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Trunzo's main concern with eldercare, however, is that it isn't really applicable to Marin seniors across the board. As this series has previously explored—and the Division of Aging has documented—Marin elders are generally not as wealthy as the county's high median income might lead one to expect. With the steep cost of living and the fact that many older adults live on fixed incomes and struggle with age-based disabilities, slightly more than half of Marin residents over 65 could be considered "low-income" based on the latest HUD and American Community Survey reports. Even if they live in homes bought and paid off years ago, paying $26 an hour for in-home care may not be an option for many of the county's seniors.
"Affordability is an issue," says Trunzo, explaining that although Napa's Agency on Aging requires home-care providers to be certified through the county—a creative fix to the lack of state-wide licensing, but one that charges caregivers a fee—Marin is reluctant to raise the bill on homecare any higher.
And this economic imbalance slices both ways. For caregivers, making it on an hourly wage of $11.50–$16 in a county where the median rent is over $1,500 isn't easy, either. For some, this means working for a higher, cash-only fee as an independent contractor and sidestepping agency benefits and workers' compensation. Others commute long distances; Boudinot says she's seen caregivers drive into the county from as far away as Sacramento. And with its decided lack of workforce housing, some simply pay rents far beyond their means and try to survive.
Maria Alarid pays $600 a month to split her canal-neighborhood one-bedroom with two roommates. A caregiver for the public agency In Home Supportive Services (IHSS), she says she's been working up to seven days a week lately to make ends meet at an hourly rate of $11.55.
Alarid doesn't have a long history in the industry. Since emigrating from Mexico in 1974, the 64-year-old San Rafael resident has worked as a housecleaner and been employed by a Spanish-language newspaper. But she's highly recommended by her government-sponsored place of employment, which serves lower-income elderly who qualify for Medi-Cal. And she loves her job, adding, "I respect anyone who does it, because it's not always easy."
Along with physical hurdles—like lifting elderly clients into their wheelchairs with an already strained back—Alarid says the fear of being taken advantage of in this intimate industry has led to false accusations. Once, an elderly woman reported that she'd stolen $1,000. The woman later found it tucked away in her own home, Alarid says.
"When they accuse you of something you didn't do, you feel really bad," she says.
But while many caregivers, like Alarid, may seem to disprove the notion that quality of care and pay scale rise together, Aneice Taylor of Woodacre says she's sometimes struggled to find good caregivers at a rate she can pay.
Paralyzed from the neck-down in a 1982 mudslide that destroyed her house, Taylor qualifies for Medi-Cal. She's used IHSS, which she describes as "generally a very good system," but the amount of care she needs—everything from help with meal preparation to help getting out of bed—has led her to seek out caregivers independently as well.
"I'm sad to say that I've had to hire really unpleasant, dangerous people out of desperation," she says. "If you have no one who's going to get you out of bed or get you dressed or feed you or take care of your bodily needs—believe me, I have had people living here who were not people I wanted to be living with."
Taylor says she's fortunate to have a home with extra rooms, so she can offer caregivers a place to live to supplement their pay. But this has forced her to let people into her home—not just on an hourly basis, but constantly—whose company she later regretted. She's employed homeless caregivers before, she says. Caregivers with substance-abuse problems. Caregivers who stole. She's known and employed many wonderful people at a relatively low wage, she adds, who have come to feel more like friends than employees, but when asked if it was financial desperation that led to the hiring of poor-quality employees, she replies, without pausing, "That was it."
Taylor is the founder of In Spirit, which helps quadriplegics like herself stay independently in their homes. Through her nonprofit, she's able to secure grants and donations for others who might need them, to supplement their caregiving, and she's currently using some inheritance funds her mother left to supplement her own care.
However, like Marin's vast aging and disabled population who may not be able to afford a high-quality agency, private caregiver or geriatric care manager, she's unsure of what the future holds. Speaking of her mother's money, she says, "I don't know what I'll do when that runs out."
This article was produced as a project for the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communcation & Journalism.