Purpose: This study explores the role of the family as the primary source of support in elderly care, focusing on its impact on older adults’ well-being, quality of life, and social inclusion, as well as the challenges faced by family members in fulfilling caregiving responsibilities. Method:The paper is based on a narrative literature review of recent theoretical and empirical studies, international reports, and policy documents, using a conceptual framework drawn from the sociology of ageing, family studies, and social policy analysis. Findings: The analysis shows that family care encompasses emotional, social, physical, and economic dimensions that are essential to maintaining autonomy and dignity in later life. While consistent family involvement enhances psychological resilience and social participation among older adults, caregiving is also associated with financial strain, time constraints, and emotional exhaustion for family members particularly women. In contexts such as Romania, where institutional care remains limited, families compensate for systemic gaps, resulting in a highly familialized care regime. Conclusion: The family remains a key actor in elderly care; however, its effectiveness depends on the availability of formal support mechanisms and public policies that recognize and assist caregivers. Strengthening both family resources and institutional frameworks is necessary to ensure a balanced, sustainable, and inclusive caregiving model in ageing societies.