More than 4.5 million Americans suffer from this form of dementia. Guess who gets to take care of them until professional help can be obtained? It’s their own middle-aged children or life partners, like Aaron Alterra. He penned this painful memoir of what it’s like to be married for 60 years and then be responsible for finding support groups and home day care for a spouse with major memory loss and related personality challenges.

When caregivers like Aaron Alterra wear out from their 24-hour shifts, the nearly 50 million US families looking after an elderly or disabled person turn to home health aides. In big cities and rural areas, the burden of caregiving then shifts to poor and working-class women with few other job options. In the South Bronx, they are people of color who, as Schweid argues, need better training, pay, and benefits, as well as organizational support from unions.

In America, the ever-increasing financial or emotional cost of caring for the elderly at home leads to their next expensive (or Medicaid-funded) stop: long-term care in an institutionalized setting. The late Tom Gass was a minimum-wage nursing home worker in the Sun Belt. His insider account of what life, death, and work is like for the denizens of for-profit nursing homes is a powerful call for social alternatives to “warehousing of the elderly.”