We didn’t set out to make América, or even go looking for a story like it.

Rather, it was born out of a chance meeting.We were working in Puerto Vallarta on a different project that was going nowhere fast when we met Diego at a mutual friend’s birthday party. As anyone who has met him can attest, his small frame belies his outsized and gregarious personality. He regaled us with stories about his work as a circus artist and his love for Alejandro Jodorowsky. He ended up crashing with us that night.

It was the first of many such nights. As we slinked around Vallarta for a few more months, trying to make something of our other project, Diego was our constant companion. And when one day he announced that he had to return home to Colima to care for his grandmother, we followed him not as a subject but as a friend.

There we met América for the first time and were taken by the secret language Diego seemed to share with her. Though at that point it wasn’t clear where their story was headed, or that there was a story at all, we immediately felt their dynamic was more compelling than whatever else we were working on. With our friendship with Diego as the foundation, we ended up following the family for the next three years, with Erick intermittently living with them to film.

To be sure, it wasn’t hard to be intrigued by Diego and his brothers—this hangout crew of artists who juggled circus, marijuana and a search for deeper meaning alongside the responsibilities of adulthood. They were our fellow creatives and age peers. Like them, we also had aging family members, some with the early, devastating flashes of dementia. Unlike them, we were far from home. To see other young men at similar points in their lives commit themselves full-time to caregiving was inspiring.

Still, the situation presented entirely new challenges for us as filmmakers. Though more people are living with dementia than ever before, their stories remain underrepresented on screen, in part because they are difficult stories to tell, perhaps especially for documentarians. A common misconception is that those with dementia cease to be themselves as they lose their memory. Though for us, as for Diego, América's personhood was never in question, in place of one-time consent to a long-term project, we sought to renew participation with her each time we filmed.

It was also important for us to remain alert to América’s desires and needs when filming. On the rare occasion that she seemed bothered by the camera, we stopped. Then in editing, we had to determine what was essential to portray honestly the immense physical and emotional demands of care, whilst respecting her dignity and privacy. This determination wasn’t always easy, and ultimately audiences will decide whether they think we got it right.

Throughout the process, we were guided by Diego’s examples—for him, América’s vulnerability and dependence never negated her humanity. Beyond the confines of dementia, every day presented new opportunities for joy, laughter, beauty and love. In this spirit, we wanted the film to emphasize all that América had to give, rather than what she required.

Nearly everyone deals with a care situation at some point in their lives—whether it be for a parent, grandparent, other family member or themselves. But few will be celebrated in a documentary film for their efforts. Though the brothers deserve enormous credit for the energy and tenderness they brought to América, there are countless millions whose work as caregivers goes unseen and undervalued.

Indeed, it’s hard to imagine work more essential to human life than caregiving, and yet this labor is commonly unpaid or underpaid. It is also work typically performed by women, especially immigrant women and women of color, who are sometimes imagined to be “natural” caregivers. We reject this sexist, racist premise! The brothers demonstrate that anyone—even twenty-something circus artists—can find value and dignity in care work.

The question is whether society can reflect that value. The fall of real wages in recent decades has made it difficult to support a family on a single income, forcing traditional caregivers to seek work outside the home. Family and friends who step in sacrifice their own wellbeing to do so, and paid caregivers toil for low wages without basic workplace protections. As can be seen in the film, care work is real work, it’s hard work and it deserves the same social recognition and entitlements afforded to other types of labor.

But rather than meet the growing need for care with greater assistance for families and care workers, governments have enacted steep cutbacks in public services. Today, high quality care is available only to those who can afford to pay for it, and vulnerable populations are left with few options.

We believe everyone is entitled to high-quality care, regardless of income, and we stand with the movements of care workers, mothers, elderly people and people with disabilities fighting for universal and comprehensive care coverage that expands options for people needing care and their families and provides a living wage for care workers.

América is the story of three brothers who come together to care for their grandmother. Though in its domestic intimacy it may seem far removed from the politics of care, it was a yawning lack of social support that brought them together in the first place, and that also birthed the stressors that tore them apart. As viewers watch Diego and his brothers struggle to give the best care possible to América, we hope they will be inspired to imagine a society that regards caregiving as the essential life-giving work that it is.

—Erick Stoll and Chase Whiteside, Filmmakers, América

This guide is an invitation to dialogue. It is based on a belief in the power of human connection and designed for people who want to use América to engage family, friends, classmates, colleagues and communities. In contrast to initiatives that foster debates in which participants try to convince others that they are right, this document envisions conversations undertaken in a spirit of openness in which people try to understand one another and expand their thinking by sharing viewpoints and listening actively.

The discussion prompts are intentionally crafted to help a wide range of audiences think more deeply about the issues in the film. Rather than attempting to address them all, choose one or two that best meet your needs and interests. And be sure to leave time to consider taking action. Planning next steps can help people leave the room feeling energized and optimistic, even when conversations have been difficult.

For more detailed event planning and facilitation tips, visit www.pbs.org/pov/engage/.

Diego is an easygoing twenty-something who works in a surf shop and performs on the boardwalk of Puerto Vallarta for tourists. Diego’s seemingly carefree life is disrupted when his 93-year-old grandmother, América, injures herself and his father—América's sole care provider—is imprisoned for negligence. Diego returns to his hometown of Colima, Mexico, to share the suddenly urgent caregiving responsibilities with his estranged brothers, Rodrigo and Bruno, and to join in the effort to free their father. Caught between love and obligation, the eccentric trio of acrobats clash over money, communication, decision-making and the considerable challenges of caring for someone with dementia.

As a film, América is a tender character study of a unique family grappling with common conflicts and pressures. How long should the brothers put their own lives on hold to care for América? Even if they can free their aging father from prison, is he capable of caring for his mother on his own? Should family caregivers be compensated for their labor, or otherwise supported by the government? What stressors cause conflict among the brothers? And what can we learn about ourselves from their experiences?

América – 93 years old when the film begins

Luis – América’s son and father of Diego, Rodrigo and Bruno

Diego – acrobat, the youngest son who returns to Colima to care for América

Rodrigo – the oldest brother

Bruno – the middle brother

Cristina – Rodrigo’s girlfriend

América will be of special interest to people who want to explore the following topics:

• aging and health
• dementia
• elder care options
• the government’s role in care
• family dynamics of care
• support for caregivers

Immediately after the film, you may want to give viewers a few quiet moments to reflect on what they have seen. Or pose a general question (examples below) and give people some time to jot down or think about their answers before opening the discussion:

If you were going to tell a friend about this film, what would you say?

Describe a moment or scene in the film that you found particularly disturbing or moving. What was it about that scene that was especially compelling for you?

Did anything in the film surprise you? Was anything familiar?

If you could ask anyone in the film a single question, whom would you ask and what would you want to know?

What did you learn about caregiving from watching the brothers’ interactions with América? What sacrifices did they make to care for her?

Rodrigo looks for logical strategies and plans ahead. Diego is more idealistic, appreciating América for all she has to offer despite her frailty and dementia. What are the strengths and weaknesses of each approach?

Rodrigo and Luis want to pursue lives beyond being full-time caregivers for América. In contrast, Diego says that he and Bruno “will do whatever it takes to stay with her.” What sacrifices should we expect from family members of those who need care? How long should family members be expected to put other interests or plans on hold to provide care?

In contrast to their sacrifices, in what ways did caring for América enrich her grandsons’ lives?

In an argument over the timing of a medical appointment and use of the car, Diego implies that Rodrigo is self-serving. Is it fair or helpful to blame one another for looking out for their own needs?

Bruno and Diego fight over money. Have you experienced conflicts over money in your family, especially involving adult children with aging parents? How were the conflicts resolved? What sorts of planning could you do to prevent future conflicts? Does Diego’s role as primary caregiver constitute work? Should he be compensated, and if so, by whom?

Many seniors do not have sufficient family members available and willing to care for them, and must rely on paid care from home health aides. What workplace issues do paid caregivers face? What do these challenges tell us about how our society values caregiving?

Rodrigo and Diego argue about whether América is “conscious,” with Rodrigo saying she is not while Diego argues that “she lives her reality.” What does América do or say that supports or contradicts the brothers’ differing assessments of her level of awareness?

In the park, Bruno insists that América try to stand on her own, despite her resistance. How might a caregiver know what is and isn’t in someone’s best interest? What say should someone with dementia have in their care?

Bruno tells his brothers that police in the park demanded that he do what his grandmother asked. He tried to explain to them that “she asks for a lot of things.” Diego responds to his story by saying, “Nobody’s going to understand that.” Why wouldn’t people understand? What could be done in your community to increase the likelihood that people would understand?

When should people in América’s condition be given the autonomy to choose or reject treatment (like whether or not to take medication)? Under what circumstances is it appropriate to take decision-making power away from them?

At one point América asks about the presence of the camera. What are the ethics of filming someone with dementia? What degree of consent can a person with dementia give?

Rodrigo says that he gives América “the best quality of life I can,” but he questions the value of the brothers’ efforts to keep her alive because much of the time “she is not conscious. She operates under nothing but the most basic instincts.” How do you define quality of life? In your view, should quality of life be linked in any way to decisions about sustaining physical life?

Diego and Bruno reject the possibility of placing América in a nursing home where they fear “she would suffer, alone and afraid.” Instead, they put their own lives on hold to help their grandmother stay in a family home. Should public policy (or subsidies) favor one option over the other? What factors would you use to determine whether home-based or facility-based care is the best option?

Do you think that the government agencies entrusted with protecting the elderly acted in América’s best interest?

Diego explains, “What happened is that América fell from her bed. My dad, Luis, cares for her, but he wasn’t there. The neighbors heard her yelling for help and called the police. They found América on the floor, bleeding and confused. She seemed abandoned. My dad was accused of abusing a senior citizen and they took him to jail.” How would you distinguish between lapses in care and abuse? What clues could authorities use to tell the difference? Is imprisonment a just or useful solution to the situation?

Diego and Rodrigo suggest that police are quick to make arrests: “You could do something minor, and they’d send a helicopter.” “If they don’t like you or if you’re difficult with them, you’ll end up like Luis… Or worse.” Why might Bruno’s actions in the park have been perceived as abuse? What non-criminal responses could be implemented to improve care in such situations? If you could give officers training, what would you want them to know or do? What could Bruno have done differently to avoid this situation?

América says to Diego, “There are people who end up with nothing, right? Alone, abandoned... with nobody that loves you.” Are there ways that public policy could address this fear and ensure that no one ends up abandoned? Is ensuring the well being of aging adults and all those needing care a private responsibility to be handled by families, or a human right requiring robust public services and support from governments?

At the end of your discussion, to help people synthesize what they’ve experienced and move the focus from dialogue to action steps, you may want to choose one of these questions:

What did you learn from this film that you wish everyone knew? What would change if everyone knew it?

If you could require one person (or one group) to view this film, who would it be? What would you hope their main takeaway would be?

This story is important because ___________.

What question(s) do you think the filmmakers were trying to answer? Do you think they found the answers they were looking for?

Complete this sentence: I am inspired by this film (or discussion) to __________.

Additional media literacy questions are available at: https://www.amdoc.org/engage/resources/media-literacy-questions-analyzing-pov-films/using-framework/

If the group is having trouble generating their own ideas, these suggestions can help get things started:

Find ways to disseminate information to your community about elder care options and/or tips for caring for people with dementia.

Organize counselors who might be willing to volunteer to meet with siblings who need help working out elder care issues.

In 2017, seniors and their caregivers in Hawaii successfully organized to pass the Kapuna Caregivers program, which provides daily benefits to family caregivers with jobs. Are there movements of care givers and receivers in your state?

Investigate the insurance coverage and/or subsidies available for in-home health care in your state. Tell policy makers and legislators about any unmet needs in existing services and what you think should be done to fill the gaps.

Convene a working group with community, political, medical and business stakeholders to ensure that high quality nursing home care is available to every person in your community who needs it.

Film-Related Websites

Explore content related to América on the POV website, where you’ll also find other relevant features, shorts and digital projects.

América - The film’s official website

American Association of Caregiving Youth – This national network provides resources and support to youth caregivers.
Caregiver Burnout: How to Take Care of Yourself

Eldercare Locator – A U.S. government site that describes resources and options for eldercare in the U.S., including a search function that helps users find resources in their own communities.

National Center on Caregiving (Family Caregiver Alliance) – A robust website provides learning opportunities and other resources for caregivers of all ages.

National Dementia Association - The online resources from this small nonprofit include basic information about dementia and practical strategies for family members caring for a person with dementia.

National Institute on Aging – A U.S. government source for research and information on health and aging. Also a co-sponsor of the Mexican Health and Aging Study.

World Health Organization Department of Aging and Life-Course – Resources include a database featuring concrete actions to make communities better places to grow old.

50 Ways for Family Caregivers to Take a Break

Writer
Faith Rogow, InsightersEducation.com

Guide Producers, POV
Alice Quinlan
Director, Community Engagement and Education, POV

Rachel Friedland
Impact Associate, POV

Thanks to those who reviewed this guide:
Erick Stoll and Chase Whiteside
Filmmakers, América

Produced by American Documentary, Inc., POV is public television’s premier showcase for nonfiction films. Since 1988, POV has been the home for the world’s boldest contemporary filmmakers, celebrating intriguing personal stories that spark conversation and inspire action. Always an innovator, POV discovers fresh new voices and creates interactive experiences that shine a light on social issues and elevate the art of storytelling. With our documentary broadcasts, original online programming and dynamic community engagement campaigns, we are committed to supporting films that capture the imagination and present diverse perspectives.

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This resource was created, in part, with the generous support of the Open Society Foundation.