Roughly 53 million Americans provide unpaid caregiving to a family member with a disability or chronic condition, according to CDC caregiving data — and a significant portion of them are doing it while quietly watching their own financial security erode. Monique Washington, 43, is one of them. She just doesn’t talk about it much.
I met Monique on a gray Tuesday morning in Baltimore, at the kitchen table of the rowhouse she shares with her younger brother, Darius, now 36. There were pill organizers on the counter, a medical transport calendar on the wall, and a half-finished cup of coffee she never got back to. She works a full-time route for UPS five days a week. Then she comes home to a second job that doesn’t pay.
When the Parents Are Gone and You’re All That’s Left
Darius was 25 when he was struck by a drunk driver while walking to a convenience store two blocks from their childhood home. The accident left him with a traumatic brain injury and partial paralysis. He spent months in inpatient rehabilitation. He came home, eventually, but he never came back to the person he was before.
Their mother handled most of the caregiving in the early years. Then their father died in 2014. Their mother followed in 2019. Monique, who was already working the UPS night shift and helping out on weekends, became the plan by default. There was no family meeting. There was no agreement signed. She was simply the one who remained.
Darius receives Social Security Disability Insurance. According to the Social Security Administration, the average monthly SSDI benefit as of early 2025 is approximately $1,580. Darius receives slightly less than that — Monique told me his monthly check is around $1,410, a figure that reflects his limited work history before the accident.
He also receives Medicaid in Maryland. But Medicaid, Monique explained, does not cover everything. Not even close.
The Gap Nobody Advertises
Medicaid covers Darius’s physician visits, hospitalizations, and a portion of his in-home aide hours. What it does not cover, Monique told me, is the accessible transportation to specialists outside the Medicaid network, the specialized medical supplies her brother’s occupational therapist recommended, and the gap hours — evenings and weekends — when the state-funded aide isn’t scheduled.
Monique estimated that she personally absorbs roughly $700 to $900 per month in care-related costs for Darius. That includes a private transportation service she uses for his quarterly neurology appointments across town, adaptive equipment her brother’s aide needs to assist with transfers safely, and a portion of the household utility bills that Darius’s benefit doesn’t fully offset.
“I sat down one night and actually added it up,” she told me. “I knew it was a lot. I didn’t know it was that much. When I saw the number I just closed the laptop and went to bed.”
A Good Income That Doesn’t Go as Far as It Looks
Monique is a top-rate UPS driver under the Teamsters contract, which means she earns well — in the range of $85,000 to $95,000 annually before taxes, depending on overtime. By most measures, that’s a strong household income. But she points out, with a patience that sounds practiced, that she is running a two-person household on what looks like a single person’s expenses from the outside.
She cannot transfer to a closer facility or take a different shift because her schedule is synchronized around Darius’s aide hours and medical appointments. She hasn’t taken a vacation of more than two days in six years. Her 401(k), which she contributed to regularly in her late twenties and early thirties, has sat untouched for years.
The retirement math concerns her more than she lets on. Monique’s full Social Security retirement age, based on her 1982 birth year, is 67, according to the SSA retirement age chart. That’s 24 years away. The years she isn’t contributing to her 401(k) are years of compound growth she won’t recover. She knows this. She mentioned it twice without my prompting.
What She Wishes the System Understood
When I asked Monique what she would change if she could change one thing about how disability benefits work, she didn’t hesitate. She said the system doesn’t account for the person standing next to the beneficiary — the family member who quietly absorbs whatever the benefit doesn’t cover.
There is no federal caregiver credit within Social Security’s retirement benefit formula. Unlike some other countries, the United States Social Security system calculates your retirement benefit solely based on your own 35 highest-earning years of work, regardless of whether years were lost or financially compromised by caregiving. For Monique, years of reduced savings will show up later as a smaller personal retirement benefit, compounding the gap she’s already building.
She isn’t asking for sympathy, and she was quick to say so. She loves her brother. She said that plainly and without embellishment. But she’s also 43 years old, and the math of the next 20 years weighs on her in ways that don’t have a clean resolution.
Where Things Stand Today
Monique told me she recently looked up her Social Security statement online for the first time in a few years. The projected retirement benefit estimate made her stomach drop — not because it was catastrophic, but because she could see the trajectory. Years of not maximizing her earnings record, combined with years of not contributing to her 401(k), are compounding into a retirement picture that doesn’t match the life she envisioned in her twenties.
She’s started asking questions — to her union’s benefits coordinator, to a social worker connected to Darius’s care team — about what programs or support structures she might be missing. She recently learned that Maryland has a state-funded caregiver support program she hadn’t known about. She applied. She is waiting to hear back.
When I left Monique’s house that morning, she walked me to the door and then turned immediately back toward the kitchen — Darius’s morning routine was starting. The calendar on the wall had three medical appointments marked for the coming week. There was a sticky note next to it that read: Call SS re: Darius review. I noticed there was nothing on the calendar for Monique herself.
Hers is not a story with a tidy ending. She isn’t out of the woods financially, and she doesn’t pretend to be. But there are millions of Americans absorbing the same invisible costs in the same quiet way — filling the gap between what disability benefits cover and what actual care costs, year after year, with their own money and their own futures. Monique Washington just happened to let me sit at her table and write it down.
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