Honoring and supporting Alameda County’s caregivers

My Aunt Sandra “Sandy” Ramirez, one of my favorite people in the world, passed away this fall. 

Enya’s music made her smile. She loved my puppy, a six-year-old Rottweiler, so much so that even as her Parkinson’s began to limit her ability to speak, she would ask to see him, mouthing her nickname for him, “Big Muscle,” whenever we cared for her.

Her recent passing would have been a moment of grieving with my family, no matter what. Yet the challenges facing our family and many others compounded our pain during her final years.

I served as her respite caregiver within my family, while her sister, my Aunt Marcy, juggled being her primary caregiver. It was a privilege to support both of them, spend time together and repay them for the generosity they showed our family throughout our lives.

There is no stronger way to express love than to feed and bathe someone, looking after their most basic needs. Caring for others in this way is at the core of our humanity, but it also takes a toll we must appreciate.

As a member of the Alameda County Board of Supervisors, balancing my responsibilities to the county’s residents and to my family is a great honor and a great challenge. My time and focus are in high demand in the best of times, and when Aunt Sandy entered hospice care in April, that bandwidth was further strained. 

We are challenged to rise to the moment when we are needed to focus on the care of others. Serving as a caregiver did not distract me from my job as a Supervisor. It made me better at it. 

But specific policies, workplace practices and HR regulations exacerbated the difficulty of this balancing act. For example, I could only participate in a board meeting remotely when I was caring for my grandmother, not Aunt Sandy, despite her being in the final days of her life, due to the Brown Act’s limited definition of caregiving.

Walking this tightrope will feel familiar to the estimated 239,000 family caregivers who are our neighbors in Alameda County, according to the Family Caregiver Alliance. Caregiving has become medically complex and longer-term. Many are balancing caring for their aging parents, young children or family members with disabilities with showing up to work and putting food on the table. Caregivers often face lost income, stress and isolation, and the burden that our system puts on caregivers is only growing heavier.

More than one in five Americans provides care for an aging loved one. Alameda Health System, the County’s integrated public health care system, shared that California caregivers work an estimated 1.8 million hours of unpaid labor to care for an elder in their lives who has dementia. None of this work would allow them to qualify for Medicaid under HR 1.

Budget cuts and policy changes at the federal level are decimating SNAP benefits, increasing work requirements and bureaucratic paperwork, and severely cutting Medicaid, which serves as a lifeline for the long-term care of disabled and older adults. Thirteen percent of family caregivers in the U.S. receive health insurance through Medicaid. While we can’t fill these gaps alone, locally, we can do our part to support the caregivers in our communities.

In July 2025, the Alameda County Board of Supervisors voted to add $10 million this fiscal year to support our Countywide Area Plan for Older Adults. These funds will provide relief to 4,400 family caregivers through direct assistance, 9,000 hours of family caregiver support and 9,500 hours of family caregiver respite.

My Aunt’s journey and my family’s response remind me that we can be more supportive of individuals in the workplace who are balancing responsibilities or losses at home. It also reminds me of the deep need to address the unmet needs caregivers face and to plan for the future. I firmly believe we need to find resources wherever possible to support working families and caregivers.

With the Governor’s January budget release just around the corner, we must uplift the importance and challenging reality of caregiving alongside trusted local advocacy organizations like the Senior Services Coalition of Alameda County. When we meet caregivers where they are, we can promote safe, accessible and inclusive communities for all.

Our County is rapidly aging, and our seniors and their loving families deserve lives of dignity. The time is now to create an Alameda County that honors the broad spectrum of our caregiving needs, making space for the fullness of each of our humanity, all of our grief and all of our love.

Supervisor Elisa Márquez represents District Two of Alameda County, which includes the vibrant communities of Hayward, Newark and Union City. She wrote this to mark the recent National Caregivers Month in November and to memorialize her beloved Aunt.