Background <p>Informal caregiving is a critical component of elderly care, particularly in countries like Romania where formal long-term care (LTC) services are underdeveloped or inaccessible to many. Family caregivers often provide the majority of daily care, yet little is known about how they perceive this role - whether it is taken on voluntarily, out of love, as an unavoidable necessity, a combination of the abovementioned, or out of other reasons. This study explores Romanian caregivers’ perspectives on the motivations behind caregiving, their lived experiences, and their preferences and expectations regarding future care arrangements, especially in the context of a healthcare system that does not formally recognise or support their contributions.</p> Methods <p>A qualitative study was conducted using in-depth semi-structured interviews with 14 informal caregivers, primarily family members caring for elderly relatives. Participants were purposively recruited to reflect a diversity of caregiving contexts (e.g. spouses, adult children, grandchildren). The interviews explored motivations, challenges, rewards, and perceptions of formal support systems and LTC alternatives. Transcripts were analysed in the original Romanian language using inductive thematic analysis, with emergent themes later translated into English for reporting.</p> Results <p>Caregivers described a continuum between obligation and choice. Many viewed caregiving as a moral responsibility driven by family values or reciprocity, while others emphasized their personal willingness and affection, reporting they cared “with no feeling of obligation, only love.” Participants often reported burdens including emotional and physical exhaustion, financial strain, social isolation, and limited access to formal support. Despite these challenges, caregivers also expressed emotional rewards such as fulfillment, pride, and strengthened family bonds. Most preferred home-based care over institutional care, citing cultural norms, cost, and mistrust of facilities. At the same time, caregivers voiced strong needs for more structured support: accessible information, formal training, and inclusion by healthcare professionals.</p> Conclusions <p>Informal caregivers in Romania play an indispensable role in supporting the elderly, often with minimal formal assistance. Their work is driven by both love and obligation and marked by both burdens and rewards. Findings point to the urgent need for policy reforms that recognise informal caregivers and provide structured support - through financial, educational, and psychosocial interventions -within a more integrated and culturally responsive LTC system.</p>