For Rosa Vasquez of Chatsworth, a typical week includes busy days at her corporate job, with multiple daily calls to check on her aging parents, followed by regular visits to their home.
Like many people, Vasquez often feels like there aren’t enough hours in the day to juggle her job, household responsibilities and doing whatever she can on evenings and weekends to help her mother – who is the primary caretaker for her 76-year-old father, who has Alzheimer’s disease.
It’s a family effort, she said. Vasquez, her brother and their spouses, who all work, lend a helping hand and provide financial support to look after her parents, who still reside in their own home. Despite living close by, Vasquez is often wracked with worry. Is her dad having a good day? Is her mom feeling overwhelmed? Did they get enough rest last night, or did her dad’s anxiety and restlessness keep them both awake, with her mom watching over him to ensure he remains safe?
“It’s frustrating because I want him to have a good quality of life and it’s awful to see him suffering,” explained Vasquez, noting that her dad’s Alzheimer’s disease is entering the final phase. Though he still recognizes his close relatives, he often doesn’t remember other people, repeats himself, loses track of conversations, forgets where he is and experiences confusion.
Her father also struggles with anxiety and agitation almost daily, sometimes for hours, which has led to several emergency room visits. Other concerns include difficulty walking, resulting in recent falls, and an increasing need for help with bathing and personal hygiene.
“After years of caring for him, the stress is taking a serious toll on my mother’s health. Her blood pressure is often high and … we can see that her health is deteriorating,” said Vasquez. But when they look into senior care facilities, her mother finds reasons to reject every place they visit.
“She thinks she’s betraying him if we place him somewhere, and she feels bad,” she said. But the family also worries about the level of care her dad would receive at a nursing facility that is currently covered in full by her parents’ Medi-Cal coverage – the Medicaid program in California – which provides free or low-cost healthcare for low-income adults, kids and people with disabilities.
“A lot of those facilities are not very nice, and there are long waiting lists for the good ones,” said Vasquez. Other alternatives, such as private facilities, are just too costly for most people.
That’s one of the growing dilemmas for the state’s, and the country’s, rapidly aging population.
Aging and Healthcare
“For the first time, Californians aged 60 and older outnumber children under 18, and it’s projected that by 2030, about one in four Californians will be 60 or older,” said Maria Zamora, president and CEO of the Center for Elders’ Independence (CEI).
California is currently home to nearly 9 million older residents, and within the next four years
approximately 1 million people will be 85 years of age or older, the California Department of Aging (CDA) reports. Nationwide, nearly one in four Americans is expected to be 65 or older by 2060, cites the National Council on Aging (NCOA).
As people age, said Zamora, even relatively healthy older adults begin to experience gradual physical, cognitive and social changes over time. Others might be struck with multiple health conditions they need to manage. And overall, many aging adults lack the social interaction they need to stay healthy – socially isolated older adults face a 29% higher risk of early death.
“The goal is to try to prevent problems from becoming crises whenever possible, and make sure that older adults have access to the right level of care in the right setting and at the right time when they need it,” continued Zamora, adding that research has shown “definitively that loneliness and isolation are just as impactful as some chronic diseases for older adults.”
Unfortunately, many seniors, like Vasquez’s parents, who qualify for both Medi-Cal and Medicare – the federal health insurance program for people 65 and older – are at risk of seeing their benefits reduced for Medi-Cal-specific services – including routine dental, vision or hearing care, and in-home supportive services – due to the looming cuts from the passage of HR-1.
That’s the last thing Vasquez hopes will happen – the help her parents receive is already too little. Although Medi-Cal does provide in-home care workers for her father, the hours and days per week are limited, so the family pays out of pocket for additional care workers throughout the week. But the expense adds up quickly, and they’re currently unable to pay for overnight care.
“I would love to have more resources, like having a nurse at night or transportation” – not less, said Vasquez.
Other Changes on the Horizon
Changes to asset and home equity limits are expected to reduce the number of seniors eligible for Medi-Cal. Upcoming federal regulations under HR-1 will cap home equity limits at $1 million starting Jan. 1, 2028. The state’s individual asset limit will remain at $130,000 through June 2027, but will drop dramatically to $21,000 per person or $31,000 per couple on July 1, 2027.
Other changes will impact many noncitizen immigrants who are lawfully present in the U.S., including refugees and people with temporary protected status (TPS), who may lose their Medicare and Medi-Cal coverage between 2026 and 2027, despite having paid into Medicare for years or decades.
Further, the passage of HR-1 is delaying new rules that were supposed to be implemented to make it easier for people to get and maintain Medi-Cal coverage. Instead, eligibility redeterminations will double from once a year to every six months. These changes make it critical for Medi-Cal recipients to stay on top of paperwork, because missing deadlines could result in a loss of benefits.
“[The changes] are incredibly confusing, even for those of us that have been working in this field for a long time,” said Karen Lauterbach, senior director of community programs for Valley Community Healthcare. “Every person’s scenario is different. Their immigration status is going to be different. Their work history, all of those things. It’s important to get [information] from a trusted source, [to] talk to somebody who can go over your particular situation and coverage.”
Don’t Delay Renewing Coverage
Lauterbach stressed that all Medi-Cal recipients should be timely about filling out and submitting their paperwork to renew their current coverage, and provide any change of address directly to Medi-Cal, not their health plan provider. People in the San Fernando Valley can get free assistance with updating or filling out Medi-Cal paperwork at many local community clinics.
“Every time [they] introduce new or additional forms that people have to fill out, people always drop off [Medi-Cal],” warned Lauterbach, adding that a significant percentage of people “just had a bad address – that was the only problem. … Anything coming in the mail from Medi-Cal is important. You need to look at it, and if you don’t understand it, ask somebody to help you.”
Available Resources
For aging adults and their families looking for an all-in-one location to support their diverse healthcare and support needs, Zamora recommends Program of All-Inclusive Care for the Elderly (PACE), which offers a range of services for Medicare, Medi-Cal or self-pay patients.
“It’s very comprehensive. Just about every health care and social service need that a patient might have is delivered and coordinated out of one center,” said Zamora, noting that the goal is to help patients continue to live independently in their own homes instead of going to a nursing facility.
In the San Fernando Valley, there are three PACE-based centers: the Brandman Centers for Senior Care in Reseda; WelbeHealth North Hollywood Center; and AltaMed PACE in Sunland.
For people who need help with Medi-Cal, or who have lost their coverage and are unable to obtain Medi-Cal or other healthcare coverage, nonprofit community healthcare clinics support people of all ages – including seniors – in under-resourced communities across LA County.
“Community health centers … see people regardless of whether or not they have coverage,” Lauterbach.
Despite the challenges of helping support her aging parents, Vasquez views it as a natural and inevitable life transition – they cared for her as a child, and now their roles have been reversed.
“It demands a lot of effort and sacrifices, but you do it willingly when you really love someone.”
For information about PACE centers in California, go to: www.calpace.org.
To learn more about nonprofit community healthcare clinics and find a location near you, go to the Community Clinic Association of Los Angeles County at: www.ccalac.org.
For information about One Generation, which serves older adults, children and their families, go to: www.onegeneration.org.