# Presentation: 011851

## Barriers to Resources for Socially and Economically Disadvantaged Caregivers

- Laura Trejo, MSG, MPA
- Chief, Older Adult Services Division
- Los Angeles County-Department of Mental Health

- National Family Caregiver Support Program  Conference
- From Enactment to Action

## Who are the Socially and Economically Disadvantaged ?

- Women
- Older adults
- Ethnic and Racial Minority
- Lower level of education
- Geographically isolated
- Poor
- Limited or non-English speaking
- Disabled

- The Problem ACCESS

- Older Adult Services Division

- 2001

## LOS ANGELES COUNTY

- Population estimated at 10 million.
- Over 4,000 sq miles highly urban to rural areas.
- 1.3 million 60 years and older.
- Ethnic/racial minorities represent about 66%.
- Almost 40% foreign-born.
- 54% of households are English-only at home,  31% Spanish, 8% Asian Pacific languages, and 4% other Indo-European languages.
- Refugees and immigrant from groups with tribal traditions and directly from tribal societies.

- Older Adult Services Division

- 2001

## CAREGIVING: 

- A WOMAN’S ISSUE

- Majority of caregivers are female
- Women can expect to spend more time caring for an aging parent than raising children.  Caregivers on average spend 10.2 hrs in caregiving / Females 16.1hrs
- Older women are at low or poverty level

- Older Adult Services Division

- 2001

## OLDER ADULTS

- Widowhood
- Living alone
- Lower basic levels of education
- At low or poverty level
- Live in substandard housing
- Inadequate health care coverage
- Spending down
- Little chance for employment to supplement income
- Mobility

- Older Adult Services Division

- 2001

## Hidden costs of "free" services to the client
Members of ethnic/racial minorities are often unaware of services available
The role of Informal support networks  and impact appears to vary across group
Differences in language and cultural perceptions may affect the provision of services if misunderstood by the service provider
Experience and exposure racism and discrimination resulting from rules, regulations, and policies.

- Hidden costs of "free" services to the client
- Members of ethnic/racial minorities are often unaware of services available
- The role of Informal support networks  and impact appears to vary across group
- Differences in language and cultural perceptions may affect the provision of services if misunderstood by the service provider
- Experience and exposure racism and discrimination resulting from rules, regulations, and policies.

- Older Adult Services Division

- 2001

## EDUCATION & LITERACY

- Families experience difficulties, such as:
- Searching for information
- Reading written materials
- Using technology (internet, phone systems that assume a basic level of formal education)
- Completing forms without assistance

- Older Adult Services Division

- 2001

## GEOGRAPHICALLY ISOLATED

- Isolation can occur in both rural and urban populations, challenges include:
- Lack of transportation
- Decreased social support and increased social isolation
- Lack of service availability
- Lack of mobile services
- Geographic inequities in service distribution

- Older Adult Services Division

- 2001

## POVERTY

- Lack health care coverage
- Limited choices
- Lifelong exposure to risk factors associated with work, environment, nutrition, etc
- “Blame the victim” attitudes and policies

- Older Adult Services Division

- 2001

## LIMITED OR NON-ENGLISH SPEAKING GROUPS

- Difficulties include:
- Linguistic Isolation
- Lack of bilingual personnel
- Lack of information in the clients language of choice
- Lack of clear guidelines for use interpreters

- Older Adult Services Division

- 2001

## DISABLED

- Limited choices
- Social stigmas
- Transportation
- Defining quality of life, meaning of recovery and wellness

- Older Adult Services Division

- 2001

## SYSTEM BARRIERS

- Low visibility of caregiver concerns
- Multiple and at times conflicting eligibility criteria, service area boundaries, lack of service coordination, etc
- Lack of trained personnel
- Lack of consensus on “who is the client?”

- Older Adult Services Division

- 2001

## STRATEGIES

- Focus is on the family
- Lifespan approach to caregiving career
- Focus on strengths and merits of survival
- Multiple service sites (home, office, etc)
- Multi and Trans disciplinary Teams
- Formal collaborative service development and delivery

- Older Adult Services Division

- 2001

## ACCESS
QUANTITY & CHOICE of service delivered
QUALITY of how well service was delivered
OUTCOME of how better off is anyone as a result of services

- QUANTITY & CHOICE of service delivered
- QUALITY of how well service was delivered
- OUTCOME of how better off is anyone as a result of services

- Older Adult Services Division

- 2001