The Care Economy Gap: How North Carolina's Invisible Workforce Crisis Is Costing Families, Communities, and the State's Future

Somewhere in Guilford County, a woman in her late forties just turned down a promotion. Not because she lacked the skills or the ambition, but because her mother's memory care needs have grown beyond what evenings and weekends can absorb. Somewhere in Robeson County, a father of two young children has trimmed his work schedule to part-time because the nearest affordable childcare center has a waiting list stretching eighteen months into the future. These are not isolated stories. They are the daily arithmetic of a care infrastructure that North Carolina has allowed to erode for decades — and the economic consequences of that erosion are far larger than most policymakers have been willing to acknowledge.

Kelly believes it is time to stop treating this crisis as a private family matter and start addressing it as the serious public economic failure it truly is.

The Scale of What We're Not Counting

The Bureau of Labor Statistics and academic researchers have long struggled to assign a dollar figure to unpaid caregiving, precisely because it happens in living rooms and kitchen tables rather than in offices or factories. But the numbers that do exist are striking. Nationally, unpaid family caregiving is estimated to represent more than $470 billion in labor annually. North Carolina, with its aging population and persistent childcare deserts scattered across rural counties, carries a disproportionate share of that invisible burden.

Approximately one in five North Carolinians provides some form of unpaid care — whether for an aging parent, a child with a disability, or a family member managing a chronic illness. Among working-age adults who have reduced their professional hours or exited the workforce entirely to take on caregiving responsibilities, women represent roughly two-thirds. The result is a persistent, structural suppression of female labor force participation that carries compounding consequences: lower lifetime earnings, reduced Social Security benefits, diminished retirement security, and a narrowing of the generational wealth that families can pass forward.

The Ripple Effects Communities Cannot Afford

The economic drag does not stop at the household level. When skilled workers leave the labor market — or are forced to underperform within it — local businesses lose experienced employees, regional tax bases shrink, and communities lose the consumer spending that sustains small enterprises. In North Carolina's smaller cities and rural areas, where the workforce is already under pressure from decades of manufacturing decline, this secondary effect is particularly acute.

Consider the math in a mid-sized Piedmont community. A registered nurse who reduces her hours from full-time to part-time to care for an aging parent is not simply losing personal income. Her employer faces increased staffing costs, her reduced tax contribution affects municipal revenues, and her curtailed spending ripples through local retail and service businesses. Multiply that story by tens of thousands of households across the state, and the aggregate economic loss becomes substantial enough to reshape regional growth trajectories.

North Carolina's rural counties face an additional layer of vulnerability. Many already struggle with physician shortages and aging populations, meaning the demand for informal family caregiving is higher while the resources to offset it — affordable care facilities, respite programs, home health aides — are thinner on the ground. Families in these communities are not making choices; they are absorbing impossible situations with whatever resources they can marshal.

Why the Current System Is Not Working

North Carolina currently ranks among the most expensive states in the nation for center-based childcare relative to median household income. At the same time, the state's Medicaid-funded home and community-based services for elderly and disabled residents carry persistent waiting lists, sometimes stretching years. Private long-term care options remain financially inaccessible for the majority of working and middle-class families.

The result is a care infrastructure that functions adequately for the affluent and fails almost everyone else. Families earning too much to qualify for subsidized programs but too little to afford private alternatives are left to solve an impossible equation on their own — and the solution they most frequently arrive at is workforce withdrawal. That withdrawal is not laziness or a lack of ambition. It is a rational response to a system that has provided no viable alternative.

Meanwhile, the professional care workforce itself is stretched to a breaking point, with home health aides and direct care workers among the most underpaid employees in the state's economy. The pipeline of care professionals is narrowing at precisely the moment demographic trends are expanding the need.

Kelly's Vision: Care Infrastructure as Public Investment

Kelly's platform is built on a foundational premise that most political conversations have been reluctant to embrace directly: care infrastructure is not a social program. It is an economic investment with measurable returns in workforce participation, tax revenue, business productivity, and community resilience. Treating it as anything less is not fiscal conservatism — it is fiscal negligence.

The core elements of Kelly's care infrastructure strategy include:

Expanding subsidized childcare access across income brackets. Kelly supports significantly increasing the income threshold for childcare assistance eligibility, closing the gap that currently leaves working-class families earning just above the poverty line with no meaningful support. This means more parents — and in practice, more mothers — remaining in or returning to the workforce.

Investing in home and community-based elder care. Kelly is committed to eliminating the waiting lists that strand families in crisis and to expanding the network of home health services available in underserved rural counties. Keeping older North Carolinians in their homes and communities is both more humane and more cost-effective than institutional alternatives — but it requires a functioning professional care workforce to make it possible.

Raising wages and expanding training for direct care workers. The care economy will not function without the people who staff it. Kelly supports raising the wage floor for home health aides, certified nursing assistants, and childcare workers — recognizing that these roles carry genuine professional responsibility and deserve compensation that reflects it. Workforce development partnerships with community colleges across the state would expand the pipeline of trained care professionals.

Providing caregiver tax relief for family members. For families providing unpaid care that cannot be replaced by professional services, Kelly supports targeted tax relief that acknowledges the economic sacrifice caregiving families are making. This is not a comprehensive solution, but it is a meaningful acknowledgment that the state has an obligation to those who absorb its care gaps.

Piloting regional care hubs in high-need counties. Kelly envisions a network of coordinated care resource centers — particularly in rural and underserved communities — that connect families with services, provide respite support, and reduce the administrative burden that often prevents eligible families from accessing programs they qualify for.

The Investment That Pays for Itself

Skeptics will ask how North Carolina pays for this. The more accurate question is how North Carolina continues to afford not paying for it. Every skilled worker who leaves the labor force to provide unpaid care represents lost income tax revenue, reduced consumer spending, and a weakened local economy. The cost of inaction is already being paid — it is simply being paid by families and communities rather than appearing in any state budget line.

Research consistently demonstrates that investments in care infrastructure generate strong returns in workforce participation and economic activity. States and nations that have treated care as a public good have seen measurable improvements in female labor force participation, reduced poverty rates among older adults, and stronger regional economies in previously struggling areas.

North Carolina has an opportunity to lead on this issue — to recognize that a state's economic strength is only as durable as the infrastructure that allows its people to work, to contribute, and to build stable lives. That infrastructure includes roads and broadband, yes. But it also includes the care systems that make it possible for North Carolinians to show up.

Kelly is committed to building those systems — for families across every county, every community, and every stage of life.