Think Now About Tomorrow's Aging Families

Demographers project that by the year 2050, 1 in 4 Americans will be elderly. Many of these elders, particularly those who are frail or over 85 years of age, will require assistance from their families over the long term if they are to remain out of nursing homes.

In turn, those families will need our help.

The United States, however, is ill-prepared for the changes that are about to take place as we rapidly enter an aging society.

As Congress debates changes in the eligibility and coverage of Medicare and Medicaid, we need to keep in mind the impact that these changes will have not only on the elderly but on their families as well.

Unless we turn our attention to and prepare to meet the needs of adult children caring for elderly parents, families will be besieged by yet one more stress that could break the camel's back.

Over the last four years, I've been gathering data on middle- and working-class adult children who care for elderly parents. I've met with and interviewed 50 adult children in central Massachusetts - it was a privilege to go into their homes and share their lives.

I've interviewed adult children who have sacrificed their marriages and their jobs because their parents always told them that they never wanted to go into a nursing home.

They provide the kind of care that none of us even wants to think about, let alone undertake for years at a time, such as changing and cleaning incontinent parents. Yet they did not complain or see it as a burden.

They told me that they would continue to care for their parents as long as possible. They did it out of love and a desire to pay parents back for all that had been done for them.

These families provide care to their elders against overwhelming odds and competing responsibilities.

All of those I interviewed had worked outside of the home at some point while care-giving. Yet half made significant changes in their employment that were at least spurred on by caregiving demands, if not totally attributable to caregiving. This included cutting back on hours, switching to part-time work, and quitting jobs.

How many of us, already burdened by financial pressures, are prepared to make such sacrifices in the future?

Exhausted and often fighting back tears, those who did not alter their work because they were single parents or sole income earners told me of the toll that it took on them to be caregivers while also working.

For example, Ruth, a full-time manager in a high-pressure office and the single parent of a college-aged daughter, had only Sunday afternoons to herself to clean her own house and do her own laundry.

She said she was so short of time that she would iron only the front of her blouses.

She told me that she didn't have time to go out on a date, to plant flowers in her yard, or to even have lunch with her own daughter.

Caregivers also struggled with the lack of assistance from other family members, particularly siblings.

According to the results of my study, 68 percent received little or no help from siblings, 20 percent received some limited help, and only 12 percent were part of a network of siblings who shared in the tasks of caring for their parents.

Hurt and incredulous at their siblings' unwillingness to help, over half were in conflict with brothers and sisters. Angry and exasperated, they told stories of trying to get siblings to help, only to be disappointed time and time again.

JEAN, for example, stated that she had always had a good relationship with her brother and sister; that they were a close-knit family. She had expected that they would help her to care for their mother. But when I interviewed her, the siblings were not even speaking to each other.

Her brother felt that since she had taken on the responsibility, Jean should do the work herself. Because Jean had taken possession of a priceless family heirloom, her sister believed that she shouldn't be expected to help Jean care for their mother.

Jean believed very strongly that her relationship with her brother and sister would never be the same.

And where will adult children be in the future as more and more of us find, like the Jeans and the Ruths of our generation, that our aging parents need our assistance?

The Family and Medical Leave Act of 1993 provides that companies with 50 or more employees must give up to 12 weeks of unpaid leave to employees who must care for a sick family member. But the adult children in my study said time and again that that was tantamount to providing nothing at all.

Family members need our help, and they need it now. They don't want the government to provide care for them, but they do need the assistance that will enable them to provide care themselves for their aging families.

According to the caregivers I interviewed, the following changes are necessary to make it possible for families to continue to take care of their elders:

Make respite care more affordable.

If it were more affordable for the paid professional caregiver to come temporarily into the home to stay with the parent, it would allow adult children to occasionally spend time with their own families and provide time to meet their own needs.

This kind of a break would make it more feasible for adult children to continue to provide care to their parents over a longer period of time, keeping them out of nursing homes, for example.

Extend adult day-care hours.

Working people who care for elderly family members frequently rely on adult day-care programs, but such programs often end several hours before adult children are able to return home from work.

If adult day-care centers were open through normal working hours, this would allow caregivers to continue to work outside the home when necessary. It would also extend the length of time adult children can be long-term caregivers.

Provide paid leave to cover emergencies.

If the Family and Medical Leave Act entitled workers to a portion of their pay during their 12-week leave to care for a sick parent, adult children would not have to choose between their parents and their jobs.

These changes, however, will require a commitment to our families and our elders and a major shift in policy in order to support them.

They are not without significant cost.

BUT in the long term, costs will be even greater if we don't make these changes.

Without them we will find more and more elders unnecessarily placed in nursing homes or at risk of neglect in their own homes. And more and more middle-aged children will risk their own financial security because they quit their jobs or are unproductive in the work force.

At the end of my interviews with these families, I used to go home exhausted after just hearing about - let alone experiencing - the lives of the caregivers I was interviewing.

In the tranquillity of my home, I would think about my own mother and how I will care for her in the future.

With my mother in mind, I pray that we as a society hear the cries of aging families who so desperately need our help and prepare for the needs of our aging society.

* Deborah M. Merrill, an assistant professor of sociology at Clark University in Worcester, Mass., is the author of "Caring for Elderly Parents: Juggling Work, Family, and Caregiving in Middle and Working Class Families" (Auburn House, 1997).