Repaying the Impossible Debt

Caring for the elderly — what are your options?

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My Mother, the Care-Taker

My 90-year-old abuelita’s cataracts gleam under the florescent kitchen light as she watches my mother, her caretaker, pour her a warm cup of milk. My mom has just finished her eight-hour shift at Keiro Nursing Home in Lincoln Heights, California, but still holds to her nightly tradition of pan dulce and a good night drink with my abuelita and tía.

“Tengo el don de cuidar y la practica y se como hacerlo. Cuando sabes hacer algo tu tienes una obligacion para mejorar el mundo.”

“I hold the responsibility and am familiar with the practice. When you know how to do something, it’s your obligation to make this world a better place,” my mother said in Spanish, when I asked why she cares for my grandmother.

My mother then shifts over to my aunt in order to check her blood sugar levels while teasing my grandmother for not eating enough earlier. After ensuring her last two patients have received plenty of nutrients and rest, the three of them sit in silence.

“Mija, no me pongas en un rest home. Me sentiria muy sola.”

“Do not put me in a rest home, my daughter. I would feel so lonely,” my mother said.

I often wonder how someone can work in a nursing home without believing in them. My mother has been a caretaker her entire life. The eldest of 17 in her family, she took care of her siblings as a child. She took care of her own mother before she died of cancer. And now she has taken care of my abuelita for the last four years. As a child of immigrants, I question if Latinxs are culturally inclined to take care of their own; if it is an endless thank you we are trying to repay.

In 2029, the youngest baby boomer will turn 65. By 2056, those above 65 will outnumber anyone under 18. By 2060, about one in three U.S. citizens will be Hispanic according to the 2012 US Census data. The number of senior citizens in Latinx populations will grow by 170 percent. The Asian American population is expected to more than double from 15.9 million in 2012 to 34.4 million in 2060. The African American population is projected to increase from 41.2 million in 2012 to 61.8 million by 2060.

As the population of people of color rises proportionally to the general elderly population, the demand for around the clock care is imminent, while resources, especially in underresourced communities are shrinking. Zhanlian Feng, assistant professor of community health in the Warren Alpert Medical School of Brown University, believes the quality of nursing home care is headed in an unstable direction. Future residents are likely to reside in low-standard facilities with high rates of closing. Residents are also expected to live in low-income areas that don’t provide assisted living facilities, or have underfunded homes, as well as homes that are too expensive for the community members that reside there. This limits the options family members will have when considering their future.

As Medicare funds funnel into nursing home care, the focus on long-term care is expected to decrease and trends of short-term nursing homes are on the rise according to The New York Times. These for-profit homes promote short periods of rehabilitation rather than end of life care.

Although the expensive decor and promising appeal make these specific nursing homes seem like a dream, many companies are geared for higher profits by the cost of quick resort-style stays, and the residents in these homes are on the losing end.

I look at my mother and I understand it’s a universal need to reciprocate the care you were raised with. It worries me that I do not know how I will set aside the money, resources and understanding to prepare for her growing older.

After all, I won’t be able to see someone else feed her once her hands get too weak. I don’t want to witness someone else brush her delicate silver hair. I cannot fathom a stranger observing her reflect on her entire life without me.

On the Other Side of Family Care

Eleven-year-old Samantha lives in Tijuana with her mother, grandmother and dog in a two-bedroom apartment and travels to San Diego every day for school. Although her school is unaware of her living situation, Samantha would not have it any other way. She loves living with her grandmother, Lupita. Oftentimes, just the idea of nursing homes in Latinx families sparks a sentiment of taboo. Lupita does not believe in leaving family members in nursing homes and says they are quite uncommon in Tijuana.

Samantha learns how to make pastries with her grandmother and how to care for herself and others in her family. Likewise, Lupita, at 72 -years-old, feels rejuvenated living with her granddaughter. They both watch each other tenderly as if sharing secrets that will forever be kept between sisters. Samantha teaches her grandmother the things she learns in school and Lupita teaches her granddaughter the many traditions of cooking homemade Mexican dishes.

“Siempre estoy muy contenta, nos llevamos muy bien y todas salimos juntas. Yo soy la mama mallor, la abuelita. Nos complementamos.”

“I’m always happy and we get along so well. We all go out together. I am the oldest mom, the grandmother. We compliment each other,” Lupita said.

Lupita’s eyes swell with tears as they turn to her granddaughter. She listens in pride to what Samantha thinks about nursing homes.

“Yo pienso que una casa de descanso esta bien para la gente que no puede estar con sus padres todo el tiempo, pero esos que si pueden cuidar y estar con ellos, y los ponen en esa situation no es correcto. Alamejor ellos quieren estar mas tiempo con ellos, y alamejor no tienen tanto tiempo de vida y no van a pasar lo con alguien que aman.”

“I think a rest home is a good idea for those who can’t be with their parents all the time, but for those that can be with them and put them in that situation, I think it’s incorrect,” Samantha said. “Maybe [the elderly] want to spend more time with their children, and maybe they do not have much time left.”

Inside An Assisted Living Facility

As millennials continue to grow into their newfound responsibilities, their parents and grandparents will be added to the list of bills, jobs and necessities. Full-time UC Santa Cruz student and certified nursing assistant Karen Khangura works late night shifts at Sunshine Villa after classes.

Sunshine Villa is an assisted living facility based by the boardwalk of Santa Cruz. Supervision in the apartment-style houses support independence. Ranging from assisted living, memory care and respite living, the home provides a guiding hand to those in need.

Once she clocks in at 2:30 p.m., Khangura checks on her residents and prepares them for dinner. She washes their hands, combs their hair and checks that they are dressed. While she enjoys meeting her residents’ family members, as they are always kind and appreciative, she could never put her own family members in a home.

“My parents would never put my grandparents in a nursing home,” Khangura said. “They will always take care of them. I just can’t imagine leaving my parents to be taken care of by other people.”

Khangura’s cultural connection plays a large role in her beliefs. She is close to her parents who immigrated to the U.S. from Punjab in India, and she believes in honoring their sacrifices. As children of immigrants prepare for the costs of student loans, mortgages and insurance, the cost of care for our loved ones will also play a major role in our decisions.

“It’s a vital part of Indian culture to respect your parents and really value them,” Khangura said. “They took care of me when I was a baby. They’ve given me everything I’ve needed in my entire life, and I want to do the same.”

Meeting in the Middle

According to the U.S. Department of Health and Services, it costs $229 daily or roughly $7,099 monthly for a private room in a nursing home, compared to a $19-21 hourly rate for homemaker and health aide services.

For those that can afford the choice, a live-in aide is someone that can provide personalized care and a relationship that may make an individual’s final years meaningful. This is also an option for families who need assistance caring for a loved one with conditions like Alzheimer’s or Parkinson’s disease. Local facilities like Oceanside Supported Living provide care takers for at home supervision and care.

UCSC student Joe Charles works as a caretaker with his patient James, who he was paired with after an afternoon, picnic style meet-up last year.

“My favorite experience was probably Halloween when I first barbequed burgers with James,” Charles said. “I really enjoy seeing his genuinely ecstatic face when something captures his attention. It’s infectious. So being able to contribute to that makes this line of work gratifying.”

James is an elderly patient who requires 24-hour supervision from Charles and eight other caretakers. Charles is able to care for him for 10 hours per day on weekends, on top of school, while his other caretakers are assigned weeknight shifts.

James only has his sister left, and she is unable to care for him. He looks to his caretakers for companionship, survival and human connection. As Charles slowly discovered parts of James’ history, like his parents being avid farmers, he also learned about his impact on the quality of life for those around him.

“It really inspires me to be patient and enjoy spending time with him while also being responsible enough to provide him with a mentally and emotionally improved home life,” Charles said. “I would hope my parents would have me and my siblings to spend time with or have trustworthy care provided to them.”

In My Heart 

I look at my abuelita and I notice the wrinkles around her eyes. They make me smile the most genuine smile I’ve ever known. I do not know what it is to care for an elderly family member, but I do know what it means to love them. One day I will understand what it truly means.

As many young adults struggle to find their place in their communities and understand the economy’s ever shifting ground, our parents will look to us to guide them. Their eyes, though decorated with the gift of time, may look up with an infectious childishness that will be our duty to protect.