For many years, Cassilyn Brown’s home in Madison has housed three generations, including her husband, three children and father-in-law.
Since COVID-19 hit, her concerns about her family have grown as their multigenerational household works to stay safe during the pandemic, especially her 79-year-old father-in-law, who has chronic pneumonia and a heart arrhythmia.
Brown and her family welcomed her father-in-law, David Ralph Brown, into their family home back in Kentucky after the death of his wife in 2010. The family—including her husband, David Bingham Brown; their children, Ash, Alaric and Victoria; and a cockatoo named Casper—moved to Madison in 2014.
For Brown and her husband, this type of family dynamic was nothing new; both had lived with grandparents during their childhood. But the virus caused them to change family life as the younger elementary-aged children were warned from spending too much time close to their grandfather, who lives in the basement of the family’s three-level condominium.
“The kids would go down there and they would see what he was up to,” Brown said, adding that her father-in-law often played guitar for the children or designed math games on the computer for them. “We did tell the kids to kind of stay away from dad and not be climbing on him.”
Brown’s job as a forensic nurse examiner at UnityPoint Health-Meriter Hospital, where she cares for individuals suffering from sexual or physical assault and violence, created another level of concern.
During the pandemic, she regularly monitored herself for the virus. But Brown feared the exposure to patients and the lack of personal protective equipment in the early part of the pandemic put her family at risk.
“We were given one N95 and told to reuse it until it became visibly soiled. And that was for use if you had a known COVID-positive patient; otherwise, we were working in a surgical mask,” said Brown, 43. “That had me very nervous.”
These days, she worries less. Brown, her 43-year-old husband and her father-in-law have received all of their shots. Their oldest child, who is 20, has not yet gotten the vaccine. No one in the Brown household has gotten sick from the virus.
But many families in Wisconsin, nationwide and elsewhere have not been so lucky. Studies in the United States and the United Kingdom found that older members of multigenerational households are at increased risk of death from COVID-19—and ethnic and racial minorities are more likely to be part of such living arrangements.
Multigenerational households also often include essential workers, such as Brown, who are at greater risk of bringing the virus home. Brown recalls one such scare—in which she briefly thought she had lost her sense of smell—but it turned out to be a false alarm. At the time, she thought, “Now I potentially exposed everybody in the household.”
Multigenerational homes common for some
The Center for Public Integrity found that 18% of U.S. households are multigenerational, containing at least two generations. That includes parents and adult children as well as families that extend from grandparents to grandchildren.
The CPI analysis of every county in the United States shows that people of color, at greater risk from the virus for a variety of factors, are far more likely to be living in the same home as older relatives: 30% among Latinos, 25% among Asians and 24% among Black families, compared to 15% for non-Latino white households.
Just a handful of states have formally recognized COVID-19’s threat to multigenerational households and prioritized them for vaccination.
Wisconsin this month expanded vaccine eligibility to all state residents ages 16 and older, and it has funded programs to narrow the state’s wide racial disparities in COVID-19 vaccinations. But it is not among the states that prioritized multigenerational homes for vaccination. Washington, for example, became the first state to put multigenerational households near the top of its COVID-19 vaccine priority list on Jan. 6.
Wisconsin has about 325,000 multigenerational households, or 13% of all households—lower than the national average—but the racial disparity is similar. Among Black households, 19% contain multiple generations, according to CPI data analyzed by Wisconsin Watch. About 20% of Hispanic and 23% of Asian households in Wisconsin contain multiple generations, the analysis showed.
Counties with a high percentage of multigenerational households include Kenosha (17%), Racine (16%), Rock (16%), Milwaukee (15%) and Waukesha (15%). In four of those counties—Kenosha, Milwaukee, Racine and Rock—the percentage of fully vaccinated residents ranks at or below the state’s average of 43.4% as of Monday, according to data from the Wisconsin Department of Health and Services.
Multigenerational living among nonwhite families is also more common in Rock and Walworth counties than in most places statewide. In Rock County, 27% of all nonwhite households are multigenerational; that figure is 29% in Walworth County, two of the top four highest rates in the state, according to the data.
In-home infection hits people of color
Nationwide, these households include millions of Americans and immigrants who live with extended family to suit elders’ needs, for cultural reasons or because it’s more affordable.
“Inside-the-home transmission is what has been killing so many older people of color,” said Dr. Ashish Jha, a leading global public health expert and dean of the Brown University School of Public Health.
Jha agrees with other specialists that vaccinating essential workers, from teachers to farmworkers, is crucial to stop the spread of the virus.
But early vaccination of essential workers “alone probably is not enough,” Jha said. “We really do need to find ways to prevent the intergenerational spread of the infection in these households.”
‘It felt like we were invisible’
As anticipation of a vaccine release grew last year, leaders in the state of Washington’s immigrant communities and communities of color asked the state to designate multigenerational families as an early high priority.
About 22% of Asian households in the state are multigenerational. But “it felt like we were invisible,” said Seattle resident Trang Tu, who lives with and cares for her 90-year-old mother.
COVID-19 fatality rates in Washington have been disproportionately higher among households of color—a trend seen nationally and in Wisconsin. Since the pandemic began, Latino, Native American and Alaskan death rates in Washington have been three times higher than for white residents. And it has been nearly twice as high for Black residents.
Katie Meehan, the Washington Department of Health’s equity and social justice manager, said prioritizing multigenerational families was “one of the strongest themes” that emerged in talks with community representatives last fall.
By mid-April, all U.S. states had opened vaccine eligibility to all adults. But before that expansion, when timing was a matter of life or death, at least three other states adopted versions of Washington’s policy.
Alaska began vaccinating people 45 and older in multigenerational households in February. Crucially, older adults might be more inclined to get vaccinated when they can do so with a family member, said Clinton Bennett, a spokesman for the Alaska Department of Health and Social Services.
In early March, Minnesota began expanding eligibility to people 50 and up in homes with at least three generations, such as a grandparent, parent and grandchild. Oregon also has targeted multigenerational households for vaccines.
COVID-19 infection rates high in multigenerational counties
Some of the counties Public Integrity found to have exceptionally large concentrations of multigenerational households have also been ravaged by COVID-19.
In Wisconsin, counties with the largest percentage of Latino multigenerational households also have seen some of the state’s highest proportion of positive COVID-19 cases. Menominee County, which ties for third highest percentage of Hispanic multigenerational homes at 30.6%, has seen the highest share of its population testing positive. In all, 799 of its 4,579 residents—that’s almost one out of six people—contracted the virus as of Monday morning, according to state data.
The Muriels, a Latino family in Florida’s Hernando County, know how easily the virus can spread inside a larger household. All members of the household, which includes four adult sons, caught COVID-19 last year.
The family tried to fend off the virus with hand washing, masks and distancing in public. But it was unnatural to be so careful at home. “By the time we figured out, ‘I think you may have COVID,’ we all went down within a week’s time,” mother Kathy Muriel said.
Multigenerational living becoming more prevalent
As of 2016, more than 64 million Americans lived in multigenerational households, according to the Pew Research Center.
Donna Butts, the executive director of Generations United, a national organization that aims to strengthen intergenerational connections, sees this trend continuing, particularly during the pandemic: “Multigenerational families are on the rise, and they’re here to stay.”
The National Association of Realtors found 11% of homebuyers just before the pandemic had purchased multigenerational homes. But because of the economic pressures, fears of sending relatives to nursing homes and assisted living and the shifts to remote working and schooling, the proportion of such purchases has now hit 15%—with nonwhite families driving that trend, according to the Realtors’ most recent data.
“We certainly are seeing that minorities are embracing this way of living at higher shares than we do see for white families,” said Jessica Lautz, the vice president of demographics and behavioral insights at the National Association of Realtors.
Marci Spoke of Milwaukee is part of that trend.
Since the loss of her husband—and more recently her daughter—Spoke, who is white, became the sole head of the household for a home that includes her son, Greg, 51, who is on the autism spectrum, and her two biracial grandsons, Brion and Anthony, ages 22 and 16.
In her job with the Salvation Army as an on-call chaplain for the Milwaukee Police Department, Spoke, 68, comforts grieving families, where she runs the risk of being exposed to COVID-19. Her eldest grandson also works outside their home.
But while Spoke tries to carry on with her life as safely as possible, she has had to limit or completely stop any in-person interactions with some of her other family members, including a sibling who does not believe in COVID-19.
“There were a lot of times that I’d get in the car and I’d put sanitizer over everything,” Spoke explained. “But still, you gotta have faith that you could do it, help people and still live.”