Who Provides the Care and Who Pays? The Stark Reality of Family Caregiving Burdens Based on Birth Order

Caring for aging parents is an unavoidable reality for families. However, the burden of "who provides the care," "who pays the bills," and "who makes the decisions" is rarely distributed equally among family members. The way care is managed, and the very nature of the hardship, changes depending on one's position in the family—the voices of caregivers quietly reflect the inherent imbalances in family roles.

To explore this, Speee Inc. (Headquarters: Minato-ku, Tokyo; CEO: Hideki Otsuka; TSE Standard: 4499), which operates the nursing care facility review site 'Caresul Kaigo', conducted a survey on "Parental Care and Sibling Relationships" targeting 451 men and women nationwide who are currently providing care or have caregiving experience.

The survey categorized the 451 respondents (excluding only children) into three groups based on their birth order attributes: "Eldest Child" (Eldest sons/daughters 48.4%, spouses 11.0%), "Middle Child" (Middle children 12.2%, spouses 2.4%), and "Youngest Child" (Youngest children 14.4%, spouses 1.8%). By analyzing how practical tasks, costs, conflicts, and countermeasures differ by sibling position, the report highlights the true nature of the differing hardships each role faces. *Note: Younger siblings in two-child families were categorized as youngest children.

[Survey Results Summary]
- Eldest children have the highest rate of solo caregiving: 48.8% handle daily care almost entirely by themselves, more than double the rate of middle children (18.0%) and youngest children (20.8%).
- Middle children face the most financial challenges: They have the lowest rate (32.8%) of covering costs entirely with parents' funds, and when out-of-pocket expenses occur, their burden rate is 68.3%, second only to eldest children.
- Middle children experience the highest conflict rate at 77%: The most common issues, at 19.7% each, are "being blamed by siblings without understanding legitimate reasons for not helping (e.g., distance, work)" and "being conveniently burdened because they are 'the youngest/single/living with parents'."
- Conflict types vary by birth order: Eldest children face fixed roles like "because you are the eldest" (33.9%), while youngest children deal with being burdened (20.8%) and anxieties over inheritance (15.3%).

Topic 1: Daily Care Tasks Concentrated on the Eldest Child

When asked who handles daily practical tasks like accompanying parents to the hospital, procuring care supplies, and managing medications, a clear difference emerged based on birth order. 48.8% of eldest children reported taking on "almost 100% of the practical tasks (solo operation)," more than twice the rate of middle (18.0%) and youngest children (20.8%).

Conversely, the most common setup for middle children was "myself as the main caregiver + others helping" (42.6%). While they are less likely to fall into complete solo operations, they often manage tasks as the primary person in charge. Youngest children were most likely to report "others are main + myself as support" (23.6%), showing a tendency to provide secondary assistance.

[Chart 1] Practical Care Task Distribution by Birth Order
- Eldest Child: Solo operation 48.8% / Main + others help 25.2% / Completely equal 8.3% / Others main + myself support 12.4%
- Middle Child: Solo operation 18.0% / Main + others help 42.6% / Completely equal 8.2% / Others main + myself support 19.7%
- Youngest Child: Solo operation 20.8% / Main + others help 22.2% / Completely equal 18.1% / Others main + myself support 23.6%

Topic 2: The Structure of 'Costs' - Who Pays When Parents' Funds Run Out?

Overall, 55.2% of respondents indicated that care costs are "100% covered by parents' assets." However, this rate varies significantly by birth order. While 64.0% of eldest children can cover costs with parent funds, only 32.8% of middle children can. This suggests that in families with more siblings, the parents' assets per child tend to be lower.

Who pays in families where parents' funds are insufficient? Excluding those who answered "100% parents' funds," the out-of-pocket burden rate (paying the full amount alone or paying the most) reaches 78.2% for eldest children, far exceeding middle (68.3%) and youngest children (21.2%). The structure reveals that not only practical tasks but also financial burdens concentrate on the eldest. Even when costs arise, youngest children tend to share them "completely equally" (45.5%) or have other siblings pay more (24.2%).

[Chart 2] Out-of-Pocket Cost Burden by Birth Order (Excluding 100% Parent Funds)
- Eldest Child: 100% parent funds 64.0% / Out-of-pocket burden (full/majority) 78.2% / (Of which completely equal 14.9%) / (Of which others pay more 4.5%)
- Middle Child: 100% parent funds 32.8% / Out-of-pocket burden (full/majority) 68.3% / (Of which completely equal 22.0%) / (Of which others pay more 7.3%)
- Youngest Child: 100% parent funds 54.2% / Out-of-pocket burden (full/majority) 21.2% / (Of which completely equal 45.5%) / (Of which others pay more 27.2%)

Topic 3: Types of Conflicts Also Differ by Birth Order

The experience rate of sibling conflicts is highest among middle children at 77.0%. However, around 60% of eldest (56.6%) and youngest children (59.7%) have also experienced conflicts, showing that friction is common regardless of birth order.

Yet, the "substance" of the conflict differs greatly.

For eldest children, the top conflict is "being forced to care 'because you are the eldest son/daughter'" at 33.9%. This is a structure where roles are fixed by the unchangeable attribute of birth order.

For youngest children, the top issue is "being conveniently burdened because you are 'the youngest/single/living with parents'" (20.8%). Furthermore, "distrust/conflict regarding the management of parents' assets or future inheritance" was notably high at 15.3%. A complex anxiety unique to the youngest child is: "I am bearing practical and financial burdens, but I might be disadvantaged in future inheritance."

Middle children, who have the highest conflict rate, tied for the top issues: "being blamed by siblings without understanding legitimate reasons like distance or work" (19.7%) and "being conveniently burdened" (19.7%). This illustrates a squeeze structure where they face misunderstandings and pressure from both older and younger siblings.

[Chart 3] Conflict Experience Rate and Top Conflicts by Birth Order
- Eldest Child: Experience rate 56.6% / Top conflict: Forced care because of being the eldest (33.9%) / 2nd: Specific sibling running away (11.6%)
- Middle Child: Experience rate 77.0% / Top conflict: Blamed despite legitimate reasons not to help (19.7%), Conveniently burdened (19.7%)
- Youngest Child: Experience rate 59.7% / Top conflict: Conveniently burdened (20.8%) / 2nd: Distrust over asset management and inheritance (15.3%)

Topic 4: Eldest Children Bear It Alone, Middle Children Move to Break the Situation

What countermeasures are taken against conflicts and imbalances