Since her elderly parents moved into her Butler County home more than two years ago, Sue Kushner has learned how demanding it is to ensure their safety and handle their health crises.

The trim physical therapist thought she knew what lay ahead. Two days each week, she does physical therapy with elderly people who also live with their younger children and she believed she understood her clients' challenges.

"I thought I was empathetic. You have no clue until you are living it with your parents. What a humbling experience that has been," said Ms. Kushner, who teaches physical therapy at Slippery Rock University.

At times, the tasks and responsibilities are overwhelming.

"There are days when I think my head's going to explode and there's going to be gray matter all over these walls. I don't even know what normal is anymore," said Ms. Kushner, who lives in Middlesex.

Part of her juggling act includes efforts to finish her doctoral dissertation in exercise physiology at the University of Pittsburgh.

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• Dr. Ann Baldwin Taylor's story

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As an adult daughter, Ms. Kushner is typical among caregivers in America. Half of elderly people who need long-term care but have no family members to look after them are in nursing homes while only 7 percent of the elderly who have a family member caring for them are in institutions, according to the Family Caregiver Alliance, based in California.

Mildred Morrison, administrator of the Area Agency on Aging in Allegheny County, said 80 percent of all caregiving is done by family and friends at home. For every hour of care provided by her agency, a nursing home or an assisted living facility, "family members are doing four."

Sometimes, Ms. Kushner compares notes with her friend, Claire Molinaro, who lives less than a mile away in a Butler County ranch house with her husband and her two elderly parents. Mrs. Molinaro's parents lived in Akron, Ohio before she moved them to her grown son's bedroom.

Like Mrs. Molinaro, Ms. Kushner has an understanding husband. In fact, when Ms. Kushner noticed her parents were slowing down, her husband, Dr. Ronald Mettus, suggested his in-laws move from Shaler into their home because neither he nor his wife thought George and Teresa Kushner needed assisted living. Dr. Mettus operates his dental practice out of the couple's home in a separate wing.

But, Ms. Kushner said, "We didn't know my dad had full-blown Alzheimer's," adding that she thought they would continue to lead their own lives, make their own meals and join her family for dinner daily.

She explains her decision to keep her parents at home succinctly.

"When the kids were little, they baby-sat one day a week. Now, it's our turn to give back," she said.

But no one, Ms. Kushner said, could have predicted the steep decline of her mother's health. Since April 2006, when her parents moved in, she estimates she has made 3,000 phone calls to pharmacies, doctors, social workers, insurance carriers, banks, equipment companies, home care nurses and relatives.

That's because during the past two years, Ms. Kushner's 79-year-old mother, Teresa, a diabetic, has had five operations, nine late-night visits to the emergency room and 13 hospitalizations. She had a toe amputation, followed by infections and vascular surgery to increase blood flow to her legs and feet.

During her mother's hospitalizations, Ms. Kushner logged many miles. On her three teaching days, she drove 30 miles to Slippery Rock, another 55 miles into Oakland to check on her mother at the hospital, and another 25 miles to return home. Her mother also had several lengthy stays, including one four-month stint at St. John's Lutheran Care in Mars to heal her leg and foot.

Luckily, Ms. Kushner found Laury Darragh, a neighborhood woman with nurse's aide experience, and hired her to help her parents. Mrs. Darragh has helped Mrs. Kushner shower, made meals for the couple and taken them to doctors' appointments.

"She just has a way with people that's above and beyond kind. She was just a godsend to them," Ms. Kushner said.

Her 88-year-old father is frail and weighs 130 pounds. He can walk, bathe, dress himself, converse and often attends his grandchildren's soccer, football and baseball games.

If an emergency arises, Dr. Mettus is close by.

"My in-laws, who live in Peters Township, come over one day each week when I work late and they make dinner for the family," Ms. Kushner said.

Before her parents moved in, Ms. Kushner and her brother, Rich Kushner, cleaned out their parents' home. At the same time, a contractor remodeled an upstairs apartment that already existed in their home by installing a raised ceiling to make room for a walk-in closet, skylights, a bay window, hardwood floors and an updated kitchenette.

Late last year, Mrs. Kushner fell and broke her leg and entered a nursing home on Dec. 29. Now she's recovering and exercising daily at an assisted living facility called Elmcroft of Allison Park, located in Hampton.

"She still needs to lose a lot of weight and gain a lot of mobility before returning home is a possibility," Ms. Kushner said.

While her mother heals, Ms. Kushner is applying for veteran's benefits for her father, who participated in seven invasions in the Pacific during World War II.

Vacations are infrequent. Ms. Kushner ruefully recalls a trip to the Outer Banks, N.C., in the summer of 2006 that her family took with Rich Kushner's family and some of her husband's family. The week-long trip was packed with bathroom disasters on both legs of the trip, administering IV antibiotics to her mother, plus lots of worry.

Two of the bright constants in Ms. Kushner's life are her 15-year-old daughter, Roberta, and 13-year-old son, Jackson, who remember their grandparents when they were in better health. They often deliver meals upstairs to their grandfather.

"Let them see that this is not a day at the beach. I would never want them to do this. It's too much. It's too disruptive. But hey, it's part of life that they're seeing," Ms. Kushner said, adding that caring for her parents "makes child rearing look easy."