Christian Fritzberg's life was in chaos.
Just a month into a new job, he moved his 74-year-old mother out of assisted living and into his home.
Fritzberg, 35, worked nights and weekends to get his work done as he juggled his new caregiving duties. His mother was frail and in a wheelchair, and could no longer cook, bathe or get herself dressed.
He believed he was managing; his bosses felt otherwise. Within the year, he was out of work, with four weeks' severance.
"I was pulled in two directions," Fritzberg said. "At the beginning, they said they'd be flexible and would accommodate whatever time I needed. It went quickly to becoming an issue."
Growing numbers of American workers will confront this dilemma as the baby boom generation ages: how to take care of an aging parent and still hold a job.
Surveys show that more than two-thirds of those caring for their frail loved ones suffer job-related difficulties. They cut back on hours, take unpaid time off, retire early or receive a warning about performance or attendance.
The United States is one of the few industrialized countries that doesn't guarantee workers paid leave to care for family members, and most employers do not offer it. This leaves many without guaranteed job security, flexibility or a financial safety net.
"We are still using caregiving policies from the 1950s, when many more families were composed of one breadwinner and one stay-at-home parent providing unpaid family care," said Sarita Gupta, co-director of the national advocacy group Caring Across Generations. "Families today are overwhelmed by the physical, emotional and financial costs of both child care and elder care."
A drain on productivity
With an unprecedented age boom unfolding, the need for workplace policies to support the nation's 25 million family caregivers has never been more pressing – for the workers, the nation's elders and the economy.
Informal caregiving costs U.S. businesses as much as $33 billion in lost productivity each year, according to the National Alliance for Caregiving. That includes the costs of replacing workers, shifting them from full- to part-time positions, absenteeism and making workday adjustments.
Meanwhile, those who drop out of the labor force or reduce hours put their current and future financial security at risk to avoid the high cost of home care, assisted living or nursing homes.
"These are folks who are struggling," said Vicki Shabo, vice president of the National Partnership for Women and Families. "Without income when they need to take time off of work, they face falling deeper into a financial hole. They may need to rely on public assistance. They may need to go into debt."
A quarter century ago, Congress passed the federal Family and Medical Leave Act (FMLA) in an effort to address the problem.
The law allows eligible workers up to 12 weeks of unpaid leave a year for their own medical emergencies and sick family members, without fear of getting fired. But about two in five workers aren't covered because they work part-time or for a small business, or they're caring for a relative who isn't included in the law, such as a grandparent, in-law, sibling or domestic partner.
And because FMLA leave is unpaid, most low-wage workers can't afford to take it.
"Anyone can become a caregiver at any time," said Tay McNamara, co-director at the Center on Aging & Work at Boston College. "And a lot of people will face this at a time when they should be making peak money. If your employer doesn't offer it, your recourse is to get another job or leave your job."
A few companies offer leave
With a tightening job market, a small but growing number of large companies have established paid-leave policies or expanded existing coverage to attract and hold on to skilled workers.
But just 13 percent of the nation's private-sector workforce is offered paid family leave. Such benefits are two to three times more likely to be given to managers and professional workers than to lower-wage workers. And companies are much more apt to offer paid time off to bond with a baby than to care for an aging parent with medical needs.
Minnetonka, Minn.-based Cargill established its first paid leave program in 2017, and designed it to be broad enough to include a range of family members and life events. The benefit is available to 16,000 salaried and nonunion U.S. employees, and allows up to four weeks of full pay each year to bond with a new baby or to care for any seriously ill family member.
"It provides them with an opportunity to care for that family member, but also takes away that financial piece that was a burden previously, and which required employees to make choices," said Patty Babler, Cargill's vice president of human resources. "Now it's easier for them to make that choice."
Deloitte had similar reasons when it launched one of the nation's most comprehensive and generous paid-leave policies in September 2016. The accounting and consulting firm provides fully compensated medical and family leave for up to 16 weeks a year for all U.S. workers, not just managers.
"It's an effort to say, we've got your back whatever your life situation is," said Jen Fisher, Deloitte's national manager for well-being. "We want you to be able to take care of those things and those people that matter the most to you, but also to have a meaningful and valuable career."
Michelle Weaver, a Deloitte consultant now in Atlanta, was among the first to take advantage of the program when she was based in Minneapolis.
Weaver's father is a disabled Vietnam veteran who doesn't drive, and her mother is his main caregiver. When Weaver's mother needed surgery on both knees simultaneously, Weaver knew her parents couldn't cope alone.
She took two weeks of paid leave and moved into their home in Beloit, Wis., where she did all the driving, grocery shopping, cooking and laundry. Weaver helped her mom with personal needs, managed her pain pills and kept her on task with physical therapy exercises.
Then her father got hurt falling off a step.
"I ended up taking care of my dad a lot more than we were planning on," she said.
Weaver, 42, enjoyed being there for her parents, but it was all-consuming. She was up several times a night, and always on high alert. It was a relief to be free of work stresses.
"It was pretty much 24/7," she said. "If I'd had to be online, attending meetings and e-mailing, it wouldn't have worked."
How to pay for leave
Paid family and medical leave has bipartisan support both in Congress and among the public. But figuring out how to pay for it has long been a partisan sticking point.
In Minnesota, efforts to establish a statewide paid-leave policy have failed twice in recent years.
Democratic lawmakers generally have favored social insurance programs, such as those in California and a handful of other states, which are available to all workers and funded by a payroll tax on employees and businesses.
Republicans tend to reject publicly funded insurance programs because they create new government programs and taxes, and limit employers from crafting programs as they see fit. Generally, Republican plans have favored tax incentives.
"Our view is that these employers do a pretty sharp job of offering benefits that really work for their employees and their communities," said Laura Bordelon, senior vice president of advocacy for the Minnesota Chamber of Commerce, which has long opposed laws that regulate paid family or sick leave. "That's where we get stuck in these debates with the Legislature and around policy questions about which mandate fits best."
Competition for skilled workers is already forcing businesses to adjust, Bordelon argues, even among small- and medium-sized companies with limited staffing and resources.
"Employers acknowledge the challenges that are happening with families," she said. "They do offer benefit sets that are tailored to the employee as much as they possibly can. They want to keep those folks there."
Whether by mandate or market force, the landscape is indeed shifting. This year, legislatures in 29 states discussed paid-leave bills.
President Donald Trump, led by a push from daughter Ivanka, pledged his support for paid parental leave during his State of the Union address. Congress' new tax law includes a tax break for companies that provide paid family and medical leave for workers earning less than $72,000 a year, though it is a voluntary incentive and will sunset after two years.
Four states – California, New Jersey, Rhode Island and New York – have now implemented paid-leave laws that cover family leave financed through payroll contributions from workers and their employers. Washington state and the District of Columbia will join the list in 2020.
In Hawaii, a measure passed last summer provides a $70 a day stipend for working caregivers to hire help for ailing family members so they don't have to give up their jobs.
The need for family and medical leave – whether paid or unpaid – is felt broadly across the U.S., according to Pew Research. Roughly six in 10 workers say they have taken or are very likely to take time off from their jobs for family or medical reasons at some point.
Last year, nearly 7 million Americans who needed to take a leave didn't take it because they couldn't afford a hit to the paycheck, according to another study.
"It's a double-edged sword. This silver tsunami is roaring down the bend at us, and the state is going to have to figure out how to respond," said Debra Fitzpatrick, co-director of the Center on Women, Gender and Public Policy at the University of Minnesota, who was hired by the state to help research how Minnesota could design and implement a paid leave insurance program.
"Paid family leave is one way to help workers take responsibility for this themselves and figure it out," she said. "Businesses are concerned that people will be out every other day given the demographic realities and need for elder care. But in the states with programs, this hasn't been the case."
Angela Byrne packed up her mother's belongings at her home in Robbinsdale. Byrne lived with and cared for her mom during her cancer treatments; she died in February. Byrne said her bosses were supportive, but workplace pressures were ever-present.
Long-term costs for caregivers
Angela Byrne, 32, who works for the state of Minnesota, took two unpaid FMLA leaves to care for her mother, who died in February after two years of cancer treatments and intermittent hospitalizations.
"One day you're minding your life," Byrne said, "and the next day your mom is sick and before you know it you're thrust into full-time care."
An only child, Byrne found it impossible to work during hospitalizations. She moved into her 57-year-old mother's Robbinsdale, Minn., home to help out during the extended treatments that left her mother weak, dehydrated and nauseous. Byrne's husband, Patrick, who also works, took over household duties at their home and care of Henry, their toddler.
"I was walking around in this fog, like I was on cough medicine," Byrne said. "Physically I was OK, but my brain was mush. And I'm trying to have these highly technical conversations with doctors and coordinating all of this care, and also trying to be happy and upbeat for my 3-year-old."
Byrne said her bosses were supportive, but workplace pressures were ever-present. And the hit to her family's finances was substantial.
"I'm losing out on pension, seniority, income – this is going to impact me forever," she said.
Americans who provide care for their aging parents lose an estimated $3 trillion in wages, pension and Social Security benefits when they take time off to do so, according to research by MetLife Mature Market Institute, the National Alliance for Caregiving and the Center for Long-Term Care at New York Medical College.
Women, who now are breadwinners in 40 percent of the nation's families, are hit hardest.
Female caregivers who are 50 and older who leave the workforce to care for a parent can lose $325,000 in lifetime earnings – 25 percent more than men, according to the MetLife study.
Gail Gibson Hunt, founder of the National Alliance for Caregiving, argues that unless policymakers make it easier in the coming years to balance work and family caregiving, adult children will either continue to reduce hours and drop out of the labor market, or more frail elders will receive insufficient care.
"If you don't help out the family caregiver," she said, "they're going to push this responsibility onto Medicaid. And then the taxpayer is on the hook for a much bigger hit."
'I was good at the job'
Fritzberg wanted only to do right by his mother.
Barbara Fritzberg had been diagnosed with Parkinson's disease 17 years earlier, and she had spent the past six in assisted living. After a quick succession of falls, and trips to the emergency room, her son felt she needed more attention. With her rent at $7,000 a month, he feared she was plowing through her small nest egg too quickly, and had become socially isolated in her apartment.
He jumped at a chance to buy the house next door, just steps away from his in a quaint south Minneapolis neighborhood. Barbara flourished under her son's care. She ate better, got outside in the sunshine and delighted in visits with his golden retriever, Griffin.
"Her cognition was back, her mobility and strength was back," Fritzberg said.
But roadblocks were everywhere.
The senior center where Barbara spent her days closed at 2:30 p.m., providing a scheduling challenge. Metro Mobility proved to be unreliable, so Fritzberg took a late lunch to pick her up. He hoped there would be no hitches so he could tuck Barbara in for a nap and head back to his job as property manager of a senior housing cooperative.
"Sometimes she'd ask for something or wanted to change her clothes or use the bathroom for an extended period," he said. "I'm happy to do it, but it was stressful trying to pull it together. You've got appointments in the afternoon, you're fighting traffic. You need a quick turnaround."
Nine months into the job, Barbara fell and broke her hip. Coordinating her recovery meant hours on the phone dealing with health insurance and scheduling doctor's visits, rehab and physical therapy at home. None could be handled after hours.
Fritzberg, who'd been with the company for more than two years, decided against taking an FMLA leave. Staffing was thin, and he didn't want to further burden his co-workers. It's a decision he now regrets.
Six weeks after his mother's fall, Fritzberg was boxing up his desk and telling colleagues goodbye.
"I was hurt," he said. "I was good at the job by the time they terminated me."
Fritzberg now feels as if he's turned a tough experience into a positive. He got his real estate license, and now specializes in helping seniors and their families sift through housing options. The flexibility has relieved some of the pressure of caring for his mother, whose motor skills and memory continue to deteriorate.
"Things happen for a reason," he said. "Now I'm able to be there for my mom."