This article reports on qualitative research project, in-depth ethnographic interviews and focus groups of African American caregivers during a stressful time in their family development – caregiving at the end of the life – and the grieving through the aftermath. Results suggest that formal care is complicated by the distrust that many African Americans hold toward the health care system. The findings also highlights the importance of hearing from African American families to gain an understanding of what services, including family therapy, and other psychotherapy that families will need during this process.