CARING FOR YOUR AGING PARENTS Three pillars will support your parents: the government, their own assets and you. Here's how you can help them cope with a wide range of health, housing and financial problems.
By Augustin Hedberg Reporter associate: Jacqueline Smith

(MONEY Magazine) – Face this fact: If you have a parent alive today, you likely have a crisis waiting for you somewhere down the road. Sooner or later that parent will need help. The problem your parent will have may be financial, medical or emotional. Often it will be all three at once. And inevitably you will be central to the solution. However you choose to lend your support -- whether with money, time or a compassionate blend of both -- the effect upon your own life will undoubtedly be seismic. Consider the following: an estimated 7 million to 8 million adult Americans now provide personal care to their parents, in-laws or other elderly relatives. And an estimated 20% to 25% of the employees at any typical U.S. company spend six to 35 hours a week on responsibilities to the elderly, equivalent for some to a second full-time job. According to a recent study by William M. Mercer Meidinger Hansen, a consulting firm based in New York City, the demands placed upon these workers eventually force 12% of them to quit their jobs and another 55% to reduce their work hours. Take the poignant and not atypical case of Alita Dougherty, 45, a finance manager for a home- building firm. Three years ago, when her mother Margaret broke her leg, Alita had to give up her job and the man in her life in Minneapolis and move in with her mother in Portland, Ore. In the years since, Margaret has developed incipient Alzheimer's disease, and Alita has had to give up a 30% higher paying job to allow her to spend more time caring for her mother. The burden placed upon women is particularly great. Three out of every four people who tend to the needs of the elderly in their families are female, according to a recent survey sponsored by the American Association of Retired Persons (AARP) and the Travelers Cos. Foundation. The same study found that more than half of these women provide this care -- often, by the way, for in- laws -- while holding down full- or part-time jobs. Nearly 40% are simultaneously raising children of their own. (Indeed, statistics show that while these women spend an average of 17 years caring for their kids, they can expect to devote 18 years to caring for an elderly parent.) There is a name for Americans caught in this vise between young and old -- the sandwich generation -- and it is growing larger by the day. Over the next 10 years, the ranks of Americans age 65 and older will increase by 11%, while those age 85 and older will swell 42%. And as more of our parents live into their seventies, eighties and beyond, more of them will inevitably become ill or infirm. Even among those elderly who do not require acute medical care, nearly 60% need assistance to perform the most basic tasks of daily life -- paying bills, eating, dressing, bathing. More than a third of people age 65 or older, for example, find it hard to climb stairs or carry a bag of groceries. ''It's difficult when your parents get older,'' says Lucy Jones, 58, of Houston, who now visits her 89-year-old mother in an elder-care home four or five times a week, following a long period of looking after her at home. ''All those years they've been the boss, and then the child finds herself being the parent, and the parent must be the child. But if you love your parents, it's something you just do.'' We often castigate ourselves as a nation of self-centered baby boomers who, unlike past generations, care more for our own needs than those of the good folks who raised us. But the reality is quite different. The common image of the grizzled parent living out his or her last years in a nursing home is largely a myth. Today only 6% of all Americans 65 and older live in nursing homes. By contrast, 70% of the dependent elderly receive all of their care from family or friends. Says Dr. Robert Butler of the Mount Sinai Hospital geriatrics department in New York City: ''The surprising fact is that in America, children do look after their parents.'' What we typically do not do well, however -- if, in fact, we do it at all -- is prepare ourselves and our parents in advance for the help that they eventually will need. Yet the best way to avoid the most wrenching choices is to get ready for the worst while the older generation is still independent. Bill Wright, 69, kept a weather eye out for a comfortable retirement home for himself and his wife for years before he actually retired from his job as director of a charitable foundation. After moving to the head of a long waiting list -- it took seven years -- the Wrights were admitted to a home in San Francisco. ''We think it may well be the best present we've ever given our children,'' says Wright. There is no painless substitute for this kind of advance planning. But as the stories that follow in this MONEY special report prove, there are financial strategies that you can pursue (see page 148) as well as health-care and housing options to explore (see page 158) that will help you help your parents make the best of their situation. Use the resource list on page 169 as a supplementary primer. It's ironic that we spend so much time and money insuring ourselves against calamities like tornadoes and lightning. Yet we rarely think about the one crisis that is almost inevitable -- that our parents will need our help in their old age. In most families, the subject is taboo. Parents are perceived as being the ones who provide help. It is they, after all, who nurtured us through our infancy and through many years thereafter. In the eye of our childhood imagination, which we never quite outgrow, our parents are immutable, indestructible, one of life's constants. We recoil from the idea of openly admitting that they may someday be helpless. So do they. People struggle to stay in charge of their own lives. Acknowledging difficulties to your own kids, whatever their ages, can be one of the most painful parts of growing old. Rona Bartelstone, president of the National Association of Private Geriatric Care Managers, points out: ''It's very hard to go to someone whose diapers you changed and say, 'I need your help.' '' That need naturally leads to another ongoing problem: balancing the personal demands and expense of caring for your parents against your responsibilities to all the other important people in your life -- your spouse, your children, your employer and yourself. Constant compromises and tough choices are inevitable. Long-quiescent sibling conflicts resurface when one child feels that he or she is shouldering a disproportionate share of the burden. But it would require a Solomon to divide the load equitably in an increasingly centrifugal society where 25% of parents live more than half an hour's drive away from their nearest child. Where does one begin to calculate exactly what or how much one owes one's parents? And how can we be so crass as to talk of debt in a relationship as hallowed as that of parent and child? The answer is, of course, that we owe them everything. (It was they, after all, who gave us life.) And we owe them nothing. (We never asked to be born.) Employers, although not notably magnanimous when it comes to maternity leave and flextime to accommodate the child-rearing demands of the working parent, are, in general, even less understanding when an employee needs regular time off to care for an aging parent. True, the National Council on the Aging reports that at least 300 employers now offer elder-care programs, up from virtually zero five years ago. But that is still a .0002% sliver of corporate America. And most of these programs are merely informational -- that is, they provide seminars or pamphlets on caring for parents but are chary about granting leaves or arranging flexible working hours for an employee who must care for an elderly parent. Estimable exceptions include IBM, AT&T and Stride-Rite Shoes, which have put real time and money on the table. The Travelers Cos. of Hartford, Conn., for instance, has a program that includes counseling, flexible work time, four weeks of unpaid personal leave a year and a dependent-care allowance program that deposits pretax dollars from an employee's paycheck into a special account exclusively for elder care. Federal and state governments have not filled the private-industry breach. True, the Medicare Catastrophic Coverage Act of 1988, which entitles patients to an unlimited number of hospital days free after paying an annual deductible of $560, will help some families avoid the financial ruin that can attend the last years of an aging parent. But welcome as the subsidy may be, it is not single catastrophes but rather chronic disabilities, such as arthritis and hypertension, that most commonly afflict and impoverish the elderly. The current maximum tax credit for a person holding a job and caring for two or more dependents is only $1,440, far below the typical cost of professional care. More than 97% of the elderly, whether living at home or under professional care, at some time or another draw upon federal assistance. Their principal resources are Medicare, the national medical insurance program for the elderly, and Medicaid, the federal and state health plan for low-income Americans of any age. The inexorable racheting up of medical costs has virtually swamped these programs, which already account for 11% of all federal spending. Nevertheless, since 1984 the elderly have been using a greater percentage of their income for health care than they did before Medicare and Medicaid were launched nearly 25 years ago. And when parents can no longer afford their share of these bills, their children are typically the ones who pick up the tab. Still, the emotional components of caring for an elderly parent can quickly overwhelm financial concerns. As parents grow old and their role in the family structure changes, so does everyone else's, as Peter Guren, 37, of Cleveland has found out. For the past four years, Guren, a nationally syndicated cartoonist, and his two brothers have been sharing the costs and responsibilities of caring for their Alzheimer's-ridden father Jack. The past two years have been particularly difficult. For example, they realized they could no longer allow their father to drive because of his erratic memory. ''Taking his keys away,'' says Peter, ''that was a tough one.'' Four months ago the brothers placed their father in an Alzheimer's clinic, where Peter now visits his father every other day. Although bearing witness to his father's continuing deterioration is depressing, Guren takes comfort from his closeness with his siblings and stresses that not every aspect of caring for his father has been bad. ''I've changed my priorities,'' he admits. ''I mean, my business could be all-consuming, but the heck with it. When my own kids interrupt my work, instead of saying go away, I see what they need. My kids and people in general have become more important.''