Somewhere in corporate America today, an employee is on a performance improvement plan. Her manager sees distraction, missed deadlines, slow responses. What no one has asked: Did she spend last night coordinating her mother's home health aide and hasn't slept through the night in months.

Caregiving doesn't show up on a claim line. But it's showing up in the performance improvement plan, in the leave that follows and, eventually, in the resignation.

"Sometimes they see it as a performance issue," said Dr. Madhavi Vemireddy, CEO of Cleo, a global family care platform . "When you dig deeper, you realize caregiving is at the root cause, and they're doing it without any support."

Nearly three quarters of employees have some caregiving responsibility . For most companies, it is the most common condition in the workforce, and the most invisible.

Eight Years: The Gap Between Burnout And A Diagnosis

"Typically, it takes about eight years before they would actually seek treatment," Vemireddy told Forbes. That's eight years of declining health and compounding stress, absorbed quietly by the caregiver and paid for invisibly by the employer.

Part of what keeps it invisible is fear. Only about half of caregivers tell their managers about their responsibilities, per Cleo data. "Nobody wants to raise their hand and say, 'I'm a caregiver,' because they're afraid that's essentially saying, 'I've got a lot of things happening in my life,'" Vemireddy said.

The body absorbs the silence, too. The CDC documents higher prevalence of poorer health rates for caregivers across 13 of 19 tracked conditions versus non-caregivers. These include the costly and the deadly: obesity, arthritis, hypertension. Often, caregivers stop going to their own doctors while prioritizing everyone else.

Joshua Freund, senior benefits manager at Genentech, has watched this from the employer side. "Caregiving affects overall health management," he said. "It's not just about reducing healthcare costs. Caregiving has a real impact on conditions like MSK, obesity, and mental health. If you're not accounting for caregiving, you're missing a major part of the picture when trying to improve healthcare access and outcomes."

The Women Bearing The Heaviest Load—At The Worst Time

About 60% of all caregivers are women. Among Cleo's member population, 66% are women, and the average female member is simultaneously caring for 1.5 care recipients.

Women ages 40 to 54 face the highest burnout risk of any cohort Cleo tracks—46% identified as high risk, compared to 32% for women 55 and older, and 27% for those in earlier family-forming stages. This is the perimenopause window, the peak-career window, and the sandwich-generation window, all at once.

Fifty-three percent of women in this cohort screen positive for depression and anxiety on the PHQ-4, the standard clinical screener. A Mayo Clinic study adds a clinical dimension most benefits conversations haven't reached: Women who caregive 15 or more hours per week are 57% more likely to report severe menopausal symptoms versus non-caregivers.

"You have this perfect storm," Vemireddy said. "You're a sandwich generation caregiver, so you're already at high risk for burnout and mental health strain. And you're also going through menopause."

The U.S. caregiver population has surged nearly 50% since 2015 . The women absorbing most of that growth are doing it during the most medically and professionally demanding decade of their careers, with almost no targeted employer support.

Liz Powell, founder and CEO of G2G Consulting and Women's Health Advocates, framed the economic consequence this way. "We're talking about millions of women who are the engine room of the paid workforce,” she said. “When they crash, the fallout is huge. Families fracture, unnecessary and avoidable healthcare claims go up, companies lose talent, and communities suffer. Obesity, hypertension, depression, early retirement, financial strain—these are all symptoms of a system that fails to support women through predictable life transitions."

What The Missing Claim Line Is Actually Costing

The financial case is concrete. High-burnout caregivers incur $1,000 per member per month in healthcare costs versus $600 for lower-risk members—a 67% premium tied directly to burnout risk.

Women who ultimately exit the workforce lose an estimated $350,000 in retirement savings—and become the next generation of the very crisis they are living through now.

Jason Resendez, CEO of the National Alliance for Caregiving, put the human accounting plainly. "Nearly two-thirds of family caregivers, many of whom are women, face high emotional stress, losing a full week every month to poor mental health,” he noted. “This isn't a test of individual resilience; it's a systemic failure to provide the support these emotional realities demand."

Making The Invisible Visible

Cleo's answer is a proprietary eight-minute assessment called the Family Health Index, which measures seven dimensions of caregiver health: mental health, physical health, self-care, connectedness, caregiving balance, family support, and confidence. Since its February 2023 launch, it has been completed more than 19,000 times, and two-thirds of high-risk members improve their overall score with Cleo's support.

Cleo members are four times more likely to utilize mental health benefits than non-participants and 40% more likely to comply with preventive care. Early identification prevents an estimated 25% to 30% of avoidable leaves of absence altogether.

The Architecture Of The Problem And The Fix

The invisible claim line is not an accident. It is the product of a healthcare system designed to treat patients, not the people caring for them, and a benefits ecosystem that measures what it can see while ignoring what it cannot.

The argument for change is gaining traction beyond the benefits’ space. As explored in a previous Forbes examination of workforce caregiving risk , companies such as ELIXR are now positioning caregiving as an operational variable—one that can be identified, measured, and managed—rather than a cultural one.

AARP puts the scale in stark relief : 59 million Americans provide 49.5 billion hours of unpaid care annually—labor that would be valued at $1.01 trillion if paid at market rates. "Caregiving strain is no longer invisible, and neither are its health consequences," Vemireddy said.

For employers still waiting to see caregiving on a claim line before they act, the evidence is already here. It’s just misfiled under performance, absenteeism, mental health, and turnover. The cost is real. It was just filed under the wrong name.