Infrastructure, Investment, and the Invisible Labor of Care

If caregiving is the connective tissue of our social systems, then today's infrastructure is fraying. Despite mounting evidence of the demographic and economic urgency of care, the tools and systems we rely on remain fragmented, reactive, and largely inattentive to the realities of those doing the caregiving. Two recent reports—Milken Institute’s "The Future of Connected Care" and Women of the World Endowment & Tesser Capital’s "Caring for Tomorrow"—offer bold visions for the future of care from their respective vantage points. Each makes critical contributions, and together they provide a frame through which we can assess both the progress and the persistent gaps in how care is being understood, funded, and designed.

What if one of the most important opportunities today is right in front of us—in the care economy? According to the Women of the World Endowment, Americans spend $648 billion annually on care-related services—a massive but underrecognized system propping up households, employers, and aging infrastructure. Recent research, such as the report Caring for Tomorrow: A Guide to Investing in the Care Economy by Pooja Eppanapally (Women of the World Endowment), Safo Ngunga (Women of the World Endowment), and Jenna Bussman-Wise (Tesser Capital Management), highlights the urgent need for investment and innovation in this sector. As more people need help with childcare, elder care, and more, the demand for caregiving is growing quickly. By using smart AI tools to support human caregivers, we can make a real difference in people’s lives and help meet this growing need.

Changes in Our Population Are Increasing the Need for Care

In the United States, over 73 million people are expected to be 65 or older by 2030. This means many more families will need help with care—from looking after young children to supporting older adults. The care economy is huge, but it has many challenges. Caregiving jobs are often undervalued and underpaid, and there aren’t enough workers to meet the demand. Services can be scattered and hard to access, making it tough for families and caregivers alike.

Caregiving doesn’t just affect one generation—it brings together people of all ages, strengthening bonds between grandparents, parents, and children. When families support one another across generations, everyone benefits, from the youngest to the oldest. These intergenerational connections build resilience in both families and communities.

Why Care Matters to Everyone

Caregiving isn’t just about money—it’s about people’s lives and well-being. There are about 130 million caregivers in the U.S., and their work supports families and communities in countless ways. Caregiving also plays a big role in promoting fairness, especially since women often take on more care responsibilities. Supporting caregivers helps everyone be healthier and more productive.

Many caregivers face stress and burnout. That’s why new ways of supporting them are so important. Using a mix of funding sources and working together can help build better care systems that reach more people. Right now, many care providers work independently, which can make it harder to improve services and share helpful ideas.

Technology like AI and digital health tools can help ease some of these problems. They can reduce paperwork, help coordinate care better, and improve the quality of care people receive at home. A recent Milken Institute Future of Aging report, "The Future of Connected Care: Enabling Healthy Longevity and Aging at Home", authored by Lauren Dunning and Jennifer Rossano (Milken Institute of Health), explores how connected care technologies can address these challenges and enable healthy aging at home. But there are still challenges, like confusing rules and payment systems, that slow down progress.

Two Visions: Infrastructure and Investment

The Milken Institute's "The Future of Connected Care" outlines a roadmap for aging at home through connected technologies, with a focus on integrating health systems, building sustainable payment models, and fostering data interoperability. It is a systems-level blueprint aimed at policymakers, technologists, and health leaders.

In contrast, "Caring for Tomorrow" by Women of the World Endowment and Tesser Capital frames the Care Economy as a multi-asset class investment opportunity. It centers gender equity, workforce participation, and social returns, guiding institutional investors on how to deploy capital across child care, elder care, and beyond.

Both reports are essential. And both reflect the incentives of their intended audiences—one aligning with systems design and health policy, the other with financial strategy and gender-lens investing. Yet for all their vision, each leaves important dimensions underexplored. "The Future of Connected Care" is narrowly focused on older adult care and healthcare systems, while "Caring for Tomorrow" covers both child and elder care, emphasizing gender equity and financial pathways. The absence of childcare from Milken’s roadmap is a notable gap, given its centrality to most real-life caregiving.

New Ideas and Challenges in Connected Care

There are exciting new tools being developed to help caregivers and people receiving care. These include apps that help manage time off work or link student loan payments to healthcare jobs, making it easier to keep workers in the field. Reports like "Caring for Tomorrow" and "The Future of Connected Care" both note the need for scalable, accessible solutions and greater collaboration across the care sector. But the care world is still very spread out, and many small providers don’t have the resources to grow or share technology easily.

Protecting privacy and making sure different systems can work together are other important hurdles. Some organizations are working to build more childcare centers and senior housing to meet growing needs, but it takes cooperation from many groups to make these improvements happen.

Understanding the Real Needs of Caregivers and Families

Caregiving is deeply personal and varies widely from family to family, yet most solutions fail to address the complex, everyday realities that caregivers navigate. The gap between policy frameworks and lived experience remains vast, leaving many caregivers without the support they need. This disconnect highlights why we must listen more closely to caregivers themselves—not just as recipients of services, but as experts in their own right.

What’s Missing: Lived Experience and Micro-Realities

While Milken and WoWE offer clear macro-level strategies, neither fully engages with the day-to-day friction of caregiving—the emotional labor, identity strain, and improvisational knowledge that make caregiving deeply human and deeply difficult. They nod to caregivers, but often as endpoints or implementation audiences, rather than co-designers or protagonists.

Key omissions include:

• The absence of nuanced, cultural, and socio-economic perspectives on caregiving experience.
• A lack of detailed strategies to revalue care work beyond economic productivity frames.
• Minimal consideration of trust, continuity, and emotional affirmation as core system features.
• The invisibility of the “missing middle”—caregivers ineligible for subsidies but unable to afford private services or cutting-edge tech.

What Else Is Missing: AI as a Double-Edged Tool

Both reports mention the promise of technology—but stop short of offering a framework for how AI, in particular, should be governed in this space. While AI is a welcome innovation in a historically low-tech field, it introduces new risks: data privacy, algorithmic bias, cultural mismatch, and opaque decision-making among them. Neither report offers a governance or accountability framework for how AI will be evaluated or integrated ethically—despite both emphasizing its promise.

We need more than tools—we need trust. That means clear ethical principles around how AI in caregiving is trained, evaluated, and deployed. Who decides what “good care” looks like? Who gets to revise that? And how do we ensure the systems built to support caregivers don’t end up extracting from them instead?

A true care economy isn’t just smarter. It’s more accountable.

Why Supporting Care Matters to All of Us

These recent reports reinforce the urgency of investing in care—whether through better infrastructure or more inclusive capital strategies. But to truly build systems that work, we must also start with the caregivers themselves: their needs, their wisdom, and the emotional, logistical, and cultural realities they navigate. That’s where innovation can be most transformative—not just in scale, but in how it feels.

Looking Ahead

Ignoring the care economy is no longer an option. Both reports offer moonshot visions—from digital care front doors to universal pre-K—but none center the caregiver as a knowledge holder or cultural actor in their own right. But building it only from the top down—via investment theses or policy frameworks—will miss what matters most. We must start from the ground up: from the caregivers already doing the work, already carrying the system. That’s where the next generation of care infrastructure should begin.