Who will care for the elderly?

Seniors and the state depend on families to help provide basic caregiving

Cristina Hernandez walks with her dad, Francisco Rios, 91, at her Pomona home. Hernandez has been his primary caregiver for 15 years.

Cristina Hernandez walks with her dad, Francisco Rios, 91, at her Pomona home. Hernandez has been his primary caregiver for 15 years.

Sean Havey for California Dream

This story is part of The California Dream project, a statewide nonprofit media collaboration focused on issues of economic opportunity, quality-of-life, and the future of the California Dream. Partner organizations include CALmatters, Capital Public Radio, KPBS, KPCC, and KQED with support provided by the Corporation for Public Broadcasting and the James Irvine Foundation. An unabridged version of this story is available at newsreview.com/sacramento.

When Cristina Hernandez notices her father is withdrawn or hasn’t come out of his room for the day, she uses her cell phone to turn on Glenn Miller or blast salsa music. Almost every time, she’ll see the 91-year-old start tapping a finger on the table or hear his walker tip tap on the floor in his room before he emerges into the kitchen.

Francisco Rios has lived in Pomona with his daughter for the past 15 years. “I know music cheers him up,” said Hernandez, 52. “He used to dance tango, swing, boogie, cha-cha and that kind of music from south Mexico.”

Rios is part of the upward swing of a coming population wave of seniors in California. Experts say there will not be enough caregivers as the senior demographic swells and the number of younger Californians shrinks. State officials are working on a plan for aging, and senior housing researchers and experts are trying to get ahead of the coming challenges.

“The Golden State is getting grayer,” Gov. Gavin Newsom said during his State of the State speech in February. “We need to get ready for the major demographic challenge headed our way. For the first time in our history, older Californians will outnumber young children.”

Newsom called for the creation of a Master Plan on Aging, proposed spending $3 million on Alzheimer’s research and named former California first lady, Maria Shriver, to lead an Alzheimer’s Prevention and Preparedness Task Force. The plan, Newsom said, should work to address the nursing shortage, the patchwork of senior services, the social isolation seniors often experience and the “demand for In-Home Supportive Services that far outpaces its capacity.”

There is no timeline for the plan, and Newsom’s office said it is still developing its structure.

By 2030 about 19 percent of Californians, or about 1 in every 5 people, will be 65 or older, up from 12% in 2012, according to research by the Public Policy Institute of California. This group will be more racially and ethnically diverse and will have more single and childless seniors, portending a need for culturally sensitive and professional caregivers.

And by 2032 there will be more people age 65 and older than children younger than 15, said Kathryn Kietzman, a research scientist at the UCLA Center for Health Policy Research specializing in older adults who depend on support to remain at home.

The state is “woefully unprepared in terms of policies to support people as they age at home,” Kietzman said. She hopes Newsom’s plan will begin the conversation to address the issue.

Kietzman said the biggest challenge in senior care will fall on middle-income families who don’t qualify for state assistance and who aren’t wealthy enough to pay for services at home or at a facility.

A key piece of any plan, experts say, should be making sure there are enough caregivers because they are often the difference between a senior getting to stay at home or having to go to a facility.

Caregivers help with things like bathing, dressing, cooking, feeding, cleaning, moving around, dispensing medications, paying bills and other tasks some seniors can no longer do alone.

It’s a tough job. A senior’s mental state may be fragile. They may need help with everything from getting out of bed to staying in bed at night. Some may not remember the caregiver or what they had for dinner. It can be frustrating, tiring and emotionally draining for caregivers.

A tough task

Cristina Hernandez has had those moments. In early winter her dad was admitted to the hospital for a week. It was during that hospital visit that Hernandez found herself in the bathroom crying so much that a nurse asked if she was OK.

“I said I was a little bit frustrated. It’s a lot on your shoulders,” she said. “I have to make the right decision, choose the right treatments. You feel like his life depends on you.”

Becoming a caretaker impacts every part of your life, Hernandez said. “At the beginning, I was able to say, OK, you are good. I’m going to go with my girlfriends. And I was able to do that,” Hernandez said. ’Now, I don’t have a social life. It does change your life. There’s a lot of compromise and a lot of responsibility.”

Taking care of Rios isn’t something she ever envisioned. She didn’t grow up with him and only got to know him as an adult after she moved to the Los Angeles area.

Rios danced ballroom competitions and worked as a glassmaker in Mexico City before moving his family to Tijuana. The last of his seven children were born in the border city after he had begun to cross regularly for work in a shoe factory. By the time Hernandez, the youngest, was born he had stopped coming back home.

“I didn’t have a relationship (with him) so it was kind of a surprise for me,” she said. “It took me a little bit of time to get used to it—to have him living with me.”

But they’ve gotten to know each other and there is an ease between them. She calls him Paco, hardly ever “dad” unless she’s talking to doctors or others about his care.

“It fell on her,” said Rios. “‘Oh well,’ I tell her. But it went fine, and I’m better here.”

Family caregiving is not new but it has changed. Most families do not have a stay-at-home partner who can take on the responsibility. Many adult children live across the country. And others don’t have children at all. So families adapt by taking in elders and cutting back work hours or hiring help. Some manage paid caregivers and doctors from afar. Others move back home to help.

The state operates a program called In-Home Supportive Services that identifies low-income seniors that need help with basics to stay at home and provides a certain amount of paid hours for caregiving. The senior hires a caregiver, usually a family member, to take care of those needs and the state program pays, usually minimum wage.

Among the more than 506,000 caregivers enrolled in the program, about 70% are family members according to the state’s Department of Social Services. Hernandez is paid for about 90 hours a month to care for her dad, even though she cares for him around the clock.

The money helps a little since she’s had to cut back her hours as a cashier at Target because Rios can’t be home alone. Hernandez considers herself lucky because her husband’s job provides health insurance for her family, and he earns the majority of their income.

Thousands more seniors being cared for by family members don’t qualify for assistance. They make up the largest group of caregivers, said Jeannee Parker Martin, president and CEO of LeadingAge California, a trade association that represents providers of senior affordable housing including independent living, assisted living and skilled nursing facilities, as well as services offered in the home.

“There will be a huge need for more caregivers in the state,” said Parker Martin. “Every state across the country now is having this issue. But in California, in particular, we already have a lack of caregivers.”

A lack of caregivers

According to the California Employment Development Department, the state will need an additional 200,000 home care workers by 2024 to keep up with current levels of care. UC Berkeley’s Center for Labor Research and Education estimates California could need as many as 3.2 million home care workers.

One program is helping to fill that gap for mainly low-income individuals 55 and older with health needs, but it isn’t widely available, Kietzman said.

Programs of All-Inclusive Care for the Elderly (PACE) offers day care services and in-home health care. Qualifying seniors get transportation to and from centers one or more days per week, receive meals, participate in activities and see a physician. In Southern California, AltaMed operates eight sites that serve about 2,600 seniors, said Maria Zamora, who oversees the program for the health care provider. There are 12 health care providers offering PACE services throughout the state.

Hernandez is committed to caring for her father until she can’t do it anymore. That’s why she signed up for a caregiver class for Spanish speakers put on by the California Long-Term Care Education Center, in partnership with LA Care Health Plan. She is learning more about how to care for her dad, such as lifting, bathing and helping with medications. And she meets other caregivers and talks about the challenges they face.

“I [feel] really strong that I’m going to take care of him,” Hernandez said. “I see myself taking care of him until I can’t. I think about, what if he gets older and, hopefully, makes it to 100.”