August 9, 2023
By Mike Davidoff
The intent of this blog is to share in more depth some of the common emotional and financial challenges that are unique to the sandwich generation. I write this from the perspective of both a lifelong personal finance and investment professional, but even more so from the lens of someone who believes we all learn from each other’s shared experiences and knowledge to make our own lives just a little bit better.
When I was in my mid 20’s, I lived in Chicago, which was 800 miles and five large states away from my family in New Jersey. My father used to call me every couple of days to check in. He would often ask me a similar set of questions that likely provided him comfort that I was safe and happy. “How are you feeling?" "How is Amy?" (my girlfriend at the time and now my wife) "How is the job going?" "Do you have enough money?”
One morning, he called in a more somber tone to tell me that my grandfather had suffered a nasty fall, and he was at the hospital with a badly bruised hip. The doctors wanted to hold him to run a series of tests, including a neurological evaluation given his recent bouts of confusion and moodiness. After a few days, the medical diagnosis arrived. My grandfather was exhibiting strong signs of dementia and early-onset Alzheimer's disease.
My family investigated different plans of action for keeping my grandfather out of a post-acute care facility, but it was ultimately decided that it was safest and most practical for him to move into a nursing home. My father served as the lead caregiver for the family, and he spent countless hours over the following weeks and months revising budgets, communicating with nurses, doctors and case managers and running back and forth to the nursing home to visit my grandfather.
My grandfather passed away in 2006 after living with Alzheimer's disease for six years in the nursing home. His disease progressed to the point where there were many times when he could not remember our names or recognize who we were. It was an intensely emotional and difficult experience for all of us in the family. Now that I am near the age that my father was when he went through it, I have a greater appreciation for what he must have been feeling.
The current cohort of Sandwich Generation members can certainly identify with the growing need to serve as caregivers for their aging parents or relatives. According to a recent study, 17% of the U.S. population, or 42 million people, are caregivers of recipients aged 50 or older. Of this group, 29%, or 13 million, are Generation X members (born between 1965-1980) and 34%, or 14 million, are Baby Boomers (born between 1946-1964).
There are situations when your role of caregiver unrolls in a measured and incremental manner, and there are circumstances when it will be thrust upon you overnight following a major medical event or diagnosis. You have no way of knowing ahead of time. Similar to other areas of life involving big stakes and high levels of uncertainty, making plans ahead of time can reduce the burden on you and your loved ones when the time comes to take action.
Here are some different areas of planning to consider as you move through the continuum of life stages with your aging parents or elderly loved ones.
Understand your role today and how it may change tomorrow.
You are likely to wear many different hats in your relationship with your parents as they age, and your role will evolve as their needs change. You will be at times an organizer, a problem solver, an emotional cheerleader, a money manager, a medical-lingo interpreter, a travel agent, a driver and so much more. As your parents age, their ability to stay fully independent may be compromised, and part of your role may be filling the gap between what they were able to do in the past and what they need help with today.
Make plans early and often to spend time together.
The pandemic may have changed expectations and appetites for travel for many of us, and it seems to have had an outsized negative impact on the baby boomers. For those of us like my wife and me, with parents living many miles away, this makes it a challenge to physically see each other as often as we did in the past. This is especially true as our own lives are busy raising our kids and staying on top of work responsibilities. Price inflation on travel and the higher cost of everything only makes it even tougher. There is nothing more valuable than time spent together so make sure this is properly budgeted and planned for in everyone’s lives.
Get your kids in front of their grandparents. Even better if it is without you.
Once your kids are old enough, fly them out or drop them off at your parents’ house for overnight trips and “grandparent camp.” Let them hear stories directly from their grandparents about your family’s history without your eye rolls or interruptions as you have heard these stories a thousand times. Have your parents visit and attend school plays, soccer games, birthday parties and basically any other excuse to spend time seeing their grandkids grow up.
Make it a priority to have senior life planning family discussions at least once a year.
There is important information that needs to be passed down from mom and dad to their adult kids in case of emergency or sudden death. While it may be uncomfortable to have these discussions, create a safe space where you can openly talk about topics including the location of key documents such as wills, trusts, healthcare and financial power of attorney and advanced medical directives. Talk about your parents’ goals and wishes for how they will age. Do they want to stay in their home for as long as possible? Would they prefer to move to an assisted living facility at some point to increase socialization and reduce the burden of running their own home? Revisit these conversations over time and talk about how changing circumstances may require a change in their expectations for how to proceed going forward.
Talk about the level of financial resources that will be available for elder care planning.
While some parents may be more private than others in terms of disclosing how much money they have and how their financial life is structured, it will be important at some point to know what kind of financial resources are available as you move through the elder care process. Examples of resources include brokerage accounts, retirement accounts, real estate properties, pensions, annuities, social security, bank accounts and trusts as well as insurance policies such as long-term care and life insurance. This is also the time to share information on any liabilities such as outstanding mortgages or other forms of consumer debt. It is important to be thoughtful about how to deploy these resources once they need to be tapped for caregiving, and this is absolutely the time to hire third-party advisors for guidance, if necessary.
Become an expert in your parents’ ecosystem.
Develop relationships, if possible, and create a list of names, phone numbers and e-mail addresses for the key advisors in your parents’ lives including doctors, financial planners, accountants and estate or elder-care attorneys. Do the same for their neighbors and local friends in the area who may serve as a local set of eyes for you in times of emergency, especially if you live far away.
If it gets more serious, step up to manage finances, work directly with health care agencies and talk to an elder-care attorney.
As the caregiving needs intensify, you may need to take an expanded role by assuming financial power of attorney for your loved one in order to be able to write checks, move money and make critical investment decisions. You may also become the healthcare power of attorney, wherein you make medical decisions based on your parents’ needs. If necessary, have a consultation with a local elder-care attorney to understand your options for post-acute care needs and how to navigate the complexities of Medicare, Medicaid and IRS rules in order to protect assets for your parent in need as well as their surviving spouse.
Get a set of eyes on them on a more frequent basis.
You may need to take time away from work or social activities in order to more frequently visit your aging parent as the need to manage issues amps up. If you can, split the duties with other siblings or family members. It is important to walk around their home, see how they are moving and thinking, and really make sure they are safe and getting the care that they need.
Most importantly, operate with a sense of humility and grace.
This is likely one of the most difficult processes you will ever go through, and there is no standard playbook for how best to navigate. Mortality is a reality of life, and it is something that we all need to come to terms with at some point. It is best to give yourself grace and appreciate that you are doing the best that you can. Caregiving can be a thankless and exhausting duty but understand that this phase will not last forever. Appreciate the remaining time with your loved one and take comfort in knowing that you are doing some of the most important work you will ever come across during your life.
 Caregiving in the U.S. 2020 Report by AARP, National Alliance for Caregiving, (https://www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html)