Seventy-eight-year-old Angelita Perez is a working senior who truly cares about the men and women of her generation as they walk through the sunset of their lives. She owns and still opts to be an active caregiver at Hillcrest Care, a small assisted living facility she founded in 2014 in El Dorado Hills, Calif.
What looks like a middle-class residence perched on the elevated suburban outskirts of El Dorado Hills — which lies 30 miles to the east of California's capital of Sacramento — is actually a haven for six male seniors, five aged 85-97 and a 52-year-old Navy veteran under hospice care. With most assisted living facilities and nursing homes tending to at least 20 wards, Hillcrest Care is a much smaller operation.
But what it lacks in size, it makes up for in better care and homelier ambience — Perez says that, in such an intimate setting, seniors' needs are more easily monitored and served. Helping frail seniors perform even the most basic chores may be easier said than done, but Perez — who goes by "Lita" to friends and family and "Angel" to a grateful patient's family — mastered the work with a natural ease.
What has endeared her to her patients and their families is the commitment and familial warmth that comes into play in every aspect of caregiving for residents who are mostly in their late 80s and 90s.
"I make sure they feel so fresh and in fine spirits throughout the day," she stressed, "from the moment they wake up till bedtime."
She and her staff perform the work generously — with a human touch that lifts their patients' sense of self-worth — a gentle circling pat on the back, a loving swipe on the cheek, reassuring pressure on the palm and even a soft kiss on the forehead makes the seniors feel as though they never left home.
Everyone is freshened up and garbed in comfy casual wear before taking meals, oftentimes as a group, giving them a chance to engage in a little lively banter every day. Occasionally served are Asian dishes that always excite senior palates numbed by continental tastes.
An important rule of the house is to never engage in a verbal joust with the patients, some of whom are experiencing dementia or sheer memory regression. Perez underscores the importance of keeping the mood on the sunny side, even to the point of flattery. She finds the trick to dealing with patients' mental and emotional swings and quirks essential to enhancing their overall well-being.
She proudly recounts an incident in which a patient was rushed to the hospital in need of urgent care and, feeling overlooked while under observation, loudly complained, "Get me back (to the care home); I'm treated like a king there!"
In the two assisted living facilities she's started since 2012, Perez has attended to dozens of seniors. More than a few times after a resident's death, bereaved family have conveyed to Perez their gratitude for her help in ensuring their loved one could spend their twilight years in grace and dignity.
Perez is well-cut for the calling. Arriving in California in 1987 as a Filipino immigrant with only a high school diploma, she found a job in housekeeping at a hospital in Alameda. While doing her chores, she observed patient care, too, sometimes extending an extra hand when it was needed.
Eventually, she felt like she could offer more for others than making their beds and doing their laundry, so she negotiated with her supervisor to have time to take a course to become a Certified Nursing Aide. Her supervisor responded with a firm work-or-study option. A future supervisor, fortunately, was more sympathetic to her plan for a career change.
After earning her CNA certification, she worked in that capacity for the hospital for the next 19 years, experiencing the many varied aspects of patient care.
By 2012, she'd saved up enough to go out on her own, setting up an assisted living facility in Folsom, some 10 miles east of El Dorado Hills, where Hillcrest Care started business two years later.
She opted to move to El Dorado Hills but eventually shuttered the Folsom location.
Perez's concern for those under her charge is emblematic of a serious challenge facing America's health care industry: caring for the country's rapidly aging population.
Health-care statisticians forecast the United States' Baby Boomerswill have 75 million seniors in the next 20 years. There are currently 40 million Americans aged over 65, including 5.6 million aged over 85; the nation's population of those at least 85 years old is expected to double by 2036.
Currently, only 3% of seniors occupy some 78,000 units between the assisted living facilities and nursing homes in the U.S. An estimated one million units will be needed by 2040. California, where Perez is located, is home to some 5,600 units but is expected to need 127,000 in the next 20 years.
Beyond the physical structures, an equally urgent challenge is the number of trained caregivers, whose ranks were decimated by the COVID-19 pandemic.
All of that raises two pertinent questions: How many like Angelita Perez will the country's nursing educational institutions be able to train to meet the massive need for senior care in the coming years? And will the U.S. reopen its doors to Philippine-trained nurses?
There are anecdotal tales in hospitals worldwide of Filipina nurses being the preferred "marines" assigned to dispense convalescent care in wards for seniors, as well as those with special needs, primarily due to their extraordinary patience and natural social skills to relate with such patients, even under strenuous conditions. As with Perez's life experience, Filipina nurses' outlooks are often shaped by a culture that reveres its elders and an ability to survive with minimal resources.
Such traits, Perez believes, make her stand out as in the field of gerontological care. And at her age, she could be a patient herself, but she's defying expectations — petite and barely under five feet in height, she may look fragile; however, she is agile and sturdy for a woman of her age; she could assist bulkier patients doing strenuous maneuvers all by herself.
Where does that strength emanate?
Perez has the genes of a long life. Her father passed away at 93, far higher than the average Filipino's life expectancy, and her paternal grandfather lived to 104. At 93, her eldest sister in Virginia still regularly mows the lawn and drives long distances without any reliever; an aunt with fairly good cognitive functions just marked her 101st birthday.
Perez and her nine brothers and sisters were also raised in the rural Philippines, where they were steeped in the virtue of contentment.
"We grew up together happy with whatever we had, never craving for the extra stuff our peers were enjoying," she reflected after recalling the times when she and her four sisters would sleep together under a mosquito net on their home's bamboo floor in the living area while her brothers did likewise in a space in the kitchen.
Her father was a carpenter who was only able to get by after finishing an ordered furniture crafted to customized design. Her mother performed a full-time role attending to her family and home. And in observance of a cherished Filipino tradition, the entire family would gather at the end of every day in front of their waiting father and mother to do the "mano" — young Filipinos' gesture of holding their elders' hand and pressing it gently on their forehead. The duty was done without fail every day when the church bells tolled at dusk.
Perez believes that sort of childhood may have fortified her with the kind of physical and mental constitution needed to take on the rigors and routines of caregiving where younger care staff could easily give up.
Asked how long she'll be able to do the arduous tasks that come with the work, she snapped, "As long as I can!"
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