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Who'll be there when boomers need elder care?

Just after Jane -- a working wife, mother and daughter -- saw her grown children move out on their own, she inherited another "child": her 90-plus-year-old father.

He had reached the age Shakespeare referred to as "mewling and puking," refusing to get out of his wheelchair until an assistant came to help him in the bathroom. The psychological trauma of several near-death experiences had instilled a fear of falling. 

He rebounded from the physical problems but refused to reside in assisted living and opted for a nursing home instead, even though it was costly and his limited funds would soon run out. When his money is gone, the financial burden will fall on Jane and her siblings, none of whom have the ability to care for him in their homes. 

"Jane" is a fictitious name, but her story is real. It's a sad story, but it could be a weather vane for what will happen when her baby boom generation needs help and fewer children will either be able or willing to care for their aging parents.

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"The resulting higher ratio of parents to children suggests a potentially bigger burden for the baby boomer generation's children," according to a study by the Center for Retirement Research (CRR) at Boston College. "To the extent that this burden is too much to handle, it will likely fall on formal care providers and insurers, particularly public programs like Medicaid."

Ironically, Jane and so many others will attain the age of vulnerability in 2033, just when the Social Security Trust Fund is due to either run out of money or cut back benefits by around 20 percent.

The CRR study analyzed three factors. First, the need for elder care and how much of it adult children provide. Second, the burden of that care on adult children like Jane. Third, the number of adult children who actually provided the care and what it costs them, both now and in the future when they may need similar assistance themselves.

Less than 20 percent of people in their 60s need care, but by age 85 more than 50 percent will require assistance to tie their shoes, use a cell phone, cook and, sometimes, just get out of bed. Their first choice for such a helper: a family member, usually one of their children.

The burden may fall on children regardless of whether they volunteer. According to the CRR study, about 17 percent of children will provide parental care at some point in their lives. 

But the burden rests more heavily on the shoulders of children aged 70 and older, the ones for whom bending and lifting are the hardest. While many children find ways to avoid being put in this position, those who don't wind up putting in a lot of time -- an average of 77 hours a month, or about two weeks of work. For those who've retired and are more than 70 years old, it's even greater -- 95 hours a month.

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When the time comes, who actually assumes responsibility for mom or dad? Usually daughters and, in particular, unmarried ones. Living closer to the parent means they're more likely to be called on for help as opposed to siblings residing out of state.

Children whose parents still have a living spouse, have long-term care insurance or are eligible for Medicaid aren't bothered as much. And when it comes to care, children tend to discriminate between parents. They provide care for married parents and widowed and divorced mothers at similar rates, but divorced fathers fare worse, the study showed.

Jane and her siblings found out rather quickly just how expensive nursing homes can be, but care provided by relatives can cost even more. According to the CRR, "The cost of informal care in the United States was $522 billion in 2012, more than double the total cost of formal care at $211 billion."

"In recent surveys caregivers reported that they spent 35 percent of their budget on parental care," said the CRR. The financial assistance that caregivers provide is -- in most instances -- more than what they spend putting a roof over their own heads.

Becoming a caregiver has forced Jane to do a balancing act with her full-time job. Companies are required to give parents consideration for child care, but senior care doesn't merit the same response. That's why many people wind up exiting their careers earlier than originally thought. 

Men who provide this type of care were 2.4 percent less likely to work, but the biggest burden fell on women, the study showed. Women were more likely to stop working and, even if they didn't, wound up working three to 10 hours less per week and earning 3 percent less.

The hard work of caring for someone who is bedridden or in a wheelchair also takes a toll. Women caregivers experienced more pain and 47 percent higher out-of-pocket health costs for themselves. Both men and women became increasingly depressed and had a higher incidence of heart disease.

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So will the baby boomer generation see their children step up to care for them? A low birthrate makes it increasingly unlikely. Jane and her siblings were part of a huge post-World War II population explosion, which is how they earned the name "boomers." In contrast, in 2016 the birth rate was at its lowest in 100 years.

America's fractured and changing culture also works against baby boomers. Divorce is more common, which often leaves one parent outside the family unit. Some children move further from home -- often across the country -- and so can't be counted on in an emergency.

The CRR warned about this: "The informal care the boomers need may not be there, and the demand for formal care may soon increase." The Center said an average couple aged 65 incurs $200,000 in uncovered medical expenses, and the cost of this is likely to fall on the "already overburdened Medicaid system," which handles care for the indigent.

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