This is when Medicare gets more expensive

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Elderly Americans are at risk of spending more in Medicare when they are disabled and already suffering.

One in five older adults who are aging in place experience numerous negative consequences – such as staying in bed, going without a hot meal or fresh groceries and mistakenly taking the wrong medication. They’re also likely to spend more in Medicare than those who also had disabilities but had the proper support, according to a new study from Johns Hopkins Bloomberg School of Public Health researchers.

See: What you need to know about Medicare open enrollment

Researchers used data from the 2015 National Health and Aging Trends Study, which is a national survey of Americans 65 and older and does not include those who live in nursing homes or died 12 months after the interview. They specifically focused on almost 2,000 people with fee-for-service Medicare claims and who reported needing help with daily household and mobility activities, which include bathing, eating and getting in and out of bed.

The findings were published in the Annals of Internal Medicine last month.

Caregiving may help these older Americans with debilitating disabilities, but it comes at a cost to either them, if they or their loved ones have to pay for it, or if those family members and friends take on the role without pay, and often with significant financial penalty in their own lives.

More than 43.5 million adults are unpaid, informal caregivers who have to rework their schedules, pay for medical expenses out-of-pocket and give up much of their lifestyles to watch over a loved one. The average caregiver, many of whom are women, spends more than 20 hours a week on these responsibilities, and nearly $7,000 on the associated costs.

Also see: Not expecting to be a caregiver? You’d better check that with your parents

Taking on the role of caregiver is a sacrifice, since they must be available to the sick or elderly physically, mentally, emotionally and financially. Some families might make arrangements among siblings and relatives to get paid for the work, or one person may volunteer for the job. And although it can be emotionally and physically draining, many have said they couldn’t imagine not being their loved one’s caregiver.