California’s Caregiver Crisis: African Americans Most at Risk


Karen Lincoln
Karen Lincoln

California’s population is aging. By 2030, 18 percent of the state will be 65 or older. More significantly, this population will be increasingly racially and ethnically diverse. Current projections suggest that 52% of these older adults will be members of a minority group.

This demographic shift is likely to have a profound impact on California, with studies projecting increased older adult poverty rates, rising health-care costs for the elderly, and significant long-term care shortages. [See the state’s 2015 report A Shattered System.]

No population is expected to be harder hit than African Americans.

Disproportionate rates of chronic illness and dementia among African Americans will increase the reliance on family caregivers and the need for community-based supports. Meanwhile, a lack of culturally sensitive services and awareness of available resources pose barriers to access and use.

Studies have shown that African Americans have higher rates of dementia than both Latinos and whites, and face the highest risk of Alzheimer’s disease when compared to any other racial or ethnic group — three times as high, in fact.

These racial disparities also extend to diagnosis and treatment, with African Americans far less likely to be diagnosed with Alzheimer’s or prescribed approved treatments.

[pullquote]Op-ed: California Voices[/pullquote]

Yet these higher rates of Alzheimer’s and other forms of dementia are just the tip of the iceberg for aging African-Americans. Another major challenge is caring for this group.

African-American caregivers are on average 46 years old, compared to 52 for white caregivers. More than half of African American caregivers are “sandwiched” between caring for an older person and a younger person under age 18 – or are caring for more than one older adult. In addition, 66% of African-American caregivers are employed full- or part-time, while their average household income is less than any other racial or ethnic group.

This increasing need for caregivers is a growing concern throughout California, and not just for African-Americans. An estimated 5.8 million Californians already provide 3.9 billion hours of unpaid care to nearly 75% of older adults needing care in the community. While California ranks ninth nationally in terms of long-term care services and support, it ranks just 24th in supporting family caregivers. More needs to be done — and now.

Anticipating an aging population and caregiving shortages, other states have already begun to put innovative programs in place. Minnesota is consistently ranked first when it comes to providing support for older adults and caregivers, with a decades-long plan in place to transform the delivery of long-term care in homes and communities – not expensive nursing homes.

Minnesota was the first state to receive funding from the federal Centers for Medicare & Medicaid Services for a demonstration project to improve long-term care services for dually eligible individuals who receive support from both Medicare and Medicaid (Medi-Cal in California).

Since then, Minnesota has experimented with other unique approaches, such as financial and non-financial incentives to increase service quality, and more assistance to seniors who want to move from nursing facilities back into their own homes.

Minnesota provides more comprehensive information and referral services to caregivers – and more flexibility – so seniors and their caregivers can choose options that best meet their needs. The state’s Own Your Future initiative encourages Minnesotans to plan and finance their own long-term care, promoting individual responsibility over government reliance.

For aging African Americans, few best practices exist to support them or their caregivers. Lack of access and awareness of caregiver services, especially for low-income and low-literate African Americans, and a disconnect between what caregivers want and what they’re offered, has led to unmet need.

California is beginning to take steps to address the looming caregiver shortage. Assembly Concurrent Resolution No. 38, authored by Assemblywoman Cheryl Brown (D-San Bernardino), recently established the California Task Force on Family Caregiving to address the significant need for long-term services and support for this surging population of older adults.

The task force will examine the challenges faced by caregivers, available services, ways to support them, and other programs across the U.S. that show promise like those in Minnesota. It will then make policy recommendations to the state legislature.

As the number of caregivers for our growing older adult population rapidly declines — and disparities in caregiving support continues for all underserved groups – more advanced planning and research are desperately needed at state and local levels. Setting new policies and programs in motion now will be critical to ensuring that our most vulnerable populations have access to high-quality, culturally competent caregiver services in the future.

Karen Lincoln is director of the USC Hartford Center of Excellence in Geriatric Social Work. A member of the California Task Force on Family Caregiving, she is also associate director at USC’s Edward R. Roybal Institute on Aging, and is the founder and chair of USC’s Advocates for African American Elders.




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