You Are the Sandwich Generation

Physician's Money Digest, May 2007, Volume 14, Issue 5

Dr. Warren Burrows,a Groton, Conn-based handsurgeon, sheepishly admits that he followed in hisfather's footsteps by becoming a doctor. "Probably, Ican't deny it," he says with amused resignation. Yetthe pride in his voice is apparent when he speaks ofBelton, his 88-year-old father who now suffers fromsecond-stage Alzheimer's disease. The senior Dr.Burrows once ran the radioisotope unit at BostonUniversity. He was an academic in the pioneering ageof nuclear medicine, and he and his wife, Dorinda, anartist, raised six children. Dorinda, age 85, developedParkinson's disease 10 years ago.

Assuming the Caregiver Role

Today, Dr. Burrows and his sister help care forboth parents while living in the family home inConnecticut. Though home health aides visit daily,Dr. Burrows and his sister give showers and share theenormous role of caretaker. "It's hard to articulateit?the sadness, the frustration...you get burnedout," he comments. What about some other form ofcare? "There are good nursing homes," Dr. Burrowssays, "but they are still nursing homes."

To help care for his parents, Dr. Burrows relocatedfrom North Carolina 2 years ago. Though his wifecurrently remains there, they are in the process ofmoving. Their two daughters, ages 22 and 26, are incollege; the eldest is completing her third year of medicalschool. Burrows, who retired after 22 years ofpractice in North Carolina, now works 3 days a weekat Crossroads Orthopedic to "keep [his] hands busy." The rest of the time, "we're pretty much tethered tothe house," Dr. Burrows says of he and his sister.

In semiretirement, with two children in college andtwo aging parents, how does Dr. Burrows handle itall—not only emotionally but financially? "We're veryfortunate," Dr. Burrows says, "?we're not rich, butDad has enough savings that it has not been an immediateproblem." Thus far, his parents' money has beenable to pay for their own care—but it's going veryquickly. "I have been doing most of the billpaying...it's scary the way it flies out the window," Dr.Burrows says. He adds that if both parents were in anursing home, costs could easily reach $180,000 to$200,000 a year. "It's more than a college education?.I don't think I realized that you spend moremoney in the last few years of your life than you doraising children."

Juggling Your Responsibilities

Two For the Money: The

Sensible Plan For Making It All Work

Most experts recommend that in the financial trinityof saving for retirement, paying for college, andcaring for elderly parents, the top priority should besaving for your own retirement. Jonathan and DavidMurray, coauthors of (Carroll &Graf; 2006), write, "There are many ways to getfinancial aid for college—but there is no such thingas a retirement scholarship or loan." The authorsalso remind readers that caring for parents is not asolo job, and in many cases, your parents themselveswill have some means.

Exactly how much those "means" are variesgreatly by family, yet finances are inextricably boundwith basic quality-of-life issues for the elderly. Canyou keep the family home? Can you afford at-homecare? Is the best nursing home financially feasible?Fortunately, many resources are available to helpcaregivers. Your first step may be to visit the familylawyer, accountant, or financial advisor so you canassess the tax implications of how money should bespent on your parents' care. To help stretch theirfunds, tools like reverse mortgages, annuities, andlong-term care insurance may be worth evaluating.

Keep in mind:

Learning from his parents' situation, Dr. Burrowshas now taken out long-term care insurance for himselfand his wife. Such insurance is meant to cover thecost of a nursing home or assisted living facilityshould you need one. In their book, the Murraybrothers report that about half of all people over age65 end up needing long-term care someday. Likemost policies, the rates become more expensive asyou age. The Murrays say most people should buycoverage sometime in their late 50s (roughly $2000 ayear). If a person is much older than age 60 ratesclimb quickly, but insurance may still be worth itgiven the astronomical costs of assisted living facilities.If you cannot pay the premiumsat any point, the policy is canceled and the moneyinvested to that point becomes wasted. Also, youmay never need to use the policy. But for those whodo, the savings can be substantial.

The Doctor Factor

Physicians with aging parents are often in a uniqueposition due to their knowledge. While you maywind up as the go-to person for health decisions, youmay also find it easier to get things done. "Being adoctor in the family, you do have a better understandingof the whole medical game," Dr. Burrowssays. "You can charge through a lot of the barriers?.I've been able to cut through a lot of red tape." Thisapplys to making doctor appointments, keeping aneye on medications, looking at x-rays, filling informs, working out Medicare issues, and more. "I domake the medical decisions," he admits, but adds, "Ithasn't been hard for me to take that role on."

Dr. Burrows acknowledges how well his familyhas fared—particularly because his parents havefinanced their own care. "That would be a very difficulthurdle to get over," he confesses. Yet it easilycould have turned out that way. "My father was nota planner and did not discuss his financial situationwith his kids," Dr. Burrows says. Essentially, he andhis siblings had no clue what they were walking into."We didn't have a good idea until we took over hisfinances?it was a total mess." To make mattersworse, Dr. Burrows senior had been financiallyexploited for nearly a year as his mental capabilitiesdeclined. The family had tried to intervene. "He'd getmad at us?. Dad's always wanted to feel useful." Plus, a universal family behavior came into play."The two things you don't talk about are sex andmoney," Dr. Burrows states.

Stumbling Over Family Taboos

As a family mediator and cofounder of Lexington,Mass-based Elder Decisions, Blair Trippe has seenthis sort of situation over and over again. In fact, theBurrows family was one of her recent clients in theemerging field of elder mediation, which helps familiesdecide on issues relating to care of aging parents.Often, she says, siblings are not on the same page orthe parents are in a state of avoidance. "As long asthere are two people, there are politics?it's all familydynamics," she adds. As a result, her number onerecommendation to families is to get over the tabooof talking about money and aging. "Start the dialogue?have the conversation," she urges. "See whatpeople want, to avoid conflicts later." Key decisionslike power of attorney and health care proxy shouldbe communicated to everyone, she says.

In their aforementioned book, the Murray brothersalso recommend having this talk. Indeed, "goodplanning and honest discussions about money transcendmere dollars and cents," they write, and theyoffer the following tips to help make the discussionless awkward:

•"Keep in mind you are trying to help your parents,not invade their privacy." Think of the way youexamine patients, then apply those skills.

•Make it clear everyone shares the same goal:maintaining the parent's independence.

•Let them feel like the solutions are their own.

•Discuss advanced health care directives andwills in terms of life planning and legacies.

•Involve everyone.

•Be honest about your own financial concerns.

"It's a difficult subject to bring up," Dr. Burrowsadmits. "I'm slowly trying to let my daughtersknow my financial situation?there's a fine balance." He adds of caring for his parents: "One thingit's taught me is to do as much planning as youcan?look the reaper in the eye?[and] save as muchas you can."

Sandwich Generation Resources

•AOA National Family Caregiver Support ProgramTopic: Finding support services in your community;www.aoa.gov/prof/aoaprog/caregiver/carefam/carefam.asp

•Women's Institute for a Secure Retirement(WISER)Topic: "Financial Steps for Caregivers" plus awealth of resources;www.wiserwomen.org

•AARPTopic: Reverse mortgages;www.aarp.org/money/revmort;Topic: Long-term care insurance;www.aarp.org/money/financial_planning/sessionfive/longterm_care_insurance.html

•National Council on AgingTopic: "Benefits Check Up";www.ncoa.org

•Eldercare LocatorTopic: Caregiving services and resources;www.eldercare.gov

•Elder DecisionsTopic: Family mediation for care of the elderly;www.elderdecisions.com