Elder Caregiving: Will you be ready for the challenge?

Love, respect, and devotion to one’s spouse or parent manifests itself in many ways but perhaps most meaningfully as the sense of obligation to care for that person throughout their old age. Based on the demographic trends in the U.S., an increasing number of us will be called upon to care for our elderly relatives. Those who have not yet played this role, however, could be caught unprepared for the physical, emotional and financial challenges associated with it.

According to a 2014 study published by the Department of Health and Human Services (DHHS), providing long-term, informal care for aging and vulnerable family members rather than paying for outside help is the norm in America. Approximately 20 million unpaid caregivers provide care to almost 10 million older (aged 65+) adults who are unable to perform essential daily tasks on their own. Not surprisingly, this assistance is concentrated among the highest-need recipients including those suffering from dementia and debilitating physical conditions. In those households, informal caregivers, who are overwhelmingly elderly spouses and adult children, provide an average of 30 hours per week of assistance.

Dramatic shifts in our nation’s elderly population caused by increasingly longer life spans virtually ensure that geriatric care demands on family members will escalate in the future. In 2012, the 65-74 age group numbered 24 million, more than ten times that in 1900. The 75-84 group was 13.3 million or 17 times larger, and the 85+ group numbered 5.9 million which was 48 times larger. By 2040, there are projected to be 80 million older persons, over twice the number living in 2000. Within that group, the 85+ subset is projected to more than double from 5.9 million in 2012 to over 14 million in 2040. The burdens on caregivers increase with the severity and duration of the patients’ disabilities and is closely correlated with advancing age. The reality is that guiding sick loved ones through old age will be a more demanding and protracted commitment than ever before.

Because of its profound implications, the area of family caregiving has been the focus of intensive research. Several themes emerge with remarkable consistency across the numerous studies.

First, there is a growing body of evidence that for patients with chronic health conditions, what matters most is the relational rather than the functional aspects of their care. Functional refers to the quality and efficiency of the clinical care. Relational, on the other hand, relates to the elder person’s sense of dignity and self-esteem. It has to do with being listened to, having meaningful involvement in decisions about their care and being supported emotionally in a respectful way. It’s not surprising, then, that in most instances caring for frail family members at home results in a material improvement in the patients’ lives and better health outcomes. There is also a higher overall sense of well-being and a slower rate of mental and physical decline.

The second line of research on family care has focused on the effects on those who provide the care. Studies have shown that while the patient benefits from this personal attention, it is often to the detriment of the caregiver. The work can be physically exhausting and emotionally draining, involving a huge range of responsibilities like managing activities such as administering medications and navigating a complex health care system. It also includes attending to the full spectrum of personal care (eating, bathing, etc.) and household management (shopping, cooking, cleaning, paying bills, etc.) needs. Furthermore, as the health conditions of the elderly worsen, the demands on the caregiver intensify. It is particularly difficult for the caregiver who is an elderly spouse simultaneously coping with their health limitations or an adult child juggling other important family and job responsibilities. Not surprisingly, caregivers suffer from high rates of anxiety, depression, social isolation, and physical health problems. Caregiving has been described as a “life deferred”. Sleep, good nutrition, exercise and time spent with other family members and friends are often sacrificed in order to attend to the needs of their loved one.

While the health effects of providing long-term care are significant, so too is the economic impact. The fact that the two are closely associated underscores the importance of both the patient and the caregiver of preparing financially for the task. Even for households whose family members bear the brunt of the daily caregiving responsibilities, certain outlays are unavoidable and substantial. For example, expenses for out-of-pocket medication, consumable supplies and special sleeping, bathing, and other equipment can easily total several thousand dollars each year. Also, if the physical demands of the work exceed the capacity of the caregiver, it may be necessary to hire outside help. Even a relatively low-skilled home health aide assisting for just two hours a day could easily cost $30,000 per year.

The true financial impact on families, however, extends far beyond the out-of-pocket expenses. Caregiving responsibilities can have a negative effect on employment. The compromises required, including a reduced schedule and passed up opportunities for overtime or promotions, can adversely affect a career. The result could be lost income, smaller retirement savings and reduced pension and Social Security benefits. Although projections vary depending upon the assumptions used, one study conducted by the National Center on Women and Aging estimated that on average, caregivers lose almost $650,000 over a lifetime in lower pay and other benefits.

Although much of the discussion around caregiving is framed in terms of the burdens and difficulties, many caregivers perceive and describe their role as gratifying and personally rewarding despite the sacrifices it requires. The act of caring for an elderly spouse or parent seems to satisfy the basic human desires to aid and protect those who are vulnerable and improve the quality of life of a loved one. In the process, it can strengthen bonds, bring the family closer together and perhaps even model the kind of behavior that they hope to instill in their children and grandchildren.

A long life is a blessing in many respects. It allows us to spend more time with our family members and experience more throughout the course of our lives. Naturally, however, it is often accompanied by the realities of age-related limitations and illness. Because of financial constraints, shortcomings in our country’s long-term care system and other factors, elderly Americans in failing health will continue to rely primarily on family members to assist them in old age. For those providing the care, it can be a difficult proposition. However, with proper financial preparedness, one aspect of this challenge can be alleviated, allowing caregivers to maintain a higher quality of life for themselves and provide better care for their loved ones, too.

By: John Spoto, Sentry Financial Planning, LLC, 49 Lowell Street, Peabody, MA (978) 475-2533

Sentry Financial Planning is a member of the Peabody Area Chamber of Commerce