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PUBLIC HEALTH
to the caregiver-recipient relationship. Having more extensive social networks and supports through community organizations, such as neighborhood associations and religious groups, also appears to positively increase caregiver hardiness.9 A survey of 200 California Community-Based Organizations (CBOs) revealed that about half of those organizations offered training for caregivers — with particular attention to Alzheimer’s care — and provided some stress management sessions
for caregivers. This report suggested that supportive CBOs (such as Jewish Family Services in Delaware) might encourage more family members and friends to become family caregivers. Others have argued that caregivers should be recognized as integral to the health care system and that they merit increased support from governmental argued that helping caregivers to be part of a social network, such as a caregiver support group, would result in less stressed and more able caregivers.
to the caregiver is more problematic. Though caregivers provide extensive services to the recipient and therefore to the community, these services are not typically reimbursed in this country. Nor are they covered by health insurance.
In the United Kingdom, however, there are some limited programs that directly reimburse caregivers for their efforts. Several million dollars apparently
have been made available from the government in previous years in the
UK.3 Even if our federal government
is unlikely to provide direct stipends
to caregivers to support their work as does Britain, there are indirect means
by which it could bolster caregivers by adopting policies to foster the growth of respite services, more extensive adult day hours for caregivers. Meanwhile, many
U.S. states have experimented in the last few years with certifying patients’ family members as home health aides in order
to make them eligible to receive state and county funding to compensate them for the home care they are already providing.
Physicians play a key role in supporting family caregivers. A 2011 article in American Family Physician suggested that family physicians could assess caregivers for stress and burden (using a paper-and-pencil questionnaire, such as the Zarit Caregiver Burden Interview), recommend engaging in respite and maintaining good health habits, offer coping strategies such as prayer and increased social supports, and direct them to local resources such as an
Area Agency on Aging or disease- 10 A 2010 Journal of General Internal Medicine article, written by staff members of
the American College of Physicians, emphasized that physicians should
value caregivers’ contributions, monitor them for distress, and provide them
with reliable and accessible means
of communication about patients’ treatment issues.11
Recent articles have described the innovative efforts of some health systems and insurance companies to develop more formal and rigorous means of supporting family caregivers as a way of decreasing patients’ hospital readmission rates and thereby decreasing health
care costs.5,12,13 Among the ideas they have implemented are more widespread caregiver assessment for stress and depression, the use of caregiver navigators and community health workers, offering stress management classes, and linking caregivers to community-based support services. Early outcome studies of these interventions have found that they reduce not only patients’ hospital and ER utilization but also caregivers’ rates of depression and overall health care utilization.
SUMMARY
Long-term informal care provision is a complex phenomenon including multiple actors in various contexts.14 It involves many persons as recipient or caregiver.
Most caregivers provide care because they feel it is the right thing to do. Some feel obliged. Many have expressed a need for support. Such support could
be-established government or other sources. The potential of Medicare providing support would need to be considered. Respite care services and educational programs for caregivers need to be available. Physicians
have an important role in facilitating informal care by partnering with
family caregivers in their efforts to competently and resiliently care for their loved ones.
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ADDITIONAL SUGGESTED READING
Chari, AV et. al. The Opportunity Costs of Informal Elder Care in the United States. Serv Res 2015; 50:871-882
http://clinicaltrials.gov. Individualized Informal Caregiver Training for Palliative Care at Home. Posted October 29, 2015
Thai, JN et.al. “It Just Consumes Your Life:” Quality of Care for Informal Caregivers of Dvierse Older Adults with Late-Life Disability. American Journal of Hospice and Palliative Care. 2016; 33:644-653
Triantofillo, J et.ai. Informal Care in the Long-Term Care System, 2010. European Overview. http://interlinks.euro.centre.org. Accessed June 21, 2018.
