As parents and caregivers for our children, we usually expect that at some point in our lives our children will grow into adults and eventually become self-sufficient. It usually happens around the time we realize that our days of being a caregiver are not really over, but merely shifting from our children to our aging parents.

The costs of elder care, such as assisted living facilities and nursing homes, has risen dramatically over the past few years, along with the cost of health care. Fortunately, we have Medicare and Medicaid to carry some of the weight of this expense burden.

But what we almost always fail to realize is the hidden costs to the caregiver in these situations.

Caregiver demand

According to data from the Department of Health and Human Services (HHS), the demand for informal caregivers such as family members, friends or neighbors, is expected to increase by more than 20 percent in the next 15 years, and by 85 percent in the next 40 years.

Nearly 62 million people already care for another adult at least part-time, an expensive and time-consuming undertaking. It usually starts when you notice your mother or father is having trouble getting up the stairs, or begins to fall in the bathroom.

Even if you hire someone to provide care, more than half of the related care-giver -- the son or daughter -- will spend more than $4,500 a year on expenses such as food, transportation and medication for their elder parent.

What about the physical and emotional cost to the caregiver? According to a 2010 study of employees by the National Alliance for Caregiving and the MetLife Mature Market Institute, an estimated 11 percent of caregivers report feeling stressed compared with seven percent of non-caregivers. Marc Agronin, a geriatric psychiatrist and the author of "How We Age," says the stress and physical demands can bring about higher medical expenses and career roadblocks for anyone tending to another person.

Addressing hidden costs

Based on the MetLife and National Alliance for Caregiving Study, here are some hidden costs along with some ways to address them.

Hidden cost number 1.

Caregivers of all ages have a heightened risk for chronic health problems. Among working women 50 and older, the MetLife/NAC study found 20 percent of caregivers report just fair or poor health -- more than double the number of non-caregivers. Nearly 26 percent of adult men under the age of 39 say the same thing, which is more than three times the rate of non-caregivers in that group. Among the most common chronic health conditions reported at higher rates are diabetes, high blood pressure or hypertension and high cholesterol.

Those, and other related illnesses, can be expensive to treat. And because many caregivers are strapped for time, they end up skipping or delaying the medical care they need.

The best way to deal with this is to carve out time for your health needs. Consider using an adult day care center, which run about $75 per day, or hire a temporary home health aide once or twice a week to give you a break. You can usually find a list of such services, as well as other resources, at and

Hidden cost number 2.

Your career could easily take a hit. Nearly half of caregivers report that they've lost a job, had to change shifts or have missed out on career opportunities as a result of their responsibilities. A 2010 study by Genworth Financial and Age Wave found that those lost wages, promotions and other benefits can add up. The study also showed that 37 percent of caregivers quit their jobs or cut back on hours. Even those who keep their jobs may be overlooked for promotions and raises because of the time they're forced to spend away from the office.

You can deal with this by making your work schedule work for you. If you've established yourself as a strong performer, you can try to negotiate a flex-time or partial work-from-home arrangement. Newer companies in creative and high-tech fields often are most amenable to such arrangements. If ever you can't meet a deadline, talk to your boss and offer alternatives.

Hidden cost number 3.

You may have to delay retirement. The Genworth study found more than half (57 percent) of caregivers used their retirement savings to care for a loved one at some point during the past year. It also discovered that 63 percent of caretakers suffer a reduction in or loss of income because of their responsibilities. That double whammy makes it difficult to save enough to retire at a reasonable age.

You can deal with this by taking advantage of assistance programs. In 15 states, caregivers -- even family -- can get paid for their services through Cash and Counseling programs which dole out payments to Medicaid recipients who can then use the money to pay their caregiver. Some long-term care insurance policies may allow for compensation to a family member for providing in-home care, though pay rates vary widely depending on the policy and some require caregivers to complete a training session to qualify. Make sure to maximize available caregiving tax deductions, including a deduction of up to $3,650 for taking care of a qualifying relative.

Hidden cost number 4.

A family lawsuit. Fights between siblings over money used to care for parents are common and can lead to legal wrangling. Issues like who pays for care, the level of input each sibling has in caregiving preferences and how much time each sibling spends on care can top the list of hot button issues. Then there are those "medical end-of-life issues" that throw some families into an emotional hurricane that can cause lasting damage. A legal fight with your siblings over the estate, end-of-life care or a small stipend you may get for caring for mom can end up costing tens of thousands of dollars. Even mediation is pricey with sessions cost anywhere from $2,000 to $10,000 depending on the weightiness of the issues.

You can deal with these issues by talking it over among the entire family and then put into writing all health and end-of-life care preferences, as well as estate issues. All siblings and immediate relatives should sign a caregiving agreement.

You can get an outline for such a document at It lays out the financial and time responsibilities that each person will assume. If the family fighting becomes problematic, consider hiring a care manager to oversee and organize what needs to be done for a parent and who does it.