Retooling for an Aging America Building the Health Care Workforce (2008) / Chapter Skim
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6 Patients and Informal Caregivers
6 Patients and Informal Caregivers
Pages 241-270
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From page 241... ...
The chapter also discusses the role that assistive technologies can play in enhancing and prolonging the independent functioning of older adults, making them less reliant on direct-care workers and informal caregivers. The committee recommends that federal agencies take steps to assist in the development and increased availability of these technologies.
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From page 242... ...
Any reductions in caregiver support could have serious negative implications for the adequacy of the direct-care workforce, which makes it particularly important to determine how best to support caregivers in order to maintain the availability of their services. Both patients and informal caregivers are important parts of the health care team, yet little has been done to impart the necessary knowledge or skills to these team members.
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From page 243... ...
. Individuals with low health-literacy rates report having poorer health status and using fewer preventive services (Williams et al., 1998)
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From page 244... ...
. Assistive technologies are designed to support and extend the independent functioning of older adults, which can in turn reduce the need for support from direct-care workers and family caregivers.
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From page 245... ...
. One study found that people who needed assistance with ADLs and who did not use any assistive devices required an average of 4 additional hours of personal care per week compared with individuals who did employ the devices (Hoenig et al., 2003)
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From page 246... ...
These demonstrations need to assess the effectiveness of these technologies in promoting functional independence and in easing the physical strain on, and the need for, direct-care workers and informal caregivers.
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From page 247... ...
. Overall, the economic value Informalcaregivers are also, at times, referred to as family caregivers.
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From page 248... ...
. The following sections describe the size and composition of the informal caregiver population in the United States, the responsibilities they assume and the specific tasks they perform, the effect they have on patient outcomes, and possible supports that might be provided to them, such as increased training to help to promote greater competency among this group.
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From page 249... ...
In contrast to the results cited above, household surveys that use a narrower definition of caregiving examine only the care provided to a more narrowly defined group of disabled older adults, and use much shorter time-frames for providing care yield substantially smaller estimates of the number of family caregivers. For example, several iterations of the National Long-Term Care Survey (NLTCS)
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From page 250... ...
Spillman found that the declines in aggregate numbers of informal caregivers between 1984 and 1994 were largely attributed to a drop from 1.7 million to 1.1 million individuals serving as secondary caregivers, with no evidence to suggest fewer primary caregivers
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From page 251... ...
Data from the NLTCS and its Informal Caregivers Survey indicate that caregivers commonly assist with the full range of these tasks. In one study, large percentages of primary caregivers reported helping chronically disabled older adults with shopping and/or transportation (85.3 percent)
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From page 252... ...
. A study following stroke and traumatic brain injury patients and their caregivers from hospital discharge found that during the home health period, families provided three-fourths of total patient care hours (Levine et al., 2006)
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From page 253... ...
Similarly, family members' understanding of the providers' treatment recommendations and their ongoing interactions with the patient at home and in the community can influence the patient's behaviors, treatment adherence, and health. Impact on Outcomes There is strong evidence that informal caregivers have a profound effect on long-term care processes and outcomes.
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From page 254... ...
. Caregiver support may allow older people to remain in their communities in cases where it would not otherwise be possible otherwise and the importance of informal caregivers in reducing the risk of nursing home entry is well documented (Miller and Weissert, 2000)
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From page 255... ...
To improve the care that older patients receive in private settings and to support informal caregivers who are often ill-equipped to perform the necessary medical tasks, the committee recommends that more training opportunities be made available. Recommendation 6-2: Public, private, and community organizations should provide funding and ensure that adequate training opportunities are available in the community for informal caregivers.
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From page 256... ...
. Integration with Medical Team A more explicit recognition of informal caregivers as providers and partners in health care processes could benefit both patients and caregivers in the management of the health needs of older adults in the community.
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From page 257... ...
. Establishing better linkages between the medical care team and informal caregivers is Health Insurance Portability and Accountability Act of 1996.
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From page 258... ...
A large number of caregiver interventions have been developed, with a large range of strategies, services, and target populations. Programs have been established to provide caregivers with greater education and training, strengthened partnerships with the medical community, and a number of other types of aid including respite care, web-based monitoring systems, technologies that reduce physical strain, and financial supports.
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From page 259... ...
The objective of the program is to allow states to develop a network of respite care providers that will provide family caregivers with high-quality planned and emergency respite services. There have been discussions of an appropriation of $10 million for fiscal year 2008, which would be substantially more limited in scale and scope than the $289 million authorized over 5 years.
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From page 260... ...
. Moreover, informal caregivers were shown in one study to be more satisfied with the Medicaid recipients' overall care and their own lives, as compared to a control group, and, that they experienced less financial and physical strain (Foster et al., 2007)
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From page 261... ...
Respite Respite is among the most common requests of informal caregivers (Jenson and Jacobzone, 2000) , and ensuring that it becomes more widely available is one of the goals of the National Family Caregiver Support Program and Lifespan Respite Care Bill.
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From page 262... ...
Employer-based approaches have focused, among other things, on restructuring the workplace to facilitate greater flexibility, the provision of family and medical leave, access to supportive services such as adult day care, and the availability of tax-deductible dependent-care assistance programs. And given the high costs and difficulty that individuals face in getting health insurance outside of the workplace, some have suggested providing caregivers with government-assured access to coverage through measures such as broadening Medicare eligibility to include informal caregivers for older adults.
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From page 263... ...
2007. The national family caregiver support program.
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From page 264... ...
2002. Reverberations of family illness: A longitudinal assessment of informal caregiving and mental health status in the nurses' health study.
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From page 265... ...
2004. A study of 10 states since passage of the National Family Caregiver Support Program: Policies, perceptions, and program development.
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From page 266... ...
2003. Incidence and preventability of adverse drug events among older persons in the ambulatory setting.
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From page 267... ...
2006. "This case is closed": Family caregivers and the termination of home health care services for stroke patients.
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From page 268... ...
. National Family Caregivers Association & Family Caregiver Alliance.
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From page 269... ...
Does inpatient interdisciplinary geriatric assessment help the family caregivers of acutely ill older patients? Journal of the American Geriatrics Society 38(4)
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From page 270... ...
2006. Technology depen dence in home care: Impact on patients and their family caregivers.
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