March 30, 2024 - PBS News Weekend full episode

[BREAK] JOHN YANG: Tonight on "PBS News Weekend," the burden on women across the country as the primary caregivers for loved ones.

Then, what's at stake for the tens of millions of Americans who rely on Medicaid, the nation's biggest government safety net program?

MARROW WOODS: I go to the hospital a lot.

I am in and out of appointments constantly.

And so, without it, there's a lot up in the air about what I could even do, what medications I could have if I could still afford my medication.

JOHN YANG: And the story of a Black woman who dedicated a lifetime to serving her country and her community.

(BREAK) JOHN YANG: Good evening.

I'm John Yang.

Tensions ratcheted up today along the border between Lebanon and Israel.

Three U.N. military observers and a Lebanese interpreter were wounded in an explosion.

They were patrolling the Lebanese side of the border as part of their peacekeeping mission.

A U.N. spokesperson says they're investigating the source of the explosion and that the observer's vehicle was clearly marked and that all parties had been told about the patrol.

Israel's military denied any involvement.

Israeli troops and Hezbollah fighters have been trading attacks across that border for weeks.

Meanwhile, a convoy of three ships carrying 400 tons of food and other aid set sail for Gaza from Cyprus today.

The U.N. has warned of imminent famine in Gaza.

Ukrainian President Volodymyr Zelenskyy fired more of his top aides in his ongoing government reshuffle.

It comes as Russia launched more drone and missile attacks on Eastern Ukraine overnight, killing two people in Donetsk.

Over the last 24 hours, there's been a barrage of strikes from Russia, many targeting energy infrastructure.

Ukraine has put planned power outages in place for about 120,000 people in the region.

In Peru, government agents raided the home of President Dina Boluarte as part of an investigation into a collection of luxury watches and whether they had been disclosed.

Last night, a team used a battering ram to break down a door as they sought multiple Rolex timepieces.

Boluarte has been president for a little more than a year, and she said she's owned at least one Rolex watch that she bought with her own money when she was 18 years old.

Today, Boluarte defended herself, saying she's an honest woman with clean hands.

And in Rome, Pope Francis resided over an Easter vigil service at St. Peter's Basilica.

He missed last night's Good Friday procession as a health precaution.

The 87-year-old pontiff has limited his public appearances lately, even skipping his Palm Sunday homily.

He's been struggling with respiratory problems.

Still to come on "PBS News Weekend," the role of the nation's largest health insurance program in America's safety net, and the hidden history of a Black nurse who served her country in a variety of ways.

(BREAK) JOHN YANG: America's population is aging.

Currently, one in six is older than 65.

By 2050, that's projected to be one in four.

Women bear the biggest part of the burden of caring for older Americans and their growing need for medical care and other support.

Ali Rogin takes a look at the often-unseen costs of caregiving.

ALI ROGIN: In the United States, women make up almost 60% of unpaid caregivers and over 80% of paid in-home caregivers for seniors.

According to a recent "Wells Fargo" report, taking care of loved ones often takes a financial, physical and emotional toll.

We spoke to some women about their caregiving experience.

RUTH LEAL: My name is Ruth, and I'm in Virginia, and I take care of my 82-year-old dad.

It started about 12 years ago, when he had prostate cancer.

KENYA SERVIA: Kenya Servia, I'm from Bayboro, North Carolina, and I'm caring for my mom.

I've been a caregiver since I was 8 years old.

I started taking care of my great-grandma.

Then I was taking care of my grandma, and now I take care of my mom.

DEANZA VALENCIA: I'm DeAnza Valencia.

I live in Albuquerque, New Mexico, and I am a family caregiver for my mother, Linda Valencia, who is 75 years old.

One day, our family learned that she was going to need a liver transplant, and she wasn't going to live much longer without it.

So at a moment's notice, this responsibility fell on me.

I was the one that had, you know, the resources, the ability to leave home for a period of time and take care of my mom.

AILEEN RUESS: My name is Aileen Ruess, and I took care of my mother for 15 years, and I'm currently taking care of my husband.

RUTH LEAL: My biggest struggles have always been that this kind of also happened at the same time that I was finishing college and entering the workforce.

KENYA SERVIA: The hardest part is just sort of stepping into that being in charge role when they're, you know, essentially they're your parents, so you're used to them being the person in charge.

AILEEN RUESS: You start neglecting your own doctor's appointments, and you neglect your own personal care.

It's not good for the person that you are taking care of, and it's not good for yourself.

RUTH LEAL: At times I felt like I wasn't doing a good job, and sometimes I still feel like I'm not doing a good enough job.

I cannot focus at work because my dad, something happened this morning that really worries me, or I can't really be a good caregiver because my job is really stressing me and it's not really giving me the flexibility to be a good caregiver.

DEANZA VALENCIA: I literally had to leave a business that I had started up.

I left the workforce completely to move to another state.

I left behind a husband, and my marriage suffered because of it.

AILEEN RUESS: It's almost impossible to take care of someone else all by yourself.

You really need to surround yourself with a community, a village.

KENYA SERVIA: Thankfully, I have uncles, cousins, aunts, in-laws, my brother, neighbors, even if they're only able to come long enough to allow me to get a shower.

DEANZA VALENCIA: I wish that I would have known that there were others out there like me that were still struggling with the same financial issues, struggling with what to do next, and were frankly tired and could have used a little relief.

RUTH LEAL: I also try to give myself as much grace as I can because, you know, I think just showing up is already like 50% of the effort.

KENYA SERVIA: Just take it one day at a time.

There'll be times when you'll get frustrated.

There'll be times when you'll be overwhelmed.

Stop, take as many breaks as you can.

Don't be afraid to ask for help.

You'd be surprised how willing people are to help.

ALI ROGIN: Joining me now is Emily Kenway, author of "Who Cares: The Hidden Crisis of Caregiving and How We Solve it" and a former caregiver herself.

Emily, thank you so much for joining us.

Can we start with your own caregiving journey?

What did you go through and when did you realize that this is indeed a crisis?

EMILY KENWAY, Author, "Who Cares": Yes.

So I cared for my mother.

She was a single mom, which meant I needed to step in as her daughter when she was diagnosed with cancer in 2016.

And obviously that was incredibly difficult personally.

But it also woke me up politically to what's going on with caregiving around the world today.

And we know that this is just going to get worse over time as well, right?

So we have aging populations around the world.

You know, one demographer has called it the greying of America.

And so we can all expect a greater and greater load of caring responsibilities and to be in the crisis that I was in unless we introduce major changes.

ALI ROGIN: And when you talk about who's taking on those responsibilities, it is disproportionately women.

Why have you found that to be so?

EMILY KENWAY: We have this historical heritage whereby around industrialization, we created this cultural norm, right, that the man goes to work and does waged work and the woman stays at home and does unpaid care.

And we haven't caught up with today's reality at all, because, of course, today more women are working.

Many households need the women to work.

You know, those wages are not things that can just be tossed aside.

And so this idea that we can carry on ascribing to one gender all of the weight of care for our entire species is really outdated.

ALI ROGIN: And given all those realities you just laid out, what are some of the challenges that women tend to face when they become caregivers?

EMILY KENWAY: Of course, there's a financial impact.

Most of the time, if you're a caregiver, you'll need to reduce your working days and you may give up your work entirely.

In fact, we know in the U.S., on average, women caregivers lose about $320,000 in lost income and lost social security benefits.

And that doesn't just harm us right now.

That means we're going to have a real problem in retirement, right?

Our security in old age is harmed just because we stepped in and did the right thing.

There's also a massive psychological toll.

You may be having to constantly monitor and watch your loved one's condition.

You're experiencing what we call role reversal.

So you suddenly become the mother of your mother, right?

And you're dealing with that strange dissonance.

And then, of course, you're moving through a world that doesn't recognize or support this.

So your employer may well not accommodate your caring responsibilities.

And it bears out in the statistics, too.

We know that caregivers have higher rates of depression and anxiety for these reasons.

ALI ROGIN: Given the fact that so few resources exist, I would imagine that also comes with a lot of assumptions and misperceptions.

What are some of the most pervasive that you've come across when it comes to caregiving?

EMILY KENWAY: I think one of the most pervasive assumptions is that caregiving is kind of something that doesn't have any costs when it's performed by the family, right?

So, yeah, it's free.

We're not being paid, but there are enormous costs.

When you're very elderly or very unwell, you need to be kept warmer.

There's higher energy costs.

There's mobility aids.

There's special diets.

There's all of this kind of thing.

So there's a material, practical reality there.

The other misperception I encounter a lot is this idea that some cultures can manage this more naturally than white Western cultures, right?

So that would typically be countries in the Global South.

And it is very much more normalized that they would perform care, for example, for their parents-in-law, not just their parents.

But when you actually listen to them, they are struggling in exactly the same ways as I was, the same ways as women everywhere are, because care is hard.

So we have to be very careful of making assumptions based on people's culture, ethnicity, nationality, and so on, and instead see that women around the world, we're all in the same fight here together.

ALI ROGIN: And Emily, here in the U.S., one in five adults right now are working as caregivers.

How can we better prepare to care for these aging populations in the years to come?

EMILY KENWAY: What we need to do here is really recognize that humans are going to have to provide care.

And so we need to embed policies that recognize that.

That's things like paid caregivers leave from work, right?

So at the moment, the Family and Medical Leave Act only provides unpaid leave.

And in fact, the Department of Labor found that 41% of private sector employees aren't even covered by it.

So there are these fundamental economic policies that we shouldn't even be having to ask for, frankly, because it's so obvious that they're necessary.

But basically, we've arranged our work world as if we're not actually humans who love people who need us to step in.

And that's got to change.

ALI ROGIN: Emily Kenway, author of "Who Cares: The Hidden Crisis of Caregiving and How We Solve it," thank you so much for joining us.

EMILY KENWAY: Thank you.

JOHN YANG: Medicaid is the nation's biggest health insurance program, covering nearly 80 million people.

That's more than one in five Americans.

For many people who have low incomes, are disabled, or who are either very young or very old, it's a vital government program in America's safety net.

MARROW WOODS: So I felt like that will work.

But white chocolate-covered strawberries sounds amazing.

JOHN YANG: Like most college students, Marrow Woods takes full advantage of mom's cooking while home from school.

But on top of keeping up with classes and friends, Woods, who uses they-them pronouns, also balances their health.

MARROW WOODS: There are definitely concerns about my ability to, like, hold a job if I don't have the proper accommodations, or just kind of figuring out a life as a 21-year-old with a chronic illness.

JOHN YANG: Woods has a rare inflammatory skin condition called hidradenitis suppurativa.

It causes painful cysts on their body.

They take experimental medications and go to an Atlanta hospital every month for infusions of a drug to reduce inflammation.

Can you imagine doing this without Medicaid?

MARROW WOODS: Absolutely not.

That has been the one thing, like, getting me through this entire process.

Without Medicaid, I wouldn't be able to receive this medication.

JOAN ALKER, Executive Director, Center for Children and Families, Georgetown University: Medicaid is often the unsung hero of our public coverage system.

JOHN YANG: Joan Alker is the Executive Director of Georgetown University's Center for Children and Families.

JOAN ALKER: Not many people are aware that all poor children in this country have a right to Medicaid.

Medicaid is also the primary payer for long-term care, and it's a key backbone of health care for low-wage workers.

NO NAME GIVEN: The Harry S. Truman Library at Independence, Missouri, is a scene of an historic event.

JOHN YANG: Medicaid was one of President Lyndon Johnson's Great Society programs.

He signed the bill creating it in 1965, offering states federal funds for providing basic health care services to families on public assistance and people with disabilities.

It's voluntary, but by 1982, all 50 states and the District of Columbia had adopted it.

Since then, both Democratic and Republican presidents have signed coverage expansions.

By the late 1980s, the program covered all poor children and all low-income pregnant people.

JOAN ALKER: On many, many of the basics, for example, access to prime and preventive care, Medicaid is performing about as well as private insurance.

There are differences.

Dental care is very hard to access, particularly if you're on Medicaid.

Behavioral health care is another area where it's harder to access, but the answer is not to not give people Medicaid, because then they're in worse shape.

BARACK OBAMA, former U.S. President: This is going to take a little while.

JOHN YANG: In 2010, President Barack Obama's Affordable Care Act expanded Medicaid even further, offering states a generous subsidy if they covered all poor adults.

BARACK OBAMA: We are done.

JOHN YANG: Today, more than 21 million adults have Medicaid because of the ACA.

JOAN ALKER: The marketplaces were kind of the new shiny toy, but Medicaid was kind of the workhorse.

Because the Medicaid expansion for poor adults was really the way in which more uninsured people accessed coverage.

We see Congress turn to Medicaid time and time again because it's a system that's been in place, it works.

Most recently, Congress adopted a new option to allow states to cover postpartum women and people for 12 months after birth.

DR. KEILA BROWN, Chief OB-GYN, Family Health Centers of Georgia: Pain?

NO NAME GIVEN: Sometimes.

JOHN YANG: Dr. Keila Brown is Chief OB-GYN at the Family Health Centers of Georgia.

Many of her patients either are on Medicaid or pay on an income-based sliding scale.

DR. KEILA BROWN: Pregnancy can be very trying on a patient, whether it's emotionally or physically.

And there are a lot of medical issues that can arise during pregnancy or that may have even existed before pregnancy that need continual treatment.

JOHN YANG: Georgia is one of at least 47 states that expanded Medicaid to cover women for a full year after giving birth.

Before, Georgia covered only six weeks.

DR. KEILA BROWN: That finite period was just not sufficient in order to be able to treat any of those things that may have come about during pregnancy or even to put them in a better place post-pregnancy, whether it be for any cardiovascular issues, diabetic issues, which primarily affect the population that we serve.

There's also some mental health issues that go along with being postpartum.

So how are we doing today?

JARICA WILLIAMS: I'm OK.

I'm in postpartum.

It's been a little different this time around.

JOHN YANG: Jarica Williams gave birth to her son, Bryce, two months ago.

Bryce is also covered by Georgia's Medicaid program.

JARICA WILLIAMS: I really appreciate Medicaid.

It takes a large burden off of me, takes some weight off my shoulders when it comes to making sure that my child is getting proper health care.

JOHN YANG: During the pandemic, the federal government increased Medicaid funding to states and prohibited them from kicking recipients out of the program, even if they were no longer eligible.

But when the COVID-19 public health emergency ended last May, states resumed checking eligibility, a process known as unwinding.

So far, 11 million people have lost Medicaid coverage, including more than 4.5 million children.

Some were no longer eligible, but others were dropped for bureaucratic reasons, like re-enrollment forms sent to an old address.

JOAN ALKER: There are many, many ways that Medicaid is working, really to essentially prop up our private health insurance system for people who don't have enough money to be able to afford private coverage, or for people who are disabled, for whom the services that you typically get in an employer-sponsored package simply don't meet their needs.

In our health care system, having coverage is the price of admission.

And you're just not going to see a good show in our health care system if you're uninsured.

JOHN YANG: College student Marrow Woods will soon have to have their eligibility checked.

They can't bear to think about the possibility they may lose coverage.

MARROW WOODS: It's definitely terrifying.

I go to the hospital a lot.

I am in and out of appointments constantly.

And so, without it, there's a lot up in the air about what I could even do, what medications I could have, if I could still afford my medications, so definitely a very stressful time.

JOHN YANG: Tomorrow, we continue our series America's Safety Net with a look at Georgia's unique and controversial program that expands Medicaid coverage, but only to those who meet a work requirement.

Finally tonight, as Women's History Month comes to a close, the next in our series, Hidden Histories.

Tonight, Michelle San Miguel of Rhode Island PBS Weekly introduces us to a woman who embodies what it means to live a life of service, even when that service wasn't always welcome.

MICHELLE SAN MIGUEL: At the age of 100, Bennie Fleming knows by heart all the notes to "Over the Rainbow," a song that, much like her own life story, embodies hope.

But the life that Fleming's created for herself in Providence is one, she says, she never could have imagined as a child.

BENNIE FLEMING: That's the family home in San Antonio, Texas, which was just sold four years ago.

MICHELLE SAN MIGUEL: Growing up in South Texas, Fleming dreamed of being a nurse, but she learned it wouldn't be an easy path for a black woman.

BENNIE FLEMING: There were no hospitals in San Antonio that would hire a nurse, a black nurse.

The only thing I could do was private duty, and that was very expensive, and you're doing private duty for black patients, so, you know, you didn't have a lot of people who could afford a private nurse.

MICHELLE SAN MIGUEL: It was 1945, the United States was engulfed in World War II.

NO NAME GIVEN: Noble women doing a hard job and serving their country in time of need.

MICHELLE SAN MIGUEL: Fleming's friend had joined the U.S. Cadet Nurse Corps, and she decided she wanted to do the same.

Fleming was 21 when she enlisted in the Army as a second lieutenant.

At the time, the armed services were still segregated.

BENNIE FLEMING: You lived in a black dome while the nurses lived in a white dome.

You were separated that way.

MICHELLE SAN MIGUEL: When she was stationed at Fort Huachuca in Arizona, she met the man who would become her husband, Lieutenant Theodore Fleming, a doctor in the Army.

The two went on to witness an historic moment.

In 1948, President Harry Truman signed an executive order banning segregation in the military.

By 1946, Fleming had left the Army and relocated to Providence, Rhode Island, and eventually took a job working full-time at Rhode Island Hospital's School of Nursing.

But after two years -- BENNIE FLEMING: Somebody came into my husband's office and said, I see you've got your wife working.

That was it.

I had to quit.

MICHELLE SAN MIGUEL: Because, your husband did not want you working?

BENNIE FLEMING: No, he wasn't too happy about it anyway.

My husband is just so -- he was of that era.

That's my daughter Jackie.

My son, Theodore.

MICHELLE SAN MIGUEL: Fleming became a stay-at-home mother for a few years, raising her two children, and then made a career change.

BENNIE FLEMING: I decided, well, maybe if I went into public education, maybe that would help.

Because I would be out the same time that my kids would be out.

MICHELLE SAN MIGUEL: For more than four decades, she served in various roles, from teaching to overseeing the district science curriculum.

She also made history as the first black nurse to teach at Rhode Island Hospital.

Service, she said, is in her blood.

BENNIE FLEMING: I was taught that you give something back.

MICHELLE SAN MIGUEL: Fleming remains sharp and mobile at 100.

She still drives and goes for a two-mile walk in Providence three times a week.

She lives with her 75-year-old son.

She credits him with being able to maintain a high quality of life.

BENNIE FLEMING: I'm so lucky because people my age are stuck in nursing homes, nobody to see them, nobody to do anything for them, but yet I still have people around me, and I have young people around me.

MICHELLE SAN MIGUEL: As you reflect on your life, the people you've met, the experiences that you've had, what is the most important lesson you think that you've learned?

BENNIE FLEMING: You have to be kind.

I try not to hurt people's feelings, and I know my kids don't think that.

And I try not to get into people's business.

MICHELLE SAN MIGUEL: She says she remains focused on enjoying her own.

BENNIE FLEMING: At this stage in my life, happiness is all I'm looking for.

MICHELLE SAN MIGUEL: For "PBS News Weekend," I'm Michelle San Miguel in Providence, Rhode Island.

JOHN YANG: And that is "PBS News Weekend" for this Saturday.

I'm John Yang.

For all of my colleagues, thanks for joining us.

See you tomorrow.

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