Those who provide care are often at need themselves

Caregiver burden is a growing public health concern. Recent estimates reveal that more than 52 million caregivers are providing long-term care in the home setting. These numbers are expected to rise further as more baby boomers enter the retirement age.

Many caregivers are elderly, with healthcare needs of their own. One quarter of all care- givers are between the ages of 65 and 74, and 10 percent are older than 75. The family and not the formal healthcare system provides 80 to 90 percent of care to the chronically ill and injured, and to elderly family members, with services such as medical and nursing care, transportation, shopping, cooking, cleaning, and assistance with activities of daily living.

Common chronic illnesses such as arthritis, heart disease, diabetes, multiple sclerosis, Lou Gehrig’s disease, Parkinson’s, Alzheimer’s, and renal failure affect nearly every single American family. As lifetimes lengthen more families are struggling with the changes and strains that come with long-term illness. Caregiving is a big job, and emotions are varied. According to a national survey, feelings reported by caregivers include: loving (96 percent), appreciated (90 percent), proud (84 percent), worried (53 percent), sad or depressed (28 percent), and overwhelmed (22 percent).

A Taxing Role

Our communities have a vital and dynamic asset in family caregivers. Informal caregiving has been called the backbone of long-term health care in America, and most families will agree that this asset must be protected. It may not be possible for the struggling healthcare delivery system to address the needs, or shoulder the majority, of the financial burden for caregiver support, yet many healthcare dollars are funneled through the system in order to pay for care- giver and care recipient illnesses and injuries that preventive and supportive measures could have alleviated.

Caregiving often results in physical and psychological strain, financial stress, and social isolation. Many caregivers have chronic health problems themselves, either pre-dat-ing assumption of the caregiving role, or as a direct result of the burden itself. Working caregivers may reduce their work hours, take frequent leaves of absence, arrive late or leave early from their work setting, and miss career opportunities.

Case managers are in a unique position to help caregivers recognize and address sources of burden, and to assist with the implementation of well thought-out interventions. Our current healthcare environment is complex, and it challenges the case manager to advocate for what is needed to make the system work better for our chronically ill and disabled clients and the caregivers who support them. The nursing care plan provides a consistent and systematic method that focuses on individual needs as they evolve. A written plan of care with input from all stakeholders allows for the inclusion of preferences of all family mem- bers and can instill a commitment to active participation.

Many caregivers have chronic health problems themselves. Working caregivers may reduce their work hours, take frequent leaves of absence, arrive late or leave early from their work setting, and miss career opportunities.

The plan of care should address perceived and real barriers to service and support. Evaluating the family as the whole client will help achieve the goal of maintaining control of the situation at hand. Including out-of-area family members if they wish to be a part of the supportive interventions is also effective. Many adult children live long distances from their family but want to be an integral part of the caregiving process. While being physically present may not be possible, financial support or weekly calls at a specified time can provide much help to the caregiver and the care recipient. Out-of-town family members may have an unrealistic idea of what is needed; including them will not only add additional support, but can help clear up any misconceptions.

Caregivers and families may not recognize the benefits of community supports, nor have the desire or financial resources to use them. The case manager can assist in compiling a list of low or no-cost services available in the community for respite care, household chores and volunteer services. Reliable sources of support and information can help guide appropriate decision-making. Providing multiple options grants the care- giver choices and helps maintain a sense of accomplishment and independence.