Home care costs $80K a year and NOBODY warned you | Neal K. Shah

Added: 2026-05-28

[00:00:00]He was managing $250 million he became a caregiver and then decided to redirect his life and work to supporting caregivers and he has a wonderful and heart-wrenching and heart-warming story.

[00:00:19]>> While I was accelerating my career and built my fund from nothing to $250 million you know by the time I was 35, I had two major caregiving experiences starting in my early 30s and then in my mid-30s. You know in my early 30s for my grandfather going through dementia, kidney failure, cancer and then end-of-life care where really I was care coordinating within my family uh but my mother ended up leaving her career to be the full-time caregiver because just the quality of the care we received we were not thrilled with and we felt really guilty. So, you know, she was like I'll do it myself. And that opened my eyes for the first time in my life to how difficult this is on you know so many people and all the years of caregiver support groups and just meeting all these other people and seeing them struggling. And then at the peak of my fund career I became a primary caregiver for my wife as she went through a multi-year cancer battle and it was really difficult. Um I ended up taking a lot of sabbaticals from my work to manage her care and ultimately I just tapped out and shut down my fund and you know did it full-time because I thought it'd have a great impact on the outcome.

[00:01:15]At that point I was almost 40 and I was like, "Okay, this is like this is a major problem across the country. You know, so many family caregivers are dealing with the situation." And I was like, "How can I redirect my talents and my energy and the rest of my life and work to improving things for caregivers out there." That was a catalyst for a big shift in my career and my work. Um and you know while I I was good at what I did before I find a lot more meaning and purpose in the work I do now um because it's directly helping many people's lives uh who are in very difficult situations. It's the magnitude is um heartbreaking because many people for for on average for many people caregiving for a family member is equivalent of another half to full-time job on top of whatever job they have to do. Uh I think the reasons that the crisis is getting worse is also the cost of care has become extremely unaffordable in our country. Just the average statistic of the cost of home care help. If you need help for 40 hours a week so you can do your job, it's now upwards of over $80,000 a year. Wow.

[00:02:12]>> And that number was 60,000 only a few years ago and 40,000 a few years prior to that. It is inflating at triple the rate of inflation in our economy.

[00:02:20]So, the cost of care is getting really out of control. And then on top of that, if you think about who the care workforce is, people aren't rushing to do this type of work. First of all, it's a heavily immigrant workforce, like anywhere from a quarter to a third are immigrants. And with recent kind of restrictions on immigration, the workforce is dropping. Then obviously during COVID and all that, you already had a big loss of workforce. So, you're heading into a situation where the workforce is going down, cost of care is skyrocketing, and we're just societally hitting the point where the oldest of the baby boomers are turning 80. This year in 2026 is 80 years after 1946 post-World War baby boom. Right. So, we're just starting the wave of people hitting 80 in the biggest population cohort in our society. And 80 is typically when your care needs jump, you know, from a long-term care perspective. The rates of dementia, you know, about about if you're lucky to live long enough, you have one in three chance of getting dementia at 80 or beyond, um physical frailty, et cetera. So, we have like the perfect storm here where we're going to have a skyrocketing need of care in our country, a rapidly dropping workforce to provide the care, and a care economy and a care industry that has completely antiquated and broken business models that is um having an affordability issue. So, I think a lot of people are going to be like, how can you pay $80,000 a year for care? You know, if you have to calculate that I must make 120 plus pre-tax in order to pay that. So, a lot of people will just drop out of the workforce and do it themselves. And and I think that's something we need to get ahead of as a society. Yeah. So, I think a lot of families are like dealing with this kind of like compounding series of issues that in my opinion is a completely fault of like the care industry and lack of innovation. and you have like a daughter in her late 40s caring for a mother with Alzheimer's and going out and looking for help. The average rate in that metro area is $42 an hour to get care. So, if you're just thinking, "Hey, 40 hours a week while I'm at my job, I need help." You're looking at north of $1,600 a week, you know, so over the course of, you know, the year you can just do the math, but it's going to easily get to over $80,000 a year. So, cost is like a major issue and affordability. But, more importantly, most of that money is not going to the care worker. While the average cost of care in America is 80-something thousand dollars, the average worker pay in America is $33,000.

[00:04:33]And that's average, right? You know, that the money you're paying to the care company, more than half is going to the company and other marketing and franchise fees and all that stuff, not going to the care worker. So, the care worker is barely making a, you know, living wage, so to speak.

[00:04:48]>> yeah. And as a result, that feeds back into the quality. That that person is going to be super stressed out, that person is going to be looking for any other job at any other opportunity. You know, why wouldn't they work at Walmart?

[00:04:58]Why wouldn't they work at McDonald's?

[00:04:58]Why would they do this? And caregiving is very difficult work, by the way. So, God bless that there are workers doing this type of work, but they're often burned out, you know, they're exhausted, they're not getting paid that much, they have their own stress, they have their own bills to pay. And then that feeds back into reliability. That many times I found on average in researching the care economy, over 15% of shifts in a given week were full-out no-shows or multiple hours late to the point where the family member can't even reliably count on it.

[00:05:23]So, all that results in a lot of guilt that oh, I'm leaving my mom and dad with this person who doesn't even want to be there or is so stressed out just doing the task, but oftentimes goofing off on their phone.

[00:05:36]Oftentimes the person doesn't show up on time and then I have to call in sick for my own job. So, I think a lot of families are like dealing with this kind of like compounding series of issues that in my opinion is a completely fault of like the care industry and lack of innovation. So, that's really where I saw like a major opportunity of like how can we put on our thinking caps and like do something to help people in a good way and in a good sustainable reliable way. But, that's really where I saw like a major opportunity of like how can we put on our thinking caps and like do something to help people in a good way and in a good sustainable reliable way. So, that was kind of like what inspired our innovation and and and to your second question of what Carii does is let's take that same exact example in New York. So, Carii runs a tech platform that connects families across America with over 50,000 healthcare students at some of the top universities in the country to do the care at highly affordable rates. We charge no fees or markups. It's fully social impact funded. So, that exact example in New York City, instead of going to a local care agency and paying 42 bucks an hour, a family can come to Carii's site or app and you know, just go to carii.org and very quickly, conveniently in less than 2 minutes, book, schedule, and find NYU pre-medical students, Columbia University nursing students, or you know, pre-physician assistant students, Hunter College, Fordham, you know, there's like we have thousands of wonderful students in the metro area and we're expanding all over the country. And these students are people who want to go into future clinical careers. I think many families we help find themselves where they're trying to convince the older person, "Hey, you need help." But, then that person's like, "Well, I don't want babysitting, you know." Yes.

[00:07:13]>> can you imagine? I I see this sons and daughters Yes. are you with their parents all the time on that. And and and reframing it as you're mentoring this 20-year-old pre-medical student is like a big reframe, you know, that I think the older adult feels like I'm also Yes, I'm getting help, but I'm also helping mentor them and they're going to go to a future clinical career. And the young people love, you know, kind of meeting older people in their community and I think that's kind of like the coolest part of the program. So, yeah, that's kind of like the high level on what we're doing.

[00:07:39]>> that. Absolutely. Cuz there's a lot of wisdom Yeah.

[00:07:43]>> older people Yeah. want to give and share and younger people can learn from.

[00:07:48]Agreed.

[00:07:49]>> said So you said you're in the metro area of New York's and then I heard you say we're expanding.

[00:07:56]Are you able to talk a little bit about that? Yeah, yeah. We actually So we started um initially and our home market was Raleigh-Durham, North Carolina. So like Duke University, UNC Chapel Hill.

[00:08:05]We expanded to New York City metro.

[00:08:07]We're also all over Boston. We're in parts of Connecticut, Rhode Island. Um we're all over Washington D.C., Wow.

[00:08:14]Atlanta, um parts of Texas, Florida, Los Angeles, San Francisco, Chicago. So we're kind of like Wow.

[00:08:21]>> quickly going nationwide. We have over 50,000 students on the platform and we're active at over 35 different universities. If you think there's an opportunity for us to come to your area, definitely reach out to me. I'm happy to expand anywhere. We kind of grow grassroots, you know, in terms of wherever professors and pre-health career advisors reach out to us, we operationalize the program at their university. Um and then wherever there's a need in the community, you know, we typically partner with uh caregiver support groups, faith-based organizations, local hospitals, things like that. But we do zero advertising, zero kind of paid marketing. It's all grassroots built. Uh and I think as a result of that, the cost savings can be passed on to the family. If someone's a caregiver for an aging parent or a spouse or their spouse is is not has poor health, Yeah.

[00:09:06]>> what are some immediate steps that they can take?

[00:09:10]I think first of all, number one step, get yourself enrolled in a caregiver support group.

[00:09:16]Whatever it is, typically your hospital, your, you know, faith-based organization, anything Multiple places are running support groups in every community. But if it's often times geared towards dementia and Alzheimer's, there's tons of support groups. You can find them at Alzheimer's Association, etc. Cancer, been a lot of support groups. But first I'd say plug into the support groups because you need to quickly Yeah. share the journey with other people that are maybe a little bit ahead of you that have gone through it and can give you advice because there's going to be a lot of things that come up that you need help with. And frankly, sometimes you just want somebody to talk to, you know, and I think that I found it I I found caregiving, you know, not to be dark, but it's very lonely and isolating, you know, um that when you're going through it, if your friends aren't it's kind of like you don't want to talk about it because you're going to bring down the party and they don't want to hear about all the time because they want to talk about positive things. So, I think that finding a like-minded group of people who are also going through it or have gone through it is absolutely critical. That's number one step you can take. I think number two is like figure out very rapidly within your community and where you're at and based on what resources you have available, what types of help options are available. Whether it's respite, you know, whether it's day programs, you know, a lot of churches run dementia daycare programs where you can drop off someone for a few hours a day. There's also other kind of like private organizations that run those, you know, whether it's some sort of other assistive support. You kind of need to start planning how you're going to manage a journey and figure out educational resources, you know, that you can kind of like gradually upskill yourself on because often times it's a multi-year journey ahead. And then I'd say financial planning is an absolutely key component. I hate to say it, like it's so under appreciated. I mean, all the families that we help like, man, I'm just like I wish they would have planned for this 10 years ago or 5 years ago even and I think it's like a big opportunity for a public service announcements across the country. Like planning that you are going to one day get older and need long-term care and or your mom or dad are going to need it or your kids are going to have to manage it for you. Like I think it's a critical and essential element of financial planning that sadly most people aren't doing and can't blame them, you know, I think most people are not aware until this happens to them. And you know, I think most people don't want to think about it because it's like sometimes unpleasant to think about. But if you just [snorts] look at the probabilities and the statistics like it's might happen to you and do you want to leave your spouse or your kids in that jam or you know, do you want to be a little bit proactive about it?

[00:11:33]But yeah, so I think that's that's absolutely essential and the and the ones who plan they have way more stress when it happens to them. I'll I'll you know, guarantee that. Yeah. Yeah. No, that's interesting and we do talk a fair amount in Prime Life podcast about financial impacts again longevity. Yeah. You don't really know how long you're going to live for. What And and what you said was interesting and so poignant. really do not like that so much capital allocation in this country by very large investment firms is going into in my opinion not only foolish but potentially unethical chase of immortality when there are people who need help now in practical things like good way and a graceful way to spend their final years. But if you look at the allocation of investment capital in this country, like the VCs are pouring tens and hundreds of billions into this like longevity and mortality and why are no one focusing on caregiving? You know, so I actually have I've often thought about that that back in the day 50 years ago, 75 years ago a lot of great care was being provided by community and faith-based organizations and then like look what happened with the assisted living and the nursing home industry. It got taken over by conglomerates, corporate chains, private equity. It's like margins over mission, you know, and I think that in this in this work I think it has to be mission over margin but you know, I think that kind of goes full circle with like people's like beliefs and how they think about the world. It's in kind of my my number one thing is if you find yourself in a caregiving take immediate steps to get as much resources and information as possible.

[00:13:05]Don't delay because a preponderance of studies and evidence has come out in recent years that within one year of somebody becoming a caregiver up to a third of people report significant mental health challenges including depression and and severe anxiety that lasts for a long time even after the caregiving is over.

[00:13:25]Take steps quickly. Moreover, one in four people report within less than 1 year of becoming a caregiver major physical health issues. We are helping thousands of family caregivers throughout across the country and you have no idea how many times we see people that caregiver end up in ER with heart issues. I mean it is absolutely heartbreaking and when they're in the ER with heart issues, they're checking in on their wife or their mom or dad and seeing how it's going. So I think that that that this the amount of stress that people are under, I mean it's like crazy because they realize suddenly they're going to be the main provider and they're going to have to do this on the side. How are they going to manage?

[00:13:58]They're going without sleep. Their constantly adrenaline is up. So I'd say number one thing is just like you're in for like going into a battle or a war even. So you want to take proactive steps to get as many resources as you can.

[00:14:11]And then probably I think yeah, the second thing is just like finding ways to get support so that you don't end up doing it yourself. I think whether it's like respite care if you can afford it or whether it's like sharing the burden with members of your family or it's finding day programs or something, but I think that if people don't very quickly find and plan for that, I think it often becomes very unmanageable and then has a second and third order impact on their ability to do their job. You know, often times the the sandwich generation I find is probably the most stressed where you're taking care of your kids and you're doing that for your mom or dad. Like can you imagine like the time for yourself goes to zero basically or negative. You know, you don't even have time to sleep.

[00:14:48]So yeah, I think those things are like very actionable practical things that people can and should do. Agree with you 100%.

[00:14:54]So our final question for you is you shared your background. You can really do anything at all that you want.

[00:15:01]You're you're intelligent. You have good credentials educationally. Why do you wake up every day and do what you do, Neil?

[00:15:09]Yeah, great question. I think because I can see the impact on individual people.

[00:15:16]I really I you know, I find the most satisfaction is hearing about the families that we helped, especially if they were struggling to find other care options or having an affordability issue or rationing the hours. I think that just like the human impact, I think it's really cool to see.

[00:15:35]Similarly, the impact on the students, many of them going out in their community and helping people. I think it reframes the way they think about what their purpose in life is. And I think that I mean, to kind of go full circle back to the point, I think we as a society have sometimes become disconnected and lost a lot of purpose and meaning of like, why are we here?

[00:15:52]What are we supposed to do? And I think that goes kind of across the younger population, the older population.

[00:15:57]And I think while technology is a good thing, I think sometimes technology has isolated us to some degree. So, yeah, I find a lot of purpose and meaning in bringing people together, often times helping each other at very difficult times in their life journey.

[00:16:12]And I think that's like that's very motivating.