With COVID-19 Concerns, Anxious Families Eye In-Home Senior Care

Note: To respect the privacy of the family in this story, and because of sensitivity around their work visa, we are not using their full names.

One evening in August, Johnny was at home with his family in Europe when his phone rang. It was the director of his mother’s assisted living facility in Oakland, with news he had dreaded for months: His mother tested positive for the coronavirus. The director said his mother was asymptomatic. But she hadn’t eaten in days.

Johnny was halfway across the world from his mother. He had a newborn daughter to care for, and his visa application process was in limbo. Once he left Europe, he didn’t know when he’d be allowed back. But something told him his mother’s life might be at risk.

“I lost all trust in the information they were giving me,” Johnny said in a recent phone interview. “I had to come back.”

Since the onset of the pandemic, Johnny’s experience has become all too typical. Residents in assisted living facilities and nursing homes have accounted for more than a third of coronavirus deaths statewide. But until recently, California care home populations were reaching record highs. From 2012 to 2019 alone, assisted living populations statewide grew by 30%. For thousands of families like Johnny’s, these facilities once seemed safer than leaving an aging parent at home. Now, some of these families are grappling with what to do next.

The flight to Oakland took 12 grueling hours. Thirty minutes after landing, he was at his mother’s bedside. He found her covered in bedsores, dehydrated and malnourished. Her doctors warned that her kidneys weren’t working properly, and she would need immediate hospitalization to stay alive.

Johnny rode with her in the ambulance on the way to the hospital. When she went in alone, he wasn’t sure he’d ever see his mother again.

“She could have very easily died all by herself,” he said. “I felt a lot of guilt.”

That guilt Johnny felt stems from the fact that he was responsible for putting his mother in the facility in the first place.

Before April 2019, Johnny’s parents had lived together in their Oakland apartment for decades. But they’re both in their 80s, and his mother has advanced dementia. By early last year, she could no longer walk, and it was clear to Johnny that his father couldn’t care for her on his own. So Johnny suggested moving her to a home, but his dad resisted.

“He wasn't physically able to provide the care for her,” Johnny said. “Emotionally, he wasn't ready to be separated from her.”

Johnny insisted. He found a memory care home nearby designed for dementia patients. His mom would be living an active, social life and getting round-the-clock care. Johnny felt confident in his choice. Still, the day they dropped her off, his father was distraught.

“It was heartbreaking,” Johnny said. “To him, it was as if my mom was dying.”

Johnny’s debate with his father isn’t unique. For decades, families with aging parents have faced a similar decision: to keep an aging parent home or move them out for better care. Today, as the pandemic rages in senior care homes across the state, the stakes of that debate are higher than ever.

Since the onset of the pandemic, assisted living facilities have become virus hot spots — with nearly 450 outbreaks statewide so far, according to the California Department of Social Services. The Centers for Disease Control and Prevention estimates that more than 100,000 aging Californians currently live in care homes. For their families, an already tough decision could turn deadly.

But there’s another option.

At a tiny downtown Oakland office, Leah Bloom runs Homewatch CareGivers of Oakland, which connects Bay Area seniors to caregivers who come directly to their homes. Bloom has run the agency with her husband, Ben, since 2014. Homewatch is one of thousands of licensed home care agencies in the state, according to the state’s Home Care Services Bureau.

Bloom said she sees aging couples like Johnny’s parents all the time. And she says being a caregiver when you’re 80 just doesn’t work.

“It’s really dangerous to be an elder yourself, caring for elders,” Bloom said.

But to Bloom, “assisted living” doesn’t require a facility. Her caregivers help with everything from moving around and eating, to driving and companionship.

Once, Bloom says, home care was a niche industry.

“I used to be in the business of convincing people that there was a need for home care,” Bloom said. “Now the industry is really booming.”

Even before COVID-19, there weren't enough home care aids to meet the increase in demand, according to an analysis from the U.S. Bureau of Health Workforce. And, though the state has not yet collected data on the home care industry this year, long-term care researchers have warned that the coronavirus will only accelerate this demand.

But, like assisted living, home care is expensive. Most of Bloom’s clients have long-term care insurance, or can afford to pay out of pocket.

“Home care is still not considered a medical necessity,” Bloom said. “Even though there is study after study that shows that after a hospital discharge, you're much less likely to return to the hospital again if you have the proper home care.”

Back in the hospital, Johnny’s mother was one of the lucky ones: She began to recover. As she regained strength, Johnny and his father felt they could never send her back to the assisted living facility. Then, a social worker told Johnny about Homewatch CareGiver. Today, caregivers from the agency work with his mother around the clock, in the apartment she shares with his dad.

“To come back from where she was, the day that I got back, I never would have guessed,” Johnny said. “It's nothing short of a blessing.”

And, now that Johnny’s father doesn’t have to worry about taking care of his wife’s medical needs around the clock, Johnny says he can instead focus on the moments he has left with her.

“It’s been him reconnecting with her,” Johnny said. “It’s kind of like getting reacquainted.”

Johnny’s still waiting to fly back to Europe to see his own family again.