Healthcare assumes every patient has a trusted adult nearby. That assumption quietly transfers an essential part of care onto families—most often women.
I recently read about Capital F, a new venture firm investing in what its founders call the “female economy”: markets in which women drive demand and where their needs have historically been overlooked.
It is an encouraging and overdue investment thesis. It also brought me back to a blind spot I see in nearly every conversation about women, healthcare, work, and caregiving.
We talk about women as family healthcare managers. We talk about the days they miss from work, careers they interrupt, earnings they lose, and institutional knowledge their employers lose with them. We talk about childcare, eldercare, home care, hospital-at-home, and support for people managing chronic illness.
But we rarely talk about the millions of individual healthcare events that depend on a woman simply being available.
A father needs someone to take him to a colonoscopy and remain responsible for him afterward.
A husband needs an escort after cataract surgery.
An adult child has moved away for college or a first job and needs a procedure in a city where no trusted person is close enough to help.
An older parent lives several states away from the son or daughter who manages appointments, prescriptions, and decisions from a distance—but cannot board a plane for every outpatient procedure.
Or the woman herself needs a procedure and postpones it because she is everyone else’s responsible adult, yet has no one available to be hers.
We do not usually call this caregiving.
That may be why we do not count it.
The overlooked category: episodic healthcare support
Most caregiving research understandably focuses on ongoing assistance for older adults, children, people with disabilities, or people living with complex medical conditions. That work is enormous. AARP and the National Alliance for Caregiving estimate that 63 million Americans—nearly one in four adults—provided ongoing care in 2025. Women remain the majority of caregivers.
But there is another category around the edges of those statistics: episodic healthcare support.
It may involve only one procedure or one day. It is not necessarily clinical. It may not look like traditional home care. Yet it requires time, trust, physical presence, responsibility, and coordination.
After sedation or anesthesia, a facility may require a responsible adult to receive discharge instructions, escort the patient home, and help ensure the patient is safely settled. A taxi or rideshare can provide transportation. It cannot necessarily assume responsibility for the patient.
That distinction matters. The missing resource is not always a ride.
It is a person.
Love is not the missing resource. Physical availability is.
Sometimes the patient truly has no one nearby. But often, the patient has people who care deeply.
That person may be a daughter living three states away. A son who has just started a job in a new city. A college student without a car. A sibling managing children, work, and another aging parent.
These families are not absent. They are geographically distributed.
More than 10 percent of family caregivers already live at least an hour from the person they support. Many others coordinate care for relatives without identifying themselves as caregivers at all.
Yet healthcare still operates as though every patient has a trusted adult living nearby who can leave work, drive to a facility, wait through a procedure, receive discharge instructions, and remain with the patient afterward.
Love is not the missing resource.
Physical availability is.
Women have become healthcare’s default shock absorbers
When formal systems stop at the facility door, families absorb what remains. Within families, women still absorb a disproportionate share.
Their time is treated as free. Their availability is treated as unlimited. The consequences for their work, income, health, and other responsibilities are treated as somebody else’s problem.
The economic effects are not confined to a single missed afternoon. The U.S. Department of Labor estimates that unpaid family caregiving reduces a mother’s lifetime earnings by 15 percent—an average employment-related cost of approximately $295,000, including lost earnings growth and retirement income.
The workplace effects are already visible. Seven in ten family caregivers are employed. Research has found that working caregivers reduce hours, turn down promotions, take leaves of absence, and sometimes leave the workforce entirely.
Employers lose more than hours. They lose continuity, judgment, relationships, and institutional knowledge—the accumulated understanding that makes an experienced employee especially valuable and cannot be restored simply by filling a vacancy.
Traditional caregiver benefits are important, but they tend to focus on information, referrals, flexibility, or ongoing care. Those services do not necessarily provide the trusted person who can physically appear at 6:30 on a Tuesday morning and complete the last mile between outpatient care and home.
The patient pays a price, too
When no responsible adult is available, a patient may postpone a procedure, conceal the problem until the last minute, or cancel altogether.
That affects more than scheduling.
The patient may live longer with pain, uncertainty, reduced mobility, or an untreated condition. The family member trying to coordinate from another city experiences worry and guilt. The healthcare facility loses clinical time that may be difficult to refill. Staff repeat work. A carefully arranged surgical event comes apart because one nonclinical requirement was never truly resolved.
Software can send another reminder. A scheduler can ask again whether the patient has an escort. A dashboard can flag the risk.
But identifying the problem is not the same as solving it.
The gap is physical. The solution must eventually become physical, too.
From family assumption to healthcare infrastructure
This is why we are building Kithli.
Kithli is being designed to connect outpatients with vetted, insured companions—Kiths—who can serve as the responsible adult, provide door-through-door accompaniment after an outpatient procedure, and help ensure the patient is safely settled at home.
Patients and Kiths will be able to connect before the day of the procedure. That matters. A patient recovering from sedation should not have to leave with a total stranger who was assigned at the last moment. Compatibility, familiarity, and trust are part of the service—not decorative extras.
For a son or daughter living far away, a Kith does not replace involvement. The family can remain informed and connected without having to personally perform every physical task.
For an employee, Kithli can provide an alternative to sacrificing a workday—or asking a colleague to cover again.
For a healthcare facility, Kithli can help turn a known risk into a resolved requirement rather than another reminder in the patient record.
And for a patient with no nearby support network, a Kith can be the difference between having a procedure and postponing it indefinitely.
Kithli does not replace family caregiving.
It makes family caregiving less compulsory.
A missing piece of the female economy
The female economy does not need only more products marketed to women or more services that help women perform the work already assigned to them.
It needs infrastructure that stops assuming women will provide missing labor for free.
That is the larger opportunity behind Kithli. The responsible-adult requirement after outpatient procedures is the immediate gap. The broader challenge is building the clinical logistics infrastructure that helps outpatient healthcare work in the lives people actually have now: smaller households, geographically distributed families, longer careers, more people living alone, and fewer relatives who can be physically available on demand.
Healthcare currently assumes every patient has a trusted adult nearby.
Kithli is building the trusted human infrastructure for when they do not.
No surgery should be cancelled because a patient had no one.
What is episodic healthcare support?
Episodic healthcare support is nonclinical assistance required for a specific medical event rather than ongoing daily care. It can include accompanying a patient, receiving discharge instructions, escorting the patient home after sedation or anesthesia, and helping the patient get safely settled.
Why can’t a patient simply use a rideshare after outpatient surgery?
A rideshare provides transportation. After sedation or anesthesia, a healthcare facility may require a responsible adult who can receive instructions, assume responsibility for the patient at discharge, accompany the patient home, and provide appropriate support. Transportation alone may not satisfy that requirement.
What is distance caregiving?
Distance caregiving occurs when someone helps coordinate or manage another person’s care while living too far away to provide routine in-person assistance. Families may be highly involved emotionally and administratively while still being unable to appear physically for every appointment or procedure.
How can the responsible-adult requirement affect employers?
Employees may need to miss work, reduce hours, decline advancement, or leave jobs to meet family healthcare responsibilities. Employers can lose productivity as well as continuity, relationships, and institutional knowledge. Practical services that resolve specific in-person needs can complement leave, flexibility, and caregiver-resource benefits.
What is Kithli?
Kithli is building Clinical Logistics-as-a-Service for outpatient care. Its first service will connect patients who need a responsible adult after sedation or anesthesia with vetted, insured Kiths who provide trusted door-through-door accompaniment from discharge until the patient is safely settled at home.
Sources
- TechCrunch, Capital F closes $17M debut fund with goal to back the future of the “female economy”
- AARP and National Alliance for Caregiving, Caregiving in the U.S. 2025
- Caregiving in the U.S., Living Situations and Caregiver Distance
- U.S. Department of Labor, Lifetime employment-related costs of family caregiving
- AARP, Caregiving’s effects on working caregivers