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Millions of Americans, most of whom are women, are not only providing care to aging parents and loved ones, but they’re also serving as “financial” caregivers.

In fact, some 92% of caregivers are paying bills from their care recipient’s accounts; monitoring bank accounts; handling insurance claims; filing taxes, and managing invested assets, according to a new Merrill Lynch study, conducted in partnership with Age Wave.

And all that financial caregiving comes with a big price tag. Consider: Some 40 million family and friend caregivers in the U.S. collectively spend $190 billion per year on their adult care recipients, according to the Merrill Lynch study, "The Journey of Caregiving: Honor, Responsibility and Financial Complexity."

And along the way, more than half of caregivers (53%) have made financial sacrifices to compensate for caregiving expenses and four in 10 caregivers under the age of 64 have made sacrifices at work due to caregiving responsibilities. So, what advice to experts have for current and future financial caregivers?

Plan in advance 

Some big decisions with regard to the person being cared for need to be made early, says Anna Rappaport, a retirement consultant and chair of the Society of Actuaries’ Committee on Post-Retirement Needs and Risks.

“Buying long-term care insurance can help finance care, and in some cases, increase the options for care, but it must be purchased while the person covered is insurance,” she says. “Continuing care retirement communities offer an option for getting care over many years, but for a substantial price, but the move must be made while the person is still healthy.”

Plan for long-term care

“Long-term care planning is very important and it is often overlooked,” says Rappaport. Consider, she says, the needs of both the person getting the care and the care-giver. “Failure to plan for long-term care can easily lead to running out of assets for average families where there is a major paid long-term care event,” says Rappaport. “Where there is a failure to plan for long-term care, this can create major problems for the family as well as the person needing care.”

Get smart fast

Nearly six in 10 respondents (57%) to the Merrill Lynch study find navigating health insurance expenses to be the top challenge of financial caregiving. Given that, caregivers must become knowledgeable about both state and federal programs and guidelines ASAP, says Jack Tatar, author of Having the Talk: The Four Keys to Your Parents' Safe Retirement. “I’ve found that this can be a tricky area to navigate,” he says. “Few resources exist that go to the local level and what may be true in one state regarding benefits may not be true in another state.”

Rappaport notes, for instance, that Medicaid can be an extremely important source of support for some situations. “When it might apply, it should certainly be investigated,” she says.

Caregivers should also learn about specialized senior housing. “There are a number of options and there is a lot to think about in making this choice,” says Rappaport. “Particular care should be taken in thinking through any option that requires a large up-front payment.”

Plan on taking care of yourself 

The toll caregiving will take on caregivers is not insignificant. Respondents to Merrill’s survey report cutting back on expenses, having trouble paying their bills, dipping into personal savings, reducing their work hours, and leaving the workforce. “No. 1 —  take care of yourself — healthy wise and financially,” says Tatar.

His advice: Find resources for your own well-being — including communicating with others in a similar situation. “Learn estate laws and recognize how you can use programs to help fund your needs and the care recipient that allow you to protect your own assets,” says Tatar.

For her part, Rappaport says caregivers should not be afraid to speak up if they need help. “It is not uncommon for one or two-family members to bear most of the burden,” she says. “The caregiver needs to be able to ask for help, and push for the burden to be distributed if it is not. It is important to the caregiver to find suitable ways to get breaks and to take care of yourself. It is easy for caregiving to overwhelm the caregiver.”

Don’t give up your day job

Caregivers should not give up their job or reduce the schedule without exploring other options and costs, Rappaport says.

“Giving up a job has a huge hidden cost,” she says. “It has been estimated that the average cost to care-givers who give up their jobs is in excess of $300,000. Options that look expensive may turn out to be much more attractive when the hidden costs of informal care are considered.”

Put in place checks and balances 

While caregivers can help safeguard the person cared for from fraud, they can in some cases also be the perpetrator of fraud, says Rappaport. “Where a caregiver, family or otherwise, takes over the finances for the person cared for, it is very desirable to have some checks and balances,” she says.

Work with knowledgeable advisers 

Not all advisers are trained and equipped to address needs related to caregiving, Tatar says. “Many advisers are not willing to be engaged in an area that is so foreign to them,” he says.

But that may change over time, Tatar says. “I expect that you’ll see more firms and advisers step up their efforts to provide advice and resources in this area simply to address their client fiduciary responsibilities because of the financial impact,” he says.

In the meanwhile, Tatar says, many advisers should — at a minimum — be able to help “build flexibility and contingencies into a caregiver’s and a care recipient’s financial plans to address the problem when it occurs.”

Robert Powell contributes regularly to USA TODAY, TheStreet, and The Wall Street Journal. Got questions about money? Email Bob at rpowell@allthingsretirement.com.

Retirement columnist Robert Powell