Hurricane Milton had blown off the carport roof, damaged the lanai and broken several windows of his Sarasota home.
But during that October in 2024, L. Paul Laramee was reeling from an even greater shock.
After months of troubling behavior – including an uncharacteristic suspiciousness – Paul’s beloved wife, Marie, was diagnosed with Alzheimer’s disease.
For Paul, much of the next year passed in a blur.
But one thing stayed constant for the overwhelmed 83-year-old: the need to keep working.
Juggling a part-time job long before Milton and Marie’s diagnosis to stay on top of rising housing costs, Paul watched as storm repairs wiped out their savings.
Then as bills mounted, so did pressure on how best to care for Marie – his childhood sweetheart and wife of 64 years.
Stricken with guilt but unable to afford home health care or qualify for Medicaid, Paul’s only solution was to leave Marie home alone while he went to work, struggling to maintain a roof over their heads.
“It bothers me that I can’t be there to help her,” Paul said.
“But we have to live because Social Security doesn’t take care of much anymore. Money coming in is not keeping pace with money going out.”
A dual burden
With little warning, Paul had found himself at the juncture of two phenomena that are sinking millions of older residents – that of housing and caregiving.
“The housing crisis and the caregiving crisis are not parallel problems,” said Maricela Morado, president and CEO of the Area Agency on Aging for Southwest Florida.
“They are the same problem,” Morado said, “and older Americans are bearing the weight of both.”
The challenges are expected to worsen in coming years as more Baby Boomers reach advanced age.
Within the next decade, older adults will outnumber children for the first time in U.S. history, according to the Urban Institute.
Yet even as seniors’ numbers are exploding, housing and caregiving are failing to keep up, experts say.
Affordable housing options and federal vouchers lag well behind spiking demand. So does the home health and long-term care industry, which is experiencing a “critical labor shortage.”
In a report titled “The Dual Burden of Housing and Care for Older Adults,” Harvard University’s Joint Center for Housing Studies found that the number of households headed by people over 80 will double between 2021 and 2040.
However, while about 70% of older residents need some type of long-term care, only 24% of those surveyed could afford a single daily visit by a paid home health worker after paying for housing and other living expenses.
And even before requiring long-term care, more than one-third of older residents could not meet basic housing and living costs, the study showed.
It concluded that the “dual burden” in housing and caregiving is hastened by rising costs in both as well as financial fragility and limited insurance coverage.
Most private insurance does not cover long-term home and facility care services.
Generally, nor does Medicare.
Medicaid may pick up coverage, albeit with enrollment caps, and only once a person’s income drops low enough.
That leaves many moderate-income seniors making too much to qualify but unable to afford housing or long-term care on their own.
(In Florida, the median annual cost of in-home care in 2025 was $73,216, while nursing home care was $124,100 for a semi-private room and $146,000 for a private room, according to Genworth Financial’s CareScout.)
Meanwhile, for low-income seniors, the Harvard study found that because of long waiting lists, of those who do qualify for subsidized rental housing or long-term care services, “relatively few actually receive them.”
‘Know us before you need us’
In retirement haven Florida, the interlinked challenge is particularly acute.
Across the Sunshine State, seniors make up the fastest-growing group of people facing homelessness.
Gone are generous pensions of the past, leaving many of the later portion of retiring Baby Boomers to rely solely on Social Security, which trails well behind skyrocketing costs of living.
In Sarasota and Manatee counties – as in the rest of Florida – half of all senior households are now struggling on the economic edge or have fallen into poverty, studies show.
Just as their income is declining later in life, they are whipsawed by:
As a result, many are one emergency away from being out on the street, case managers say.
Often that comes in the form of a medical bill, the illness or death of a spouse – or a hurricane.
It was after Hurricane Ian when calls began to pour into Morado’s Agency on Aging branch offices, which are located in seven counties – including Sarasota, Charlotte and DeSoto counties.
Seniors were increasingly at risk of becoming homeless.
Morado said many of those seniors owned their houses outright, but they didn’t have adequate homeowners’ or flood insurance policies. And many of those affected could not afford new homes, Morado said.
“It’s all those challenges,” she said. “It’s very heartbreaking.”
Intertwined with financial worries were concerns about caregiving.
Morado said many seniors expressed fear that if they missed a housing payment, they would face eviction – as well as the loved ones in their care.
In recent years the agency has aggressively promoted a new campaign for older caregivers called “Know Us Before You Need Us.”
The mission is to connect senior caregivers with resources and partnering agencies early in a diagnosis or illness of a loved one before the situation escalates into a full-blown emergency.
Sometimes the agency can cover an immediate need from funds it has raised.
For longer-term challenges, it offers programs funded through various pots such as the Older Americans Act and Alzheimer’s Disease Initiative.
That includes community and in-home caretaker or homemaker assistance based on the agency’s initial assessment of care need. The actual care is provided through the agency’s lead partners in each county.
In Sarasota, that lead partner is the Senior Friendship Centers, whose case managers follow up with an in-home assessment to develop a care plan at no cost or sliding scale. That plan can include access to its programs as well as in-home help provided by one of its home health vendors.
But wait lists are long and the need is stark.
“We are getting a lot of people walking in our door or calling the center call line worrying about not having a place to live – a lot more this year than the past couple of years,” said Joni Ricker, director of adult day services at Senior Friendship Center’s Caregiving Place Adult Day Care and Caregiver Resource Center.
Senior Friendship Centers tries to lessen the burden by offering prepared meals and various day programs.
Like advocates nationwide, it is also pushing for big-scale policy solutions, such as massive increases in public and philanthropic investment in home and community-based services to allow seniors to “age in place” at home, as many of them wish to do.
Other advocates seek changes in Medicare and Medicaid coverage to meet the growing demand.
For now, Senior Friendship Centers’ case managers help coordinate placement into a facility or the homes of loved ones, Ricker said.
In general, though, she added, adult kids are rarely in a financial position to move down to help mom and dad. “When they do come down,” Ricker said, “they are shocked at how bad it is.”
Running themselves into the ground
Often the caregiving parent is in worse shape than their spouse.
Numerous studies show the severe impact on caregivers’ health due to the physical strain and chronic stress of caregiving – particularly dire for spouses of dementia patients.
The added housing worries are almost too much to bear.
Older caregivers often ask: “’Do I pay the mortgage or rent – or buy the medication that my wife needs?'” says Michael Cochrane, caregiver resource coordinator and the facilitator of the Senior Friendship Centers’ support groups.
Cochrane understands.
A caregiver for his husband, who had been diagnosed with Alzheimer’s disease and later passed away, Cochrane had to exhaust their retirement savings and sell the house.
Until he discovered the support group, Cochrane didn’t realize how much help he needed, too.
Older caregivers often think of their needs last and quickly wear out – many are in their 80s juggling jobs and caregiving, Cochrane said.
Even if they qualify for home health assistance, aides are hard to find, he added.
Florida ranks dead last in the nation in availability of home health care.
In Sarasota County, the shortage is exacerbated by a lack of affordable housing for workers.
“They are running themselves into the ground and getting sick,” Cochrane said of older caregivers.
‘My honey’
For Paul, it was love at first sight.
Leaving baseball practice one day in his small Massachusetts town, the high school freshman looked across a parking lot to a square dance taking place.
And he saw the most beautiful girl he’d ever seen.
After running the entire three miles home, Paul got permission to attend, then showered, threw on a white shirt and a clean pair of chinos, and ran back to ask the eighth grader for a dance.
“I got in three or four sets with her,” Paul said, laughing at his efforts.
“It’s all her fault for being so pretty.”
They married after graduation and went on to raise three kids over the next 64 years.
Paul worked as an insurance agent for almost two decades before buying and running a dry-cleaning business, while Marie was a receptionist for a big company.
In the early 2000s, they began visiting Florida, buying a home in Sarasota in 2005.
Life was fun, filled with friends and travel.
Then about a decade ago, Marie’s health started to decline.
Back issues flared, and she required several surgeries.
Two years later, Paul picked up a job as an attendant at a local funeral home.
He enjoyed the extra spending money and the work helping grieving families.
But after the pandemic hit, Paul’s job turned into a necessity. Costs were soaring – the lot rent for the mobile home they owned had spiked along with higher payments for utilities and car insurance.
After Milton, the couple received a payout of about $7,000 from homeowners insurance and $700 from FEMA. But they needed to cover the remaining $13,000 in repairs out of their own pockets, draining their savings.
Meanwhile, food costs and other expenses kept going up – leaving no room to afford home health care for Marie.
“At work, she’s on my mind,” Paul said.
He thinks about Marie when it’s time for her to take her pills and worries she might forget.
But Paul bottles his concerns inside, determined to keep his burdens from his children.
Finally, last May, after learning about the support group at Senior Friendship Centers, Paul began to attend.
“I didn’t know what I didn’t know,” he said of the sharing that takes place.
“That has been very good for me at least.”
With the help routed through Area Agency on Aging, Marie was assessed.
Recently, due to her advancing condition, she was granted up to 15 hours a week in minor housekeeping assistance and companionship.
She will also be able to go to the Senior Friendship Centers to take part in their day programs – which, at a cost of $145 a day, the couple otherwise could not afford.
The development has brought Paul some peace of mind.
Now she will be in good hands while he goes to work, something Paul anticipates having to do for the foreseeable future.
“Retirement is not a word that I would use,” he said. “I haven’t even thought about scaling down.”
Though Paul never imagined that the couple’s life together would take such turns, he wants to do all he can to make sure Marie is happy and comfortable.
“My wife is not a burden,” Paul said. “She is my honey.”
FOR MORE INFORMATION:
Call the Senior Friendship Center’s Caregiving Place Adult Day Care and Caregiver Resource Center at (941) 556-3268.
For Sarasota, DeSoto and Charlotte counties, call the Area Agency on Aging for Southwest Florida at (866) 413-5337 or visit https://aaaswfl.org/caregiver-support/
In Manatee County, call the Senior Connection Center, Inc. at (800) 963-5337 or visit https://seniorconnectioncenter.org/services/caregiver-support/
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This article originally appeared on Sarasota Herald-Tribune: ‘My wife is not a burden.’ Caregiving crisis grows for Sarasota seniors
Reporting by Saundra Amrhein, Sarasota Herald-Tribune / Sarasota Herald-Tribune
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