This as-told-to essay is based on a conversation with Kim Berling, 66, who lives in Albuquerque. Berling and her husband, 72, are caring for his 99-year-old mom, and both work to support her. This interview has been edited for length and clarity.

I have five adult children. I work in financial advising and insurance sales. I have lived in New Mexico my entire life. My husband operates his own business as a technician for ATMs, where he installs or repairs them on site.

My father passed away in 2018 from prostate cancer. My mother is 86 and lives independently. I reside near her, as do my four siblings. She has no health concerns that need attention right now.

I purchased long-term care insurance for myself. My husband has medical conditions that prevent him from qualifying. I expect to become his caregiver eventually.

My mother-in-law resides in the Dallas area. Her family has a history of longevity. Aware of this, she secured a long-term care policy in her late 70s. The policy stays active with ongoing premiums until her death and offers a death benefit, though it builds no cash value. She continues paying $405 monthly in premiums.

Her health began to decline at age 90

At 90, she confused the brake pedal with the gas and collided with a tree. She was unharmed, but her younger son, who lived nearby, concluded she should stop driving. He suggested a nursing home, yet we disagreed, so I took greater initiative in her care. I arranged for a companion to assist with driving and church attendance. Fortunately, my brother-in-law's ex-wife needed work, and the arrangement succeeded.

When she turned 92, she fell from a ladder and fractured her femur. Following surgery and rehab, she returned home. We understood recovery would take considerable time before she could move about independently. I obtained her medical power of attorney.

She could no longer manage alone, so I searched for caregivers

We tried several caregivers. It proved challenging to locate individuals who delivered both quality care and a positive outlook. Older adults often have little daily interaction and need conversation, yet many caregivers avoid engaging.

Although long-term care insurance existed, a 100-day waiting period required us to pay fully out of pocket before coverage began. I sometimes drove to Texas to verify proper care. She remained optimistic, which helped me feel confident about the setup.

I was fortunate to connect with a reliable network of caregivers who offer fair rates and show genuine compassion and skill. They have supported her for the past six years.

Her home care totals roughly $6,600 monthly, rising to about $11,000 when all expenses are included. The long-term care policy pays around $4,200 monthly once active, leaving a shortfall. She has $41,000 in remaining benefits, so coverage will end within a year. My husband and I cover the gap, which grows harder over time and restricts our other spending.

Additional costs add up quickly

Her monthly income is about $3,000 from Social Security, a small teaching pension, and an annuity from her late husband's life insurance. This amount exceeds Medicaid limits. If eligible, Medicaid would cover around $1,500 monthly for full-time family care. A program for middle-income families who earn too much for Medicaid yet lack funds for long-term care would help greatly.

She pays privately for doctor transportation. Other overlooked expenses include gloves, bed pads, and diapers, which can reach several hundred dollars monthly.

We appreciate that these costs are lower than many caregiving cases we hear about, where families face state facilities or must leave jobs to provide care.

At 99, she remains mentally sharp

Mobility is difficult for her. She experiences short-term memory loss, repeats stories, and has significant hearing loss. I hold regular Zoom calls with her and the caregivers. I feel at ease leaving her for up to 30 days. I visit once a month to check medications. The drive takes nine hours, and I usually stay one or two days.

Staying involved is essential. In May, she developed a persistent cough. A new primary doctor refused antibiotics until an in-person visit, which required me to travel. The delay led to pneumonia and a 10-day hospital stay.

I continue working because we need the income. My husband wants to retire, but we cannot afford it. When my mother-in-law passes, we will return to our prior financial position without extra savings. We have no funds set aside for our own long-term care needs. Both of us will require such care, and I expect a long lifespan.

I also work because if the current caregivers become unavailable, I would need to step in while still maintaining employment. My husband has physical limits that prevent him from handling full care.

We work out of necessity, not choice.