WASHINGTON (AP) — Adult caregivers looking after aging relatives and friends have little training for their stressful roles but still find the experience rewarding, according to a poll released Thursday.

The Associated Press-NORC Center for Public Affairs Research survey finds that long-term caregivers don’t just provide rides to the doctor and run errands. Nearly half perform some kind of medical care, from changing bandages (30 percent) to inserting catheters or feeding tubes (6 percent).

Only 47 percent of those say they got most or all of the training needed for their often delicate tasks.

Despite all the challenges, more than 9 in 10 call their care-giving experience worthwhile, even if they also find it stressful (77 percent), and overwhelming (52 percent).

“It’s a labor of love, but it can be stressful,” said Cheryl Johnson, a factory supervisor from Bay Minette, Alabama, who along with other family members is caring for her elderly mother and stepfather. “Nobody can ever be prepared for that.” Her mother has liver disease.

The poll of people age 40 and over who have either provided or received long-term care offers a glimpse into homes across the United States where aging and disabled people are being cared for by an ad hoc army of relatives, neighbors and friends.

It highlights how long-term care remains a major unmet need for government programs and private health insurance.

The lack of training for caregivers is a shortcoming in the health system, said Judy Feder, a professor at Georgetown University McCourt School of Public Policy.

“Caregivers are taken for granted and they are invisible in the system,” Feder said. “It’s bad for them, it’s bad for care recipients, and it’s bad for the system because there’s evidence that if you engage them, it improves the quality of care.”

According to the poll, most caregivers are also trying to hold down jobs.

Johnson said her employer has been very supportive. “There have been times when they said, ‘Cheryl’s got to go home,'” she said.

Nearly half of caregivers say it’s moderately or very difficult to balance work and caregiving. Men are more likely to report that their employers are not at all supportive