Long-term care is expensive. And sometimes it costs a lot of money too.

Sometimes there may not be a great deal of cash changing hands as a result of a spouse or partner’s gradually increasing need for long-term care, but that doesn’t mean a steep price is not being paid. Often, it’s the person closest to the senior that pays the bulk of that price.

Of course, I’m not just talking about a financial price. It’s a physical, psychological and emotional price. Often the caregiver will say with complete sincerity that he or she does NOT begrudge the role. So many spouses I’ve met – especially women – would not dream of allowing anyone else to take the role of primary caregiver to their spouse.

Back in the day, when they said, “for better or for worse” and “till death do us part,” they meant it.

But please, watch yourself or your parent very carefully. She may literally work herself to death caring for her husband, and that wouldn’t be good for him, much less for her.

In addition to the physical, emotional and psychological costs associated with long-term care giving, yes there are financial costs. But it often comes as a surprise how these various costs compare to one another.

Often an early step in care giving is to hire someone to help. And that’s great. If Mom just needs some extra help around the house for a few hours a day, you might get away with paying someone $10 an hour for 20 hours a week. Let’s call that $800 a month. Now that’s not chump change, but if it gives Mom a break it can be worth every dime.

Now, I hate to say this, but those situations rarely stand still – they move in one direction or another. The inevitability is that someone needing long-term care will either die or continue declining. He or she is unlikely to simply remain in his present level of health.

So, fast forward a year or two. Imagine that you don’t need care-givers for four hours a day, but 24-hours a day. Assuming the same hourly pay rate, that comes to $87,000 a year. And my experience is that once you get to that level, $10 an hour ain’t going to cut it. You’re probably looking at $15 an hour, or about $130,000 a year.

Now many are surprised to learn that a nursing home is not the most expensive option, but actually the least expensive option for someone needing full-time, round the clock care.

In the abstract, before they experience a day, week, or month of round-the-clock care giving, I’ve heard well-meaning adult children say, “I am never going to let Momma go to a nursing home.”

Well, I understand the emotion behind that statement, but it’s a foolish promise to make. You just don’t know what the future is going to bring.

So, what can be done before all that begins?

1. Honest conversations. Adult children need to have very honest conversations with their parents about where they are now and what their wishes are. Be frank with one another about the state of their financial, physical and emotional resources. It’s their money, and it’s their lives, so an adult child shouldn’t try to dictate anything. But most parents have a strong urge to “not be a burden” to their children, and are interested not only in their own well-being, but also in that of their off-spring.

2. Holistic planning. Work with an elder-care attorney to explore any options for financial assistance available to you. Very few people have a grasp of what resources are available and when one might qualify for those benefits. An experienced elder-care attorney can be very helpful in educating you about your legal options. The services of a financial advisor may also be helpful, but not as a replace[ment] for, but simply supplemental to the work of an elder-care attorney.

Now, a word of caution, as people age, often their capacity to make difficult decisions declines as well. The default mode of “do nothing and hope for the best” can kick in.

So, adult children, the most helpful thing you may be able to do for your parents is to gently prod them into action. Initiate that honest conversation. Set up a meeting with an elder-care attorney.

Those would be meaningful first steps in the journey on which you’re embarking, of giving care back to your own parents.

Offering you Wisdom on Wealth, I’m Byron Moore.

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