What to Do with Abuelita Challenges Traditions, Wallet

When Helen Von Hapsburg asked her 76-year-old mother to consider talking to an elder law attorney about preparing for the next phase of her life, the conversation didn’t go so well.

Her mother, Macrina, immediately jumped to conclusions: This was the beginning of the end; her family was going to put her into a nursing home.

“I’d rather you put me on a bus to any hotel in Mexico, left to die!” she said.

Which was ironic, considering Von Hapsburg’s profession: As an operations manager at a family elder care center in Austin, Texas, she works to provide senior citizens with in-home care so they’ll be able to live outside a nursing home as long as medically possible.

It’s also ironic for another reason: One of eight children in a Mexican-American family, her mother Macrina and father Ferdinand are both 76 and 78, and she doubts she will be able to afford that kind of care for her own parents.

Von Hapsburg, like an estimated 8 million Latino baby boomers, is a part of a “sandwich generation” taking care of both elderly parents and children. They’re toggling between two cultures, two sets of expectations, as they face the difficult question of how to take care of their aging parents at a time of changing demographic and economic realities.

And more Latino families will be dealing with this in the future: By 2050, there will be an estimated 16 million Hispanic elderly living in the United States, according to a study out of the University of Texas; up from an estimated 4 million Latino seniors today.

Von Hapsburg is passionate about her work. “I landed in elderly care and it’s been a calling for me,” she says. She says she would consider nursing home care for her parents, if medically necessary.

But just across the border, she has family members who wouldn’t think of doing anything but keeping their parents in the homes when they are no longer able to take care of themselves.

That’s been the Latino way for generations, and it’s clearly what her mother, Macrina, would prefer. But, for Von Hapsburg, it’s simply not economically possible. A divorced mother of two, she says she would have to quit her job. “My economic status and that of my kids would go down,” she says. “Financially, I would now be putting myself and kids back – forget saving for college.”

Like most Latinos across the U.S., she is unable to provide her parents with what she calls a “Hollywood-type ending,” in which they die in their own home, surrounded by family.

“It is this generation’s responsibility to meet those demands for our elders,” she says. “Both my grandmothers died in my parents’ arms. But, how are we supposed to pull that same experience off?”

Though surveys find that Latinos are more likely than non-Latinos to say they want to keep aging parents at home, data suggests the opposite is happening. According to a Brown University study, white nursing home residents in the United States declined 5.5 percent from 2000 to 2007, whereas Hispanic residents grew 43.3 percent.

Across the country, the increase in the population of Hispanic seniors is startling. In Chicago, for example, the total Hispanic population aged 65 and older grew 58 percent from 2000 to 2007, and the number of Hispanic nursing home residents increased 81 percent. In Miami and New York City the Hispanic population over 65 grew 14.5 percent and 34 percent, and the nursing home residents grew 26 percent and 68 percent respectively. In Houston and Dallas, both the Hispanic 65 and older population and nursing home residents grew by over 50 percent during the same 8-year period.

“Latino middle-aged individuals and boomers need to face reality,” says Fernando Torres-Gil, Director of the UCLA Center for Policy Research on Aging. "We are not going to be able to uphold the traditional values and expectations of keeping the elders at the home."

Latinos are “in denial,” Torres-Gil says, about living longer and the need for long term healthcare, so they under-prepare. (Hispanics live an average of 80.6 years, longer than any other ethnic group in the United States, according to a recent report from the CDC.) By the time families begin to look at options for their loved ones, it’s too late and the traditional cultural expectations cannot bear up to the heavy financial burden.

"Latinos have the lowest rates of savings, health insurance and pension coverage’s amongst all groups,” says Torres-Gil who was also appointed by President Clinton as the first Assistant Secretary for Aging in the U.S. Department of Health and Human Services (HHS).

Torres-Gil says that Hispanics are moving towards nursing homes as an option for their elderly because in-home care requires large out-of-pocket expenses, and many families quite simply cannot afford the costs.

They also can’t afford to quit their jobs to stay at home and provide the care themselves. Public funding for in-home supportive services, home health aides, and adult aid centers are mostly available to those of very limited means with no assets.

According to Von Hapsburg, 24-hour care through her employer can be $10,000 dollars a month, or $18 to $22 dollars an hour. (They do offer discounted need-based rates.)

Though Von Hapsburg is adamant that she doesn’t see helping her parents as a burden, but as a responsibility, she agrees the cost of care is high, and Latinos are overall under-prepared.

“There is no middle ground,” she says. “You are either a Medicaid patient or paying $4,500 dollars a month out of pocket.”

Torres-Gil recommends applying for economic benefits under the Community Living Assistance Services and Support (CLASS) Act, part of President Obama’s healthcare reform act, when it goes into effect in 2013. Though it is expected to help modestly at best, CLASS will provide some financial help for families paying out of pocket to keep a loved one at home.

“The number of Latinos in nursing homes is going to continue to rise, but I don’t think it is the preference,” says Jacqueline Angel, Professor of Sociology and Public Affairs at the University of Texas.

She led a 15-year study that followed 3,050 foreign- and native-born Mexican-American women as they aged into their 80s. It was the first long-term study to track both native- and foreign-born Hispanic elderly.

Among its subjects, 45 percent of the women alive at the end of the study were living with their children or spouses.

“Often we think of older immigrants being heavily reliant on public services. But there is never enough focus on what the families offer for elders,” she says. Angel hopes that policymakers understand that most individuals want to be as independent as possible, but the elderly Hispanic population is much poorer than the rest. She’d like policymakers to start taking cultural uniqueness into account, and so provide options that will support families who wish to keep loved ones at home but can’t afford the out-of-pocket costs.

“Scarce economic resources and the lack of private medicare policies in this demographic requires the family to fill that gap,” she says.

As for Von Hapsburg, she is preparing to forfeit her career, although not permanently, in order to move onto the same block as her parents to take care of them. But she also believes the real attention needs to be focused on the quality of nursing home facilities, because those do have a place in the Latino community.

“There is a line where keeping someone at home becomes a wrong choice,” she says. “What are we doing to get nursing homes to increase their standards? There are not enough beds and definitely not good beds for Medicaid patients.”

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