As the middle generation has been hollowed out by the abuse of opioids and other substances, the oldest generation has become increasingly responsible for their grandkids, experts say. It’s a responsibility that many didn’t expect and weren’t prepared for. Retired folks find themselves trading their sedans for minivans, moving out of their adult-only communities, and searching for work to cover the expenses that come with raising a child.

The shift tends to be sharpest in rural, mostly white states such as New Hampshire and West Virginia, which also ranked in the top three in substance-abuse death rates. These figures are for the five-year period ending in 2017, the most recent available. Death rates are reported by the Centers for Disease Control and Prevention. Synthetic opioids have hit black communities hard since then.

The weight the opioid crisis has placed on grandparents was made heavier by changes to the foster-care system, experts say, particularly the Fostering Connections to Success and Increasing Adoptions Act of 2008, which encouraged the placement of children with relatives.

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The limited data available on the Native American population shows a large and rising share of grandparents in those communities are also taking care of grandkids. The fastest-in-the-nation increase in children being cared for by grandparents was in South Dakota and concentrated in counties with large Native American populations.

Meanwhile, grandparent caregiving of black children has declined as the share of black children living in poverty has fallen.

Statistics often focus on the number of grandparent caregivers, rather than the share of children who are cared for primarily by grandparents. These figures could be distorted by falling fertility rates and an aging population.

Parenthood without warning

The arrival of two preschool-age children upended Bette Hoxie’s life, even though, in theory, nobody should have been better prepared.

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The 72-year-old from Old Town, Maine, northeast of Bangor, has raised more than 150 foster children. She has adopted at least eight children and given birth to three more. A national organization named her Maine’s 2018 Mother of the Year.

In 1997, the year her husband died, she helped found Adoptive and Foster Families, an organization that helps Mainers who care for relatives’ children. She was the group’s executive director until she retired in November 2017, in part to take care of her own grandchildren.

Less than a year later, she was back at the organization. She works as a kinship specialist so she can afford to care for her own kin, newly arrived under her roof.

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“I sometimes think God has one heck of a sense of humor,” she said.

Hoxie said it has been more challenging to work with the foster system this time around. It’s worse for those who haven’t made it their life’s work.

“Unlike traditional foster parents who typically plan and go through a series of trainings, and plan for months or years to take on the role of caring for an additional child, grandparents and other relatives typically step into the role of raising children with little to no warning,” said Jaia Peterson Lent, deputy executive director at the advocacy group Generations United. “They often get a call in the middle of the night, saying, ‘Pick up your grandchild, or they’ll go into foster care.’ ”

Working grandparents

Little about a grandmother’s work status, income or pension influences whether she’ll end up caring for her grandchildren, according to a 2015 analysis of the long-running Health and Retirement Study in the journal Demography by Robin L. Lumsdaine (American University’s Kogod School of Business) and Stephanie J.C. Vermeer (Roland Berger Strategy Consultants). Their work adjusts for differences in family characteristics and health.

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“Care decisions are sometimes driven by the needs of the grandchildren’s parents, rather than the circumstances of grandparents,” Lumsdaine said. “The birth of a new grandchild increases the chances that a grandmother will provide care by nearly 70 percent.”

Retired grandmothers weren’t more likely to become caregivers, but grandmothers who became primary caregivers were 9.6 percent more likely to retire, Lumsdaine and Vermeer found. The researchers also found that about 10.5 percent of those retired caregivers would, like Hoxie, return to the workforce within two years — while still raising their grandchildren. Another 13 percent would stop caregiving entirely and return to work during that time.

About 95 percent of caregiving relatives work outside of the official foster system, according to Generations United. They often lack official financial, practical and emotional support.

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In a 2013 analysis in Marriage and Family Review of caregivers in rural Montana, Sandra J. Bailey (Montana State University) and her collaborators found that “for many grandparents in our study, retirement became a distant or unreachable goal.”

Grandparents who had grown up in a culture of rugged self-reliance now faced a rise in food, transportation, heating and child-care costs beyond what many could handle alone.

“For grandparents still in the workforce or simply needing respite care, the cost of child care was shocking,” Bailey and her colleagues wrote. “Although many grandparents anticipated child care costs, the current rates were much higher than when they had parented the first time.”

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The latest figures from the Census Bureau show the share of Americans age 65 or older living in poverty has remained steady, even as the rate among younger groups has fallen.