Geoffrey J. Hoffman, a doctoral candidate at the UCLA School of Public Health, is lead author of a new policy brief on the stress and financial burden placed on the state’s informal caregivers. In this brief interview, he talks about who the typical caregiver is in California, why more don’t use state services and programs, and what federal and state officials can do to prepare for a "silver tsunami" of aging baby boomers.

Q: Can you describe who the typical caregiver is in California?

Caregivers look like they are doing pretty well. A typical California caregiver is a white, middle-aged female with at least some college education. She is likely married or living with a partner, working full-time or part-time, and living in an urban or suburban area. Caregivers tend to be in relatively good health, and have a decent income. A closer look, though, reveals some chinks in the armor.

Generally, California caregivers are providing about a half-time job’s worth of work every week. In addition to working the equivalent of a job and a half, many are spending upwards of $3,000 per year on caregiving. This may be why one out of every five California caregivers experiences at least moderate levels of distress—that is, to some extent, feeling hopeless, restless, depressed, or that everything is an effort. Large proportions of these distressed caregivers also feel that their social lives and household chores are severely impacted.

For individual and cultural reasons, many caregivers do not want to put an aging family member into a facility. Even for those who want to, the costs may be prohibitive. Long-term care facilities can cost as much as $200 per day, and while Medicaid may cover a high proportion of those costs, not all Californians will be eligible for Medicaid coverage. So even for those Californians who are better-off, informal caregiving can be a difficult, expensive, and emotionally challenging experience.

​Q: Why don’t higher numbers of caregivers use state services that might alleviate both financial and psychological distress?

Californians may not be using these resources for a number of reasons. Unfortunately, obtaining access to caregiver training or being reimbursed for useful services like respite care, adult day health care, or others can be difficult. Because California programs that are available to caregivers are offered by a host of different federal, state, and local agency programs, the system can be difficult to navigate. Additionally, the eligibility requirements for the programs are often strict, allowing lower-income—but not other older adults—to participate.

Perhaps most importantly, California social services for seniors have undergone dramatic funding cuts in recent years, including in this past year’s state budget. Programs that help seniors stay in the community, and thus also benefit caregivers, have had their funding slashed. These include Caregiver Resource Centers, which provide training, education and respite care, Adult Day Health Care (ADHC) programs, and In-Home Supportive Services, which provides home health aides to seniors. ADHC funding will be entirely eliminated in the Medi-Cal program as of December 1. These cuts have had dramatic effects on the availability of services for caregivers and those who receive care.

A recent study indicated that baby boomer caregivers may forego as much as several hundred thousand dollars in wages, pension, and Social Security benefits because they are caring for seniors. However, aside from a small, successful Medi-Cal program that pays hourly wages to certain family caregivers and an infrequently used and limited Paid Family Leave Insurance program, California’s family caregivers have few options to help reduce their financial stress.

Q: What actions can federal and state officials take now to prepare for a more than doubling of the age 65 and older populations in the next 30 years?

Planning for the “silver tsunami”—the rapid aging of the baby boomer generation —is no easy thing, particularly in California. Our state has the nation’s largest baby boomer population.

But there are some basic principles to guide federal and state officials. First, better help for caregivers at the state level is needed. As we have seen, federal and state programs are under severe financial pressures. In California, this has resulted in extensive cuts in funding for senior services, including ADHC, In-Home Supportive Services, and Caregiver Resource Centers. However, these are the very programs that keep older adults in the community, where most seniors want to be. Informal caregivers are the backbone of a community infrastructure to care for a society with a growing proportion of older adults. Thus, supporting caregivers is the first way to support seniors.

Second, building a better eldercare workforce, of which informal caregivers are just one part, is a necessity. The Institute of Medicine wrote a report several years ago focusing on the lack of qualified professionals that are certified to provide care to older adults. The country does not have enough geriatricians and geriatric-certified nurses, social workers, pharmacists and other health workers. Direct care workers—trained home health aides or others who come to the home to help out older adults—would benefit from increased training requirements as well as greater employment security. Congressional funding for the Affordable Care Act, which includes increased pay for primary care physicians, may also help.

Third, efforts to improve the structure of the long-term care system at the federal and state levels are needed. Many Americans are unaware that Medicare, the primary source of insurance for seniors, covers short-term, rehabilitative care, and not long-term care. To care for a rapidly aging population Congress needs to fund the CLASS Act, a long-term insurance program, which would provide a daily cash benefit that could be used to purchase in-home supportive services, including caregiver support. And in California, the extensive resources of local and state agencies should be made more widely available to all caregivers, not just those caring for low-income individuals.

Read the policy brief: Stressed and Strapped: Caregivers in California​