The lunch rush at a diner on North Charles Street in Baltimore had thinned out by the time Monique Washington slid into the booth across from me, still in her UPS uniform. She had driven her route since 5 a.m., gone home to check on her brother Marcus, and then driven back out to meet me. She ordered coffee. She didn’t look at the menu.
Monique is 43 years old, a Teamsters union member with nearly two decades of seniority, and she has not taken a real vacation since 2019. She has not contributed to her retirement plan in roughly the same stretch of time. And when I asked her how she was doing — genuinely — she paused for a long moment before answering.
“I’m fine,” she said. “Marcus is fine. That’s what matters.”
That deflection, I would come to understand over the next two hours, was the most honest thing Monique Washington could say.
When the Accident Happened, Everything Shifted
In 2007, Marcus Washington was 25 years old and working a warehouse job in Baltimore County when a driver ran a red light and hit him. The collision left Marcus with a traumatic brain injury and limited mobility on his left side. He requires daily assistance with basic tasks — bathing, medication management, appointment transportation — and cannot live independently.
Their parents handled most of Marcus’s care in those early years. When their mother died in 2016 and their father in 2019, the responsibility passed entirely to Monique. There were no other siblings. There was no family trust. There was just her.
Marcus currently receives Social Security Disability Insurance. His monthly SSDI benefit is approximately $1,340 — a figure that reflects his limited work history before the accident. He also qualifies for Medicaid, which covers his primary medical care and some in-home support services.
But Monique was careful to explain what Medicaid does not cover. “There are gaps everywhere,” she told me. “His wheelchair needs maintenance that takes weeks to get approved. His transportation to specialist appointments — Medicaid’s paratransit is unreliable, so I take him myself or I pay for a private van service. The medical supplies that aren’t on their list. It adds up to real money, every single month.”
The Numbers That Don’t Add Up
When I asked Monique to walk me through her actual monthly expenses related to Marcus’s care, she had them memorized without looking at her phone. She’s clearly done this math many times.
Those out-of-pocket costs — roughly $900 a month by her estimate — go toward supplemental personal care aide hours that Medicaid doesn’t fully fund, accessible transportation, medical supplies, and what she calls “the small things that aren’t small.” A grab bar that took three months to get approved through Medicaid. An adaptive kitchen tool she bought outright at $60 because waiting wasn’t an option.
Monique earns a solid wage through her Teamsters contract — she declined to give me a specific figure, but senior UPS drivers in the Baltimore metro area earn between $42 and $48 per hour under recent contract terms. By most measures, she is not a low-income worker. But caregiving costs don’t care about your wage scale.
The Retirement Clock Is Running — Without Her
This is where Monique’s voice shifted. For most of our conversation, she spoke about Marcus’s needs with clarity and practicality. When I turned the conversation toward her own future, she got quiet for a moment.
“I know I’m behind,” she said. “I’m not naive about it. But what do you want me to do? Stop paying for his care aide on Tuesdays so I can put $200 in a 401(k)? That’s not a real choice.”
She’s right that the math is brutal. A worker who stops contributing to retirement savings in their mid-thirties and doesn’t resume until their late forties loses not just the contributions themselves, but years of compounding growth. Financial planners often describe this as one of the most costly interruptions a worker can experience — more damaging in the long run than a lower salary.
Monique’s Social Security retirement benefit will also be affected, though in a more complicated way. Her FICA contributions continue because she’s still working full-time. But the years when she might have earned more — taken overtime, worked a different shift, pursued a supervisory role — have been foreclosed by caregiving obligations. She can’t change shifts because Marcus’s care aide is only available during the hours her current route allows. She hasn’t pursued advancement because the schedule flexibility required is something she doesn’t have.
What the System Does — and Doesn’t — Offer
I asked Monique whether she had ever looked into whether she herself might be eligible for any caregiver support programs. She laughed — not bitterly, but with the weary recognition of someone who has done their homework.
Maryland does have a Medicaid-funded program called Community First Choice that provides some support for family caregivers in limited circumstances, and the state’s Department of Aging administers caregiver support grants. But Monique doesn’t qualify for most assistance because her income is above the threshold. She earns too much to access the programs designed for struggling caregivers, and not enough to comfortably absorb the costs without sacrificing her own financial future.
On the federal level, there is no Social Security credit for unpaid caregiving — a gap that advocates have pushed Congress to address for years. Countries like Canada and Germany have implemented caregiver credits that allow years spent providing care to count toward pension or retirement benefit calculations. The United States has not.
The ABLE account discovery was one of the few genuinely useful things Monique had learned recently. She found out about it through a coworker whose child has a disability, not through any official channel. “No one told us about that,” she said, shaking her head. “We’ve been managing his savings manually, worrying about the asset limit. That information should have come from his caseworker years ago.”
Eighteen Years In, Still No Roadmap
When I asked Monique what she wishes she had known earlier — about the benefits system, about caregiving, about her own financial trajectory — she thought about it carefully before answering.
“I wish someone had told me, when our parents first got sick, that I needed to set up formal legal arrangements quickly. Power of attorney, a special needs trust if we could have afforded it, clear documentation of what Marcus needs and who’s responsible. We were just doing it day by day and hoping.”
She also expressed something she hadn’t planned to say — a quiet, precise resentment that she immediately walked back, then acknowledged again. “I love my brother. I would do it all again. But sometimes I think about the version of my life where I got to build something for myself. And I have to just not think about that, because it doesn’t help anything.”
Monique Washington is not behind on her bills. She is not in foreclosure. She is, by the metrics most people use, stable. But stability built entirely on sacrifice — with no retirement savings accumulating, no career advancement pursued, no personal financial cushion growing — is a different kind of precarity. One that tends to arrive suddenly, in a decade or two, when the body can no longer drive a truck and the Social Security statement shows a benefit that doesn’t reflect what the work actually cost.
She finished her coffee. She had to get back to check Marcus’s afternoon medication. She thanked me for listening — which felt like the wrong direction for gratitude — and walked out into the cold March afternoon in the same uniform she’d been wearing since before dawn.
I sat there for a while after she left, thinking about the gap between what Monique Washington contributes to this country and what this country has built to catch her if she falls. The arithmetic doesn’t close. And she already knows it.
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