San Antonio Express-News (Sunday)
Toll on caregivers for elderly is growing
As families reunite with loved ones during the holiday season, younger adults may realize that their elderly relatives are in need of extra care.
Since 2010, San Antonio’s 65-and-over population has been increasing at a faster rate than its pool of potential caregivers, those between 20 and 64 years old, according to data from the U.S. Census Bureau.
In 2010, about 11% of San Antonio’s residents were 65 or older. That rose to 14.2% in 2020, according to census data. At the same time, the percentage of residents between 20 and 64 years old dropped from 59% to 58.3%. That follows a nationwide trend, as the percentage of U.S. residents between 20 and 64 years old dropped from 60% in 2010 to 58.4% in 2020, while the percentage of U.S. residents 65 and older rose from 13% to 16.8%.
According to an AARP report from March, young to middle-aged adults who are responsible for elderly relatives are also frequently responsible for the care of younger dependents like children and grandchildren. These individuals — known as the sandwich generation — are even more vulnerable to the issues that caregivers face, including social isolation, burnout and limited job opportunities, because of their dual responsibility.
For some families, the cost of getting outside assistance to help with this care is out of reach. In the San Antonio-New Braunfels metro area, the cost of an assisted living facility is about $41,000 per year, according to Genworth’s Cost of Care Survey. That’s nearly 50% of the median family income in the area.
Even the cost of adult day care — which offers hourly, community-based care for the elderly and those with disabilities — is about $10,300 a year.
Child care, especially for families with multiple children, also can be a financial burden for many. In Bexar County, the cost of an infant care center is $10,200. In nearby Hays County, child care is even more expensive.
For households that can’t afford these expenses, family members often step in to take care of their relatives.
The AARP Public Policy Institute estimated that 3.1 million Texans — or about 10.5% of the population — are unpaid caregivers for adults. Work that these unpaid Texas caregivers provide would otherwise be worth $41 billion. California, which has about 39 million residents, has about 4.4 million caregivers and is the only state with more people in that role than Texas.
The San Antonio metro area has about 46,500 parents and parents-inlaw living in homes owned or rented by their children. While that statistic alone doesn’t necessarily speak to whether the head of house is a caregiver, experts say many family members don’t always recognize their role as a caregiver.
If someone is improving the quality of life for a loved one through their efforts, they likely are filling that role, said Andrea Williams, vice president of programs at CarePartners, an organization that provides assistance to family caregivers.
“We really emphasize and help people to understand that you’re a caregiver and the importance of naming yourself as a caregiver,” Williams said. “It provides you with a way to speak to doctors and to speak to other people so that you’re connected to the right resources.”
Additionally, about 13% of Bexar County children under 18 living with their grandparents do so without a parent present. Dallas, Tarrant, Harris, Travis and El Paso counties — home to Texas’ largest cities — had similar percentages, hovering between 8% and 15%. Guadalupe and Hays counties have rates nearly double those of those larger counties.
Caregiving challenges
Family caregivers often deal with social isolation and burnout, especially as people adapt to the role, according to CarePartners. Williams said that 93% of caregivers report never being taught how to provide care. In addition to dealing with the emotional toll, family members in these roles may end up stepping away from a job so they can be of further assistance to their loved one.
Younger Black and Hispanic people are more likely to quit their jobs in order to take care of a loved one because they can’t afford an alternative option, according to the AARP report. Their caregiving role is also more likely to involve more complex medical and nursing tasks. In addition, Black people are more likely to be the sole caregiver, and Hispanic and Latino caregivers tend to be younger and also need to take care of children.
According to the report, Black, Hispanic and Latino caregivers are more likely to feel a sense of purpose in family caregiving — even if the needs of the individuals they’re caring for are substantial. Communities of color are also less likely to have access to quality nursing homes and other care services close to their homes.
Grandparents who are taking care of children encounter similar problems to adults taking care of elderly relatives, according to Generations United, an organization that promotes connection among different generations.
Children living with grandparents may have experienced trauma through neglect or abuse that affects their mental health. The children also may face challenges receiving help for dealing with depression and behavioral issues.
Grandparents in these situations may encounter stress-related health issues as they try to best help their grandchildren. In addition, grandparents sometimes encounter legal barriers as they attempt to become a child’s legal guardian, as well as an increased financial burden.
Resources
In 2021, Senate Bill 263 passed, allowing “kinship families” — the children’s siblings, aunts or uncles who are raising them — to receive financial support. Taxpayers also fund the Take Time Texas program, allowing family caregivers to have a break from their duties while someone else cares for their older or disabled loved ones.
According to Kathy Green, director of state and federal strategy at AARP Texas, AARP also advocated for higher wages for paid caregivers. In 2023, the minimum hourly wage for caregivers employed by companies that contract with Texas Health and Human Services Commission increased from $8.11 to $10.60, but Green said they would like to see a minimum wage of $15 per hour.
“To be able to find somebody for what is often a very personal type of care for $8 or $8.50 an hour is very hard when they can make more working down the street at Chick-fil-A or wherever,” she said.
Texas also has the Office of the Long Term Care Ombudsman to help adults and their families transition to an assisted living center or nursing home.
On the federal level, the RAISE Family Caregivers Act took effect in 2018 and serves to support family caregivers by increasing awareness and ensuring financial and workplace security. Green said AARP also has advocated for family caregivers to receive tax credits for their services.
Locally, AARP offers support for grandparents raising their grandchildren and provides support groups for local caregivers.