Approximately one in four Americans act as family caregivers, according to the AARP and the National Alliance for Caregiver’s 2025 Caregiving in the US report. This number has increased 45% during the last decade, with most caregivers providing care for older adults— although nearly one-third are responsible for both adults and children. Caring for a family member can be a significant stressor, leading many caregivers to neglect their own physical and mental health. Data from Caregiving in the US show that 20% of caregivers described their health as fair or poor, and nearly 24% said they have difficulty caring for themselves.

Duke clinical staff understand that they may be a crucial lifeline to caregivers who struggle to meet their own needs while caring for their loved ones. “The family member is the one who’s there day in and day out, providing supportive care. We need to be looking out for them, just as much as we’re looking out for that individual we’re providing health care for,” says Nicole M. Clagett, AA, BSW, director of Community Development & Caregiver Support at Duke HomeCare & Hospice. 

Below, Clagett and Natalie Leary, MSW, LCSW, director of the Duke Dementia Family Support Program, share tips on how clinicians can normalize counseling for caregivers and help families find providers and resources.

Individual counseling and support groups are essential tools for assisting care partners. However, many older caregivers grew up when mental health care was stigmatized, says Claggett. Clinicians should try to validate those concerns while also explaining that societal norms have shifted, and therapy is now viewed as a powerful wellness and preventive care tool. 

Clinicians may also reassure caregivers hesitant to start therapy by explaining that counselors can focus therapy sessions solely on caregiving concerns—the care partner doesn’t have to talk about anything personal, such as their childhood or relationship with their aging parent. Leary suggests framing counseling as a short-term tool that doesn’t require extensive commitment. 

Leary says that physicians might explain to the caregiver, “It could be really helpful to have someone to talk to that you do not have to take care of. You do not have to manage that relationship beyond that conversation. You can go in and be exactly where you are in the moment.”

Front office staff are often the first to notice that caretivers are stressed. “The waiting room can feel like you’re off-stage, like no one can see you, even though everyone can see you,” Leary says. “Staff can have some real observations of what might be going on with care partners.”

Staff can relay these observations to the clinician, who may not get the full picture during the appointment. Clinicians can then expand the focus of the appointment. Clagett notes that many caregivers and patients are able to mask their emotions when the medical visit begins, despite underlying stress. “When you see a struggling family member, who it took all they could do to get their loved one up and dressed and presented to the appointment, that’s when you’re seeing a caregiver and that patient at their weakest.” Claggett says.

Broaching the topic of counseling with caregivers should be handled with discretion, in a one-on-one dialogue. This can prove to be a logistical challenge, however. If the caregiver and the patient can be separated at any point, that’s an opportunity for a social worker or another appropriate provider to interact with just the care partner. “That conversation might be focused around changes the caregiver is noticing and offering resources, including group therapy and talk therapy,” Leary says. 

If a private conversation with the caregiver isn’t possible, the physician could say, “I’ve talked a lot with your family member today, I’m curious if you’ve ever thought about maybe talking to someone about how you’re doing?” If the caregiver seems interested, a clinical team member can share that information when the visit ends. 

Aging adults have a variety of needs, and those needs can’t be met by any one individual. “I look at it as a three-legged stool—you have the medical home, you have the patient, and you have the family supporting the patient,” Claggett says. “If we don’t look at that family member, we’re doing that patient a huge disservice.”