Thursday, August 11, 2011

Some Thoughts on Multi Generations

A recent posting by The Rebbetzin's Husband on Parenting from the Torah happened to hit home with me, particularly this summer. While the gist of the scenarios Rabbi T presents deal with the who and how of taking care of elderly parents, there is another aspect that I commented on and feel needs to be addressed.

We are b"h living longer and longer as the years progress. It is not at all unusual for there to be four generations all living at the same time. In fact, it is becoming more commonplace to see even five generations all living at the same time. Since this is the case, the issue of kibud av v'em (and how to care for parents who may need special help) is also growing more complex. In the 4-generation scenario you have three distinct sets of parents; in the 5-generation scenario you have four distinct sets of parents. Now let's complicate this just a bit more: let's assume that in each generation but the last all the children are married. This means that for each married couple there are two sets of parents to be considered: those of the husband and those of the wife.

Now start at the top of that 4-5 generation pyramid and number that generation as #1. Any parents in that #1 generation are indeed going to be older, and it is likely that health issues are being seen or independent living issues are being seen. It would seem to be logical that this generation's issues will be dealt with by their children, generation #2. However, generation #2 is not all that young and members of that generation are also seeing health issues crop up or strength issues crop up. They may not be 100% up to handling or dealing with the issues of their parents while facing issues of their own. That brings us to generation #3. In asking this generation to participate in or completely handle the issues facing their parents we may also be giving them the task of taking on the responsibility for their parents' parents at the same time. While this is happening generation #3 may still be involved in finishing raising their own children and marrying them off.

In cases where there are five generations living at the same time, it is quite possible to envision a scenario where generation #3 is getting on in age and not completely able to handle the responsibilities of caring for parents in generation #2 and generation #1. This would mean that generation #4 would have the responsibility for handling the issues that come up for generations #1, 2 and 3, all while raising their young children. And as I mentioned previously, this would not be for only one set of parents but for the parents of both the husbands and wives involved.

Now complicate this further--not all members of a family will necessarily be living in close proximity to each other. Members of the various generations could be living all over the US and/or all over the world. Even when family members might be in the same general geographic area, you could still be talking about their being quite spread out and with serious time/travel issues that will arise. It is not a mere hop, skip and a jump to travel from SI to Long Island, nor is it from NJ to the NYC environs, nor even from one area of NYC to another.

Let me also mention another issue that complicates the care-giving--work. What is commonplace today is to find couples where both the husband and the wife work at jobs outside the home. Given the economic realities today, those families where both the husband and wife work do so because they need the money. Generally speaking you won't find working members of generation #1, you will still find some working members of generation #2, but many are retired or getting there soon, you will find most of generation #3 working and, where there is a generation #5, you will find generation #4 working.

So, what does this mean apropos of kibud av v'em, and particularly as regards taking care of day to day matters for the older people of the generations present? Frankly, it means that we are going to have to stop philosophizing and start coming up with practical ways to deal with multiple generations all living at the same time. We don't have nearly enough programs, personnel, organizations, and facilities in place to help out with what is no longer a future problem but is here now, and getting larger. I've said it before, and it bears repeating now--tuition is not the only major item facing Klal. Yeshivas need to understand this fact, not only the parent body within a yeshiva.

There is going to be competition for the dollars of Klal, and yeshivas aren't going to be number one on the list for a whole lot of families. Frankly, if the choice comes down between paying X for a yeshiva education, to include all the frills and fancies, and making sure that our older folks are healthy, safe and well taken care of, yeshivas come dead last for me. I do not owe the yeshivas anything, but I surely owe my parents a lot, not least of which is making sure that what they need is provided for.

Not an easy problem to solve, and we'll never find any solutions until we admit that we do, indeed, have a problem.

Note: Just to give you an idea of some of the costs that could be involved in elder care, let me use an assisted living facility in Queens as an example--it is fairly typical of this type of facility around our geographic area. The cost to residents is $5000 per month, and if you can't pay it they throw you out. That figure does not include extra food you may buy for yourself, insurance, medications, doctor expenses, clothing, personal care items etc.; in short, you will easily need to add another $15-20 thousand per year, and quite possibly more. That is about $80K per year, per person, for the elderly in a residence catering to the needs of the elderly. Not precisely spare change.


Honus T. said...

Prof K,

You're ahead of the times. People wont realize this is an issue for 10-20 year (when the boomers really start needing help). This will exacerbate the tuition crisis (many parents are helping their kids).

The only solution is to start realigning priorities/create more sustainable models now.

Unfortunately that doesn't seem likely.

JS said...

I apologize in advance, but this post was needlessly long for making such a straight-forward point.

Also, for 4-5 generation families, you have to assume each generation, roughly, had their first child between ages 20-30. So, how exactly are the #2 and #3 generations that old? You keep mentioning how everyone is getting on in age. In a 4 generation family, #2 is likely around 60, that's not all that old. That's not even retirement age. In a 5 generation family, #3 is around age 40. Again, how is this getting on years?

This problem of taking care of the elderly should be relatively straight-forward as each older member has more and more descendants to care for them. A grandparent has children and grandchildren (plus their spouses) - even having 3 kids in each generation gives you 6 kids and 18 grandchildren (including the spouses) to care for you. Those kids and grandchildren have a total of 8 parents/grandparents to care for. 24 people to care for 8 isn't that outrageous and it's doubtful all 8 would simultaneously need help anyways.

The problem will be solved the same way it's always been solved. The children and grandchildren that are closest and most financially able and most able to give up their time will help the most and the others will chip in as they can.

JS said...

"Frankly, if the choice comes down between paying X for a yeshiva education, to include all the frills and fancies, and making sure that our older folks are healthy, safe and well taken care of, yeshivas come dead last for me."

To this point, is this only because your kids are older? What if you were a younger parent and your own parents and grandparents needed assistance? Do you pull your kids out of yeshiva, send to public school or some comparable solution and use the tuition money to help your family? Or do you spend the money on tuition and find some other solution to help your parents or grandparents?

JS said...

Also, why are you not mentioning medicaid? It's very common to spend down assets and give gifts to family in order to qualify for medicaid. Medicaid pays these extraordinary bills. Maybe it's not the Ritz, but there's good care to be had.

Chana said...

It's not a requirement JS for a private living facility to take medicaid as its only payment. I know the place mentioned in Queens and it doesn't take medicaid patients. There is another place not far from it that does take medicaid but when it's full up then what?

JS said...

You don't have the money, you don't have the money. It's really that simple. You can't afford the nice place, you go to the less nice place that takes Medicaid. That place is filled up, go to the Medicaid place a little further away. No more frum Medicaid places? Go to a non-Jewish one and arrange for kosher food. Or make some other sacrifice such as taking in this parent or grandparent and working fewer hours or quitting your job to become a full-time caretaker.

There are solutions out there, they just may not be ideal.

As for the lack of frum facilities, I'm not so concerned. If there's one thing the frum community has proven it's that when there's money to be made, someone will step up. Seems from your post people don't want the Medicaid facilities and are willing to spend tens of thousands a year to go to the "nice" place. I'm sure someone will step up and open another nice frum place and they will gladly take your money.

See "yeshivas" and "yeshiva tuition" for reference.

Allen said...

"The problem will be solved the same way it's always been solved. The children and grandchildren that are closest and most financially able and most able to give up their time will help the most and the others will chip in as they can."

JS, that's quite an assumption you are making, and your statement has the problems with it right in it. First, the children and grandchildren that are the closest, which assumes that there will be children or grandchildren who are living close by to these parents, an assumption today that you can't make across the board.

Second you have "most financially able," which assumes that there will be among the children or grandchildren at least one capable of financially bearing the load of caring for those older parents or grandparents. And if there isn't?

And then you have "most able to give up their time." And what if the one most able to give up that time just doesn't happen to live close to those parents and grandparents? And what if all married couples are all working because they have to in order to afford to live, so no one is able to give up their time?

You are describing the ideal situation, and that doesn't exist for all that many people. In my community married kids are spread out across the country and in Israel. On average we have about one out of three or four kids in a family coming back to live here, if that. Mine is an oot community and a lot of us married people from other communities. Mostly their parents stayed in their home communities.

The solution isn't as simple as you seem to be making it out to be.

Miami Al said...


If none of your kids are capable of helping you financially, and you are incapable of supporting yourself financially, then you are at the mercy of the state and the community... beggars can't be choosers. You're broke and your family is broke? You're a beggar, drop the entitlement act.

You can't afford to live on your own because of choices you made? Go move to be near your kids.

It is that simple. The idea that you should never be inconvenienced or handed the bill for your inconvenience is a bit strange.

"rankly, if the choice comes down between paying X for a yeshiva education, to include all the frills and fancies, and making sure that our older folks are healthy, safe and well taken care of, yeshivas come dead last for me."

Easy to say, pretty sure your actions speak otherwise.

"I do not owe the yeshivas anything, but I surely owe my parents a lot, not least of which is making sure that what they need is provided for. "

That's also Jewish law, but surprisingly out of practice.

Anonymous said...

...and that's why I'd like to move near the geographically isolated grandparents, the other set is closer to their kin.

-Practical Person

JS said...


I am making assumptions, the same assumptions that have been made for generations. People have been getting old for time immemorial. And those elderly people have had to be taken care of. This isn't a new phenomenon. The fact that people live longer just means we may have to care for the elderly for a longer period of time.

This is, quite frankly, the easiest of problems to deal with for the reason I mentioned above: the average elderly person has numerous children and grandchildren to help them. It's the EXACT opposite problem of yeshiva tuition in which one couple has numerous children they have to pay for.

It would seem many feel they are entitled to live out their lives in a nearby frum facility that costs around $80k per year. Further, if that money isn't available and family can't pay it, the community should. I don't understand this at all. Communal support and money should be for the rarest of instances in which a person has no family and no one to care for them. It shouldn't be used because people can't be bothered to care for their relatives. It's the same for the poor - family should help them and the community should step up when their familial safety net is gone. The entitlement is really just too much - the community doesn't owe you anything. There's nothing they HAVE to solve.

My grandmother wasn't wealthy. When she started getting ill, her children drove the 25 or so miles to see her several times a week. When she developed Alzheimer's and needed full-time care, they helped her spend down/gift away her few remaining assets and found a local Jewish nursing home that accepted Medicaid. They visited her daily. Why is this a radical solution? The children with more money and time available helped out more. No one was wealthy or not working, they made time and found money. This is normal people do who love their parents and want to care for them. And you know what? It sends a helluva stronger message to the grandchildren about what kibbud av v'eim is than having the community solve all your problems.

My other grandmother lived far away. She had an accident and broke her leg. She was brought back here to be closer to family so she could be cared for. Again, time was made available on top of busy schedules. Money was found to help out to the extent necessary.

Neither situation was ideal. Life isn't ideal. Getting old sucks. Watching once vibrant people fall ill and lose their physical and mental facilities really sucks. You find a way to make it work. That's the right thing to do.

The community steps in when the elderly have been abandoned, not when someone can't afford the luxury frum resort nursing home with daily shiurim. Ironically, I bet a lot of people who want this type of communal help rail against "big government" and welfare programs.

Anonymous said...

For those of you who think Medicaid is the answer to the problem of caring for the elderly, think again. Medicaid does pay for nursing homes and medical care if all your assets are depleted, but it does not pay for most of the services needed to allow elders to remain in their homes. Also, the rules for Medicaid eligibility and what Medicaid will cover are going to get more and more restrictive. Also, you can't just give your assets away to qualify. The look back period is going to get longer and longer. Now for example, a state my say, in determining whether you are eligible, we are going to count all the assets you gave away for the last four years. Soon, that time period is going to be seven years, then ten years. Also, Medicaid funding is such that due to low funding (and/or fraud and greed by nursing home operators and administrators) the care and conditions in many medicaid-funding nursing homes is sub-optimal.

The best thing that children and grandchildren can do is make sure the parents/grandparents have purchased good long-term care insurance (and will have the money to pay for it in the future) before they let the grandparents/parents spend money on the grandchildren's weddings, schools, vacations, etc. If the grandparents/parents can't pay for long-term care insurance, the kids/grandkids who aren't going to be willing or able to provide care for the prior generation(s) should chip in to pay for long-term care insurance that will pay for several years of in-home care, or, if needed, a good nursing home.

Orthonomics said...

Helping out an aging generation is a constant topic in personal finance publications. Some families choose to pay the primary caregiver so he/she can leave a part time job. Other families split the bills.

Taking care of aging generations will be a challenge for the frum community as it will compete with tuition.

That said, all need to be practical and relocation must be in the vocabulary.

Anonymous said...

Families tend to take care of their own. Communal concerns should be addressed toward those seniors who don't have any one to care for them, such as those who never married, never had chidren or have children who are unwilling or unable to help care for their parents. How we treat the most vulnerable members of our population is the true test of our humanity and religiousity.

The Rebbetzin's Husband said...

Thanks for the reference here, and yes, this is a huge issue, and it's here today.

Sima said...

Until you really get into this situation where you have to be caring for older parents or even parents and grandparents it's all talk. The practical is a lot tougher then what is being discussed here like philosophy. Easy to say that someone should quit a job to take care of parents. Easy to say somebody will have to relocate. Easy to say what's the big deal. Easy to say Medicaid will take care of things.

My family is already living with this problem and it is anything but easy. It's a 24/7 job and you really need about another 12 hours in the day. And forget about having a normal life for yourself and maybe your kids.