Thirty years ago disorders of consciousness (DOC) were viewed as hopeless. Clinicians who offered rehabilitation were viewed with skepticism and families who sought it were viewed as unrealistic. Subsequent research has demonstrated surprisingly positive outcomes for a minority of patients with traumatic DOC, and new diagnostic and treatment options offer further improvements in the future. But the fact remains that many with prolonged DOC will not recover functional independence and the impact on their caregivers and society is profound. How can clinicians and researchers support prolonged functional recovery while also acknowledging the complex impacts of prolonged caregiving?