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A generation caught between two others

For midlife Americans struggling to juggle caring for their elderly parents while raising their own families, there is little good news: Resources that are already strained to the breaking point will only become scarcer.
/ Source: and NBC News

For the 20 million Americans who are struggling to juggle caring for their elderly parents while raising their own families, there is little good news. Resources already stretched to the breaking point are growing scarcer, because the United States isn’t recruiting or training nearly enough geriatric care specialists to meet the needs of a rapidly aging population.

The non-profit Pew Research Center discovered some startling statistics in a study it released a little over a year ago: Slightly more than 1 of every 8 baby boomers — those Americans roughly ages 40 to 60 — are simultaneously raising a child and providing some form of financial assistance to a parent. Demographers call them the “Sandwich Generation.”

At the same time, projections from the U.S. Census Bureau indicate that by 2030, the number of Americans 65 or older will double, to 71 million, about 20 percent of the population. But the number of doctors specializing in geriatric care, already far too low, is dwindling, not growing. Medical professionals and policy makers call that the “2030 Problem.”

Too many patients; too few doctors
A report published in the journal Geriatrics: Medicine for Midlife and Beyond shows just how inadequate geriatric training already is: Only five of the nation’s 145 medical schools even have departments of geriatric medicine, and only about 3 percent of graduating medical students have taken courses in geriatrics.

The American Geriatrics Society found that the United States was already 14,000 short of the number of geriatricians it needs today. By 2030, it will need 15,000 more. Meanwhile, geriatrics fellowships produce only about 300 new practitioners a year.

“As a result of flaws in the nation’s health care delivery system, the shortage of geriatrics professionals will soon reach crisis proportions,” the society warned in a white paper it issued two years ago.

Too often, it found, “illnesses in older people are misdiagnosed, overlooked or dismissed as the normal process of aging, simply because health care professionals are not trained to recognize how diseases and drugs affect older patients differently than younger patients.”

Most medical students prefer to pursue specialties with 9-to-5 hours and fewer emergency calls, while others go after specialties that pay more than geriatrics. Geriatricians, often the lowest-paid physicians, are almost entirely dependent on Medicare revenues, according to the American Geriatrics Society, which blamed low Medicare reimbursement levels as a major explanation for the specialty’s unpopularity.

“Medicare payment policies currently provides a disincentive for physicians to enter the field of geriatrics and to carry a full caseload of Medicare beneficiaries who are frail and chronically ill,” the society said.

Dr. Laura Mosqueda, who runs a geriatric health care program at the University of California-Irvine, put it more bluntly in an interview last year with NBC’s Mark Mullen: “You’ll get reimbursed better if you remove a wart than if you take the time to talk about how somebody’s doing after their husband passed away.”

Tearing families apart
The burden thus falls on seniors’ children, and research shows that the strain can cause real tension within families. Old family dynamics come back like a boomerang during anxiety-producing conversations about aging or ailing parents, says Brian Carpenter of Washington University in St. Louis, who studies sibling issues.

Sarah Matthews, a professor of sociology at Cleveland State University who interviewed 149 pairs of brothers and sisters who care for their aging parents, found that women and men have different expectations: Sisters saw their siblings as a team, expecting cooperation and communication about what each was doing for the aging parent. Brothers, on the other hand, acted independently and expected to negotiate directly with their parent without keeping their sisters informed.

“That tended to annoy the sisters,” Matthews told The Associated Press, and the brothers didn’t understand their sisters’ irritation. When asked generally what they were doing for their parents, the men said, “Not much,” but then they gave specific examples that revealed they did a lot more than their sisters knew, Matthews said.

As a result, a industry of professional mediators has been born to help squabbling boomers work out their disputes over aging parents.

It is a thriving sub-specialty in the overall market catering to baby boomers, which economists estimate at $2 trillion a year. One company, Elder Decisions in Lexington, Mass., said it was working with about 25 families, charging $350 an hour.