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What does it mean to care for aging parents when you’re the only child in your family? We asked for your submissions after the release of Marketplace Morning Report’s investigation into elder financial abuse, and many of you wrote in. This story is the result of your contributions.
Hear from the cartoonist drawing comics about his mother’s Alzheimer’s here.
When Holly Hill’s grandfather entered hospice in June, she watched his four children — including her mother — come together as a team to care for him and support each other. But Hill, who’s an only child, couldn’t help but wonder what things might look like when it was her own mother who needed care.
“My mom even said to me at one point, ‘You can’t do it all on your own. You have to take breaks,’” remembered Hill. “And I thought to myself, ‘Who’s going to give me a break?’”
Hill, 39, a first grade teacher and a mother herself, lives two hours away from her parents. She hopes they’ll move closer to her before they start needing more care, but it’s a hard sell. They’ve lived in the same house for 40 years — the one her dad built.
“He’s been adamant that that’s where he’ll be until the day he dies. And while I appreciate that, I can’t support them from two hours away,” said Hill.
It’s a familiar concern for many only children who face the prospect of caring for their aging parents without the help of siblings.
“We always tell people that you have to build a caregiving team,” said Amy Goyer, a family and caregiving expert with AARP. “For most people, family members are the core of that team. But if you’re an only child, you don’t have brothers and sisters to draw upon. It can be really quite difficult to juggle everything.”
When the responsibility falls entirely on one person, things can slip through the cracks. “This is absolutely something that only children worry about,” said Beth Salamon, whose 89-year-old mother has dementia.
It took Salamon a while to realize that her mother was giving away thousands of dollars more than she intended to charities because she was forgetting having written the checks.
“If there were more of me, maybe I would have realized what was happening sooner,” she said.
Many people, whether or not they have siblings, struggle to balance elder care with other responsibilities like work and child care. There’s evidence that taking care of an elderly family member negatively impacts a caregiver’s health and increases stress. Over half of caregivers surveyed by the American Psychological Association as part of their ongoing study of the impact of different stressors, reported feeling overwhelmed by the amount of care their family members needed. And, according to a 2015 AARP survey, about 60% of Americans caring for adult family members also work.
Currently six states — California, New Jersey, Rhode Island, New York, Washington (from 2020), Massachusetts (from 2021) — plus the District of Columbia have paid family leave benefits in place. Connecticut and Oregon will also offer state paid family leave by 2023. As of 2018, 17% of civilian workers had access to paid family leave, and 89% could take time off without pay, according to the Bureau of Labor Statistics. But without support in the workplace and access to services, caring for an elder can mean sacrificing wages, career growth and job security.
“Most family caregivers do need to make some adaptations to their work in order to be there for their family members,” said Goyer from AARP.
Over half of working caregivers report at least one caregiving-related strain on their jobs, including cutting back on hours, taking time off or leaving the workforce altogether. And those caring for elder family members share feeling less accommodated by their employers than those with young children.
Exiting the workforce to care for an aging parent can be a cheaper alternative to assisted living or a nursing home, but it comes with its own financial consequences. One study found that people 50 and older who retire early because of elder care responsibilities stand to lose an average of $300,000 over their lifetime in wages and Social Security benefits.
“The economic impact of caregiving is privately felt but has profound public implications,” said Joseph Coughlin, director of MIT’s AgeLab.
A 2011 Gallup study estimates that elder care demands on U.S. workers cost the U.S. economy over $28 billion per year in lost productivity. And, according to Coughlin, these costs are exacerbated for one-child families.
“Unless there is a capable partner in a two-person house, the adult child is shouldering the entire burden,” he said.
When Randy Richardson’s parents started to decline, he remembers work becoming a respite from an overwhelming amount of responsibility. “As soon as the work day ended, it was just dread” said Richardson.
Richardson’s parents lived on a rural farm along the Missouri River until his father, then 68, was diagnosed with terminal cancer and passed away four months later.
Richardson, then 37, was the only close family his mother had left. She moved in with him and his wife while they helped her relocate to a less isolated area and started managing the farm remotely. Eventually, she was diagnosed with cancer herself and needed more substantial care.
It was hard for Richardson, who was working full-time and had two young children, to manage it all without the help of siblings. He got through it — in large part due to his wife Jude.
“I’m not sure what I would have done without her,” he said. “It’s an odd thing to say I guess, but she really took over the role of a sibling. In addition to being your spouse, she’s also the person that helps you make decisions.”
“It puts a lot of strain on a marriage,” he added.
Still, Richardson knows that having siblings doesn’t necessarily mean caregiving responsibilities will be shared equally. His father came from a family of five, and his mother and wife from families of six — and after watching each of them lose parents, he realized things rarely break down evenly. “There’s always one or two kids who spend more time dealing with it,” he said.
Caring for an aging family member isn’t just time-consuming — it can be expensive. The vast majority of family caregivers — 78%, according to one analysis — incur out-of-pocket expenses related to their role, with the average caregiver spending about $7,000 per year on things like rent and mortgage payments, medical bills and travel expenses (on average, 20% of the caregiver’s annual income). The average long-distance caregiver spends about $12,000.
Aisha Adkins has been her mother’s primary caregiver since she was diagnosed with dementia six years ago. Adkins, 35, was working full-time in the health care industry and decided to quit her job so that her father could continue to work and maintain benefits for himself and her mother.
But the choice has taken a toll on Adkins’ own health and financial stability. “My health issues have increased exponentially, as exacerbated by caregiver stress. I am unable to afford all of the health services I need,” she wrote in an email.
As birth rates slow in the U.S. for a variety of reasons – financial, environmental, and cultural – only children are becoming more common than they used to be.
An APM Research Lab analysis of Census Bureau data found that, among U.S. households with children, approximately 3 in 10 had just one child in 2017, compared with 2 in 10 in 1960. Back then, it was most common to have two children and remains so today. But in 1960, three and four children were the next-most common. Today, one child is the next-most common family size after two.
Experts say the trend is likely to continue.
Goyer said AARP is concerned about the shrinking ratio of potential family caregivers to elderly people who will need care. In 2010, there were about seven people between the ages of 45 and 64 available to care for every person over the age of 80, but that ratio is shrinking. By 2030, that ratio is expected to be about four to one, and by 2050, it’s expected to be three to one.
Natalie, who asked that her full name not be used, didn’t fully grasp what it meant to be an only child until her father got sick. At the time Natalie was in her late 20s and living out-of-state in Michigan. After nine months of making last-minute trips home to Florida, she knew something had to change.
“That’s when it really hit home that you don’t have your parents forever,” she said. “So I made the decision to move back to Tampa, job or no job.”
That was in 1998. Two decades later, she still lives in Tampa.
Natalie is grateful to live close to her mother, who at 77 is healthy and able to play an active role in her son’s life. “As she gets older, she’s able to stay in her home longer with us being so close,” she said.
Still, eventually Natalie wants to leave her hometown.
“I tell my mom frequently that I’m here for as long as she is fully present,” she said. “If she should fall ill and become dependent upon me to take care of her, then I’m packing her up and I’m leaving. Because she is the only reason why I’m still here in the state.”
Being an only child is something Natalie thinks about a lot, especially now that she’s the mother of one. “When you’re an only, you recognize that your family is pretty small, and that once your parents start to pass on, it becomes even smaller,” she said.
Like Natalie, Amanda Peters, 35, is an only child and now the parent of one. When her father passed away, her mother – who was 66 at the time and suffering from COPD and congestive heart failure – moved into Peters’ home.
And while Peters knew her caregiving duties were likely to get more intensive, she didn’t expect that she would take on the role of financial advisor, too.
“Your parents don’t always like to tell you what their financial situation is,” she said. “And then when one passes away, you really find out — because there’s no one else for them to talk about it with.”
Her parents hadn’t been very forthcoming about their financial lives, so Peters was in uncharted waters. She found out that they had no retirement savings to speak of, and at one point during her childhood, they had almost lost their home.
When it became clear that Peters’ mother needed 24-hour care, Peters was confronted with the difficult choice between finding a nursing home or quitting her job to become her mother’s full-time caregiver.
“I crunched the numbers and thought, ‘Can I afford to do this?’ Because nobody wants to put their parent in a nursing home,” she said.
In the end, it was Peters’ mother who made the decision. One night, after the two agreed to revisit their options the following day, her mother called the hospice coordinator and signed the paperwork without telling Peters.
“She didn’t want me to have to make that choice,” she said.
Now as a mother of one herself, Peters is taking steps to ensure that she is more financially prepared for old age than her parents were.
“I don’t want him to end up with worrying about how he’s going to bury me.”
She’s invested in her 403(b) retirement plan since her early 20s and she has an advanced directive in place. She and her now ex-husband have talked at length about their financial lives and are on the same page about what they would do if something happened to one of them.
“I hope we’ve prepared enough. But you never know – one can never be prepared enough,” she said.
We want to hear from you. How is your family navigating the economics of aging and elder care? Send us a comment using the form below.