The ACH Model as a Resource for Family Caregiving
Last month, we celebrated my mom’s 85th birthday. It was a beautiful milestone that made me reflect on all we went through this year to get there.
In May, my mom was rushed to the ER with a cascade of life-threatening complications: diabetic ketoacidosis, a bloodstream infection, septic shock, and cardiac arrest. It was one of those life-altering moments that reminds you how quickly everything can change and how important it is to have structures in place to make decisions and plan under pressure.
True to form, my mom fought her way back. Her recovery has been nothing short of extraordinary, thanks to timely medical care, the steady presence of people who show up when it matters most, and a journey that’s left us with a renewed appreciation for life. Now, we find ourselves in a different phase, one that’s less about crisis response and more about healing and caregiving.
It’s in this slower, and often more complex, chapter that I’ve found myself thinking deeply about the Accountable Communities for Health (ACH) model—the very framework I work to advance through CACHI, the California Accountable Communities for Health Initiative. In my work, we support local collaboratives across California that are building the infrastructure for health equity by centering community voice, fostering multi-sector partnerships, and aligning systems around what communities actually need.
The ACH model wasn’t created for families. But caregiving, especially when shared across siblings or a broader support network, requires many of the same skills we ask of community partners: bringing together multiple perspectives, navigating complexity, and building consensus around a shared goal.
As it turns out, many of the same principles that make ACHs successful could be just as powerful in the intimate context of caregiving. What’s often missing, however, is a framework: something that organizes all of that goodwill into coordinated action. This is where the ACH model has so much to offer, as both a public health strategy and a lens through which families might structure support for aging parents and elders.
When a loved one falls ill, especially in a sudden and severe way, most families instinctively mobilize. Some people jump in to manage hospital logistics or talk to doctors. Others handle food, rides, or calls to friends and family. Still others keep watch, offer comfort, or simply hold space.
But without structure, that instinctive mobilization can quickly lead to confusion, burnout, or missed needs. This is where the ACH model offers lessons worth borrowing.
Backbone Support, Shared Responsibility, and Decision-Making
In an ACH, a backbone organization plays a central role: holding the vision, coordinating communication, and helping partners align toward shared goals. But it doesn’t do everything. Each stakeholder brings unique capacities and contributions.
Families often have a “natural” backbone—the sibling or relative who steps up to coordinate appointments, medications, or conversations. But for that structure to be sustainable, everyone else must take meaningful ownership too. Without shared responsibility, the backbone role becomes isolating and unsustainable.
We need to create space for each person to step into a role they can sustain: whether it’s coordinating appointments, ensuring bills are paid, maintaining the home, or simply staying emotionally connected. What matters is that everyone contributes to a shared effort and that no one carries the weight alone.
Center the Voice of the Person Receiving Care
A core tenet of the ACH model is that people with lived experience are the experts. Systems are more effective when they listen to, and are accountable to, those they serve.
The same is true for families. During my mom’s recovery, it was tempting to make decisions for her about where she should live, what routines she should adjust, or what activities to forgo. But her desire to stay in her longtime home wasn’t just about logistics. It was about identity, community, and continuity.
Listening to her deeper needs—autonomy, connection, and dignity—helped us ground our choices in what actually mattered. It reminded me that centering the voice of our elders isn’t just a courtesy but a practice of care, love, and respect.
Align Around Shared Goals
ACHs succeed when everyone is aligned around a shared vision, whether that’s reducing chronic disease or improving behavioral health. That shared purpose keeps partners focused and minimizes conflict.
In families, especially those with multiple decision-makers, alignment is equally essential. What does “aging well” mean for your loved one? What trade-offs are you willing to make? What values guide your decisions?
One recurring conversation in our family has been whether my parents should move closer to one of us or stay in their home. In moments of crisis, moving felt urgent. But once the dust settled, we realized the decision couldn’t be just about convenience but had to consider meaning, identity, and autonomy. Being in alignment about what matters has allowed us to shift from reaction to thoughtful planning.
A Culture of Communication
The ACH model emphasizes continuous engagement, feedback, and trust-building. Families need this too.
For many of us, especially in immigrant families or families of color, open disagreement wasn’t modeled. We may not have grown up practicing tough conversations with compassion and care. But caregiving demands that we do. It’s hard to navigate roles, expectations, and decisions without a shared communication culture. And when that culture doesn’t exist, caregiving becomes reactive, strained, and uneven.
This isn’t just about talking more. It’s about creating space to check in regularly, disagree respectfully, and make decisions together, even when it’s uncomfortable.
A Call for Systems and Policy Action
What this experience has reminded me is that caregiving is personal, political, and structural.
If we understand families as a core part of the care infrastructure in this country, then we need public systems and policymakers to support them as such.
That means:
Investing in community-based resources—like care navigators, peer support, and respite care—that help families organize and share the caregiving load.
Training health and social service providers to see family caregivers as essential partners in care, not invisible extensions of the patient.
Expanding paid leave policies, flexible work arrangements, and financial support for caregiving across all income levels—not just for those with employer benefits.
Designing policy and infrastructure that accounts for families of all kinds, including those caring alone, navigating conflict, or living across distance.
For too long, caregiving has been treated as a private issue. But the emotional, financial, and systemic costs are all public. And if we don’t build supportive infrastructure now, we’ll continue to rely on unpaid, undervalued labor to hold up the entire system.
Closing Thoughts
In Filipino culture, there is a beautiful word: kapwa. It speaks to a shared sense of identity and mutual care—a recognition that we are fundamentally interconnected. In times like these, kapwa is not just a value to hold, but an organizing principle to guide how we show up for one another.It’s what compels people to step in,not because it’s convenient or easy, but because mutual responsibility is a cultural norm and moral imperative.
Caregiving is one of the most profound and challenging acts of kapwa. Care work, often invisible and undervalued, becomes the quiet labor that holds families and communities together.
The Accountable Communities for Health model is also a form of kapwa. It doesn’t just ask what programs or services a community needs. It asks: what infrastructure do we need to keep each other well? What roles do trust, relationships, and shared purpose play in advancing health and equity?
Families should ask these same questions. What keeps us connected, even when we disagree? How do we make decisions when it matters most? What are the rituals and practices that help us care for our elders not only as patients but as whole people?
The ACH model was designed to transform systems not families. But its core elements offer a powerful guide for families navigating care: center the voice of those most impacted, coordinate contributions across the family and support network, and align efforts toward a shared vision of what aging well can look like. In this way, the ACH model offers a template for how families can bring that same intentionality, infrastructure, and sense of shared stewardship into our homes.
