Geriatric Education Series Presented in partnership with: Funded in part by a grant from the EJC Foundation

Caregiver Support & Resources January 6, 2016 Kelley R. Macmillan, Ph.D., LSW Director Community & Social Services Sanford Center for Aging

Objectives OBJECTIVE 1: Administer and score a caregiver burden screening instrument OBJECTIVE 2: Encourage family caregiver self-care OBJECTIVE 3: Discuss referral options to community programs serving older adults and family caregivers

What is Caregiving? Hands on personal care Helping with household tasks Night-time or 24-hour supervision Financial management Care coordination A caregiver is any person, age 18 and older, who provides assistance with one ADL or IADL to any person with a physical and/or mental disability, regardless of age.

Who are Caregivers? Women (60%) Adult Children (36%) Sole Caregiver (44%) Work Full-time (60%) Caregivers of Older Adults: A Focused Look a Those Caring for Someone Age 50+; June 2015- AARP and National Alliance for Caregiving The number of older adults age 85 and older is expected to quadruple by 2030. Risk of functional impairment increases with age, from 19% for 85-90 year olds to 40% for adults 91 and older. More adult children will become caregivers due to demographic changes

Why Assess the Caregiver? A caregiver assessment helps us understand what may support the caregiver in their role which benefits our client to maintain community residence. We need to concern ourselves with the caregiver because if they are unable to provide the care to the adult, the adult is at risk of institutional care or needing limited community based social services. The social service system is often complex and fragmented. Direct social service to the client indirectly support the caregiver. Social services are frequently sought at a time of crisis and may be too little to late. A third of caregivers say a health care provider, such as a doctor, nurse, or social worker has asked them what was needed to care for their recipient, but only 16% report similar conversations about self-care. A greater percentage of 50+ caregivers find these conversations helpful than the percentage who report having had them. (National Alliance for Caregiving and AARP)

Why are Caregivers Important? In the US there are 34.2 million (14.3% of pop.) people providing care (50 & >) The estimated cost for caregiving is $470 billion per year! (2013 data)

What are Caregivers Providing? Approximately 60% of care recipients ONLY receive care from informal caregivers CG provide 24.1 hrs/wk on average 22% of CG provide 40 hrs or more/wk A caregiving career lasts 3.7 years AARP and NACG report

Risks for Caregivers - 1 Caregivers are at greater risk of health problems: Infectious disease, such as flu Heart problems Diabetes Cancer

Risks for Caregivers - 2 Caregivers are at greater risk of mental health emotional problems: Depression (two times as common) Stress and burden Interpersonal problems Anxiety

Risks for Caregivers - 3 Caregivers are at greater risk of social problems: Isolation Reduced leisure activities/time Restricted social roles

Caregiver Stress Balancing caregiving, family and work Balancing the relationship with the care recipient Making decisions regarding care Women experience more stress because of societal expectations of women's roles Men see the caregiver role as a series of tasks Men more likely to delegate & seek formal services INTRODUCE THE CAREGIVER STRESS DOCUMENTS

Benefits of Caregiving - 1 A natural support system A meaningful & satisfying role The relationship between the adult and the caregiver may be enhanced

Benefits of Caregiving - 2 An opportunity to ‘give back’ to a parent Satisfaction in knowing the adult has a good quality of life Autonomy & self-determination Remain in home/familiar surroundings Trusting relationship with caregiver

Strategies for Caregivers - 1 Social and Health Services Case management Respite care Medicaid services (HCBS) Medicare services (home health)

Strategies for Caregivers - 2 Psychosocial support - reduces isolation & permits ventilation of feelings with other caregivers Psychosocial support - reduces anxiety, guilt, depression & psychosomatic complaints Social Support Groups Peer led groups - increase social networking and support Professionally led groups - techniques on stress reduction and problem-solving Professional counseling - relationship issues, personal coping

Strategies for Caregivers - 3 Psycho-education about caregiving The aging process Coping with caregiving Communication strategies Problem-solving Information regarding community services

Strategies for Caregivers - 4 Immunizations - influenza, pneumococcal, tetanus Health screenings - cervical cancer, mammogram, blood sugar and blood pressure Mental health screening - stress, depression and anxiety

Strategies for Caregivers - 5 Encourage planning for future needs (caregiving can last for > 4 years) Living Will Advance Directive Durable Power of Attorney

Strategies for Caregivers - 6 Family member keeps copies of person’s important records. Direct deposit of person’s check(s) Automatic bill-pay Joint access to a bank account

Strategies for Caregivers - 7 Utility party notification Decide what to do about checkbook, credit cards Develop a system for handling mail Consider Volunteer Rep Payee Program

Interaction with Caregivers Give information in small doses Tackle one issue at a time Limit the length of your visits Verify that families understand Give manageable “homework” assignments and write them down!

Resources Family Caregiver Alliance http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1717 Nevada ADRC http://www.nevadaadrc.com/ Aging and Disability Resource Center (National) http://www.adrc-tae.acl.gov/tiki-index.php?page=ADRCLocator Eldercare Locator http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx AARP http://www.aarp.org/home-family/caregiving/

Sanford Center Geriatric Specialty Clinic Kelley R. Macmillan, Ph.D., LSW kmacmillan@unr.edu (775) 327-2281