Over a third of patients reported substantial care needs, such as transportation, homemaking (for example, cooking and housecleaning), personal care (for example, bathing and dressing), and nursing care (for example, administering medications). Poor physical ability, being older than 65 years of age, being incontinent of urine or stool, and having a low income were associated with the greatest care needs. Patients with substantial care needs were more likely to report financial burdens, such as having to spend at least 10% of household income on health care, having to take out loans, having caregivers who needed to work two jobs, or having to spend savings. Patients with substantial care needs were also more likely than those without such needs to consider voluntarily ending their lives. Caregivers of patients with substantial needs were more likely to be depressed and to report that caring for the patient interfered substantially with their own lives. Patients who reported having physicians who listened to the patient and caregiver reported fewer caregiver burdens.