For Alversia, caregiving is a life-changing and life-consuming endeavor
Caregiving is an essential service that is provided for free by many Americans. Edited by Christina Leonard
Alversia Stroughter (left) with Doyal Bolin Jr. (middle) and Nefateria Bolin (right)
For Alversia, deep sleep is a luxury she is rarely afforded because of the fear of something going seriously wrong.
We would often jolt awake to the sound of alarming noises, knowing we would only have a few seconds to act if something went wrong with my father.
It’s a recurring scene.
“Doyal!” my grandmother would yell.
She hops out of bed, storming out of her room in the early morning.
I hear her rushing down the hall, slippered feet hitting the carpet.
When I approach the dining room table, choking noises become louder. Alversia holds Doyal straight in his chair with a partially eaten sandwich and a Ziploc bag of Doritos on the vintage oak table.
As Alversia works to get the chip unlodged from his damaged esophagus, we grab each of his arms for stability and begin to pound his back.
“Spit it out,” Alversia says.
“What did he have?” I say.
“I don’t know, but this is really bad,” Alversia says.
As he continues to choke, his head starts to lean backward as his eyes roll back.
My heart starts racing and the room suddenly feels hot.
“Doyal, NO, let it come out. Spit it out, come on,” Alversia exclaims.
In an attempt to prevent Doyal from passing out and falling back, we guide his posture to keep his spine straight.
We pounded his back and pushed him forward for what seemed like an eternity.
Alversia decides to perform the Heimlich maneuver.
After much effort, the chip is ejected from Doyal’s throat and onto the table.
Doyal coughs as he starts to catch his breath. At this moment, me and my grandmother know that he just survived another choking attack — a painfully common occurrence.
These moments as a caregiver are visibly tough for Alversia.
She keeps both hands on Doyal’s shoulders with a look of exhaustion as she fights back tears.
“Oh lord Jesus,” Alversia says. “Oh man, that is hard D’angelo. That was hard.”
After walking over to hug her, we wait to make sure the coughing doesn’t start again.
Doyal looks at me. Then he looks at Alversia with a grin on his face.
It was like nothing happened.
“What y’all looking at me for?” he says. “What happened?”
Paid caregivers experience tremendous stress and pressure when doing their jobs, a decisive factor in why many paid caregivers decide to leave the industry.
An estimated 11.5% of the U.S. population are unpaid caregivers – and it’s much harder to just pack up and leave.
Unpaid caregivers in the U.S. provide a hefty amount of economic benefit, with their undocumented work equating to an estimated $600 billion in 2021 alone, according to a 2019 AARP report.
David Coon, director of the Center for Innovation in Healthy and Resilient Aging at Arizona State University, says unpaid caregivers provide critical support for society. Some of Coon’s work focuses on finding effective resources and skill development methods to help family caregivers manage stress
“Family members really are the backbone of long-term care or chronic care,” Coon says. “I think sometimes people forget about them.”
A 2023 AARP survey of 1,001 American adults who have provided care for a loved one within three years found that over 55% of unpaid caregivers find it hard to care for their own mental health, while 41% report loneliness
My grandmother, Alversia Stroughter, 76, has been caregiving for 20 years and has relied on her own strength to care for her son and my father, Doyal Bolin Jr.
Alversia says she feels pressure all the time and would benefit from having a support group.
But over the past year, Alversia and Doyal have discovered some help they never knew existed - from Valley Medical Center’s physical training team.
The sacrifice caregivers make
When Alversia drove over three days and three nights from Tallulah, Louisiana, to Seattle, Washington, with her four children in 1977, she was also dealing with the loss of her first husband, Doyal Bolin Sr, who died in a car crash.
She drove mile after mile with a map as her guide and would find a hotel each night until she reached her destination.
When Alversia reflects on this moment, she knows this was a dangerous thing to do while managing four kids on her own, but she felt obligated to take a risk to ensure their future.
Up to that point, Alversia never had a job because her husband worked to support the family.
That changed when she reached Seattle.
She started working at Jack in the Box with an hourly wage of just $3.25. Alversia kept two jobs until 1994, when she started full-time work with King County Metro as a bus driver. Alversia stayed with King County Metro until her retirement in 2013.
After getting comfortable in Seattle, Alversia would often visit different places – the “Fifth Sunday Jubilee” or a cookout, for example – with her friends after church.
Alversia attended softball games at Kent Commons Community Center, Rainier Playfield and Fort Dent Park.
She also liked playing card games, including bid whist and spades at Seattle Elks Lodge. She would sometimes catch a movie and enjoyed going to annual summer festivals and events such as the Seattle Seafair festival and the Washington Interscholastic Activities Association state tournament for basketball.
Softball was a significant part of Alversia’s life before she stopped playing in summer 2003. Some tournaments ran all summer, sometimes leaving Seattle to play in Yakima, Portland, and several cities in Canada.
Alversia played left field for four teams - Foster Foxes, Salt and Pepper, Elks Lodge and Marvin’s Bandits. Alversia won trophies and plaques, from seasonal team awards to personal awards like player of the year.
She had to stop everything when Doyal suffered his injury.
In summer 2003, Doyal, then 36, got into a car accident on Interstate 5 that hospitalized him and required 24/7 care.
Much like other family caregivers, Alversia must devote her time and energy caring for a loved one, which can come at the cost of free time and hobbies.
“I got to the point where I wasn’t talking to my friends,” Alversia says. “I wasn’t going any place. I wasn’t doing anything but taking care of Doyal. It was all I could handle at the time.”
Alversia remembers how much her friendships shifted with Doyal’s injury. Her closest friend, Calvin, warned her about potentially losing all of her friends. Alversia knew she couldn’t argue with him, as her personal life was already trumped by the tasks Doyal needed her to complete every day.
Doyal needed Alversia more than ever.
Alversia says no one can care for her son like she can.
“My personal life just went poof,” she says. “Mentally you cry a lot. You come out of the corner crying, and you ask, ‘Why me?’ But then you realize that there is no one, so you deal with what you have to deal with.”
Nicole Jorwic, chief of advocacy and campaigns at Caring Across Generations, says the caregiving industry needs more attention.
Caring Across Generations is a national organization that focuses on spreading knowledge about what caregivers do and achieving equitable care in America.
“We need to pull care out of the shadows,” Jorwic says. “We need to be talking about care as a collective responsibility and not this individual responsibility that can sometimes feel like a burden.”
Support programs and support groups for caregivers provide additional information, resources, social connection and emotional support.
Over time, support networks tend to shrink, which leads to isolation of the caregiver. Some caregivers don't have the time to tap into outside resources because of their everyday duties, according to the American Psychological Association.
A 2008 study showed many caregiving interventions such as home visits and enhanced social support reduced depression, while having multifaceted relief plans and telephone support reduced burden.
“When they say that we really need to talk to somebody sometimes, they are right,” Alversia says. “We do need to talk to somebody who isn't part of our family.”
The National Academies of Science, Engineering, and Medicine released an extensive report in 2020 that found one-third of adults 45 and older had feelings of loneliness, and one-fourth of adults 65 and older had feelings of social isolation, which is a risk factor for all older adults.
The U.S. population is older than ever and that trend will continue toward 2050, which is when the World Health Organization estimates the world population of people aged 60 and older will double.
AARP also published that about 3 out of 5 U.S. nursing homes have limited admissions because of staffing shortages, while almost 3 in 4 nursing home leaders are worried about having to shut down facilities.
Pay, working environment, job benefits, upward mobility, the amount of work and exterior work options have been widely documented as reasons why caregivers reconsider their jobs.
Cori Carl, director of The Caregiver Space, says caregivers should get paid more.
“In economics 101, we're taught that when a job is required, when it's necessary for society to function, that the market will adjust to make sure that happens,” Carl says.. “And I feel like it's so clear that it's not true when you look at caregiving.”
Fewer caregivers and care facilities could potentially create a larger number of unpaid caregivers in the U.S.
“If family caregivers did not do what they do, our entire long term care system would fall completely apart,” Coon says. “So really, all of these family caregivers, the cost that they're taking psychologically and financially, they're saving society's money.”
That is coupled with the reality that there is a shortage in paid caregivers.
AARP and National Alliance for Caregiving released a joint study in 2020 that found 1 in 5 Americans were providing unpaid family care in 2020. This was a 3% increase since 2015 of 9.5 million caregivers.
If the caregiving industry cannot sustain itself and the population continues to grow older, there will inevitably need to be more attention paid to the support of unpaid caregivers like Alversia.
‘I’ll do it myself’
Doyal suffered permanent brain, spinal and vocal cord damage along with half-body paralysis on his right side when a truck hit him on Interstate 5 in Seattle in 2003 — he was on the way to work on a construction site.
First responders resuscitated and immediately transported Doyal to Harborview Medical Center, where he fell into a coma for four weeks.
Once Doyal woke up, Alversia’s work began.
Harborview sent Doyal to a nearby nursing home, Greenwood Care Center, where he would receive further treatment.
“When we took him there, he was still in this state where he wasn’t really there,” Alversia says.
Alversia was the ultimate watchdog.
She advocated for better care by questioning the slew of prescriptions doctors prescribed, she alerted hospital leadership to the amount of times she would find Doyal helpless on the floor, and expressed discontent when staff failed to fulfill scheduled doctor appointments at Harborview.
Alversia was so antagonistic to Greenwood staff she received warnings about potential state interference. Alversia was reminded that she was not in charge of his care.
“I guess everybody don’t go in there and raise hell,” Alversia says. “They don’t want you to complain or ask questions.”
Alversia says staff members neglected Doyal, so she withdrew him from the nursing home and drove him to Harborview, where he underwent speech and occupational therapy once he started to show signs of recovery.
Doyal lived with his sister, Twan Bolin, in South Park for one year after leaving Harborview.
He still required a hospital bed, and Alversia drove to see him every day from Boulevard Park, which is an hour and a half drive with minimal traffic. Once the daily drive became too much for Alversia, she moved Doyal in with her. To her astonishment, she did not have to adjust her apartment for his arrival.
Her caregiving instincts went into hyperdrive as she came to terms with her new reality. Doctors told them Doyal would never walk again. Doyal and Alversia say the doctors were sure of it.
Alversia did not listen.
Once Doyal’s care schedule slowed down, Alversia trained him out of the wheelchair with no professional guidance. Within two years, she had him using a walker. Alversia also started working with Doyal on mobility, flexibility and general independence.
He started to bathe himself, put on his own shoes and clothes, and eventually fix his own bed.
Alversia used the pressure she felt as a caregiver and channeled it into positive change for her son.
“He improved because of the constant ‘let's get up and walk, pick up the spoon like this, say your words like that, move your leg like this.’ Alversia says.
A patient’s wants and needs
Within Doyal’s first year living with Alversia in 2005, he decided he did not want to use a feeding tube anymore.
These tubes, which are inserted through the stomach to deliver food, are typically used when a person cannot swallow food properly.
Doyal couldn’t bear the annoyance of having a physical object protruding out of his stomach.
“I was afraid he might pull it out himself,” Alversia says.
Alversia ran the idea by his doctors, and they strongly advised against it. The throat damage Bolin Jr. suffered during the accident would make eating solid food dangerous for him.
“In the beginning, he couldn’t object to what I was saying, but now he wants to do what he wants to do,” Alversia says.
This presents issues not only between Alversia and Bolin Jr, but also within the family.
Alversia’s daughter, Twan Bolin, has been caregiving since 1987 and has a different philosophy when it comes to the job, specifically giving immense importance to patient rights and their way of life.
This conflict can happen often.
I’m sitting at the vintage oak dining room table surrounded by wide windows. My grandmother sits on the other side of the room, relaxing on the dark brown suede sofa watching an old western movie on the mounted television.
Twan and Doyal get home from Safeway and that’s when Alversia’s curiosity strikes.
“What’d y'all get from the store?” Alversia says.
“None of your business,” Doyal says.
“Doyal,” Alversia says.
She pauses and focuses her attention on him.
“What did you get from the store?” Alversia says firmly.
Doyal gives off his usual lighthearted and mischievous smirk.
“I got him some Twix and some gum, mom,” Twan says.
“Why’d you do that? Now you know I already got him some candy and gum in the back. He don’t need all of that,” Alversia says.
“Well mom, he wanted it, so I don’t know,” Twan says.
I interject.
“He doesn’t need more candy,” I say. “We should not be giving him that much. It’s super unhealthy.”
“Who the hell died and made you God?” Doyal says.
“No one. I’m just looking out for you,” I say. “You eat too much sugar and chocolate. You gotta eat some real food.”
“I do eat real food,” Doyal says. “Don’t worry about me. Worry about yourself. Y'all always tryna tell me what to do.”
“Yeah, yeah, we know Doyal. You tha boss,” Alversia says.
She looks at me and we both laugh. I walk over to Doyal and take half of his Twix bar as a compromise. He’s not too happy about it, but he doesn’t tell me no.
Doyal waves me off.
My grandmother says my dad is more of a danger to himself because he has a mind of his own and often underestimates his own limitations — part of minimizing risk is getting him to listen to her, which has proven to be a challenge.
“Over time, they get to be grumpy, and mean, and they say things to you,” Alversia says.
Doyal will go to his sister for things he might not get from his mother. Twan is about promoting the life the patient wants to live and therefore is more lenient. What is good and bad for Doyal becomes a tricky conversation among the family.
“People receiving care still need to feel like they can have their own choices,” Twan says. “And that they can do some of the things that they want to do.”
Twan says if she were in Doyal’s situation, she would want the same freedom of choice.
Family caregiving never stops
Full Life Care has been a great relief for Alversia.
When Doyal was hospitalized and started to show real signs of improvement, his doctors mentioned the program, and it was covered through Medicaid. He started visiting the center six weeks after his second stint at Harborview.
Full Life Care is a government-sponsored care center in Seattle where anyone with a disability or an acquired traumatic brain injury can go and find communion.
Alversia calls it a “daycare center” for disabled people.
Doyal used to attend the center three times a week, but now he only goes once because of post-COVID complications. Doyal loves Full Life Care and usually will come home happier and more stimulated.
There he gets involved in activities such as karaoke, bingo, painting, card playing, and crafting things like trinkets and bracelets. Alversia likes the fact that Full Life keeps her son active and actively thinking.
“He’s around people who are in a similar situation as him,” Alversia says. “He can go and try to talk and try to sing, and that is a good thing.”
Alversia also just recently discovered that she could put Doyal through physical therapy and occupational therapy, which they undergo once a week. The Valley Medical Center physical therapist gives Doyal written instructions after each session to follow at home, where he can work on his flexibility, mobility and strength.
At home, Doyal is learning how to use a cane, or at least Alversia is trying to teach him. He can be quite resistant.
“He only goes to PT once a week and if he doesn’t do these exercises at home, I can’t force him to do it,” Alversia said.
With the guidance of his physical training instructor, Doyal has been practicing picking up safety pins so that he doesn't use his knuckles. He works on bending his knees when he walks instead of dragging his legs. He even works on his walking speed.
All of his training is a larger effort to create more independence for Doyal.
“He’s learning how to pick up objects with his right hand, which is his paralyzed side,”Alversia says. “He can sign his name right now almost as well as before. His balance is better than it ever was as he can walk across the kitchen with no walker and no help without wobbling.”
The progress Doyal has shown over the years gives Alversia a sense of hope and pride. It brings her the same joy that she feels when helping family members. Within Alversia’s time caring for her son, she has also served as the rock of the family, providing wisdom and financial support to many of her closest relatives.
Her dutiful and loving attitude toward other people provides an everyday lesson to those around her.
“It's more than appreciated. It's a debt. It's a life debt that we have,” I say.
Alversia stops me from saying more.
“No it’s not, you know why?” Alversia says. “Once a mother, always a mother. Your children, grandchildren and great grandkids all come under that umbrella, so a mother’s job is never done."
“So it’s more of a responsibility,” I say.
“You have to do it from the goodness of your heart. And because that's what you want to do. Because that's what I do,” Alversia says.
“Understood. Well, I appreciate you,” I say.
“That's the only thing — the only gift that you guys can give us. The only gift that makes us feel good, makes us feel loved and makes us feel wanted, and feel appreciated — but I’ll take a car, too,” Alversia says jokingly.