Already Toast? You’re Not Alone.

November is Caregiver Awareness Month—a time to recognize the millions of people who provide daily care and emotional support to loved ones. To kick things off, we sat down with Kate Washington, author of Already Toast: Caregiving and Burnout in America, to talk about what burnout really looks like and how caregivers can protect their own well-being while supporting others.

In this candid Q&A, Kate shares insights from her personal journey and her research—offering practical ways to spot the warning signs of burnout, set boundaries, and find balance in one of life’s most demanding (and often overlooked) roles.

Let’s dive in and learn how to recognize the signs of burnout—and what it really takes to survive and stay strong while caring for someone you love.

About the Author’s Journey

1. What inspired you to write this book on caregiver burnout?
When my former husband was coming home from four and a half months in the hospital after a stem cell transplant with extreme complications in 2016, his doctor told me I would need to have eyes on him 24 hours a day. We had two young kids at home, so that was impossible, and insurance does not cover in-home attendant care even when medically ordered. When I objected, the doctor said something like, “Well, usually family steps in and it works out fine.” I couldn’t believe—and still can’t—that such an unsustainable level of care could be demanded by the medical establishment but not supported at all. I had so many privileges as a caregiver—financial stability, a supportive community, proximity to the hospital, flexible schedule—and it was still incredibly difficult. I couldn’t imagine how the vast majority of caregivers, who don’t have those advantages, can carry on. I wrote this book both because I wanted to understand why it was so difficult on a systemic level, not just personally, and because I wanted people to understand how hard family caregiving can be. I tried to write the book I needed to read when I was going through it.

2. Did you personally experience caregiver burnout, and if so, how did that shape your perspective?
Yes, I absolutely did, though I didn’t fully realize that was what I was experiencing at the time! My burnout influenced everything about my experience of caregiving as it went on and got more intense, leading to a lot of resentment and frustration. It led me to a firm belief that we as a culture need to be more honest about the demands placed on family caregivers, the difficulty of setting boundaries, and the costs—to both caregivers and ultimately their loved ones—of ignoring how draining caregiving can be.

3. What was the most surprising thing you learned while researching or writing this book?
It’s actually something I learned later, which is that the time at which caregivers struggle most (especially with depression and anxiety) is after caregiving ends or their duties decrease. That makes sense in cases of grief and loss but seems counterintuitive in cases where the person they’re caring for is recovering. But the shift in roles, the loss of previous identities, and the new time and space to cope with the mixed emotions of caregiving all make caregivers vulnerable at the end of caregiving. During it, a lot of us just have to power through, and when it ends, support often ends just when it’s most needed.

Understanding Burnout

4. How do you define caregiver burnout, and how is it different from stress or
exhaustion?
Burnout results from ongoing, unmanaged stress and is characterized by three major dimensions: exhaustion (bone-deep tiredness you can’t recover from), cynicism (including resentment and negativity), and inefficiency (inability or unwillingness to keep going in the role). It’s closely linked to but distinct from compassion fatigue—which results from repeated exposure to suffering and often involves loss of empathy, frustration, and negative health effects. Both were first recognized in health care workers, and so it’s not too surprising that they often also affect unpaid family caregivers, who are often juggling multiple roles.

5. What are the earliest warning signs caregivers should watch for?
Irritability, a short fuse, problems sleeping, feeling like they’re just going through the motions, and a longing to escape—which can manifest in increased substance use or checking out in other ways—are all signs to watch out for. There are a lot of others, but for me feeling robotic and resentful were huge warning signs.

6. Why do you think caregiver burnout is so often overlooked or minimized?
We live in a very individualistic society where people and families are expected to solve their own problems, and caregiving happens behind closed doors. It’s also valorized, in a very gendered way, as something women just naturally do for their families. (About two-thirds of family caregivers are women.) So we expect people to just handle things while providing almost no support, much as with parenting, and if people struggle offer them empty platitudes. As a culture we don’t want to see caregiver burnout, or any signs of people buckling under the weight of their obligations, and often burned-out caregivers are too overwhelmed and sometimes too guilty or ashamed to advocate for themselves.

Practical Advice & Solutions

7. What strategies or practices do you recommend for caregivers to prevent
burnout before it reaches a crisis point?
Set boundaries, take breaks, and mobilize all the support and help you can before it’s a crisis! If any friend offers to help, take them up on it even if you don’t feel you absolutely need it at that moment. It’s OK to set boundaries even with the person you’re caring for you; you can’t do it all, and trying to will lead to burnout. I remember seeing the statistic that only 14% of caregivers use respite care. If you can be as fierce an advocate for yourself in asking for resources and leads on rest, respite, and support as you are in advocating for your care recipient, that will go a long way.

8. Are there specific self-care practices you found especially effective (or
ineffective) in your own experience?
Self-care has become such a buzzword and often so commercialized now that it’s hard to separate out real, needed self-care from, say, a mani-pedi and a massage (both of which are great, don’t get me wrong, but are just band-aids on an ongoing crisis). I struggle with the notion of self-care and often say that what we need is community care, not one more person to care for on our list, but we do have to care for ourselves. Pooja Lakshmin’s recent book Real Self-Care recommends so many great strategies. Making sure you’ve met your foundational needs—food, water, sleep, exercise—goes long way. Keeping spaces just for you and your feelings—whether that’s therapy, if you have access to it, a weekly phone or coffee date with a trusted friend, or a journal to pour it out in—helps tremendously. And when all else fails, consider leaning into self-
compassion (kindness to yourself; there are a lot of free videos and explainers online) rather than self care.

9. How can caregivers ask for help when they often feel guilty or hesitant to do
so?
I was often hesitant myself! I didn’t think it was that bad that I needed to trouble my busy friends and family. But now that I am not caregiving and I can pay the help I got forward, I’m always thrilled when people ask. I want to help my friends and it’s a gift to me when they ask for it! Of course some people won’t have the resources or bandwidth, but the people who love you probably want to rally round you and simply don’t know how. Asking them gives them the opportunity to show they love you, and it can keep you from getting so fried and overextended that you break. And if it’s truly too uncomfortable to ask directly? Delegate asking to a close friend who can be in charge of sending out support requests.

Impact on Caregivers & Families

10. How does burnout affect the quality of care a caregiver provides, and in turn, the wellbeing of the person receiving care?
For me, being burned out meant I was shorter tempered and less empathetic, and I was more duty-bound and less truly caring in the care I provided. That doesn’t feel great to admit, but it’s the truth. I was still a strong advocate for my then-husband and he recovered well from his ordeal, but I wasn’t always as kind as I would like to be, which I’m sure was hard for him when he was so vulnerable and so ill. If caregivers are pushed past their limits, some will break down and may have to downshift their care or leave a situation, which is never good for the patients who must depend on them. And there are gray areas as well: if caregivers are asked to provide round-the-clock care but have to, for instance, go to work or sleep, they have an impossible choice and often the patient’s care must suffer.

11. What role can family and friends play in supporting caregivers to avoid
burnout?
Offer specific help! Don’t just say “call if you need anything” or “what can I do to help?”; that puts the burden back on the stressed-out caregiver. A better approach is along the lines of “Hey, I’m headed to the grocery store. If I can pick up some groceries or dinner for you, let me know and I’ll drop it on your porch this afternoon.” Or offer dinner on a certain day, start a meal or support circle, or just send a supportive text. I always now add “no need to reply” if I’m reaching out to a busy caregivers; those are magic words that give the person space if they’re overwhelmed.

Looking Ahead

12. What do you hope readers will take away from your book?
If they are caregivers, I hope readers will feel seen and validated in their experience, whatever it may be, and empowered to set boundaries and seek resources to make their own journeys more sustainable. If they are not (yet) caregivers, I hope they will understand that they will almost certainly need caregiving or become a caregiver in the future, and that it’s critical to prepare for both roles.

13. If you could change one thing about how society views caregivers, what would it be?

I want us to see caregiving as a societal issue, not an individual one. In particular, want to emphasize that everything I’ve outlined above about caregiver burnout ultimately stems from structural problems of a health care system that offloads too much
responsibility to family caregivers (often in the name of cost-cutting), and not individual failings! We look at this as an individual or family issue to solve, but it needs systemic solutions.

14. Are you optimistic that awareness around caregiver burnout is growing—and if so, where do you see progress happening?
I was optimistic about it when my book came out, just after the pandemic and at a time when advances in care policy were at the top of the national agenda. Now, with cuts to Medicaid and Medicare, and slashes of the social safety net across the board, I’m worried things will only get worse. That said, I see a lot of signs of growing cultural awareness and advocacy, including activism around care and businesses that seek to ease things for family caregivers. Still, we have a long way to go to become the caring society all of us deserve.

Kate Washington is the author of Already Toast: Caregiving and Burnout In America and a frequent speaker on the systemic challenges facing family caregivers. Her writing has appeared in The New York Times, TIME, HuffPost, Eater, and many other publications. Her second book, Midstream: A Life Remade in 50 Swims, is forthcoming in July 2026. She holds a Ph.D. from
Stanford University and lives in Sacramento with her two daughters.