Caregiving Runs on a Longer Clock Than Most Benefits

A contract written around a six week episode will keep missing a role that lasts three years.

In July 2025, AARP and the National Alliance for Caregiving reported 63 million Americans providing ongoing unpaid care to an older adult, a person with a serious illness, or someone with a disability. That is about one in four adults, and roughly 20 million more than the same study counted a decade earlier. A quarter of the adult population is a benefits population, and most behavioral health contracts were not written with it in mind.

What the role does to a schedule

Caregiving is not organized into episodes. It runs for months or years, with acute spikes along the way: a hospitalization, a decision about a facility, a change in the care recipient's condition, a death. Between the spikes it is a steady load of logistics, worry, and family negotiation that does not resolve.

Benefits are organized into episodes. An EAP authorizes a small number of sessions. A therapy authorization covers a course of care. FMLA covers a defined leave with a start and an end date. Each of those works for a discrete problem. A caregiver who spends six EAP sessions in March has nothing left when the placement decision arrives in November.

Why caregivers are hard to reach

Two things keep caregivers out of behavioral health programs.

They do not identify as the person with the need. The care recipient is the patient. The caregiver's own state gets described as being busy, or tired, or fine. Asking a benefit for help requires first deciding you are someone with a problem, and caregivers are usually the last person in the family to make that call about themselves.

They also have less available time than almost anyone else in the population, which makes a weekly appointment at a fixed hour hard to hold. That is the format most therapy requires.

Neither of those shows up in a utilization report. A caregiver who never enrolls is not in the denominator.

What coaching works on here

Caregiver distress tends to run on identity change, guilt about resentment, and grief that starts well before the death. Setting limits with family members is usually part of it, and so is decision fatigue from a long run of choices that have no good option. These are patterns rather than a diagnosis, which is the material a coach is trained to work with.

Wave's Caregiving pathway covers caregiver burnout, identity shifts, the difficult decisions, grief, and finding support when you are the one everyone else leans on. Coaches are National Board Certified and work under ongoing supervision. They do not diagnose, they do not treat a medical condition, and they do not manage a care plan for the person being cared for. When a caregiver presents with something that calls for licensed care, the coach routes them to it.

Measuring across a long timeline

Wave runs the DASS-21 every 30 days for members who stay active, which produces a series of scores rather than one reading at onboarding and another at the end. For a caregiver, that series shows the spike around a hospitalization and whether the member came back down afterward. The WAI-SR runs monthly after the first month.

In peer-reviewed research published in JMIR Formative Research (Pickover and Adler, 2025, N=64), coaching users showed statistically significant greater symptom reduction than app-only controls across depression, anxiety, and stress, and the results held in sensitivity analyses limited to participants with elevated symptoms at baseline. More than half of that cohort presented with severe or extremely severe symptoms, which is relevant to a population that tends to arrive late and loaded.

What happens on the second episode

A caregiving situation in month 30 has little in common with the same situation in month 3. Wave members keep access after an episode ends and can resume with the same coach, who already has the history. A caregiver coming back after a hospitalization does not have to re-explain the diagnosis, the family, or the sibling who will not help.

Most members do not stay enrolled continuously across years, so the design point is the return rather than the length of a single enrollment. A benefit that treats the second episode as a new intake with a new person is asking a caregiver to spend their scarcest resource on repeating themselves.

Where this stops

Coaching does not provide respite care, case management for the care recipient, or clinical treatment for a caregiver's own diagnosis. A caregiving strategy needs those from somewhere else. What coaching covers is the caregiver's own experience of the role, across the length of time the role actually lasts.

For the fall cycle, the test of a behavioral health contract is whether it can serve a member whose need recurs across three years rather than resolving in six weeks, and whether the second episode starts with someone who already knows the situation.

Wave is a US mental health coaching platform built on National Board Certified coaches, measurement-based care, and continuity that lets a member return to the coach who already knows their history.

Want to learn more? Reach out to us at partners@wavelife.io.