When Diego and his two brothers are brought together to care for their charismatic 93-year-old grandmother, América, they confront the transition from carefree adolescence to adult responsibilities in the documentary América from directors Erick Stoll and Chase Whiteside.

Diego is a young circus artist living away from his family in a tourist-filled beach city when he must return home suddenly—his grandmother fell from her bed, and as a result his father was jailed for elder neglect. Diego sees poetry and purpose in this tragedy. He believes that América, despite her immobility and advanced dementia, fell on purpose to bring the separated family back together. He reunites with his estranged brothers and leaves his old life behind.

Now Diego and his brothers face new challenges: freeing their father from an opaque court system while learning to care for América. Yet the greatest challenge might be learning to work together. As the brothers clash over money and the distribution of labor, difficult questions emerge: who decides what becomes of América, and how long will they put their lives on hold to care for her?

Learn more about América and explore additional resources about the film and filmmakers at: https://www.pbs.org/pov/america/

AUDIENCE

Family Caregivers

Senior Care Students and Professionals

Activities of Daily Living
Six categories of basic skills: eating, bathing, dressing, continence, toileting, transferring

Assisted Living Facility
A housing facility designed for those who need extra help in their day-to-day lives but who do not require 24-hour skilled nursing care

Compassion Fatigue
An extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create secondary traumatic stress for the helper

Formal caregiver or home health aide
A paid caregiver who provides in-home personal care for patients who need assistance for a variety of reasons including illness, advanced age, disability, or cognitive impairment.

Informal or Family Caregiver
Any relative, partner, friend or neighbor who has a significant personal relationship with, and provides a broad range of assistance for, an older person or an adult with a chronic or disabling condition.

In-Home Care
A level of care in which the patient has healthcare issues but, with the assistance of family members, friends and others, the patient can continue to reside safely in their own home

Independent Care (Congregate Housing or Retirement Living)
A community for seniors who are mentally and physically active, able to care for themselves and want to have their own homes but as part of a community

Respite Care
Designed to provide temporary relief for those who have the responsibility of caring for a senior family member

1. What does it mean to be “old”? What are the stereotypes that we associate with our elders?
2. What are the most difficult challenges that people face as they get older? Personally, what are the challenges that you anticipate or fear as you age?
3. What strategies has your family (or community) used to address the needs of your elders?
4. What publicly-supported resources are available in your community and across the country for those in need of care? ? What about for those giving care to family members?
5. What are the most difficult challenges that family caregivers for the elderly face?
6. How are the “caregivers” in your family (or community) supported? Are there other members of the family who are actively responsible for addressing the caregivers’ needs and challenges?
7. What workplace issues do home health aides face? What do these challenges tell us about how our society values caregiving?

Part 1
Ask participants imagine that they have suddenly time-traveled to the age of 84 and have them free-write quick responses to the following questions:

● What is your life like as an 84 year old?

● What are your biggest priorities?

● What do you like most and least about being an octogenarian?

Have participants pair up to share their responses, then discuss the following:

● What are the most frustrating challenges you face on a regular day at your current age?

● What can you do now that might be more difficult when you are older?

● What support do you expect to have from family members or other loved ones as you age?

Ask for volunteers to share their responses and thoughts, then discuss the following with the whole group:

● What kind of say would you want over your care? Would you prefer to be cared for by family or a paid caregiver? What kind of support should we expect to receive from government institutions as we age?

Part 2
Repeat the activity, but this time ask each participant to imagine that they have suddenly become the caregiver for an 84-year-old family member. Have them free-write quick responses to the following questions:

● What is your life like as a caregiver?

● What are your biggest priorities when taking care of an elderly family member?

● What do you like most and least about being a caregiver?

Have participants pair up with new partners to share their responses, then discuss the following:

● How has your life changed now that you are a caregiver?

● What are the most frustrating challenges you face on a regular day?

● What support do you receive from family, and does it meet you and your family member’s needs?

Ask for volunteers to share their responses and thoughts, then discuss the following with the whole group:

● How do you think your elder will feel about your taking care of them? What can you do to take care of yourself while you are being a family caregiver? Would you prefer to hire a paid caregiver to care your family member? What public services and support do you wish were available from government?

By 2030, the entire Baby Boom generation will be older than 65 and older Americans will make up 21 percent of the population (up from 15 percent today).

More than 1 in 6 Americans working full-time or part-time report assisting with the care of an elderly or disabled family member, relative, or friend.

In the absence of a spouse, the care of a family member most often falls on the shoulders of a daughter or daughter-in-law.

Women on average spend 17 years of their lives caring for children and 18 years caring for elderly parents.

One study found that family caregivers lose an average of $659,000 over their lifetimes as a result of reductions in their salaries and retirement benefits.

In a 2012 study, more than 75 percent of caregivers reported that isolation was their number one source of stress.

In Hawaii, the 2017 Kapuna Caregivers program offers up to $70 a benefits to support those family caregivers who are also employed.

The annual median income for a home health aide or paid caregiver is $13,000 per year.

Home health aides do not have the right to a union, do not have protections under the Occupational Health and Safety Act, and those privately employed are excluded from overtime protections.

Supporting family caregivers is a global issue:

● In Australia, the value of unpaid caregivers’ contributions in time and labor is estimated at more than 1 billion Australian dollars per week.

● Across the European Union, 42 percent of non-working caregivers are in the lowest income bracket.

● More than 37 percent of French unpaid caregivers have increased their intake of prescription drugs or painkillers.

● In Italy, unpaid caregivers are entitled to as many as three days of fully-paid leave from their former jobs per month for up to two years.

● The German government provides subsidies to relieve unpaid caregivers through respite care and short-term care.

● In India, up to 97 percent of unpaid caregivers and their families live below the poverty line.

Sources:

“Caregiver Profile: The Typical Caregiver.” U.S. National Alliance for Caregiving and AARP Public Policy Institute, August 2015.

https://www.caregiving.org/wp-content/uploads/2015/05/Caregiving-in-the-US-2015_Typical_CGProfile.pdf

“Caregiver Statistics: Work and Caregiving.” Family Caregiver Alliance, 2016. https://www.caregiver.org/caregiver-statistics-work-and-caregiving

“Caregiving in the U.S. 2015.” National Alliance for Caregiving and AARP Public Policy Institute, 2015. https://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf

Colby, Sandra L., and Ortman, Jennifer M. “The Baby Boom Cohort in the United States: 2012 to 2060.” Current Population Reports, May 2014. https://www.census.gov/prod/2014pubs/p25-1141.pdf

“Global State of Care” International Alliance of Career Organizations, 2018.

https://internationalcarers.org/wp-content/uploads/2018/11/IACO-EC-GSoC-Report-FINAL-10-20-18-.pdf

“Older People Projected to Outnumber Children for First Time in U.S. History.” Census.gov, March 13, 2018. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

Redfoot, Donald, Feinberg, Lynn, et al. “The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers.” AARP Public Policy Institute, 2013.

https://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2013/baby-boom-and-the-growing-care-gap-insight-AARP-ppi-ltc.pdf

Reinhard, Susan C., Young, Heather M., et al. “Home Alone Revisited: Family Caregivers Providing Complex Care.” Home Alone Alliance, 2019.

https://www.aarp.org/content/dam/aarp/ppi/2019/04/home-alone-revisited-family-caregivers-providing-complex-care.pdf

While watching the clips from, América, encourage the audience to think about the different ways that América’s family members contend with their roles as caregivers. Ask them to note how América’s experience compares with experiences in their own families.

Clip 1 (4:37) Caring for América
Diego and Rodrigo take on the responsibility of caring for their grandmother, América.
This clip starts at 08:26 mins with Diego saying, “What happened is that América fell from her bed,” and ends at 13:03 mins with América saying, “Of course, whatever you say.”

Clip 2 (4:13) Diego and Rodrigo
Diego and Rodrigo argue about América’s care and quality of life.
This clip starts at 17:25 mins with Diego saying, “This picture was taken 20 years ago,” and ends at 21:38 mins with Diego saying, “Of course!”

Clip 3 (3:55) Institutional and Legal Hurdles of Elder Care
The brothers contend with the institutional and legal hurdles of elder care.
This clip starts at 38:32 mins with Rodrigo saying, “Good afternoon,” and ends at 42:27 mins with Diego saying, “You’re making demands on me, we’re fighting.”

Clip 4 (6:03) América's Family
América and her family face new challenges after Luis is released from prison.
This clip starts at 45:47 mins with América saying, “There are people who end up with nothing, right?” and ends at 51:50 mins with Diego and Bruno in a taxi with América’s ashes.

Discussion Prompts:

1. What surprised you most about América’s story? How did her experience compare with the experiences of seniors in your family and community?
2. What circumstances led to América’s injury?
3. What do you think about the way the police and elder-care agencies reacted to América’s son, Luis? What impact did their decision have on América and her family? If you were América’s elder-care caseworker, what solution(s) would you have suggested?
4. How might the government and/or elder-care agencies have otherwise supported the family and América’s needs?
5. What are the biggest challenges that América’s family confronts when trying to provide her with appropriate care? What are the similarities and differences in their attitudes and responses to América?
6. In Clip 2, Diego and Rodrigo argue about América’s state of mind and quality of life. What does that argument reveal about their views on aging, caregiving and what it means to be “alive”? How do you think América feels about living with and being taken care of by her grandsons?

When Luis was released from jail, he no longer wanted to be responsible for América’s care and preferred to send her to a nursing home. What do you think of his decision? What would you do in his situation?

1. Who should be empowered to make decisions about a person’s care when they aren’t able to decide for themselves—their partner, their children, their other relatives, the state?
2. Rodrigo and his girlfriend wanted to move América into a nursing home after almost a year of providing her care. As a young couple, they wanted to pursue their own ambitions. Do you think their decision is fair? Why or why not?
3. Why do you think Diego and Bruno decide to continue to care for América for the next two years? What do you think you would have done in their situation? Do you think Diego and Bruno should have been compensated for caring for América? By whom?

1) Preparing to Care
One of the biggest stumbling blocks to establishing a successful dynamic between family caregivers and their elderly relatives is the reluctance to plan ahead and discuss sensitive issues related to elder care. It can be disheartening to talk about “what ifs” with a loved one, but it can also be overwhelming to organize resources and a plan of care in the midst of a life-changing event that curtails the elder’s self-sufficiency.

Have participants develop hypothetical plans of care using the following tips from the AARP Foundation’s Prepare to Care: A Planning Guide for Families: https://assets.aarp.org/www.aarp.org_/articles/foundation/aa66r2_care.pdf

Creating A Caregiving Plan in Five Steps

Step 1: Prepare Yourself and Your Family

Step 2: Form a Caregiving Team to Evaluate Your Aging Loved One’s Needs

Step 3: Assess Your Aging Loved One’s Needs (see below)

Step 4: Establish Your Plan

Step 5: Take Action and Maintain Open Communication with All Stakeholders

Assess Your Aging Loved One’s Needs

In order to develop a thorough but efficient caregiving plan, it is important to understand exactly what your loved one’s needs are. Begin with the following questions to help organize your thoughts, then transition to a more detailed assessment of the needs in each category listed below:

Big Picture Questions:

• What care is needed?
• What will your role be in providing care?
• Will you provide the care or do you need to organize professional in-home care?
• When and how long will the care be needed? Will it be daily, weekly or 24-hour care?
• Is this a short-term or long-term care situation?
• Do you have the training needed to support your aging loved one?

Assessment Categories:

Note: See the AARP Assessment Checklist for additional details: https://www.aarp.org/caregiving/basics/info-2017/assessment-checklist.html

1. Physical health
2. Mental health
3. Medication use
4. Daily living
5. Home and community safety
6. Support system
7. Appearance and hygiene
8. Finances
9. Interests/lifestyles/hobbies

2) Caring for the Caregiver
An estimated 25.5 million Americans face the challenge of balancing work responsibilities with caring for a relative aged 50 or older. Not surprisingly, caregivers often find themselves emotionally drained, physically exhausted and also financially stretched as they try to reconcile their caregiving commitments with their own responsibilities and needs.

Have participants explore the growing demand for and needs of family caregivers, as well as the range of resources and training currently available. Ask them to examine the demographics of caregivers and what groups are carrying the majority of caregiver responsibilities as well as the following:

• How is the increasing need for caregivers affecting individuals, families and communities?
• What governmental and/or institutional supports and resources are still needed or inadequately available? How would these resources improve the caregiving experience for family members and seniors?
• What impact does long-term care insurance have on the availability and quality of care? Are the benefits worth the investment?
• How is the National Family Caregiver Support Program affecting quality of life for caregivers? Has your state adopted the option for seniors to “hire” and pay family caregivers for their time? What are the requirements for this program and how accessible is it to seniors and their families?

Have participants follow up their research by interviewing caregivers in their own communities to better understand the day-to-day joys, challenges and practicalities of caring for aging family members. Have participants use their interviews and research to develop their own tips for family caregivers in the style of this guide from the Caregiver Action Network: https://caregiveraction.org/resources/10-tips-family-caregivers

Additional Resources:

Eldercare Locator
https://eldercare.acl.gov/Public/Index.aspx
A public service of the U.S. Administration on Aging connects users with services for older adults and their families.

Family Caregiver Alliance (FCA)
https://www.caregiver.org/
Services include assessment, care planning, direct care skills, wellness programs, respite services and legal/financial consultation vouchers.

National Family Caregiver Support Program
https://acl.gov/programs/support-caregivers/national-family-caregiver-support-program
Provides grants to states and territories to fund various supports that help family and informal caregivers care for older adults in their homes for as long as possible.

USA.GOV: Caregiver Support
https://www.usa.gov/disability-caregiver
A source of tips and information to help care for loved ones with special medical needs, including programs for family members of veterans and people with disabilities to get paid to provide care.

The Film
POV: América
https://www.pbs.org/pov/america/
The film’s POV site includes a discussion guide with additional activity ideas and resources.

América: Official Film Website
https://americadocumentary.com/
The film’s official website provides information on the film and filmmakers, as well as educational resources

POV: Media Literacy Questions for Analyzing POV Films
http://www.pbs.org/pov/educators/media-literacy.php
This list of questions provides a useful starting point for leading rich discussions that challenge students to think critically about documentaries.

AARP
www.aarp.org
Provides resources, networking and support for Americans over the age of 50. The Family Caregiving page is particularly useful: https://www.aarp.org/caregiving/. The organization also has a Spanish website with caregiving resources: https://www.aarp.org/espanol/recursos-para-el-cuidado/?intcmp=AE-CAR-BB-LL5

American Red Cross Family Caregiving Program
http://www.programsforelderly.com/caregiver-family-caregiver-red-cross.php
A training program for family caregivers that covers general skills, home safety, positioning and helping a loved one move, healthy eating, legal and financial issues and more.

Caregiver Burnout: How to Take Care of Yourself

Children of Aging Parents
www.caps4caregivers.org
Information and resources for caregivers of the elderly or chronically ill.

Compassion Fatigue Awareness Project
http://www.compassionfatigue.org/
Support and resources to improve awareness and understanding of compassion fatigue and its effect on caregivers.

National Academy of Elder Law Attorneys
www.naela.org
Offers information and legal services to improve quality of life for the elderly and people with special needs.

National Council on Aging
www.ncoa.org
Partners with nonprofit organizations, government and business to provide community programs and services, online help and advocacy to help people aged 60 and above meet the challenges of aging.

National Institute on Aging
www.nia.nih.gov
This is a federal agency (part of the National Institutes of Health) with resources and information in English and Spanish on the nature of aging and extending the healthy, active years of life.

50 Ways for Family Caregivers to Take a Break

ABOUT THE AUTHOR
Allison Milewski has developed media education resources for a range of award-winning filmmakers and national media organizations, including PBS LearningMedia, Independent Television Service (ITVS), Latino Public Broadcasting, HBO Documentaries and Tribeca Film Institute. She is also the founder of the international media education program PhotoForward.org.

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