Commentary: Caregiving crisis hurting kids, elderly

The average cost of a full-time child care program in California is nearing $20,000, while the median annual cost of a semi-private room at a nursing home is more than $100,000.|

“A nation’s greatness is measured by how it treats its weakest members.”

--Mahatma Ghandi

America’s twin crises affecting eldercare and childcare, worsened and made more alarmingly visible during the pandemic, are hurting increasing numbers of families here in Petaluma and across the country.

Just look at the numbers. The average cost of a full-time child care program in California, if you can even find one, is nearing $20,000, while the median annual cost of a semi-private room at a nursing home is more than $100,000, a price well beyond today’s average household income. Meanwhile, the number of people willing to earn poverty wages to provide care for children or the elderly is dwindling as more of them take better-paying jobs. It’s an unsustainable societal dilemma that demands national, state and local solutions.

To get a better understanding of the eldercare crisis, I spoke with Crista Barnett Nelson, executive director of Senior Advocacy Services, a non-profit here in Petaluma that trains volunteer ombudsmen who visit nursing homes to ensure residents get proper care.

She told me that while the vast majority of Americans desire to age in their homes, the reality is that most people over the age of 65 will wind up needing some type of long-term care services in their remaining years, often at a nursing home. Unfortunately, due to the industry’s “terribly low wages,” coupled with the hard work and absence of effective public policies, high quality eldercare service at nursing homes has effectively disappeared.

“Skilled nursing facilities are grossly understaffed,” Nelson says, and often lack the qualified medical and nursing personnel necessary to provide an adequate level of care. Staffing shortages were endemic to the industry for decades, Nelson said, but when the pandemic hit, nursing home staffers “left in droves” as the coronavirus spread in facilities coast to coast, killing hundreds of thousands of elderly residents. The remaining staffers, while compassionate and hard-working, are completely overwhelmed.

“I’ve never seen it this bad,” Nelson said.

In America today, aging people needing care must be wealthy enough to pay for it themselves or must deplete their income and assets enough that they qualify for Medi-Cal. But for the vast majority of middle class workers, Nelson says, those options just won’t work.

Assisted living facilities can offer a better alternative to nursing home care, but with the average monthly cost at such facilities hovering around $5,000, it’s unaffordable for many middle class Californians, says Nelson. Nor is the hiring of a home health aide which can easily tally $50,000 annually.

The scarcity of affordable eldercare options has left tens of millions of Americans providing unpaid care to an older family member. Most of these caregivers are middle aged women who have had to sacrifice wages by cutting back time at work or leaving the workforce entirely.

Nelson says she knows several retirees in their 70s still caring for frail parents in their 90s. It’s not what they planned, she says, noting, “I don’t think many people have thought about how they would feel about having to give their mother or father a bath.” But with the number of American seniors expected to double in the next few decades, many more people will have to do just that.

The situation is no less desperate for today’s childcare providers and the millions of parents no longer able to access childcare services. According to Susan Gilmore, founder and president of the North Bay Children’s Center which provides services at 13 school sites in Sonoma and Marin counties, the U.S. childcare industry has always been a “fragile system teetering on the backs of employees willing to work for low wages.”

The pandemic and resulting lockdowns forced many early childhood education teachers and care givers out of the field and most have since found other jobs in the rebounding economy. “We’ve lost more than 50 percent of our capacity in the last two years,” says Gilmore. “Many child care centers simply closed and never reopened.”

The trend quickly shifted the burden of child care to mothers, many of whom were forced to leave their jobs to care for their children, thus helping to trigger the nation’s ongoing labor shortage.

“This is a workforce issue,” says Gilmore, adding that many former childcare workers have found new jobs in other industries, making it extraordinarily difficult to find qualified staff and leaving American families and employers in the lurch.

To solve this quandary, Gilmore believes the country must adopt a comprehensive family policy to address both childcare and eldercare. She supports the bill narrowly passed last month by the federal House of Representatives calling for universal prekindergarten, generous childcare cost subsidies for middle class parents, and home and community care for older Americans. The package, which would largely be paid for with tax increases on high earners and corporations, is currently being debated in the U.S. Senate.

Because the U.S. invests fewer public dollars in early childhood education and care relative to gross domestic product (GDP) than almost all other developed countries, it’s long past time for permanent and positive change at the federal level.

But Gilmore believes that an effective and lasting fix to the child-care crisis must also be matched by long-term commitments by state and local governments, and that the piecemeal policies of the past are unsustainable. As such, she supports, the Sonoma County Child Care and Children’s Health Initiative on the November 2022 ballot that would, is passed, establish a ¼-cent countywide sales tax generating $22 million annually to expand access to quality child care and promote children's health, especially kids impacted by homelessness and other traumas.

Whether the federal legislation will pass and become law is unknown, as is the fate of the proposed county childcare measure.

But one thing is certain: Without more public financial support to care for our children and our elderly, their welfare as well as the future of our country will surely decline.

John Burns is a former publisher of the Petaluma Argus-Courier. He can be reached at

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