As COVID-19 devastates senior care homes, Fresno-area families struggle to help elders

The Fresno Bee - 6/25/2020

Jun. 25--VISALIA -- In the final days of March, lunch with her 91-year-old mother turned into a nightmare for Emilia Martinez.

Martinez's mother tripped and broke her leg at a restaurant and needed surgery. Eventually, her rehabilitation treatment landed her at Redwood Springs Healthcare Center in Visalia.

She died two weeks later.

Martinez's mother was one of the 29 residents who have died from COVID-19-related complications at the facility since the pandemic.

Martinez isolated herself inside her home as much as she could, worried she'd been exposed. She feared infecting her family, including her uncle and father who are older and vulnerable. But her situation was complicated by the fact that, since 2014, she's been a fulltime caregiver for her parents and uncle.

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Martinez's situation has become a little-discussed but too-common challenge in homes across the nation during the coronavirus pandemic. Families are grappling with caring for vulnerable elderly family members at home as coronavirus cases climb.

The virus has swept through nursing homes, forcing many families to bring their loved one back home. But as the COVID-19 threat grows, older Americans also face economic challenges that make surviving the pandemic more difficult, families and workers say.

As Martinez grieved the sudden loss of her mother and struggled with her own precautionary isolation, the single mother of 10 children also remained responsible for helping her father and uncle, who have health issues.

"You can only lay in bed for so long," Martinez said. "That's what (her mother) would want me to do."

Bracing for budget cuts?

California experts have warned of a looming "silver wave" -- an influx of aging seniors. The number of those 80 and older will grow by about 65% in the next 10 years, according to the Department of Finance. The current health crisis has pushed the crisis further into the minds of families, as they turn to juggle their own lives along with their elders'.

One resource families who are caregivers look to is the Valley Caregiver Resource Center, a nine-county facility helping caregivers tend to their loved ones.

But the Caregiver Resource Center faces some uncertain months ahead, as state officials try to balance a budget severely impacted by business shutdowns imposed in order to curb coronavirus infection rates. State officials announced a $54 billion deficit.

Initially, Gov. Gavin Newsom proposed cuts to caregiver centers among its slash to health care. The move would have saved the state about $35 million by 2022. But this week, there were signs the state budget could relieve the healthcare sector of any significant cuts. Although the budget still has not been formalized, state officials announced they were rescinding more than $200 million in cuts to health care programs, including programs for the elderly.

That puts the nine-county caregiver resource center on sturdier ground than just a week ago, but it's unclear what the future holds, said director Michelle Dibuduo.

State officials are also hoping for a new federal stimulus package that could help offset the state's budget cuts, but it's also unclear whether legislators will come through.

The Valley Caregiver Center had just recovered from a 75% cut to its operating budget from the last economic recession, DiBuduo said. The previously proposed cuts would have left her center again, with a 70% slash in the budget. That would mean cuts to staffing and services for its Valley offices -- and critical support for families.

"We have to continue our advocacy," she said. "It's hard to do budgets for two months at a time."

Although the state budget has not been finalized, DiBuduo said her center is still keeping a watchful eye. The Association of California Caregiver Resource Centers pleaded with the state to reverse its course in budget cuts to its centers, citing "desperate circumstances."

Caring for caregivers

Lisa Molina has struggled during the pandemic to look after her parents. Her mother has battled dementia for nearly 20 years.

The 55-year-old Bakersfield woman quit her job as a school secretary to become their full-time caretaker.

The pandemic has made things more difficult, but it's never really been easy, she said.

Molina said her mother's habits include calling for people who have passed away. She searches for items she thinks are missing or stolen and forgets names and faces of her grandchildren. Molina said she removed mirrors and magazines from her home, so her mother isn't triggered by the sight of herself or others she doesn't know.

"She's going backwards in time; we are going forward," Molina said. "You have to adjust your life to fit theirs."

She has relied on the help of the Caregiver Resource Center, who provides a "substitute caregiver" who can step in and be with a patient when a family member needs a break. Molina has been able to schedule her father's doctor appointments and grocery trips while a companion steps in to look after her mother.

Last month, 32 hours of the service cost Molina $39.20.

"That's the best $39.20 I have ever spent," she said. "They have been heaven-sent."

Caregiver shortage?

Seniors on a fixed income often can't afford the rising costs of care, so they have to rely on family.

And the number of seniors needing care is expected to grow in coming years. But the number of people able to care for those seniors is expected to shrink -- by more than half -- in the next 30 years, according to a study from the AARP Public Policy Institute

DiBuduo, director at the caregiver center, also said the nearly four months of pandemic-related isolation has taken its toll on many elderly residents.

"It breaks my heart what COVID has done to these families," DiBuduo said. "I would encourage children to visit their parents. Prepare for the future."

Even expert officials struggle to find the best way to keep seniors from infection.

Fresno County Interim Health Director Rais Vohra said it's difficult to forbid elderly residents from visiting stores, but allowing them inside places leaves the elderly at greater risk for infection. He said it's on families and residents to help juggle and keep them healthy as state businesses reopen.

"Be mindful that it's a population that is at really high risk," Vohra said. "These are hard questions, hard questions for us to answer at a policy level."

'They didn't plan on being sick'

Professional caregivers with the state's In-Home Support Services also say they face higher risks from the coronavirus. They say budget cuts would only make things worse.

Vohra, the health director, said caregiving employees could request protective equipment from the county. Yet, some employees told The Bee they've had to purchase their own supplies.

Kim Metzler, a 56-year-old IHSS worker, said as a caregiver, she checks in with elderly residents in her Tarpey Village neighborhood in Clovis. She said she realizes part of her job is to keep elderly residents from going into nursing homes or hospitals. But low wages and threats of cuts to salary make the job less attractive at a time when more worker like her are needed.

She said getting paid for more hours would help her, and her clients. And extra protective gear would help keep her from spreading illness to some of her 12 grandchildren. She said she changes in her garage and showers before coming into contact with family after a work shift.

"It's not possible to do what I do for my client in five hours," Metzler said. "If we start losing home and healthcare providers, it'll be devastating, and it could be life and death for our clients."

There are about 24,000 long-term care workers in the IHSS program in Fresno County, according to union representative Dereck Smith. He said the union has negotiated with the state to ensure workers have what they need during the pandemic, including adequate pay.

"We actually need sustainable, well-compensated jobs to sustain the workforce," Smith said. "You can't keep balancing the budget on the back of working people."

Aside from their IHSS clients, some workers still also oversee their own families. Janice Tarango, 59, of Fresno, said she'd become almost like a detective as she organizes errands and payments for her aunt, uncle, and mother, all of whom reside in independent living facilities.

She cares for her family for free and is only paid for her IHSS work with one client.

Recent restrictions have made her job lonelier, she said. She hasn't been able to hug her grandchildren in the months since shelter-in-place was announced. Tarango said she accepts the sacrifices because they make it possible for her to care for her family.

After working 30 years as a daycare worker, she too quit her job to focus on her family's needs. It's stressful, she said, and her retired relatives are also working hard during the crisis.

"They didn't plan on being sick," Tarango said. "They are working hard in a different way. They're working hard to stay healthy."

She also takes a course through the Valley Caregiver Resource Center to help caregivers like her prioritize their own health and well-being. She is reminded she was never trained properly to care for older people. But she has managed to do it so far, she said.

The only question left for her is who will take care of her when it's her time?

"Sometimes I think, do I have someone who has my back?"

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