As part of the generation of adult children watching out for aging parents, Seay has struggled to balance Williams’s independence against selling his largest asset — his house near downtown Atlanta — to pay for care in a more secure environment.
These are the sort of fraught financial and emotional considerations facing adult children as they grapple with the increasing demand for support from their parents. The decision is all the more important, as nursing homes have become risky hot spots for coronavirus infection.
For Seay, a key argument against selling came from her father: If he moved out of his house, with its dilapidated shed in the backyard, where would he keep the mowers and the pickup truck that were the backbone of his once-thriving landscaping business?
Never mind that Williams is 93 and only takes care of a couple of yards these days, including his own plot enclosed by a waist-high chain link fence. He was not ready to give up his yard equipment after decades of manual labor.
Seay, consulting with other relatives, eventually agreed that “Pop’’ would stay in his small home, where the walls in the comfy sitting room are covered with family photos.
“One of the major challenges I have with my father is he’s very, very independent,” Seay said. “I take care of all his business affairs, but sometimes when I offer advice to him, he’s not very receptive of it. He feels like I’m trying to run his life.”
It’s part of the squeeze on the “sandwich generation,” family members confronting the costly and time-consuming needs of managing care for their parents while also facing their own set of stresses over children, grandchildren and planning for their own retirement.
Seay is 73. This is what her retirement looks like: She drives her father to the doctor, helps keep track of his medications, visits with him for hours, worries about his food, worries about his blood sugar, worries about him falling. Since the covid-19 pandemic began, she continues to visit, disinfecting all surfaces with Lysol three times a week. She wears a mask when she arrives at his house and removes it once she’s inside.
There is no clear playbook, no formula for how to deal with aging parents who need help, experts said. Every family, every story is different. What value could someone outside Williams’s family put on his wish to keep his truck and lawn mowers?
“Those sandwich families are in a tough spot,” said Joanne Lynn, an expert in eldercare and advanced illness at nonprofit health advisory firm Altarum and an aide to Rep. Tom Suozzi, D-N.Y., for aging issues. “More than three-quarters of the [elder] care in the country is given for free by family and friends. People lose income, they lose security, they often lose their careers.”
Family members work as volunteer caregivers or in-home caregivers paid by Medicaid. Estimates of the financial toll on relatives range into the hundreds of thousands of dollars, including losses they sustain in their own retirement savings. Caregivers also have been found to lack health insurance and neglect their own health at higher-than-average rates.
Long-term care insurance in the private market is unaffordable for many people. State Medicaid programs pay for long-term care in nursing homes and in private homes, but only after nearly all of a beneficiary’s assets have been depleted. Adult day-care centers help families share the load by offering a cheaper alternative to in-home care.
Among the most wrenching decisions adult children face is moving a parent to an assisted-living apartment or nursing home and selling their home. Sale proceeds of the home must be “spent down,” draining the money before Medicaid coverage takes effect. Meanwhile, many individuals have incomes or assets that are still too high to qualify for Medicaid.
Navigating this requires an enormous effort by adult children.
“Basically, it’s like a big jigsaw puzzle and you have to put all the pieces together,” said Amy Goyer, an AARP family and caregiving expert and author of “Juggling Life, Work and Caregiving.” Goyer moved from Alexandria to Phoenix to help her parents cope with their decline, quitting her full-time job at AARP and becoming a consultant for the organization on contract. Her father had dementia and her mother suffered from a catastrophic fall. Her sister moved from Ohio to pitch in.
“The stress of worrying about it all — we need to address peace of mind with the caregiver,” she said. “I had to adjust my views of success as a caregiver. I couldn’t prevent every fall my mom had. I couldn’t stop Alzheimer’s disease.”
As relatives seek to delay the reckoning, they often pitch in financially to help with bills. Atlanta and other communities across the country offer grants to rehabilitate homes to make them more habitable for elderly people, with safety upgrades such as ramps and handrails, as well as heating upgrades and bathroom renovations. Demand for home services far outstrips supply. Meals on Wheels Atlanta, which provides frozen meals several times a week to elderly people in their homes, has a waiting list 500 families deep.
Williams’s small, detached house with the screened-in porch is a short drive from the $1.6 billion Mercedes-Benz Stadium on the edge of downtown Atlanta, home of the NFL’s Falcons. The neighborhood is predominantly African American and lined by small, single-family homes.
Williams receives $870 a month in Social Security payments, and out of that he makes payments on a $39,000 mortgage on his house, insurance for his 2002 Buick LeSabre that he still drives to the grocery store and to Waffle House for breakfast, and his food and utility bills.
Seay owns her own home with its own set of costs, although she works part-time as a convention host to help make ends meet. Her daughter, Toya Seay Gant, who works for a defense contractor in Alabama, said she helps with bills and other expenses for her grandfather as well as her mother.
During a recent visit by a Washington Post reporter, Williams, wearing a flannel shirt and khaki pants, stood over his small gas range and stirred scrambled eggs and cheese, tended to a bubbling pot of grits, and sliced up hunks of piping hot sausage. He said he woke up that morning with a sore knee and was hobbling a bit.
He turned off a TV in the cramped kitchen, limped out to the sitting room and cranked up the volume on a game show. Over the meal, Williams said he felt blessed to have family members who helped him financially.
“I never worry about money,” Williams said.
Housing pressures are intense in the Atlanta region, and a few of the houses in the neighborhood around Williams’s have been fixed and flipped. He has qualified for housing assistance that will pay to replace the floorboards in his kitchen, which were damaged by a leaky water heater.
Mary Seay, who raised three daughters, all of them college graduates, has spoken to her father about moving into a high-rise apartment building with subsidized rent, to no avail. Besides, she said, the finances would not work.
“He might live to be 100,” she said. “I looked at the cost over time, and he would run out of money paying rent.”
Seay also tried to find a storage unit or garage to rent where he could keep his truck and mowers, but they were all too expensive. So Williams stays in his house. A cousin has moved in with him and helps out, but the cousin has his own health problems, Seay said. The patchwork of support includes neighbors on his block.
“He’s like the mayor of the street,” Seay said. “Everybody loves him and everybody watches out for him.”
Other families in Atlanta described similar circumstances as they work to keep the older generation in ownership of their homes as long as possible, for their quality of life and to preserve a crucial middle-class asset.
Angela Gresham helps her father take care of her grandmother, Doris Gresham, 95. They manage her finances and household affairs, after a tricky transition.
“When were first took over, everything was in disarray and things were all out of order,” Angela Gresham said. Her grandmother has lived in the house for 60 years. She has Social Security and a pension from her late husband, who was a postal worker and served in the military.
But Doris has become increasingly forgetful. The family does not allow her to cook anymore. Angela goes to the house for visits at least three days a week and often spends the night, but it’s not enough.
“Now we’re looking at possibly getting a sitter who comes in four or five hours, a few days a week,” she said.
Michelle North, who works in IT support on a night shift, is another member of the sandwich generation. She routinely visits her mother, Mary North, 85, after picking up her own grandchildren from school and before heading off to work.
Mary was a shampooist in the same beauty shop for 50 years, a job that gained her deep, lasting friendships in the community — but no pension. She survives on Social Security and help from her family.
Michelle North and her brother chip in to help with bills and drive her to the grocery store, Michelle said. Mary spends days baking and tending to her garden and loves the Atlanta home that she owns.
Her mother tries to resist help purchasing groceries, Michelle said.
“We take her to the store, and say, ‘Mama, you pick out what you want, what you need,’ ” she said. “You took care of us, you helped us when we were out of a job, or short on the light bill, now it’s our turn.”