Cultural ideologies, which build on ideas of gendered responsibility, intergenerational obligation, and reciprocity, interact with the pragmatics of need and availability to influence family decisions about the provision of care. People who are frail and elderly, as well as the very young, and others who for cognitive or functional reasons require high levels of support, depend on home-based care. I draw on research conducted in northeast Mpumalanga, South Africa, where colonial, apartheid, and post-apartheid policies, and migration flows and rights, have produced endemic poverty. Today, the region is densely populated, but with few opportunities for paid work and poor access to formal health care and medical services. Structural, social, and economic constraints determine that the general provision and receipt of care are taken on by families. In interrogating the distribution of and costs of care, I highlight the convergence of circumstance, ideology and policy. While people may draw on diffuse personal networks for assistance with emergencies, most everyday care practically is located within households. Care work largely falls to one person, seen to be most readily available, and with little practical or other opportunity to do otherwise. Primary caregivers often have constrained personal support networks and lack the negotiating power to adjust how care is delivered and who (else) might be involved. State policies and infrastructures of neglect, and disenfranchisement, amplify the difficulties faced by those most constantly involved in providing everyday care. Reimagining anthropology as a praxis of care requires that we find ways not only to give voice to those without support for the work they provide; but also to interrogate how in practical and realistic ways, state systems and local networks might acknowledge and support home-based caregivers. In this way, through its application, an anthropology of/as care is explicitly political.