Toward Caregiver Flourishing: A Framework for Sustainable Capacity in Dementia Care

Burden frameworks document what dementia caregiving extracts but offer limited vocabulary for how care holds together over time. This article develops flourishing, sustainable capacity under conditions, as a complementary framework. Drawing on 20 in-depth interviews with family caregivers in Emilia-Romagna, Italy, and the rural Midwest United States alongside 12 months of fieldwork, I describe four domains where caregivers performed ongoing work: connection (mobilizing actionable support), mastery (building routines and lay expertise), identity (preserving selfhood beyond care), and meaning (locating difficulty within purpose). The comparative design examines whether these domains appear across differently organized contexts; they appeared in both, although each took form according to local logics of obligation and selfhood. Caregivers sometimes reported profound strain while demonstrating expertise that had sustained care over years-a pattern suggesting burden and capability may operate as distinct dimensions. The framework offers vocabulary for describing not only what caregiving costs but also what caregivers build.