Patricia Angela LoManti is a 46-year-old registered nurse, separated from her husband and a mother of a 21-year-old daughter.
She teaches full-time at a community college near her home in the Auburndale section of Queens, where she lives with and cares for her 77-year-old mother, who has diabetes and heart disease.
"I spent 18 years raising my daughter," said LoManti of her only child, who graduated from a community college two years ago and moved to Florida. "I'll probably spend more time caring for my mother."
LoManti is a prime example of the so-called "sandwich generation," people who simultaneously work full or part-time while having a child under 21 and giving full or part-time care to a parent over the age of 59. Any one old enough to have children can be "sandwiched," but the majority -- 71 percent -- are between 40 and 59.
What makes LoManti and her mother most emblematic is that both the giver and receiver of care are female.
The number of men giving unpaid care to parents or other elderly relations is growing and now stands at about six million, according to AARP, the Washington, D.C., lobbying group for older Americans. But roughly three in four of the 23 million U.S. providers of unpaid care for older people are female.
"Caregiving for a sick and aging spouse, companion, sibling or parent is still seen as a woman's responsibility," said gerontologist Betty Soldz, who has served as president of Older Women's League chapters in California and Boston.
The pressures on caregivers are often obvious to the people who know them.
Lynne Gallagher, a social worker with the Family Services Association in Toronto, runs support groups for female caregivers to elderly parents. She says that 25 percent of those women suffer from chronic or acute depression. "They feel like they're never going to get out from under. They feel they can't do enough for their parents and their lives are no longer theirs."
As caregivers age, their own health becomes a concern.
"Caregiving takes a physical toll," said Soldz, "but also a mental and emotional price."
Isolation and depression exacerbate or sometimes even cause high blood pressure, erratic eating and sleeping habits, and other physical ailments that often follow stress. Sometimes the caregiver's health declines even more precipitously than that of the person receiving care. About two in five providers end up in the hospital themselves while caring for their parents, and nearly one in ten die before the parent does, according to AARP.
During this year's congressional and gubernatorial elections, AARP and other lobbying groups for older Americans have focused attention on Medicare reform and are pushing for covering more of the costs of prescription drugs and home-care services. As people, particularly women, live longer, they depend more on such medications and care. Seniors are actually paying more -- and a greater proportion of overall costs -- out of their pockets than when the so-called Part D of Medicare became law in late 2003, according to a report from the Washington-based Kaiser Family Foundation.
Falling Through the Gap
Before Part D was enacted, Medicare covered only doctor's visits and hospital stays. Part D -- which is optional for Medicare recipients -- offers prescription drug coverage, but the plan also contains a so-called coverage gap, or doughnut hole. If a recipient spends more than $2,250 but less than $5,100 a year on prescription drugs, he or she must pay for them. More seniors have fallen into this gap than anyone anticipated, according to a report from New York-based AGS Foundation for Health in Aging.
At the same time, however, AARP has also been pressing both incumbents and candidates to create legislation that would nudge employers into offering more flexible work schedules for older workers, similar to what some organizations now offer to parents of babies and toddlers. AARP has also petitioned incumbents and candidates to change Medicare, Medicaid and private insurance regulations to cover aging parents as dependents under health insurance policies and even to make certain benefits transferable.
The lobbying group argues that such laws would mean that older workers lose less work time -- and pay -- as they do now, a major consideration for many sandwiched caretakers. In 2005, U.S. women's wages averaged 76 percent of men's, according to the Washington-based Institute for Women's Policy Research. Taking care of an aging parent, meanwhile, costs a family member an average of $19,525 in out-of-pocket expenses, according to the National Council on the Aging in Washington.
Limited Incomes and Pensions
Women of LoManti's and earlier generations worked when the pay gap was even greater, so it was more difficult for them to save for such contingencies as caring for parents.
Meanwhile, the mothers, aunts or other female relatives who are receiving care may not have worked for pay and therefore have no pensions. Survivor's Social Security, for instance, is the only income for LoManti's mother. AARP studies find that about one in five women aged 65 and older -- or about four million -- share her situation.
If an older woman did work, she's only half as likely to have a pension as a man, and if she has a pension it averages only half of a man's, according to AARP. As a result, middle-aged women who are already at a pay disadvantage are saddled with the high costs of care and the limited incomes of those for whom they care.
They also may take unpaid time off from their jobs; women average 11.5 years out of the work force, according to University of Washington gerontologists Nancy Hooyman and Asuman Kiyak.
In addition to the pressures of helping a parent on a sporadic income, middle-aged women who leave their jobs in order to take care of ill parents face the prospect of diminished -- or no -- pensions as well as reduced Social Security benefits when they become senior citizens themselves.
So far, however, no major candidate has proposed such reforms as a major part of his or her campaign platform, according to AARP, and proposals to reform Medicare or Social Security have generally been sweeping and non-specific.
"It all has to change," LoManti said, "the Social Security system, the way we provide care and what we the work world expects from us. Otherwise, it'll be just like it's always been: Everything falls on women."