We talk about caring for children and aging parents. But more women are finding themselves responsible for someone else: a sibling.

As she opened the door of her sister’s abandoned car, the realization hit Andrea even harder than the hot stench of black-mold-soaked upholstery: I’m the big sister now.

Two weeks before that, her nieces had called in a panic. Andrea’s older sister Jill—always “the smart and capable one” in their family—was struggling secretly with alcohol and had gotten fired from her job and evicted from her home. Andrea—“the artistic one”—took a leave from her job and leapt into get-it-done mode.

Andrea, 59, researched several rehab facilities, flew across the country and organized an intervention with her step-sisters and nieces—along with a 30th birthday party for her niece. They accessed Jill’s accounts to pay off her bills. Then Andrea enrolled her in COBRA to help cover some of her treatment, and negotiated permission to drain a small family trust for the rest. She found a new rental for her one niece, who’d been living with her mom, and—finally and most importantly—convinced Jill to check into medical detox and rehab. 

Jill is safely ensconced, and now it’s time to pick up the pieces, literally. “The moving company had just dumped all of her belongings from the old house into the driveway of the new one,” Andrea says. She picked through it with great care, finding alcohol hidden in dresser drawers. And then realized, oh, also, her car. “When Jill had been booted out of her house, she must have thrown some wet things in there. I opened the door and the smell, I just—I have PTSD from a mold event we’d had in our home years earlier—I just … stopped. I called the junk people. I tossed it all. I realized then that she was never going to remember anyway.”

When Your Sibling Becomes Your Responsibility

Andrea is a real person whose name—like those of all of the siblings in this piece—has been changed for privacy. But with midlife depression and substance and alcohol use disorder rates increasingly high, chances are you work with an Andrea, or you’re an Andrea, yourself. An alarming 845,000 women have left the U.S. labor force since January, continuing 2025’s trend. An analysis back then showed that women who left voluntarily most commonly cited caregiving responsibilities as the reason, with moms of kids under age five experiencing the sharpest workforce participation declines in decades. And research shows that women are 73% more likely than men to leave their jobs for elder-caregiving, as well. But what about adult dependents whose rapidly aging parents can no longer manage their care? They need caregiving too.

“It’s the sandwich generation, plus a bag of chips on the side—the siblings,” says Elizabeth Gedmark, VP of the employee legal rights organization, A Better Balance (ABB), which works to fill the gaps left by America’s lackluster public policies for caregivers. Increasingly, on ABB’s call-in helpline, Gedmark says, “we are hearing from adult sibling caregivers who fall through the cracks of federal law.” She’s referring to the FMLA, a federal law providing unpaid, job-protected leave, which doesn’t include sibling care. And even if it did, that pesky little “unpaid” part means that most people couldn’t afford to use it.

Several states extend paid family leave to care for siblings or family members, but without a federal floor of support, coverage is often uneven, misunderstood, or just not available at all. “They’re shocked and angry, all the emotions, that they can’t take time to care for their siblings even when absolutely nobody else could but them,” says Gedmark, whose colleagues recently helped get coverage for sibling care incorporated into New York State’s paid family leave policy.

It’s a perfect storm of aging demographics, increased mental health and privacy needs, overwhelmed healthcare systems, and negligent public policy. And the big sisters have become America’s personal umbrella policy.

“I know that I’m incredibly lucky that my boss was wonderful,” says Andrea, whose kids are grown, and whose husband managed their dogs and home while she was away. “She just said, ‘take all the time you need.’ That’s the kind of boss I try to be, too.” After three decades at her employer, Andrea had earned that trust. But unlike work absences for a new baby or an end-of-life hospice situation, sibling care timelines are exceptionally hard to predict. Or, for siblings of those with lifelong disabilities, they can last forever.

When You Know You’re Next

Caren, 49, has never married, and works fully remotely from home in a job with few meetings and decent flexibility. She knows she’ll eventually be responsible for her younger brother, Max, who has a genetic condition that causes intellectual disabilities and cannot live totally independently. “My parents would do everything for him forever if they could,” says Caren, “but my dad is 84, and he often jokes that he and Mom didn’t get the extended warranty.”

Almost a quarter (24%) of adults in America provide ongoing care for family members with medical conditions or disabilities, a 45% increase in the last decade. And women ages 50 to 64 do more of this caregiving than any other demographic, according to a 2025 report by the National Alliance for Caregiving and AARP. 

Recently, Caren’s parents took a vacation and she got a preview. Her brother lives with a disabled roommate and has a caregiver who drives him back and forth to his job in a corporate mailroom each day. “Out of the blue, Max called me and asked if I wanted to get lunch, which is really unusual,” says Caren. “I picked him up and took him for a sandwich and then realized it was because he’d accidentally already eaten the meals that were meant for that day. He was out of food.” 

Caren’s parents re-enroll Max in a state benefits program annually and have him on a five-year waiting list for a more comprehensive care facility. They have saved money his whole life, but Caren doesn’t know how much Max’s eventual care will cost. “I don’t know all the particulars. I don’t have a binder. I don’t have notes. I have some stuff floating around in my head, and their financial planner’s number when the time comes.” For now, she’s okay with that. 

What worries Caren most is more emotional than logistical. “The million-dollar question is: Will Max listen to me? He wants what he wants when he wants it, and has a temper, and my parents are really good at talking him off the ledge,” says Caren. “This is so small, but he wears khaki pants to work every day, and my mom irons them and brings them to his house. And I’m thinking: Who’s going to iron his pants? My parents are wonderful … but also, he’s kind of spoiled.”

You’re Still Their Sister

Caring for a child or an elder offers the predictable power dynamic that comes with a difference in ages. That’s much less true with siblings. “You can deeply love your sibling and also feel angry, resentful, and burdened by the caregiving role you find yourself in,” says psychiatrist Pooja Lakshmin, M.D., author of the bestselling Real Self-Care and the forthcoming book Quantum Shifts: A Practical Framework for Navigating Life’s Biggest Challenges. She’s seeing sibling care issues come up in her practice more and more, unpacking decades of resentment for patients like Caren, or helping those facing a new and acute crisis, like Andrea. Either way, she says, “you find yourself feeling like you’re eight years old again, full of a sense of ‘But this isn’t fair!’”

Dr. Lakshmin advises sibling caregivers to ask themselves what skills and resources they have now that they didn’t as children. “What am I realistically able to give? The goal here is not to resolve every single childhood tension or dynamic. It’s to let your new adult relationship take the lead.”

These days, Andrea keeps a big note on her desk that says “breathe.” “Because I get triggered, and my sister and I have a certain dynamic, and now it’s the opposite,” she says. “She was the smart one. I was artistic. And life didn’t turn out to be that way.”