Alyssa, an effervescent 8-year-old, blows bubbles through a wand and races to chase them, her braids bouncing, her giggles unbridled. It’s a sunshine-filled autumn afternoon in southern Los Angeles County. Alyssa’s mother, Deidra, and grandmother, Felicia, watch from a picnic table in their front yard, smiling and light-heartedly teasing Alyssa about her silly moves.
The three generations share a single-family home in Compton with Deidra’s two sons, who are in their 20s. The family’s last names have been withheld to protect Alyssa’s identity, because of the sensitive health information that they shared.
The family tries to stay healthy by eating well, exercising and following their doctor’s advice, but during the COVID-19 pandemic, Deidra, 50, became skeptical about the need for some vaccinations.
“We all had the (COVID-19) shots early in the pandemic, but I’m not so sure about them now,” said Deidra, an Afro-Latina nurse, who also runs her own wellness business.
The family choosing to skip COVID vaccinations is not unusual, as only 15 percent of people 65 and older and about 5 percent of all Californians had received the updated COVID-19 vaccines as of Nov. 30.
The COVID-19 pandemic highlighted the value of multiple generations sharing living spaces, including lessening financial burdens during challenging times, sharing caregiving for children and elderly relatives, and decreasing loneliness. However, people living in multi-generational households also have increased risk of infections, in part due to denser living conditions. These risks can be reduced, health experts say, with following good hygiene practices, such as frequent hand washing, disinfecting surfaces and isolation of ill household members as much as possible. In addition, doctors recommend that all ages practice preventative health care, including receiving California’s public health recommended immunizations.
Why are multi-generations living together?
Felicia, a 75-year-old divorcée, immigrated from Panama nearly five decades ago. She lived in Brooklyn before moving in with Deidra in January. Before moving, she came down with what she described as a “nasty cold” and needed help. That convinced her to live with family.
“I didn’t want to die alone, Felicia said.
Deidra and Felicia said they’re relieved and grateful to live together.
“It’s not about being a senior, it’s about not being alone,” Deidra said.
About 4 percent of U.S. households, or 4.8 million people, lived with three or more generations in 2022, a fairly stable number since 2010. California is second only to Hawaii in having the highest number of multi-generational households.
Nationwide, 20 percent of Native Hawaiian/Pacific Islander families live in multi-generational households. That rate is about 15 percent for American Indian or Alaskan Native families, 13.5 percent for Asian families and Hispanic families, 10 percent for Black families and only 5 percent of white families, according to USAFacts, a nonprofit group that analyzes government data for the public.
More than half of adults, ages 18 to 29, lived with their parents in 2023, the highest number since the Great Depression. Lack of affordable housing was the major reason, but the changing labor market and marrying at older ages were also factors.
“The kids can’t afford their own place in this economy,” Deidra said about her sons.
Living with different generations offers more than economic benefits.
“For families to live together, it’s really a celebration and an acknowledgement that the inter-generational relationships are important for older and younger people to grow healthy and age healthy,” said Sheri Steinig, director of strategic initiatives with Generation United, a nonprofit that promotes collaboration across generations.
Steinig said they performed a survey in 2021 that found a quarter of Americans were living in households with at least three generations, which was a dramatic increase from 7 percent in their 2011 survey.
Many families did so to save money, but that wasn’t the only reason. Families reported other benefits including shared caregiving for children, older adults or disabled relatives, as well as emotional support, less social isolation and enhanced cultural connections.
“There is a team there to really try to weather the challenges together,” Steinig said.
Still, the arrangements came with some challenges, her report found, including the loss of privacy and personal space, and disputes over uneven financial contributions and household chores.
Who brings home infections?
“When someone comes home sick, we go into COVID-like quarantine mode,” Deidra said.
Alyssa and Deidra’s adult sons have had all of the recommended childhood vaccines, but Deidra now declines the COVID-19 and flu vaccines for Alyssa and herself.
Early in the pandemic, Deidra was disturbed by some of government’s actions, such as the inequities in access to testing and vaccinations, and the disproportionate illnesses and deaths for Black residents and other people of color.
“There’s a diabolic side to the health care system,” Deidra said. “… A lot of not nice stuff went on.”
Felicia, a retired nurse, doesn’t get the updated COVID-19 vaccines either, in part due to skepticism about its safety or necessity. However, she said she plans to get the seasonal influenza shot in mid-November.
Fewer than half of older adults received the 2024-25 flu vaccine, with the lowest percent at 28 percent for Hispanic/Latinx seniors. Mistrust, misinformation and the false belief that “flu” is not a serious illness are common reasons given for avoiding flu vaccines. Some people decline COVID vaccines for similar reasons.
The low COVID immunization rates may put some in harm’s way, especially the very young and older adults, as they have the highest risk for severe disease and death from respiratory infections, such as COVID-19 and influenza. In California, 1 in 14 households have young children and older adults under the same roof, like Deidra’s family.
Others are not seeking COVID vaccines due to confusion about who is eligible. In September, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention dropped previous recommendations for COVID-19 vaccines for healthy children, though millions of doses have been administered safely.
Non-evidence-based changes in federal guidance cause confusion and undermine trust in vaccinations, according to the Kaiser Family Foundation research. This has led to several medical organizations, including the American Academy of Pediatrics, and at least 20 states to depart from the CDC and craft their own policies.
California’s Gov. Gavin Newsom signed AB 144 in to law in September, establishing the state’s vaccine policies, including requiring insurers to cover vaccinations. California also joined the West Coast Health Alliance to help increase the consistency and confidence in public health guidance.
“In California, I would say that we’re fortunate, in that since the ACIP changes, California has made changes to really facilitate immunizations by following evidence-based recommendations,” said Dr. Dean Blumberg, Professor-in-Chief of Pediatric Infectious Diseases at UC Davis Health Center.
However, 1.7 million people may lose health insurance and likely forego medical care, because they can no longer afford Medi-Cal premiums on Covered California, if the Affordable Care Act Marketplace extended tax credits are eliminated.
In addition, some people have already lost their Medi-Cal coverage, including about 2,300 Deferred Action for Childhood Arrivals, DACA, recipients, because of federal eligibility changes. Also, undocumented adults, ages 19 to 59 cannot enroll in Medi-Cal, as new enrollments were paused for 2025-26, due to budget constraints.
Concern for respiratory infections
“We know that those at the extremes of age for almost every infection are at highest risk of having severe disease, and hospitalization, and even death,” Blumberg said.
He said that kids in daycare have lots of respiratory infections and are often the ones who bring them home.
“Influenza is the one (infection) that kids traditionally bring home,” Blumberg said.
Influenza season in the U.S. typically begins in late fall and lasts until April. The 2024-25 season was considered a severe year, and more than 900 people died, including 44 children, according to the California Department of Public Health.
Both COVID-19 and pertussis, also called whooping cough, are more likely to be brought home by older kids or adults, and then spread to infants and young children. Pertussis can be serious in older individuals. However, in infants, especially those younger than 6 months who are too young to be vaccinated fully, it can cause severe complications and death.
“It goes both ways. So, everyone needs their vaccinations to make sure that they can connect and be together,” Steinig said.
So far this year statewide, there have been about 20,000 hospitalizations and 667 deaths due to COVID-19 and nearly 2,000 cases of pertussis, including one infant death.
California’s Public Health department recommends that everyone 6 months and older get the seasonal flu and updated COVID-19 vaccines, and that all ages stay up to date on pertussis vaccines. The full recommendations are on their website.
“Over the next couple of weeks is a good time to get the COVID vaccine, if you want to be protected before that winter surge,” Blumberg said, “The same is true for (the) flu vaccine.”
