With increasing longevity, the prevalence of chronic disease including Alzheimer and related dementias (ADRD) is rising, representing a significant public health challenge globally. Informal caregivers play a vital role in supporting affected elderly people in many ways. While caregiver’s access to appropriate medication is crucial in effective disease management and the health outcomes of the individuals they care for, their capacity to provide care is complicated by various physical, emotional, social and financial burdens. In rural South Africa as in many low- and middle-income countries (LMICs), home-based health care is undertaken with minimal resources and support. Caregivers often encounter difficulties in accessing medication for themselves, other family members and for their care recipients. I draw on population survey and ethnographic data, involving 1012 caregivers and 21 households respectively, to explore questions of access, and the implications of this in terms of continuity of care. These data derive from a collaborative research project nested in a larger study on health and aging, particularly dementia, conducted in the Agincourt Demographic and Health Surveillance site in rural north-eastern Mpumalanga Province. The data provide rich insight into caregivers’ lived experiences of accessing medication on behalf of older people in their care, who were often unable to access the medications they needed independently. I illustrate how caregivers plan and manage to access these medications and support adherence, in a context in which they face personal, logistic and financial challenges. These challenges are complicated by historic neglect, under and post-apartheid, and continue despite government goals to integrate chronic disease management. I illustrate the complex dynamics of medication access, while highlighting the need for targeted interventions to address caregivers' needs effectively.