For Deo Agustin, 54, caregiving doesn’t stop when her workday as an in-home childcare provider ends — it simply shifts. Agustin cares for her 79-year-old mother, a job she’s proud of but that she said has worn on her sense of well-being.
“Mentally, it’s definitely taking a toll,” she said.
An increasing number of Bay Area families will soon find themselves caring for aging relatives like Agustin, and many are unprepared, experts say.
The region is among the fastest-aging in the country, with more than half of Bay Area residents expected to be over 50 by 2050, according to estimates from the Metropolitan Transportation Commission. More than 22 percent of Californians will be over 65 by 2040, according to the Public Policy Institute of California.
That’s a lot of people who will need help as they age. According to an AARP report, the job of caring for them will fall primarily on their families, with one in five adults in the United States currently caring for an elderly relative.
That work can be more challenging in California and the Bay Area than in other places because housing, health care, and long-term care costs are among the highest in the nation. Experts warn that people underestimate how quickly these responsibilities can escalate and how limited traditional safety nets like Medicare are.
“Families should expect that it’s going to be a long and sometimes confusing process,” said Nina Weiler-Harwell, an associate director at AARP. “You can’t quickly pull this together.”
Many caregivers are balancing that role alongside jobs, raising children or managing their own health — pressures that can compound quickly without advance planning.
They become, as Agustin sees herself, “the glue” holding everything together.
Whether caregiving begins with a medical crisis like a stroke or unfolds gradually as an aging parent needs more help, the role can bring intense financial, physical and emotional strain. Experts say families who prepare before a crisis hits are better positioned to manage the challenges that follow.
Here’s a look at what families can do to prepare and cope with the challenges.
Plan Ahead
Agustin began caring for her mother, once a caregiver herself, last year. But even as her mother’s health declined, she struggled to slow down.
“She thinks she’s Superwoman,” Agustin said, chuckling.
Families should start conversations early about what an aging loved one would want, who could help in an emergency, and how responsibilities might be shared, experts say. They also recommend assessing finances and addressing home safety concerns, such as fall hazards.
“People think it’s not going to happen — mom, dad, or a spouse is fine, until suddenly they’re not,” said Weiler-Harwell.
Cost Shock
Financial strain is one of the biggest challenges. Christina Irving, a client services director at Family Caregiver Alliance in San Francisco, said people are often surprised by the cumulative costs of caregiving, including transportation, home modifications for accessibility, long-term expenses, and lost income from reduced work hours. AARP research shows that the average family caregiver spends about $7,200 out of pocket each year.
Many families earn too much to qualify for public assistance, but not enough to afford long-term assistance.
“That’s where we typically see families step into that role, when they’re financially in the middle,” Irving said.
Agustin qualified through a state program to be paid for the caregiving services she provides her mother, but the financial strain remains. She receives $20 an hour for about 74 hours of work a month — income that helps cover basic needs but falls far short of reflecting the amount of care she provides. To maintain a more sustainable income, there’s the in-home daycare in San Jose, which operates from 7 a.m. to 5 p.m. with up to 14 children a day and three staff members.
Burnout
Caregiving can also take a toll on one’s health. Irving said warning signs of burnout may include changes in sleep or appetite, increased anxiety or depression, reduced patience, worsening existing health conditions, or a persistent feeling of being unable to keep up.
“It’s important for caregivers to know what’s normal for them,” Irving said.
Agustin has her own health challenges, including high blood pressure and high cholesterol, and says finding time to exercise and care for her own health is difficult. Faith and family support help her cope, but the strain is constant.
“Twenty-four hours isn’t enough,” she said.
Getting Help
Caregivers often don’t learn about state support until they are already overwhelmed, experts said. California’s In-Home Supportive Services program allows eligible Medi-Cal recipients to receive home-based support, sometimes from a family member like Agustin. Veterans and their caregivers may qualify for assistance through the U.S. Department of Veterans Affairs. In addition, California has 11 resource centers across the state, including Family Caregiver Alliance in San Francisco, which provides counseling, education and referrals.
“The challenge is that people don’t know what’s out there,” Irving said. “Navigating resources is very difficult when you’re already overwhelmed.”
Even a little time away can make a big difference for people helping an aging relative.
“Little things for myself, I put aside,” she said. “I can’t get a pedicure. I’m always moving.”
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