Op-Ed: Rethinking Survival in Long-Term Caregiving

Welcome to the reality of long-term caregiving.

In America today, more than 53 million people serve as unpaid caregivers for a loved one (AARP/NAC, Caregiving in the U.S., 2020). But behind every statistic lies a more invisible cost—the slow erasure of the caregiver’s self. What begins as an act of love often morphs into a full-time surrender of autonomy, health, and identity. Society praises caregivers for their sacrifice, yet offers little more than lip service in return.

The problem isn’t just burnout. It’s biology.

Caregiving—especially for those navigating conditions like dementia, Parkinson’s, or multiple sclerosis—isn’t a temporary detour. It’s a long, nonlinear collapse of structure and self. Sleep disappears. Friendships wither—not because people don’t care, but because invitations stop coming and phone calls go unanswered. Even your name, your former life, begins to dissolve under the weight of another person’s decline.

And yet, caregivers are expected to bear this burden with stoicism. The cultural script is clear: exhaustion equals love. Breakdown equals loyalty. To need anything for yourself is to risk being labeled selfish.

This mindset isn’t just outdated. It’s dangerous.

Chronic caregiving stress rewires the nervous system. It lowers heart rate variability (HRV)—a key indicator of stress resilience—and floods the body with cortisol. Over time, this leads to anxiety, immune dysfunction, depression, and emotional numbing. It’s not a character flaw. It’s chemistry (McCraty & Shaffer, Frontiers in Public Health, 2015).

But here’s what most people don’t know: that same biology holds the key to recovery.

While we wait for systemic change that may never come, caregivers don’t have the luxury of waiting. Survival can’t be deferred. That’s why we also need immediate, body-based tools to manage stress in the moment.

Emerging research shows that training the stress response through practices like controlled breathing, HRV biofeedback, and mindfulness-based interventions can stabilize the nervous system. Institutions such as the HeartMath Institute have led much of this work, but they’re not alone. Studies on HRV training, trauma-informed therapy, and even simple rhythmic breathing exercises all point to the same possibility: coherence. A state where heart rhythms, breath, and mind align, allowing you to respond with presence instead of panic.

This isn’t wellness fluff. It’s survival science for people making life-or-death decisions before breakfast: Do I call 911 for a choking episode? Do I adjust the medication now or wait until the nurse arrives?

Coherence practices are practical. At 3 a.m., after my own wife’s panic (night terrors) finally subsided, I would sometimes sit in the kitchen counting breaths—five in, five out—until my hands stopped shaking. That minute of rhythm didn’t erase the crisis, but it steadied me enough to face the next one.

Over 400 studies on HRV training—including many involving HeartMath methods—show measurable benefits: improved sleep, lower anxiety, reduced cortisol, sharper cognition. But even more important than the data is the deeper message: you don’t have to vanish in order to care.

What if we stopped calling caregiver collapse inevitable? Let’s not resign to their demise as collateral damage; let’s resolve to make things better.

What if, instead of applauding quiet suffering, we built infrastructures of real support—respite care, trauma-informed therapy, financial resources, and evidence-based training in stress resilience?

Emotional resilience isn’t a luxury. It should be the minimum standard for survival in caregiving.

No amount of positive thinking can offset the brutality of watching someone you love deteriorate. But it is possible to remain intact inside the storm.

Coherence isn’t serenity. It’s the ability to feel devastated and stay present. To grieve without unraveling. To show up without disappearing.

If we truly value caregivers, we must stop expecting them to be martyrs.

We must give them tools, time, and permission to return to themselves.

Because caregiving should be an act of love—not one that also results in self-erasure.

At 3:04 a.m., your husband was still convinced he was late for a flight. But that night, after guiding him back to bed, you sat with your own breath until your body steadied. The crisis didn’t disappear. But you didn’t disappear either. And that difference—moment by moment—is how caregivers endure.