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How do you care for an aging parent? When the Time Comes author Paula Span explores the topic.

Orange County (Calif.) Register

More than 70 percent of people now 65 or older will require some type of long-term care services, and more than 40 percent will need care in a nursing home.

Average median cost of one year in a private nursing home is $74,200.

The number of people 65-plus is expected to double over the next decade.

That data - compiled by Genworth Financial, which sells long-term care insurance - explains the overwhelming interest in different aspects of caregiving.

Right now, 34 million Americans care for a frail, aging family member.

But how do you know when someone is too frail to live alone? How do you begin the dialogue with a father who is fiercely independent?

Journalist Paula Span, contributing writer for the Washington Post magazine, has gathered stories from several families facing this painful question. Her new book isWhen the Time Comes, Families With Aging Parents Share Their Struggles and Solutions (Springboard, 2009).

Q: You said this book is not an elder-care manual with a step-by-step checklist, but an overview of the way families reach decisions and the way they negotiate and patch things together. Are these conversations - difficult at any time - worse during this economic recession?

A: The book provides a lot of background and it's all still true. Health care reform might be on the horizon, but families still have to decide if they are going to provide care at home, find people to help, look for an assisted living home.

Q: Families where adult children have lost jobs are bringing parents home and out of assisted living today.

A: They can't afford the fees. The theory is pay us rather than them. And there are people who can't move into these homes because they planned to fund that care through the sale of their own house and that's not worth as much today.

It's always a difficult thing to reach that point of having to care for a parent. Most people use private funds and most have no paid help. That's part of why my book deals with so many agonizing decisions and options. You still have to pay a substantial sum for help.

Q: This is one of the best books I've read dealing with the different, and difficult, family decisions associated with different levels of care. You illustrate it with real cases involving real American families yet a common theme I hear is that we "dump" our parents.

A: Thank you for your kind words about my book. The concept that Americans dump their parents is so unfair. Most people are not paid for the care they provide for family members. Usually it's women - daughters, daughters-in-law, wives.

Since 1940, our statistics show aging Americans are less likely to live with adult children. There was a big change that year. The first Social Security checks were issued. Although tiny by contemporary standards, Social Security, coupled with private pensions, gave the elders independence.

We have to stop beating ourselves up. We are very generous to our parents, for the most part.

Q: Your stories put the "face" on caregiving, with real names, real people.

A: My hope is that it helps families navigate the tough times.

fast facts

Online assistance

To complement Paula Span's book, Genworth Financial has joined with Virginia Morris to offer an interactive Web site on how to start conversations with parents needing care. Morris is the author of How to Care for Aging Parents, which she describes as a "huge yellow pages of resources." The Genworth site, she says, will emphasize helping families find ways to talk and plan. The Web site is