  |  Caregiving | Families and friends are playing a greater role as health caregivers. What issues do they face? | |
| | Story of the Week | May 14, 2009 | | Colliding mega-trends are increasingly pitting family loyalties against workplace loyalties. As the U.S. population has aged, families have become more mobile, separated by distance, and occupied by work demands. Large numbers of women have entered the workplace and global competitiveness has placed increasing emphasis on worker retention and productivity. Thus, family caregiving from a distance has become a fact of life for millions of Americans, according to a recent survey commissioned by MetLife Mature Market Institute and the National Alliance for Caregiving.1
Approximately 34 million Americans are providing care to older family members. Fifteen percent of these caregivers live an hour or more away from their relative. Nearly one-fourth of these long-distance caregivers are the only or primary care provider, and 80 percent work part or full time, according to the MetLife survey of 1,130 long-distance family care providers.1,2
Long-distance caregivers provide a wide array of services at great cost to themselves. According to the survey, they spend an average of $392 in caregiving-related expenses per month: about half of this is spent on out-of-pocket purchases and services for the care recipient and half on travel and long-distance communications.1
The expenditure in time is no less than the expenditure in dollars. Half of the survey respondents reported spending 13.6 hours a month arranging care services, and half said they spend another 16 hours a month checking on their care recipient or monitoring the care being received. Nearly three-quarters of these long-distance caregivers provide help with instrumental activities of daily living (IADL) such as transportation, shopping, cooking, cleaning, managing finances and medications for an average of 22 hours per month. And 40 percent are involved in basic activities of daily living (ADL) such as bathing, dressing, feeding, and toileting, for an average of 12 hours per month.1
What effect does long-distance caregiving have on professional work schedules? Employed caregivers are often required to make significant adjustments to allow for their caregiving responsibilities. These include coming in late or leaving early, missing days of work, rearranging work schedules, and taking unpaid leave. Twenty-five percent of the surveyed long-distance caregivers had shortened their workday and 36 percent reported missing full days of work. Twelve percent had taken a leave of absence.1
Distance, of course, makes a difference in the work accommodations caregivers make. Those caregivers who live closer to the care recipient are more likely to come into work late or leave early, as opposed to missing full workdays.1
The forces that have created today's long-distance caregiver realities are unlikely to reverse themselves in the near future. Rather, the challenges and work-balance issues are likely to accelerate. Clearly, long-distance caregiving already impacts retention and productivity. Physical distance is a key determinant in terms of complexity, as is the presence or absence of other relatives in the area. In the void of "on the ground" family support, paid support becomes more critical earlier in the aging cycle.1,2
What can an employer do? Certainly, sensitizing line managers to the issue is a reasonable starting point. Adjusting policies to allow job sharing and short-time relief, as well as providing information and help in coordinating eldercare, are definitely worthwhile investments, compared to the cost of attrition and lost productivity. Since long-distance caregivers usually have financial burdens as well as time conflicts, programs that offer help with these are beneficial. For example, voluntary pooling of frequent flyer miles for employees who need to travel on family emergencies is an idea worth considering.1,3 These tangible expressions of support face the issue head on while reinforcing shared values and joint commitment.
For Health Commentary, I'm Mike Magee.
References
1.MetLife, National Alliance for Caregiving. Miles Away: The MetLife Study of Long-Distance Caregiving. July 2004.
2.National Alliance for Caregiving, AARP, MetLife. Caregiving in the U.S.. April 2004. MetLife, National Alliance for Caregiving. Miles Away: The MetLife Study of Long-Distance Caregiving. July 2004.
3.Shellenbarger S. When Elderly Loved Ones Live Far Away: The Challenge of Long-Distance Care. The Wall Street Journal. 29 July 2004.
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| | November 24, 2008 | | By Mike Magee, MD  With Thanksgiving upon us, we have much to be thankful for, and much still left to accomplish. Health care statesmen Paul Levy, CEO/President of Beth Israel Deaconess, Lachlan Forrow of Harvard and others this month have launched the project "Engage in Grace", which zeroes in on one pressing need: end-of-life decision making and care. Their idea: trigger discussions in families and care centers throughout America through the sharing of one single slide with 5 questions.
In their own words:
"Engage With Grace: The One Slide Project started last month. The idea is to get people to share just ONE slide that helps them and their loved ones talk about having a purposeful end-of-life experience. Thanksgiving is a perfect time for families and loved ones to have this most difficult of conversations.
"We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.
"This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in the hospital. More than 80% of Californians say their loved ones "know exactly" or have a "good idea" of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences. But our end-of-life experiences are about a lot more than statistics. They're about all of us. So the first thing we need to do is start talking.
"Engage With Grace was designed with one simple goal: to help get the conversation about end-of-life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with our loved ones about our preferences.
"And we're asking people to share this One Slide - wherever and whenever they can; at a presentation, at dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven't had. Here is what we are asking you: Download The One Slide and share it at any opportunity - with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end-of-life experience for yourself and for your loved ones. Then commit to helping others do the same. Get this conversation started.
"Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together. To learn more, please go to: http://www.engagewithgrace.org. "
I think this is a great idea, and I hope you'll take a look at their site and join in this effort!
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| Story of the Week | November 17, 2008 | | By Mike Magee, MD Recently, issues of elder abuse have resurfaced in both home and institutional settings. As Stephanie Lederman, executive director of the American Federation for Aging Research notes, “A large segment of our population is both dependent and frail. Studies on elder abuse now alert us that seniors are also vulnerable and in need of help.”
How large is the at-risk segment? One study of 2,812 adults over age 65 revealed that 6 percent of them were seen by elderly protective services over a nine-year period. Nearly three-quarters of these cases involved self-neglect, but the remaining 27 percent were traced to the actions of others – nearly 6 percent of the elderly people experienced physical abuse, 17 percent had been neglected, and almost 5 percent suffered exploitation.
What is elder abuse? The U.S. National Academy of Sciences defines the problem as “intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder; or, failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.”
Elder abuse not only implies that a person has suffered injury or neglect, but also that a specific individual, entrusted to provide care, is responsible. The abuse may take a variety of forms, including physical abuse, psychological abuse, sexual assault, exploitation of material resources, or neglect. But studying elder abuse is easier said than done. For example, was under- or over-medicating a patient the result of forgetfulness or malevolence of the caregiver?
Risk factors associated with elder abuse are increasingly clear. Most incidences occur in shared living situations where there is prolonged access by a family member, friend or entrusted surrogate. Caring for a frail, dependent and vulnerable senior is challenging under the best circumstances.
Screening elders for abuse requires high awareness and good clinical judgment. General concern should be raised when physicians, nurses, and other members of the care team observe a poor social network, poor social functioning, and signs of conflict between a patient and a caregiver. Trust your instincts, experts say. Conduct a thorough evaluation with a focus on cognitive function, question the patient in private, and be cautious in discussions with the caregiver, extending empathy while uncovering the caregiver's training and coping skills.
Be on the lookout for problems. Is mom or dad declining without an obvious reason? What is the level of cleanliness of the patient and the home setting? What is the patient being fed? Are there unexplained bruises, blisters, or painful areas?
Addressing senior abuse requires a continuum of committed individuals from home to care sites and back home again. Such a network must be built, and a good place to begin is with an informed discussion of the issue between family members and their care teams. As always, watch the video embedded with this blog post for more detailed commentary; then send us a comment. Do you have experience with this problem?
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|  I think we should have health care paid for by the government for everyone. It doesn't have to be elaborate, but a socialized medical system like Canada has."  Hard for the insured, too  Keep health care private!  Work to stay healthy  Testing is important  Please keep it affordable  Everybody deserves a chance  | Dr. Tom Linden's Health Blog | | |  Water Disinfection for Developing Countries No Time for Health Like the Holidays Don't go to the Hospital Without these Ten Safety Tips Ain’t Nobody’s Fault But Mine An Open Letter to the Obama Health Team Post-Election Healthcare Reform Yearning for Universal Coverage Is Not Universal Is America's Health Care System Failing? Probiotics: Hope or Hype? |
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