Traditionally care giving was support that was provided to the elderly by family members, and through state and private institutions. Predominantly it was family members, most often children that would take a parent into their homes and provide all necessary care.
This would be through physical assistance with activities such as dressing bathing, shopping and also by providing shelter and meals, which is financial support. State run facilities would provide care for the indigent who did not have families that could provide support.
The emergence of privately run facilities provided care to millions of Americans. These facilities were privately owned and operated, but the vast majority of their revenue came from the sate and federal governments. There were some direct funds but mostly it from fees charged to the consumer and paid for with social security checks and federal insurance programs like Medicaid.
Higher quality private facilities have emerged that generate their revenue from wealthy individuals who can pay out of pocket and through long term care insurance policies. Care giving is provided to some extend by all members of society either directly, through taxation to pay for social programs or by the exercising of insurance policies.