In caregiving circles we see it every day: Sticker shock.  And no, I’m not talking about innocents pricing a senior care facility with all the amenities of a luxury resort. Sticker shock comes most dramatically to families who think they are prepared, who think their needs and expectations are modest and reasonable. The shock comes not so much at the actual cost, but at the options that are and are not available to pay for care.

A family I’ll call the Browns recently contacted the senior advisors at Care.com to find in-home care for the husband’s 89-year-old mother. The elder Mrs. Brown is still mobile, still perfectly capable of thinking for herself. She just needs someone to come in for three hours a day, help her bathe and dress and prepare meals. The younger Browns simply wanted to find the right person to spend time with Mom. After all, Mrs. Brown has Medicare and supplemental insurance, so affording an aide should be no problem, right?

You can imagine their shock and dismay when I told them neither Medicare, nor supplemental insurance would pay for non-medical home care. Either Mom, or they, would have to pay the fees out of pocket.

This scenario plays out every day in families across the U.S., and it’s often complicated by a reluctance to discuss finances. Adult children may not want to alarm depression-era parents who fear being broke more than death, or they don’t want to seem like they’re eyeing a possible inheritance. In some families, money is just never discussed and the children feel profoundly uncomfortable bringing it up.

In my own case, I’ve watched my still-working mother take responsiblity for all the finances and bill paying, a task my Dad had assumed until his dementia worsened years ago..  I suppose we’ve both been so focused on Dad, who has been living with dementia for 15 years, that I’ve forgotten to ask my mother how she plans to pay for her own eldercare needs when the time comes. I don’t expect any surprises, but after counseling the Browns, it’s definitely a conversation I plan to have.

How are you feeling about the cost of senior care (see our tool on what senior care costs in your area)? Tell us how you are starting – or started – the caregiving conversation with your family. What worries you the most?

Here are 4 ways to start the senior care conversation. We’ve also come up with a list of subsidized senior care services, which might help as well. But if you ever need to talk through your needs, our senior care advisors are happy to help (855-772-2730).

My children are lucky. At least, that’s what I’ve always told myself. My husband and I have wills. We’ve discussed our wishes with the kids and upon our deaths, there will be no surprises.

But in truth, there’s plenty of ground to cover before our eventual demise. While updating our wills this year, I began to consider the vast unknown territory between now—our healthy middle age—and our deaths. Have we planned sufficiently for different aging scenarios? And have we empowered our children to make hard decisions when we’re no longer able?

In my role as vice-president of care management at Care.com, I’ve noticed that most members of the Sandwich Generation pour tremendous energy into grooming, guiding and providing for our children. We know what our children want, and what we as parents want for them. When faced with the care of elderly parents, however, no such certainty exists. In part, I think that’s because we have few models for communicating about end-of-life issues.  Demographically, we’re in uncharted territory.  The average life expectancy in 1930—when today’s 82-year-olds were born—was right around 60. People launched their children, lived to see a grandchild or two, and then died. Very little discussion was necessary.

Today modern medicine and healthier lifestyles have given us the bonus—and the complication—of time.  And it’s become clear that we need to gift our children with more than just a solid future. We need to tell them what we want for ourselves, just as we are having to ask our parents what they want.

Recently, a Care.com client asked for help finding first a home health aide, and then an assisted living facility for her mother. Clearly, our client struggled with the idea of moving Mom from the family home, although it was the best thing for all concerned.  Then the woman added another request: She wanted all the information we had on Continuing Care Retirement Communities. This time, she was asking for herself and her husband, neither of whom would need such a facility for a long, long time. “I think my mother understands,” she said. “But emotionally, this has been so, so hard. My parents never talked about what they wanted. I know I don’t want my own children to have to go through the same thing.”

This year, when we share the details of our revised wills, my husband and I have vowed to have a much richer conversation with the kids. We may not be able to cover all possible late-life scenarios yet, but we’ll tell them what we do know, and most important, we’ll let them know their questions are welcome.

Have you decided what type of senior care you want? Do you know your parents’ wishes? How have you prepared your children for your eventual needs? We’d love to hear from you.

And if you’re looking to learn more about senior care, check out our index of all your senior care options.

My daughter Becca engages my father in ways that other people, even my mother, cannot.  Watching them sing and “perform,” I’ve come to realize that these two loves of my life simply meet together on common ground.  Becca and her Opa are able to cherish the present; their expectations limited to the joy they experience in one another’s company. 

Dad has had dementia for 15 years. Becca, now a freshman performing arts major at NYU, has only a toddler’s memory of her grandfather in his full brilliance. And while my father watched Becca grow into a talented singer, he has accepted her as she is at every stage of her life.  Others might look at my father and see what was, or look at my daughter and see what could be, butOpa and Becca always embrace one another in the moment (he never asks about her post-college plan!).

Over the holidays, I vowed to take inspiration from Dad and Becca and really celebrate the moment. My husband and I gathered with our three adult children, my still-active 83-year-old mother and my father, whose personality shines through the fog, and who remarkably continues to thrive with dementia -- past his 85^th birthday.  That we could be together this year was a gift. Old business and worries about the future were put aside. There will be plenty of time for those distractions after the New Year.

Striving to be “in the moment” for my parents and children is the closest I’ll come to a New Year’s resolution.  I’m at a life stage when grand pronouncements about my future diet and exercise habits seem silly. But I do have a goal to continue writing this blog through the coming months.  You see, I know I’m not the only adult of my “sandwich generation” who has accepted responsibility for parents, children, a career, a household and a dozen obligations in between.  Sometimes that torch is hard to carry.  I hope that by sharing the lessons and rewards of the journey, we can start a dialog and all ultimately benefit from each other’s experiences.

So tell me, what do you do to “live in the moment” with your aging parents?

For now, I’m going to spend some time watching Dad and Becca, and some time embracing the others who bring light to my table. Happy New Year!