Hurricane Milton blew the roof off the carport, damaged the lanai and broke several windows in their Sarasota home.
But during that October of 2024, L. Paul Laramie was dealing with an even bigger shock.
After months of disturbing behavior – including an paranormal suspicion – Paul’s beloved wife, Mary, is diagnosed with Alzheimer’s disease.
For Paul, much of the next year passed in a blur.
But for the overwhelmed 83-year-old, one thing remained constant: the need to keep working.
Working a part-time job long before Milton and Mary’s diagnosis to cope with rising housing costs, Paul saw his savings wiped out from hurricane repairs.
Then as the bills mounted, so did the pressure of how to care for Mary – his childhood sweetheart and wife of 64 years.
Wracked with guilt but unable to afford home health care or qualify for Medicaid, Paul’s only solution was to leave Mary home alone while he went to work, struggling to maintain a roof over his head.
“It bothers me that I can’t be there to help him,” Paul said.
“But we have to live because Social Security doesn’t pay much attention anymore. The money coming in is not keeping pace with the money going out.”
a double burden
With little warning, Paul found himself at the crossroads of two phenomena that are sinking millions of older residents – housing and care.
“The housing crisis and the caregiving crisis are not parallel problems,” said Marisela Morado, president and CEO of the Area Agency on Aging for Southwest Florida.
“They’re the same problem, and older Americans are bearing the burden of both,” Morado said.
The challenges are expected to worsen in the coming years as more baby boomers reach advanced age.
According to the Urban Institute, within the next decade, older adults will outnumber children for the first time in American history.
Yet experts say the number of seniors is growing, but housing and care is falling.
Affordable housing options and federal vouchers have lagged far behind the growing demand. So is the home health and long-term care industry, which is facing a “severe labor shortage.”
A report titled “The Double Burden of Housing and Care for Older Adults” by Harvard University’s Joint Center for Housing Studies found that the number of households headed by people over the age of 80 will double between 2021 and 2040.
However, while approximately 70% of older residents require some form of long-term care, only 24% of those surveyed can afford a daily visit by a salaried home health worker after paying for housing and other living expenses.
The study revealed that even before the need for long-term care, more than a third of elderly residents could not meet basic housing and living costs.
It concluded that the “double burden” in housing and care has increased due to rising costs as well as financial fragility and limited insurance coverage.
Most private insurance does not cover long-term home and facility care services.
Generally, neither does Medicare.
Medicaid may carry coverage, albeit with enrollment limits, and only if a person’s income drops significantly.
This leaves many middle-income seniors earning too much to qualify, but unable to afford housing or long-term care on their own.
(In Florida, the average annual cost of 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 qualify for subsidized rental housing or long-term care services, “relatively few actually receive them.”
‘Get to know us before you need us’
In retirement paradise Florida, the interconnected challenge is especially acute.
Across the Sunshine State, seniors make up the fastest growing group of people experiencing homelessness.
The generous pensions of the past evaporated, leaving many of the later-retiring Baby Boomers solely dependent on Social Security, which has fallen far behind the skyrocketing costs of living.
Studies show that in Sarasota and Manatee counties, like the rest of Florida, half of all senior households are now struggling financially or have fallen into poverty.
As their incomes decline later in life, they are being lashed out:
- Rising rent.
- Homeowners Insurance.
- property taxes.
- Major home repairs.
- Condo or homeowner association fees.
- Food, utilities and gas.
- Various health related costs.
As a result, case managers say many people are kept from getting out on the street in case of an emergency.
Often this comes in the form of medical bills, the illness or death of a spouse – or a hurricane.
It was after Hurricane Ian that calls started pouring into Morado’s Agency on Aging branch offices, which are located in seven counties – including Sarasota, Charlotte and DeSoto counties.
Senior citizens were at increasing risk of homelessness.
Morado said many of those seniors owned their homes outright, but did not have adequate homeowners or flood insurance policies. And many of those affected were not able to buy new homes.
“These are all challenges,” she said. “It’s so heartbreaking.”
There were financial concerns as well as caregiving concerns.
Morado said many seniors have expressed fear that if they miss housing payments, they will be evicted — along with the loved ones who care for them.
In recent years the agency has aggressively promoted a new campaign for elder caregivers called “Get to Know Us Before You Need Us.”
The mission aims to connect senior caregivers with resources and partner agencies at the early stages of a loved one’s diagnosis or illness, before the situation turns into a full-blown emergency.
Sometimes the agency can meet an immediate need with the funds it raises.
For long-term challenges, it offers programs funded through various means, such as the Older Americans Act and the Alzheimer’s Disease Initiative.
This includes caregiver or homemaker support in the community and in the home, based on the agency’s initial assessment of care need. Actual care is provided through the agency’s key partners in each county.
In Sarasota, that key partner is the Senior Friendship Center, whose case managers conduct in-home assessments to develop a care plan at no cost or on a sliding scale.
But the waiting list is long and the need is great.
“We have a lot of people coming to our door or calling the center call line, worried about not having a place to stay – much more this year than in the past few years,” said Joni Ricker, director of adult day services at the Senior Friendship Center’s Caregiving Place Adult Day Care and Caregiver Resource Center.
Senior Friendship Centers attempt to ease the burden by offering prepared meals and a variety of daytime programs.
Like advocates across the country, it is also pushing for large-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.
Other advocates call for changes in Medicare and Medicaid coverage to meet increasing demand.
For now, case managers help coordinate placement in a facility or in loved ones’ homes.
However, in general, adult children are rarely in a financial position to help mom and dad. “When they come down,” Riker said, “they’re shocked at how bad it is.”
run yourself into the ground
Often caring parents are in a worse situation than their spouses.
Many studies show that the physical stress and long-term stress of caregiving has a serious impact on the health of caregivers – especially severe for spouses of dementia patients.
The additional housing concerns are almost too much to bear.
Elderly caregivers often ask: “Should I pay the mortgage or rent – or buy the medicine my wife needs?” says Michael Cochran, caregiver resource coordinator and facilitator of support groups for the Senior Friendship Centers.
Cochrane understands. Caring for her husband, who suffered from Alzheimer’s disease and later died, Cochrane had to deplete her retirement savings and sell the house.
Cochrane didn’t realize how much help she needed until she discovered a support group.
Aging caregivers often think about their own needs and quickly become exhausted — many are juggling job and caregiving responsibilities well into their 80s, Cochrane said.
Even if they qualify for home health aides, aides are difficult to find. Florida ranks last in the nation for home health care availability.
In Sarasota County, the shortage is exacerbated by a lack of affordable housing for workers.
“They’re running themselves into the ground and getting sick,” Cochrane said of elder caregivers.
‘Beloved’
For Paul it was love at first sight.
Leaving baseball practice one day in his small Massachusetts town, a high school freshman looked across the parking lot toward a square dance—and saw the most beautiful girl he had ever seen.
After running the entire three miles home, Paul received permission to attend, then showered, wore a white shirt and a clean pair of chinos, and ran back to ask the eighth grader to the dance.
“I played three or four sets with him,” Paul said, laughing at his efforts. “Being so beautiful is all her fault.”
After graduation they married and raised three children over the next 64 years.
Paul worked as an insurance agent for nearly two decades before buying and running a dry-cleaning business, while Mary was a receptionist at a large company.
In the early 2000s, he began visiting Florida, purchasing a home in Sarasota in 2005. Life was fun, full of friends and travel.
Then about a decade ago, Mary’s health began to decline. Back problems worsened and he required several surgeries.
Two years later, Paul got a job as an attendant at a local funeral home. He enjoyed spending extra money and working to help unhappy families.
But after the pandemic hit, Paul’s job became a necessity. Costs were rising – higher payments for utilities and car insurance as well as the rent on the mobile home they owned had increased.
After Milton, the couple received payments of about $7,000 from homeowner’s insurance and $700 from FEMA. But he had to pay for the remaining $13,000 out of his own pocket for repairs, draining his savings.
Meanwhile, food costs and other expenses continued to rise – leaving Mary with no room to afford home health care.
“At work, she’s on my mind,” Paul said. He thinks about Mary when it is time for her to take her pills and worries that she might forget.
But Paul suppressed his worries, determined to keep his burden away from his children.
Finally, last May, after learning about a support group at the Senior Friendship Center, Paul began attending it.
“I didn’t know what I didn’t know,” he said of the sharing that took place. “It’s been pretty good, at least for me.”
Mary was evaluated with the help of the Area Agency on Aging. Recently, due to her worsening condition, she was given up to 15 hours a week of minor housekeeping help and companionship.
She will also be able to go to senior friendship centers to participate in their day programs — at a cost of $145 per day that the couple otherwise couldn’t afford.
This development has given Paul peace of mind. Now she’ll be in good hands when he goes to work, something Paul hopes to do in the near future.
“Retirement is not a word I would use,” he said. “I haven’t even thought about cutting back.”
Although Paul never thought the couple’s life would take such a turn, he wants to do everything he can to make sure Mary is happy and comfortable.
Paul said, “My wife is not a burden.” “She’s my sweetheart.”
Reporting by Saundra Amrhein, USA TODAY Network/Sarasota Herald-Tribune via Reuters Connect.