Caregivers, Part One; Facing a caregiving cliff

America, Iowa soon will see a shortage of people to help our aging population

Adalyn Pins, 6, of Hiawatha eats ice cream while her mother, Amanda Pins feeds her mother, Duanne Otts Thiel at the Hiaw
Adalyn Pins, 6, of Hiawatha eats ice cream while her mother, Amanda Pins feeds her mother, Duanne Otts Thiel at the Hiawatha Care Center in Hiawatha on Tuesday, June 2, 2015. Thiel suffers from Alzheimer’s, and the Pins family lives a couple blocks away from her care center. They walk over for dinner every day. (Adam Wesley/The Gazette)

It’s not a matter of if you’ll be a caregiver, but when.

At least that’s Eugenia Vavra’s opinion.

Vavra is the supervisor of the Lifelong Links partnership at the Heritage Area Agency on Aging, which provides services to those 60 years and older as well as their families in Benton, Cedar, Iowa, Johnson, Jones, Linn and Washington counties.

The Lifelong Links program helps connect and refer caregivers to state resources — something that can be difficult to navigate — and the hotline receives thousands of calls from across the state each month.

“There are ways to modify the home, new technologies — we try to provide options,” she said.

There are 43.5 million caregivers across the United States, with more than 540,000 here in Iowa.

On average, a caregiver is considered someone who provides more than 24 hours of care per week to aging parents, a sick spouse or child with special needs — but almost one-quarter provide 41 or more hours of care a week, according to a 2015 study by the National Alliance for Caregiving and AARP, “Caregiving in the U.S. 2015.”

“But most caregivers don’t recognize themselves as caregivers,” said Joe Sample, executive director of the Heritage Area Agency on Aging. “They think, I’m a partner or child and this is what I do.”

That care can mean picking up groceries, managing medications, cooking a meal or driving a loved one to a doctor’s appointment. In total, the AARP estimates the economic value of caregivers unpaid contributions were approximately $450 billion in 2009.


In many ways Amanda Pins, 35, represents the majority of the nation’s caregivers.

More than 60 percent of them are female. Seven in 10 are caregivers for someone over the age of 50.

In Iowa, AARP reports that 64 percent of caregivers are women. They are most likely to be married, and are working full- or part-time jobs.


Many are what Sample refers to as “sandwich caregivers,” meaning they are sandwiched between two generations of people who need care — such as a child and parent or a grandchild and spouse.

In addition to caring for her three children — all under the ages of 10 years old — Pins is the primary caregiver for her mother, Duanne Otts Thiel, who was diagnosed with Alzheimer’s when she was 58.

Thiel’s illness progressed very quickly, Pins said, adding that after her mother suffered several seizures and a shoulder injury, she lost the ability to communicate. Thiel lived with Pins for about a week before she realized it was an unsustainable solution because the level of care Thiel needed was too great.

Pins moved her mother to the Hiawatha Care Center, a skilled nursing facility that provides 24-hour care and located not too far from Pin’s Hiawatha home.

Every day, she and her children walk and ride their bikes to the care center to have dinner with Thiel and the other residents. Pins said her children love to put on shows for the residents and will help staff clean up once dinner has finished.

Both of Pins siblings live in the Corridor, but Pins — who works part time as a nurse at Mercy Medical Center in Cedar Rapids — said her background helps her stay task-oriented, which is partially why the burden of primary caretaker has fallen onto her shoulders.

Thiel “eats better for me than a lot of the workers,” Pins said. “I feed her and brush her teeth and get her ready for bed every day. The burden is there, but I wouldn’t have it any other way.”

Pins said her mother has been more alert since March, smiling, laughing and even putting together one or two words.


“She said from the beginning that she would be the best Alzheimer’s patient ever — and she has been,” she said.

caregiving cliff

But as the 79 million baby boomers — those born between 1946 and 1964 — age, they are creating, in a sense, a caregiving cliff, experts said.

Americans are living longer than ever before, but often with chronic illnesses such as Alzheimer’s, Parkinson’s, cancer or heart disease.

This, combined with an aging population — Iowans aged 65 and older make up 15.6 percent of the state’s population today, but that number will rise to 20 percent by 2030 — means that the supply of caretakers is unlikely to keep pace with demand.

In 2010, AARP estimated the caregiver support ratio — the number of adult children aged 45 to 64 years old for each person aged 80 and older — was seven potential caregivers to every person 80 years and older. But that is expected to drop to less than three to one by 2050.

In addition, social policies and community resources have not kept up. The Heritage Area Agency on Aging’s Sample pointed out that the Older American’s Act, signed into law in the 1965 and established community resources for those 60 and older, has not been fully funded since 2006.

Sample added that those older Americans today are also very different from the older Americans in the 1960s — they aren’t retiring as early, they have different health needs and they are staying in their own homes longer.

“We have more older adults than ever before in human history,” he said. “In regards to how our social policy unfolds, this needs to be heavier on the radar.”

Caregiving by the numbers

• 43.5 million adults provide unpaid care

• 85 percent of caregivers provide care for a relative

• 60 percent of caregivers are female

• The average age of a caregiver is 49

• 34 percent of caregivers have a full-time job, while 25 percent work part time


• Caregivers spend about 24.4 hours per week helping with activities like housework and managing finances

• 38 percent of caregivers report high emotional stress from the demands of caregiving

Source: Caregiving in the U.S. 2015

Coming up in the series:

June 13 — What support is available for caregivers?

June 20 — A look at the stress and strains of caring for a loved one. Also, a new comprehensive program in

Eastern Iowa

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