as necessary infrastructure for an aging state.
The woman with the binder sat for a long moment before finally allowing herself to speak the truth she had been carrying alone.
“I don’t know if I can keep doing this.”
It wasn’t a failure of love. It wasn’t a failure of effort. It was a failure of structure — a system built on the assumption the caregiver will always endure, no matter how heavy the load becomes.
If Georgia wants to prevent the next wave of health care breakdowns, this is where we must begin.
Because when a caregiver breaks, the entire system breaks with them.
Ryan Nadelson, M.D., is an internal medicine physician and chair of the Department of Internal Medicine at Northside Hospital Diagnostic Clinic in Gainesville.
