Effectiveness of use of home health nurses to decrease burden & depression of elderly caregivers

The purpose of this research was to investigate the impact of home health nursing intervention on burden and depression of elderly caregivers who were caring for an ill relative in their home. Two groups of caregivers were compared for differences in caregiver burden and depression. The caregivers in the control group did not use the services of home health nurses, whereas the caregivers in the experimental group did use these services. Data were analyzed using the Burden Interview and the Center for Epidemiologic Studies Depression Scale. Multiple analysis of variance confirmed that caregivers who used the services of home health nurses were significantly less burdened and less depressed than caregivers who did not use these services.     

Mindfulness theory and professional family caregivers in long-term care facilities

This study utilized Ellen Langer's theory of mindfulness to better understand how individuals who work in nursing homes apply their professional knowledge to their personal lives within the context of nursing home family caregiving. Using a sample of 10 professional and 10 non-professional family caregivers (n = 20), qualitative and quantitative methods were used to compare levels of mindfulness and nursing home knowledge. Qualitative analysis revealed similar responses for both types of caregivers in three out of four attributes of mindfulness. This indicates that being a family caregiver of an institutionalized parent is novel for both professional and non-professional caregivers. Narrative data indicates professionals were more mindful than non-professionals when using their nursing home knowledge to approach staff in a non-confrontational manner. Professionals were also more accepting of care-related problems than non-professionals.     

Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver’s perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.     

Predictors of Health Information Needs among U.S. Mainland and Puerto Rican Caregivers

Stroke caregivers often do not have the information necessary to adequately manage the stroke recovery process at home. We explore how the educational needs of stroke caregivers vary by race, ethnicity, and place, and their association with caregiver characteristics. We surveyed 276 stroke caregivers living on the U.S. Mainland and in Puerto Rico to assess their educational needs related to stroke recovery. Caregivers report a high overall need for educational materials with Puerto Rican stroke caregivers having greater needs compared to whites and African Americans on the Mainland. Increased caregiver educational needs are associated with greater desire to institutionalize, less positive appraisals of caregiving, greater use of coping strategies, and greater burden. All caregivers can benefit from educational materials, but special attention to island-dwelling Puerto Rican caregivers may provide additional benefit. Future research and interventions should focus on tailoring educational materials for race, culture, and other caregiver characteristics.     

A mixed methods inquiry of caregivers of U.S. veterans with sustained “invisible” injuries from Iraq/Afghanistan

ABSTRACT

An exploratory study of caregiver burden associated with family caregivers enrolled in the VA Caregiver Support Program who assist veterans with serious invisible injuries sustained post September 11, 2001. A mixed methods analysis was completed with a retroactive chart review of already collected data (172 participants) in addition to a phenomenological query of 16 participants. Results: T-tests resulted in a significantly higher caregiver burden score with caregivers who had children in the home (M = 6.84; SD = 3.21) versus those who did not (M = 5.57; SD = 2.75), t (160) = ?2.36, p = .02. An ANOVA across caregiver role (parent, spouse, significant other and other) and the Zarit Burden Inventory (ZBI) resulted in a significant difference (F [3, 159] = 1.59, p < .01, with spousal caregivers having a significantly higher ZBI score (M = 6.83; SD = 3.10) than parental caregivers (M = 4.46; SD = 2.70). The phenomenological research resulted in 22 major themes (family adjustment, subjective demands, coping techniques, social support, VA/DOD, self-care, intimacy, role strain, financial resources, life course, obligation, rewards, isolation/loss of self, reciprocity, stigma, community resources, spiritual support, tools, hope, uncertainty, guilt, leash syndrome) which supported quantitative findings. Conclusions: Caregivers and their families had a difficult time adjusting post injury. Caregivers relied heavily on their own coping mechanisms to adapt to their new role and did not find social support to be helpful with caregiving. Spousal caregivers and caregivers with children in the home had more difficulty adjusting when compared with parental caregivers.     

Characteristics of LGBT caregivers of older adults: Results from the national Caregiving in the U.S. 2015 survey

Using data from the Caregiving in the U.S. 2015 national survey, we compared characteristics of lesbian, gay, bisexual, and transgender (LGBT) and non-LGBT caregivers of older adults and explored predictors of caregiver strain. LGBT caregivers were younger, more racially/ethnically diverse, and less frequently a spouse/partner compared with their heterosexual counterparts. LGBT caregivers more frequently reported helping with medical nursing tasks and reported higher levels of financial strain. While LGBT identity was not an independent predictor of greater strain, characteristics more frequently reported by LGBT caregivers were, for instance, helping with medical nursing tasks. In addition, LGBT individuals who were children of the older adult were more likely to report higher levels of emotional strain than other relationship types.     

Association of caregiver social support with the safety,permanency, and well-being of children in child welfare

Focusing on families having contact with the child welfare system, this study aims to assess whether caregiver social support is associated with the three primary child welfare goals: child safety, permanency and well-being. The study uses a national probability sample of children having contact with the child welfare system and a prospective study design. It includes both caregiver and caseworker indicators of social support. Consistent with previous research, study results suggest that different indicators of caregiver social support are associated with different child welfare outcomes. Notably, when caregivers were more satisfied with their social support and caseworkers rated caregiver social support as adequate, children were less likely to be placed out of the home. Also, caregivers who had more people to call on for support rated their children as having less severe behavior problems. Implications for practice are addressed.     

Role conflicts & coping strategies in caregiving. A symbolic interactionist view

Institutional health care delivery is characterized by interdependency among caregivers and between caregivers and care receivers, which leads to role conflicts. This article examines role conflicts and coping strategies of health care aides who are faced with differing expectations of RNs and residents. Guided by a symbolic interactionist perspective, ethnographic data from 12 RNs, 15 health care aides, and 32 nursing home residents of Italian-Catholic and Anglo-Saxon descent in Toronto, Ontario, Canada, was gathered. Results showed that health care aides differed in how they handled role conflict and their elderly clients' concerns. Health care aides were more likely to reject conflicting role expectations from residents than from RNs.     

Caregiver–Youth Communication about Sex in South Africa: The Role of Maternal Child Sexual Abuse History

Much of the research on child sexual abuse focuses on negative outcomes. This brief report explores a potentially protective parenting behavior among black South African female caregivers with and without a child sexual abuse history. Using cross-sectional baseline data, we hypothesized that caregiver child sexual abuse history would be positively associated with caregiver–youth sex communication and this relationship would be strongest for girls. Youth whose caregiver experienced child sexual abuse were more likely to report communicating with their caregiver about sex than youth whose caregivers did not experience child sexual abuse; however, this relation did not hold for caregiver reported communication. Child sexual abuse survivors’ ability and decision to discuss sex with their youth has the potential to protect youth from sexual risk and demonstrates resilience among a group rarely acknowledged for positive parenting practices.     

Preliminary experiences of the states in implementing the National Family Caregiver Support Program: a 50-state study

Despite increased attention to policy choices to support family and informal caregivers, relatively little is known about states' experiences in providing caregiver support services. This article reports on the first nationwide survey of all 50 states and the District of Columbia in providing caregiver services since the passage of the National Family Caregiver Support Program. State program administrators reported that their program differs from other home and community-based services because of the explicit focus on the family or informal caregiver. Results suggest that despite an increasing availability of caregiver supports in all 50 states, there is also a great unevenness in services and service options for family caregivers across the states and within states.     

Decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia

Purpose: To describe factors influencing decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia. Design and Methods: Individual interviews were used to collect data with 30 Chinese family caregivers of older adults with dementia in Taiwan. Data were analyzed using thematic analysis. Results: Factors influencing caregivers' decisional conflict included the Chinese value of filial piety, limited financial resources and information, placement willingness of the older adult, family disagreement, distrust of nursing home care quality, and limited nursing home availability. Factors influencing caregivers' decisional conflict post placement included disappointment with nursing home care quality and self-blame for the placement decision. Implications: Findings resulting from this study indicate that Chinese family caregivers experience decisional conflict during the nursing home decision making process as well as after the placement decision. It is important to provide appropriate decision support beginning before admission and across the trajectory of the older person's nursing home stay in order to decrease decisional conflict and facilitate a more positive decision making process for caregivers, family members, and older adults with dementia.     

Disabling Spaces and Spatial Strategies: Feminist Approaches to the Home Environment of Family Caregivers of People with Dementia

ABSTRACT

The home environment becomes very important for family caregivers of people with dementia as a place of safety, retreat and care provision. Using a gender-based perspective, the authors analyzed thirteen interviews with family caregivers to understand how they perceived their home space. The data was analyzed thematically with the help of adjacency diagrams. Our analysis identified three main themes: compact layout, spatial flexibility, and the wider neighborhood. Given the gendered nature of caring, the findings are discussed drawing on the work of feminist architects regarding the home environment. The authors argue that feminist architectural approaches can usefully inform spatial strategies regarding dementia, ageing friendly housing, accessible living and the wellbeing of the caregiver. Different bodies and users’ needs should be at the epicenter of design, as opposed to conventional design and the current practices by developers, which may create a series of disabling spaces.     

Policy Changes in Medicare Home Health Care: Challenges to Providing Family-Centered,Community-Based Care for Older Adults

The Balanced Budget Act of 1997 (BBA) established new reimbursement systems in the Medicare home health fee-for-service benefit. Reimbursements were reduced to 1993 levels and per-beneficiary capitated limits were introduced for the first time. This article analyzes the impact of these changes on chronically ill older adults and their families. The study combined a secondary analysis of the Provider of Service file (1996, 1999, 2002, and the Medicare Current Beneficiary Survey (1996, 1998) with qualitative interviews of home health agency directors. The greatest decreases in staff and visits were for medical social work and home health aide services. Patients with caregivers saw greater decreases in visits and reimbursements for all visits, skilled nursing, medical social work, and home health aide visits. Agency directors reported that they increased caregiver education, training, and involvement in care in order to discharge patients sooner. Additional research is needed to understand the long-term, adverse impact of these policy changes on chronically ill patients and their families.     

Children's Appraisals of their Experiences in Out-of-Home Care

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.     

Caregiving transitions: Developmental and gendered perspectives

Providing care for family members is a life event that both reflects and influences family dynamics. Caregiving careers, or the length of time a person provides care, are characterized by a series of transitions to which they must continuously adapt. Women are more likely than men to assume the caregiver role and this role encompasses gender inequalities associated with work and caregiving expectations. This article presents qualitative data from interviews conducted with caregivers who participated in a community-based supportive services program. The experiences of these women provide insight into how caregivers transition into their role, strategies for supporting new and experienced caregivers, and their concerns for their future. Developmental and gendered perspectives of caregiving were used as a context to analyze their experiences.     

Psychosocial interventions for disruptive symptoms of dementia

An estimated 6% to 8% of the adult population age 65 and older and more than 30% of those age 85 and older are affected by a dementing disorder. The annual direct and indirect cost of caring for the 4.5 million people with Alzheimer's disease in the United States is estimated to be at least $100 billion. By 2030, when the entire Baby Boomer generation is age 65 and older, the increased number of people with Alzheimer's disease could exceed the ability to absorb the added cost. Both professional and familial caregivers should be familiar with the treatment interventions that are most effective in reducing the disruptive behavioral and psychological symptoms of dementia. This article discusses the various kinds of dementia, their associated symptoms, and the psychosocial treatment options that have been found to be effective in alleviating the effects of the disease on both people with dementia and their caregivers. Psychosocial strategies can be divided into four major subgroups: communication techniques, behavioral strategies, environmental modifications, and caregiver education. The ultimate goal is to optimize functioning of people with dementia and minimize caregiver strain.     

Am I My Brother's Keeper: Adult Siblings Raising Younger Siblings

Adult siblings raising their younger siblings is a family configuration that rarely comes to mind; yet, in the United States adult siblings are the third largest relative caregiver group. The experiences of a sample of 77 adult siblings raising 154 younger siblings are described. The findings revealed that adult sibling caregivers may have multiple unmet service needs but they have a relatively high degree of parenting ability, which is increased by the availability of religious-based services, availability of friends and neighbors, and the ability to network with other caregivers. Additionally, adult siblings who are parenting a younger sibling who has special needs are more likely to commit to adopting that sibling. Social work practice strategies that can be used to address the service needs of adult sibling caregivers are provided.     

Alzheimer's Disease Caregiver Burden: Does Resilience Matter?

Caring for an individual with Alzheimer's disease is at times challenging and can lead to caregiver burden. Resilience is a personality characteristic that has emerged as a protective factor among aging individuals. This study was conducted to examine the moderating effect of resilience between caregiver stressors and caregiver burden. The results indicate that resilience was not identified as a moderator between stressors and caregiver burden; however, a relationship exists between resilience and caregiver burden. Specifically, as resilience in Alzheimer's disease caregivers increases, their caregiver burden decreases. These findings highlight the importance of supportive interventions that will increase resilience in Alzheimer's disease caregivers.     

Factors Associated With Caregivers’ Use of Support Services and Caregivers’ Nonuse of Services Sought

Informal caregivers may face barriers accessing services like respite care, training, and support groups. Using multinomial logistic regression, I modeled caregivers’ probability of using all services sought (“all services used”) and nonuse of any services sought (“any unused services”) as a function of caregiver and care-recipient characteristics. Care-recipient health and function, especially dementia and need for medical task assistance, were associated with all services used and any unused services, and any unused services were more likely among adult children caring for their parents, caregivers of Black and Hispanic older adults, caregivers providing intensive care, caregivers living in metropolitan areas, and residents of states that spend more on increasing access to caregiver services under the National Family Caregiver Support Program. Regularly scheduled caregiving was associated with higher likelihood of all services used, but not with any unused services. Steps should be taken to increase access for caregivers who provide intensive care, care to dementia patients, or assistance with medical tasks and for Hispanic families.     

What Are Strategies to Advance Policies Supporting Family Caregivers? Promising Approaches From a Statewide Task Force

Family caregivers are the cornerstone of the long-term supports and services infrastructure in the United States, yet they often contend with many challenges related to this role. Public policy has been slow to change, leaving many caregivers vulnerable to health and economic consequences. Using models of policy making, we identify barriers to advancing policies that support family caregivers and overcome policy drift. We draw on discussions from the California Task Force on Family Caregiving as it prepares state policy recommendations. Identified strategies include identification of caregivers in health care and workplace settings to promote political consciousness raising, collecting and reporting on data that frame caregiving as a policy problem, borrowing policies and language from overlapping fields to emulate their policy successes, and presenting supportive caregiver policies as solutions to other policy problems. By presenting specific strategic approaches to advance caregiving policies, we provide tools to address the growing gap between caregiver needs and policy responses.