Aging and Caregiving

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I Need That looks at the relationship between Sam, an aging man whose independence is now imperiled, and Amelia, his adult daughter who finds herself called to be a caregiver. As stage characters, Sam and Amelia are unique creations of playwright Theresa Rebeck, serving to tell one specific story; however, they represent a real-life phenomenon that’s becoming ever more prominent as the world population ages. Between 1960 and 2021, life expectancy (the expected age for a human being predicted at the time of their birth) has increased across the world. Factors such as health care, nutrition, water supply, environmental conditions, as well as socioeconomic and political factors, all play a part in our life expectancy, and these prognoses vary by region and country.

The number of Americans aged 65 and older is projected to grow from 52 million in 2018 to 95 million by 2060. The aging of large demographics, specifically the baby boomers and Gen X, means that 23% of the population will soon be 65 and older, and these senior citizens will be more racially and ethnically diverse. This is happening in an age of widening economic disparity, raising a host of new financial challenges for many American families. Our growing population brings rising demands for senior care, and a 2020 report by The American Association of Retired Persons (AARP) found that 21.3% of Americans were providing care of some kind, often without receiving pay. Additionally, American Association of Caregiving Youth has identified 5.4 million children or teens (18 or younger) who are providing significant assistance to a family member. Taken together, these data suggest a substantial number of Americans will soon join the aging population or provide care of an elderly person – and many people will be doing both. 

Experiences of the Aging Population

The field of gerontology explores aging through multiple lenses, respecting the complexity of the aging process. These include:   

• Biological aging: how (and why) the body changes as aging occurs; 
• Psychological aging: how individuals cope with their own aging and the effects of changes in adaptive capability, memory, and intelligence;
• Social aging: the impact of social roles and expectations for older adults in a particular culture or society.  

Sam’s situation in I Need That sheds light on the way each person may have different needs as we age. On the one hand, Sam is both physically and mentally capable of living on his own and keeping up with daily activities; on the other hand, the massive accumulation of “stuff” in his home has provoked a complaint from a neighbor. Amelia warns him that if he doesn’t change his living conditions, the government may condemn the house and put him in state housing.  

The need for help with daily living may increase as we age. Activities like personal care and hygiene, household chores, meal preparation, money management, and health care may become difficult without some assistance. Those living alone may find new challenges around accessibility, such as using stairs or taking showers, and traveling outside of the house. Such challenges alone may not prevent someone from “aging in place” (a term that refers to living in your own home as you age). However, the National Institute on Aging lists hoarding as a sign that an elderly person may no longer be able to take care of themselves, so Amelia’s concerns about Sam’s home are not unfounded. Other signs include failure to take essential medications, refusal to seek medical treatment for serious illness, leaving a burning stove unattended, neglect of housekeeping, confusion, dehydration, and poor hygiene 

Sam is a widower living alone and not leaving his house, and loneliness has been shown to be a significant social factor in the quality of aging experience. One study of people over 60 years old identified loneliness as a predictor of functional decline (such as mobility and stair climbing) and death; it has also been associated with decreased sleep. Other studies have suggested correlations between loneliness and depression as well as cardiovascular disease.  

It’s also important to note that while this play does not touch on financial concerns, socioeconomic status has a profound impact on living conditions, access to medical care and support, and psychological health. We live in a capitalist system which inherently treats “unproductive” people as expendable; government support programs on which older people rely like Social Security and Medicare are frequently subject to policy debates and political maneuvering. Poverty is considered a risk factor for mental health decline among older people, and people living in lower socioeconomic brackets are more likely to be diagnosed with a psychological disorder. Furthermore, ageism (discrimination or prejudice against older people) still remains largely unexamined and difficult to prove.  

By understanding the biological, psychological, and social changes that come with aging, we can be more proactive about taking a positive approach to aging. We may need to make changes in our daily pace and modify our lifestyle, while remaining active. Psychologically, aging offers a chance to evaluate our lives in new ways—perhaps shifting emphasis from achieving and producing wealth to other values, such as relationships, spirituality, and leisure. The later years can be a time for more creativity and self-actualization. We can understand that Sam’s hold on specific objects allows him to connect to the important people and memories that have contributed to his life. The play shows another important (and sometimes difficult) adjustment of aging: accepting that we may need help and learning to receive that help with grace.

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Experiences of Caregivers

Although Sam is capable of living on his own and taking care of his daily needs, the fact that the government has served notice raises the stakes for Amelia, his only daughter. Amelia’s story offers insight into the experiences of the 41.8 million Americans who are currently caring for aging parents or in-laws. The prevalence of unpaid caregiving is increasing as the US population continues to live longer, often with more complex and chronic conditions. Unpaid relatives like Amelia provide the main source of long-term care for adults living at home and in the community, and the caregivers serve as a core piece of the health and long-term services and supports system in the US. 

Like Amelia, people may feel mixed emotions when they step into the role of caregiver. Within some cultures outside of the US – for example China, India, and Mexico – a greater respect for elders and families contributes to more positive attitudes about caregiving in general. Some of the positive benefits include knowing that a loved one is receiving all the care they need and helping us to think about our own future needs. It may strengthen bonds and make our life priorities clearer, but it also calls for sacrifices and adjustments for both the caregiver and the receiver.  

As we learn more about Amelia’s life outside of Sam’s house, we come to understand the impact caregiving is having on her life. AARP’s 2020 survey showed that while many caregivers found a sense of purpose in their role, many also reported feelings of stress and loneliness, along with physical, emotional, and financial strains. Caregivers found it harder to attend to their own health, family, and work. One in four reported declines in their own health. They were also likely to face financial difficulties including increased debt, depleted savings, unpaid bills, and in some cases, inability to afford their own food. 

“Respite care” is the term for short-term relief for primary caregivers. Depending on the needs of the care giver and receiver, respite care can be arranged for a few hours as a break, or for several days or weeks. Care can be provided at home, in a healthcare facility, or at an adult day center. Some providers offer respite services by the hour. In other cases, family members of friends can step in to provide respite care. It’s also important to know that, in some cases, caregivers can receive compensation from government programs, which vary in each state. For example, New Yorkers can access financial support through tax breaks, Medicaid programs, long-term care insurance, and veterans' programs. [See support resources below to learn more.]

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Caregiving Youth

While Amelia is an adult who, we can presume, has lived on her own for a long time, a profound number of children and teenagers are providing care to family members with chronic illnesses, disabilities, mental health conditions, or frailty due to aging. A 2004 survey identified up to 1.5 million caregiving youth (18 or younger), but by 2020 the number increased to 5.4 million. As with adults, caregiving youth report having mixed emotions about their roles. For many (especially older teens), the responsibility of caregiving brings a sense of purpose. Some even choose to go into careers in health or social service professionals because of their early caregiving experience; many become super-achievers at home and school. However, these responsibilities can also raise stress levels and difficulty managing other areas of life, especially education. A 2020 AARP study on student caregivers found 11% of caregivers were also students. Looking at how caregiving duties impacted academic achievement and the ability to cover education costs, it found correlation between the number of weekly hours providing care, and the level of difficulty managing responsibilities. It also found that a majority of student caregivers (86%) worked at least part-time, providing an even greater challenge to balancing school, life, and caregiving. Many youths expressed concern over whether they would be able to continue their education. 

While studies, statistics, and sociology help us understand broader trends of aging and caretaking, the power of theatre lies in its ability to make the issues personal and provoke empathy. Whether we identify more with Sam or Amelia, our time with these characters may help us experience some of the complex emotions and responses that make up human relationships.

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Resources for Support

• American Association of Caregiving Youth – The only organization in the US dedicated to solely to addressing Caregiving Youth issues.
• American Association of Retired People – The nation's largest nonprofit, nonpartisan organization dedicated to empowering Americans 50 and older to choose how they live as they age.  
• Aidaly – Advocacy and support for caregivers to access pay benefits.
• Blue Zones – Provides research, articles, and recipes to empower everyone, everywhere to live better, longer.  
• NYC Department for the Aging – Local support both for seniors and caregivers.
• US Veterans Affairs Caregiver Support Program – Clinical services to caregivers of eligible and covered Veterans enrolled in the VA health care system.

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