Trying to get an ageing parent into care can feel like trying to land a plane in a storm while also looking after kids in the back row. This is the reality for the “sandwich generation”: adults who are supporting ageing parents while raising their own children.The pressure becomes intense when a parent has a sudden health crisis and decisions have to be made quickly. In that moment, adult children are pushed into an unfamiliar, complex and expensive aged care system, often with very little guidance.Accessing care often means long wait lists, complex forms and significant out-of-pocket costs. And recent changes mean many older Australians will pay more for their aged care, whether delivered at home or in a residential facility.For most people, the first step into formal care is support at home. What does home-based care look like?The Commonwealth Home Support Program provides basic help such as cleaning, meals and transport. It’s usually delivered by local councils or community organisations. These services are heavily subsidised, but are rationed and prioritised for those with the greatest need, especially full- and part-pensioners. Many families find that what is offered is helpful, but not enough.As needs increase, people may be approved for a higher level of home support, now called a Support at Home. This is designed for people who need coordinated, ongoing help to stay at home, such as personal care, nursing, shopping and housework. But this isn’t an on-demand service you can “order” when a crisis hits. Waiting times for approval and funding can stretch to many months. In the meantime, most care is provided by family members, often on top of work and childcare, or by paying privately if the family can afford it. This gap is one of the hidden pressures on the sandwich generation.Who pays for Support at Home?Support at Home funding is divided into three broad categories: clinical care (for example, nursing or allied health)independence support (help with mobility, self care or staying safe) everyday living (things such as cleaning, shopping or gardening). Clinical care is fully funded by government. Recipients are expected to contribute to the cost of independence and everyday living support. These services are priced at market rates, which are much higher than the basic home support under the Commonwealth Home Support Program. Many families experience “bill shock” when the first statements arrive and realise that “government funded” care still comes with large personal contributions.What this might look like in practiceConsider Tom, a fictional homeowner and part-pensioner with A$500,000 in financial assets. Tom has been approved for a level 5 Support at Home package, which includes physiotherapy, nursing, personal assistance, transport and domestic assistance, including cleaning. His package funding is split 15% to clinical care, 40% to independence support and 45% to everyday living. Clinical care is fully covered by government. Tom still needs to contribute 17% of the costs for independence support ($2,749 per year) and 35% of the costs for everyday living ($6,181 per year). Even with a substantial package, his out-of-pocket costs are significant. This isn’t unusual.If Tom’s health declines further, residential aged care may be the next step. To move into a government-subsidised residential aged care, he needs a formal assessment that confirms he can no longer safely stay at home, even with support. Once approved, he still has to find a home with a vacancy that is willing and able to take him.Who pays for residential aged care?Residential aged care brings a new layer of financial complexity. If someone has assets above $214,884, they are treated as a market payer and must fund their own accommodation. This can be done through:a large lump sum payment called a refundable accommodation deposit, often priced at around $750,000a daily accommodation paymentor a mix of both. The daily payment for a $750,000 refundable accommodation deposit is $173.22 per day.In addition to accommodation, residents pay a basic daily fee (currently $66.80) and, depending on their means, additional amounts such as a hotelling supplement and non-clinical care contributions. For Tom, this adds up. His cost of care is $300.42 per day, or more than $100,000 per year. These numbers highlight an uncomfortable truth: residential aged care is expensive, even for people receiving a pension and even when the government is contributing. Means assessment doesn’t mean it’s actually affordable. Start these conversations earlyThe system is hard to navigate even for professionals, let alone people encountering it for the first time in a crisis. For those in the sandwich generation, the emotional load can be as heavy as the financial one. They’re often making decisions on behalf of parents who are frightened, unwell or reluctant to accept help. Without clear planning and open conversations about preferences, finances and care options, families may end up taking the first place offered rather than the option that best aligns with their loved one’s values and needs.Starting conversations early – before a fall, a hospital admission or a sudden health crisis – can make a real difference. Talk about what “a good old age” looks like, what kind of care is acceptable, where someone wants to live and how savings should be used to support care at home can help families avoid rushed decisions later. Starting these discussions early is one of the few things the sandwich generation can actually control.Jemma Briscoe is a Director at Aged Care Gurus.