If you’re an adult approaching retirement – or already there – it seems you hear the warning bells everywhere you turn. Long-term caregiving costs are rising, and seniors and their families need to do all they can to get their care plans in place. Whether you pay those caregiving costs through savings, insurance, the sale of assets, or a federal program like Medicaid, for most of us there’s a big, big bill looming out there somewhere in our future.

The challenge is, how long will we need care, and how much will it cost? One North Carolina family, profiled in this 2023 Wall Street Journal article, found the answer, and as we read their story, it comes as a bit of a shock. As it turned out, the out-of-pocket cost for a decade of care for their mother came to well over $1 million. Wall Street Journal reporter Clare Ansberry wrote the article which not only documents this family’s dedication to their mom but also provides a sobering glimpse of the economic realities of long-term care.

We offer the story as important food for thought. (Please note that a subscription may be required to access the original Wall Street Journal article. We’ve done our best to summarize.)

Caregiving Costs: Mom Outlived Expectations by a Decade

Ansberry begins her Wall Street Journal article with the story of Violet Carson and her family. Violet and her husband, James, raised their two children in a three-bedroom ranch-style house in a small North Carolina town. “When her husband died a decade ago, her children expected their mom, then 78, to follow soon after,” Ansberry recounts. “She had Parkinson’s disease, Lewy body dementia and required 24/7 care.”

“Never in my wildest dreams did I think she would last until she was 88,” says her daughter, Teresa Wyche. Violet died about two years ago. 

But while Violet’s longevity may have been unexpected, the related costs were even more so. “The Carson family spent more than $1.3 million taking care of Violet at her home over the last decade,” Ansberry writes. “Fortunately, she and her husband had saved, and the family could cover the cost of round-the-clock in-home care without going into debt. Many people aren’t as well positioned.”

Caregiving Costs: Median Net Worth Covers Barely a Year

According to recent numbers, most seniors aren’t in the same financial boat as the Carsons were. Ansberry explains, “The median net worth of people 75 and older is $254,800, according to the Federal Reserve, which is about the same amount that it would take to cover an estimated cost of nearly 14 months of 24/7 in-home care.” Meanwhile, caregiving is becoming more expensive as people are living longer and have increasingly complicated medical needs. 

“The median cost of a home health aide increased 12.5 percent between 2020 and 2021, according to Genworth, a long-term-care insurance company,” Ansberry writes. “Only one in five adults between the ages of 50 and 80 is ‘very confident’ that they would afford to pay for in-home help, according to a 2022 poll conducted by NORC, at the University of Chicago, a nonpartisan research organization. “ 

To prepare for the future, personal finance advisers share the widely used 40/70 rule with families: “By the time an adult child is 40 and the parents are 70, they should talk about a parent’s financial situation, insurance and long-term care wishes.” But studies repeatedly show families ignoring this advice and not “having the talk” between aging parents and adult kids at all, or else waiting until a health crisis strikes.

Caregiving Costs Aren’t the Only Challenge

It’s one thing paying for in-home care, but entirely another finding reliable and consistent caregivers in an industry with a roughly 65 percent turnover rate.  “This system is difficult to coordinate and it is getting worse,” Jason Resendez, president of the National Alliance for Caregiving, told the Wall Street Journal.

“About 31 percent of family caregivers had trouble coordinating care for their loved ones in 2020, up from 23 percent in 2015, according to research from the National Alliance for Caregiving and AARP,” Ansberry writes. This shows that a growing number of families are having challenges finding qualified care.

The Carsons avoided the turnover issue by paying a higher wage to their caregivers, averaging a total of more than $130,000 annually—their biggest expense. This peaked at $148,000 in 2020, thanks to overtime costs related to the pandemic. “There were other costs, totaling more than $50,000, and not covered by Medicare, including a special handicapped-accessible van that cost about $40,000 and $20,000 for a special tub,” Ansberry adds.

But the family is confident that their decision to pay well was a good one. “It was worth every penny,” says son Steve Carson, 68, who lives in Salisbury, N.C.

$1.3 Million Actually on the Low Side for Caregiving Costs

It’s worth keeping in mind that the cost for Violet’s care, as high as it sounds, is relative to the area where she lived. In the small community of Moravian Falls, North Carolina, wages and cost of living are lower. This means that $1.3 million was probably less than her care would have cost elsewhere.

Even so, it was more than Violet’s daughter, Teresa Wyche, expected. “If you would have asked me if I thought we would spend $1 million, I would have said, ‘No way,’” says Wyche, 61, who lived close to her parents.

But the need to provide 24/7 care hit unexpectedly. While Violet and her husband, James, had both worked for a long time and were “fastidious” about saving money and living off the dividends of retained company stock, they never had long-term-care insurance.

Finding Caregivers Through Neighbors, Family

The Carsons initially found caregiving through community. Ansberry recounts, “After James Carson retired and their mom was diagnosed with Parkinson’s, their dad hired Teresa Johnson, who lived next door, first to help clean and then to provide care as Violet’s condition deteriorated. A bond formed. The two would share a Dr. Pepper and cheese crackers and talk about their families, health and church. They shopped, put on silly hats, played Monopoly, and did exercise to Michael Jackson.”

“She became more like a daughter to Mom and had so much empathy for her,” son Steve Carson told the Wall Street Journal.

But when James passed away in 2013 of a heart attack following back surgery, “the Carson children were so convinced that their mom would die soon after that they paid for two funerals and two caskets.” As Wyche told the Wall Street Journal, “We thought within a year, she would be gone. She depended on my dad for everything.”

Caregiving Costs and a Promise to Dad

Because the siblings had promised their dad that they would do whatever they could to keep Violet at home, they asked Johnson to work full time as caregiver. “They put her on salary, offered paid vacation and gave her a generous Christmas bonus,” Ansberry writes. “Johnson’s pay exceeded the $47,188 median household income for Moravian Falls. Johnson interviewed and managed hourly workers, ending up with a small but reliable network, including her sister, who had worked at another senior-care facility, and a sister-in-law.”

And that generosity was spread across the staff. “Hourly workers were paid about $16 an hour, and received a Christmas bonus of between $250 and $1,000 depending on tenure and their responsibilities, and birthday bonuses of $50 to $75,” Ansberry adds.

According to Johnson, 62, there was little turnover. “Everyone loved Violet. The house was pleasant and the pay was good.” 

Even after Violet’s death, the family made sure to compensate the workers well with an additional three months’ severance. They even paid Johnson for the rest of the year to help them prep the house for sale. “I feel like we did the right thing. She always took care of us when we were little. I felt like we needed to pay her back, too,” says Carson.

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(originally published at www.wsj.com)