Aging in America News

| In a World That Won’t Stop Scrolling, Caregiving Is an Act of Rebellion
| Neal K. Shah

| Reprinted from his Substack by permission

It’s 3:47 in the afternoon, and my friend Sarah is feeding her mother applesauce. The spoon lifts slowly, carefully, almost rhythmically. Sarah watches her mother’s face for signs of readiness. There are pauses between motions, little moments of waiting that cannot be hurried. One spoon. Wait. Another spoon. Wait. The afternoon light through the kitchen window hasn’t moved. Her phone buzzes on the counter seven times in the last four minutes, but she doesn’t look.

This is not productivity. It is attention.

And in a world where the average human attention span has shrunk to 8.25 seconds, shorter than a goldfish circling its bowl, that makes caregiving one of the last radical acts left.

The Erosion of Everything

The philosopher Simone Weil wrote that “attention is the rarest and purest form of generosity.” She was right, but she died in 1943, before anyone could have imagined just how rare attention would become.

Our days are splintered now. Notifications blink. Metrics refresh. Seventy-nine percent of workers can’t focus for even an hour without interruption. Every platform is designed to interrupt us before thought can deepen. We scroll, we react, we measure, we perform. The economy of distraction has become so total that stillness itself feels unnatural, even guilty.

Attention, in the digital age, is a currency, extracted, quantified, and sold. Film pacing has quickened, songs have shortened by more than a minute since 1990, even the SAT was redesigned to be 45 minutes shorter. Everything is faster, tighter, more compressed. The economist Herbert Simon predicted this in 1971 when he wrote that in an information-rich world, information consumes attention, creating a scarcity of whatever attention itself requires.

But caregiving exists almost entirely outside that market. It’s unmeasured, unoptimized, largely invisible. There is no engagement rate for holding a trembling hand. No algorithm rewards you for patience. Every act of care is an act of sustained attention, and that makes it heresy in a world that worships speed.

The Rebellion of Slowness

There are 44.58 million family caregivers in America performing the equivalent of $873.5 billion worth of labor annually. Yet caregiving responsibilities lay bare and exacerbate existing economic inequalities, forcing families into impossible choices between their own livelihoods and their loved ones’ care.

If caregiving were a company, it would be larger than Apple, Amazon, and Walmart. But it isn’t a company. It can’t be.

Because caregiving forces a rhythm that the modern world rejects. It is slow, repetitive, cyclical. You bathe someone, and tomorrow, you will bathe them again. You prepare a meal, and in hours, hunger will return. The progress bar never fills.

When a society prizes acceleration, caregiving insists on deceleration. When efficiency becomes a religion, caregiving is its heresy. When the culture celebrates multitasking, caregiving demands monotasking. One person, one moment, one spoon at a time.

Sarah has been sitting in that kitchen for forty minutes now. Forty minutes in a world that fragments attention into eight-second intervals. The philosopher James Williams calls these “the externalities of the attention economy,” distractions that in the short term keep us from doing the things we want to do, but in the long term keep us from living the lives we want to live.

But what if the opposite is also true?

When No One Practices Attention

Here’s what haunts me: what happens to a civilization that stops practicing care?

Sixty-seven percent of family caregivers report difficulty balancing career and caregiving responsibilities. The modern caregiver often finds themselves caught in a delicate dance, trying to balance the steps of their career with the rhythm of care. Only one in four caregivers reports good physical health. The emotional journey of caregiving reveals challenges far more complex than we acknowledge. Twenty-seven percent shift to part-time work or reduce hours, sixteen percent stop working entirely. We can’t afford to stay, so we pay someone else to do it — someone who also can’t afford it, who’s working three jobs, who’s also drowning. The care gets distributed but the presence doesn’t. The attention fractures again.

When every interaction becomes transactional, when every spare moment is filled with noise, when attention itself becomes too expensive to give freely — what remains of empathy? If no one learns to sit quietly beside another human being, to wait, to listen, to attend — what happens to the moral muscles of a society?

We talk a lot about artificial intelligence these days. But maybe the real danger isn’t AI. It’s artificial attention. Simulated empathy. Synthetic presence. We build chatbots to mimic care, not because machines are ready for it, but because humans have forgotten how. True care isn’t about completing tasks — it’s about bringing joy and presence to another human being.

And that’s not just sad. It’s dangerous. Because care doesn’t just teach us to pay attention to others. It teaches us what attention even is. The sustained kind. The kind that doesn’t expect a return. The kind that stays when staying is hard.

Without it, we become something else. Something faster, more efficient, more fragmented. Something that can’t sit in a kitchen for forty minutes without feeling like we’re wasting time.

The Attention That Endures

There’s a kind of mindfulness research that shows up in caregiving studies. Mindfulness interventions for dementia caregivers show significant improvements in depression, perceived stress, and quality of life. The studies define mindfulness as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience”.

That’s just care described differently.

We talk about mindfulness as a lifestyle brand: apps, retreats, corporate wellness programs. But caregiving is its truest form. A mindfulness that costs something. That aches. That asks.

Because attention in caregiving isn’t just noticing. It’s enduring. It’s staying with someone through decline. It’s holding steady as everything else unravels. You can’t outsource that. You can’t multitask grief. You can’t optimize love.

I think of the young caregivers I’ve worked with, pre-med and nursing students who tell me that sitting with an elder is “the first time I’ve been truly present in years.” A generation raised in the glow of screens, learning to make eye contact again. Learning that not all meaning can be streamed. Learning that some things can only be received through the discipline of attention.

That discipline changes you. It alters your sense of time, your definition of productivity, your tolerance for silence. It reminds you that another person’s needs might be more important than your own productivity.

And in that reminder lies something we’re losing. Not just the ability to care, but the ability to exist in care’s time. The slowness. The repetition. The waiting. The staying.

What We Save When We Stay

By 2030, more than one in five Americans will be over the age of 65. Traditional caregiving models are buckling under the pressure, creating a collision between a society that needs people to stay and an economy that rewards people for leaving. The need for sustained attention, for care, is growing exponentially. But our capacity for that attention is shrinking just as fast. We’re approaching a collision between a society that needs people to stay, and an economy that rewards people for leaving.

If we lose caregiving, we lose something bigger than a social safety net. We lose the muscle memory of care itself. We forget how to attend, how to listen, how to love without distraction.

The poet Mary Oliver once asked, “What is it you plan to do with your one wild and precious life?”

Perhaps the answer, at least for some of us, is simple: pay attention to another life as if it mattered more than your own. Not because it’s productive. Not because it will be rewarded. But because it’s the last thing we do that makes us human.

When Sarah’s mother dies, and she will, probably soon, there won’t be metrics for what those forty minutes meant. No one will calculate the ROI of applesauce. But Sarah will remember that she stayed. That in a world designed to fracture, she chose to be whole in one place, with one person, for however long it took.

The attention economy wants us to believe that’s a waste. That forty minutes could have been spent building something, networking, monetizing, growing a platform.

But what if it’s the opposite? What if the real wealth is the ability to stay?

The Last Practice

I keep coming back to that kitchen. The afternoon light. The spoon. The waiting.

In a civilization that measures everything in seconds, caregiving is the last practice of hours. The last place where attention isn’t a commodity but a gift. The last rebellion against a world that would prefer we all keep scrolling.

Care doesn’t scale. It doesn’t compound. You can’t invest it and get it back with interest. You spend it, and it’s gone, and all you have is the memory of having been there. In an economy built on accumulation, care is pure expenditure. In a culture obsessed with growth, care is just staying still.

And maybe that’s exactly what we need.

Technology will keep advancing. The attention economy will keep mining. The world will keep accelerating. But somewhere, someone will still be feeding someone else applesauce, forty minutes at a time, practicing the last form of attention that still remembers what it means to stay.

That quiet, repetitive, imperfect work is the seed of a different future. One where attention is restored as an act of love, not commerce. Where technology orbits care, not the other way around. Where we remember that the moral muscles of a society are built through the small, daily practice of paying attention to each other.

The spoon waits. The mouth opens. The afternoon passes.

Somewhere, seven billion people are staring at screens, fragmenting their attention into smaller and smaller pieces, convinced that this is how we’re supposed to live.

And somewhere else, someone is caring. Slowly. Fully. Without distraction.

Attention is the rarest and purest form of generosity. Caregiving might be the last place we practice it. If we forget how, we will have built a world that works perfectly for no one.

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Neal K. Shah is a healthcare researcher specializing in workforce innovation, AI-powered caregiver training and health policy. He is the lead Principal Investigator on the Johns Hopkins-funded YayaGuide AI Innovation Grant and co-Principal Investigator on the University of Pennsylvania’s Artificial Intelligence for health insurance denials CounterforceAI grant. He serves on North Carolina’s Steering Committee on Aging. He is CEO of CareYaya Health Technologies, Chairman of Counterforce Health, and the author of Insured to Death: How Health Insurance Screws Over Americans – And How We Take It Back.

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