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Who cares for the caregivers?

SAN JOSE – After reviewing a report from the County’s Department of Aging and Adult Services (DAAS), the Santa Clara County Board of Supervisors directed County staff to consider ways to support adult caregivers in the County and provide an update to the Board in April 2024.

Stemming from a proposal from County Supervisor Joe Simitian, and co-authored by Supervisor Cindy Chavez, the study describes who our long-term caregivers are, and the barriers they face when providing care for older adults.

“As things stand today, we already have a shortage of caregivers for older adults. The study makes it clear that the shortage will get worse quickly if we don’t step up. We need to get out in front of the need so we’re not scrambling as the problem grows,” said Simitian.

Adult Day Programs (ADP) were specifically highlighted in the study as a resource that could benefit from additional resources. ADPs provide opportunities for wellness checks, nutritious meals, socialization, and cognitive stimulation for older adults. Among other benefits, these programs have been shown to reduce emergency room visits for older adults. “And,” said Simitian, “ADPs provide respite opportunities for caregivers, allowing them to take care of errands, work, and themselves.”

“The often-overlooked value of adult day services and adult day health care is the benefit to the caregiver, in addition to the direct recipient of the service,” said Simitian. “The caregiver has the benefit of respite as the older adult is getting the direct service.”

‘Family caregivers,’ who are family members, friends, and close associates of an older adult, cited the need for additional education, affordable respite care, more support groups and counseling, and the development of an information and referral system. There are approximately 177,000 family caregivers in the County.

Another 40,000 ‘direct care’ workers make up the remainder of the caregiving workforce. These personal aides, home health aides, and certified nursing assistants care for older adults and adults with disabilities.

The majority of these direct care workers are In-Home Supportive Services (IHSS) providers and have needs that differ somewhat from family caregivers. The study identified a range of needs for direct care workers: livable wages, stable and consistent hours, training and career advancement opportunities, safe working conditions, job oversight and support, and affordable housing and other supports.

“Folks who are taking care of their loved ones are asking for a little help; where we can, the County should lend a hand,” said Simitian. “Love is not enough to care for a family member or friend. It takes training, resources, and an understanding of the system.”

The number of residents in Santa Clara County aged 65 years and over is approximately 273,000, or 14.5% of the population. By 2030, older adults will make up 20% of the County’s population based on projections from the California Department of Finance.

To address the moment, the study offers 13 recommendations to be addressed as part of a five-year plan. The recommendations are spread across system changes; awareness, education, and training; caregiver services and supports; investing in direct care workers; and promotion of existing benefits. The County’s DAAS prioritized a half a dozen goals and next steps, and with prompting from Simitian, identified “Information and Referrals,” and “Respite” as priority recommendations.

“Given the sense of urgency you’ve conveyed, I’m concerned we’re looking at a five-year plan. I’m not sure we have five years,” said Simitian. “What do we know right here, right now, that we need to get started on in the next year and a half? What do we need for a ‘hurry up drill’?”

It was that question that prompted County staff and consultants to propose “Information and Referral” and “Respite for Caregivers” as immediate priorities. Simitian agreed, noting that family caregivers often find themselves caring for a loved one with little, if any, notice, and often wholly unaware of how the elder care system works.

“They need information, fast, from a trustworthy and reliable source. And given the heavy burden that caregiving can impose, they definitely need some form of respite.”

“When you have 177,000-plus family caregivers, they need to know what they need to know in order to take care of the older adults they’re responsible for,” Simitian said.

Simitian said his effort to identify immediate priorities was in part a function of the fact that the study was so thorough. “I worry that when we get a thorough response, it’s too easy to get lost in the ‘bigness’ of it all,” said Simitian. “That’s why I’m asking that we prioritize ‘Information and Referrals’ and ‘Respite for Caregivers’ when we revisit these issues next spring.”

To review the Older Adult Caregiver Study, download a copy.