| Long Term Care Link | Veterans Aid and Attendance Pension Benefit |
About Caregivingby Thomas Day
Caregivers provide assistance to other people who because of physical
disability, chronic illness or cognitive impairment are unable to perform certain
activities on their own. So-called informal care can be offered by family
members or friends, often in a home setting. Or paid or volunteer professional
care, so-called formal care, can be obtained at home, in the community or
from institutions such as nursing facilities or government institutions.
Roughly, 11.1 million Americans of all ages are receiving formal or informal
care at any given time. This represents about 4% of the population and is
comprised of about 9.5 million receiving care at home or in the community and
another 1.6 million residing in nursing or intermediate care facilities. About 25.8
million family caregivers provide personal assistance to individuals 18 years or
older who have a disability or chronic illness. And nearly one out of every four
households (22.4 million households) is involved in giving care to persons aged
50 or older. About 43% of those receiving care are under the age of 65 and
are evenly spread between ages 18 to 64. Children under 18 and receiving
assistance because of disability are often characterized under different criteria
of caregiving.
Sometimes human caregivers can be replaced or assisted by mechanical
devices. These might include special computer systems for communication,
special locomotion equipment, remote vital sign monitoring devices or remote
oversight monitoring. Continued technology advances may help relieve the time
commitment of human caregivers.
Since the implementation of the Medicare Prospective Payment System in
1999, home health agencies have been looking for more cost-effective ways to
provide care. Telehomecare is a more effective way to deliver home care
under certain circumstances. Since it is a rapidly developing field, it's difficult to
define all telehomecare applications.
It usually involves two-way electronic communication between the patient and
the formal caregiver such as a nurse or doctor. Communication can occur with
two-way radio, telephone or as is usually the case, two-way interactive video
using a computer and phone lines or satellite downlink. This electronic face-to-
face home visit also requires some means for the care provider--who might be
hundreds of miles away-- to access patient vital signs and receive patient-
initiated medical tests. The patient or her in-home informal caregiver has been
trained to use electronic monitoring or test equipment that sends the relevant
video snapshots or numeric data via phone line, or radio wave to the formal
caregiver.
Telehomecare is not only more cost-effective but also in many cases it
provides a higher quality of care. Here are some of the ways telehomecare is
proving to be beneficial:
- reducing number of visits to the emergency rooms
- reducing unnecessary visits to physician's offices
- avoiding unnecessary costly visits by health providers
- providing education of the patient in early symptom management
- monitoring vital signs on a 24-hour basis, therefore providing a potential
for early intervention and/or prevention of repeat hospitalization
Although electronic monitoring of patients is also a function of telehomecare, it
is also becoming a primary source of supplemental home care service not
always involving the use of a home health agency. This area of assistance
focuses more on the use of devices that warn of problems with homebound
people who are often without caregivers for certain periods of the day. This
may include 24-hour vital sign monitoring, video surveillance, emergency
signaling systems or GPS locator devices for wandering care recipients.
Those people requiring the assistance of a caregiver generally fall into 3
categories: Acute care patients, chronic care recipients and younger
individuals with permanent mental impairment requiring supervision.
Acute Care
Acute care is often a rehabilitative recovery from a hospital stay or it may be a
recovery from a serious illness or injury. With acute care, the individual is
typically under the formal supervision of a nurse, physical therapist or nurse's
aide. Recovery can be at home but is more likely to be in a hospital rehab
wing or skilled nursing facility. Recovery time is usually a matter of a few
weeks or months after which the person–even if not completely whole-- is
typically capable of not needing a caregiver to function normally.
Acute conditions that may require the assistance of a caregiver might be
recoverable brain damage or spinal cord injuries and orthopedic traumas or
elective orthopedic surgery, especially to the back or feet, which are slow to
heal. Other serious injuries from accidents may also require formal or informal
caregiving. Serious acute circulatory conditions such as a heart attack, mild
stroke or infectious diseases of the heart or blood vessels may require a
caregiver. Cancers, especially the types affecting the abdominal cavity, may
require a caregiver before death or recovery occurs. And many severe
infectious diseases may result in a recovery period where the patient is too
weak and needs a caregiver.
Chronic Care
Certain diseases, disorders, accidents or injuries result in disabilities that last
longer than a few weeks or months. Many of these become permanent
problems and although the disabled person may eventually adapt to take care
of himself, a caregiver is often needed. The location of where this care is
given, either in the community or in an institution and whether the care is
provided by informal or formal caregivers is dependent on the nature of the
disability and the ability of the caregiver.
Constraints on the ability of an informal caregiver to watch over a loved one
are:
- the amount of time needed to care for the disabled
- the need to balance a job with the demands of caregiving
- the need for medical supervision of the disabled person
- the physical demands of moving the disabled
- the issue of the dignity and privacy of the caregiver and the disabled over
changing dirty diapers or helping in the bathroom with toileting and bathing.
Often an informal caregiver will attempt to provide this care perhaps out of
love or a sense of obligation, but a better solution for everyone involved might
be the use of a formal caregiver such as a home health agency or an assisted
living facility. The nature of the chronic condition also dictates who gives care
and where.
Many informal caregivers attempt to cope with care beyond their ability or
expertise. Added to this pressure is the fact that the care recipient is often
reluctant to give up the familiar environment of the home in favor of what might
be better care and a more stimulating environment in an assisted living facility
or a nursing home.
Chronic conditions resulting in permanent care might include permanent spinal
cord or brain damage, disabling strokes, advanced congestive heart failure,
various dementias such as Alzheimer's Disease, Parkinson's Disease,
emphysema, various hereditary disorders such as Huntington's Disease,
advanced diabetes, obesity-induced joint failure, disabling amputation, chronic
disabling pain caused by injury or diseases such as pancreatitis, advanced
osteoarthritis especially of the back, advanced osteoporosis with stress
factors, AIDS and a host of slow-acting incurable cancers.
Many of the above problems are more prevalent with advanced ages and as a
rule, caregiving is a problem associated with aging. But many people of all
ages often develop disabling conditions requiring care. And many of these are
progressive forms of auto-immune disorders such as type I diabetes,
rheumatoid arthritis, multiple sclerosis, scleroderma, lupus, ALS, muscular
dystrophy, myesthenia gravis, and many more.
Mental impairment developed early in life
Many of the roughly 5 million persons between the ages 18 to 65, requiring
caregivers, are impaired due to mental retardation, autism, Down's Syndrome,
mental illness or severe depression. Many will live an entire lifetime needing
supervision and because they have such a long-term need their numbers tend
to skew the data for age-related caregiving. Although no studies are available
showing the incidence of first-time caregiving-–number of people per 10,000
needing care each year for the first time–-this incident rate would probably be
very low for young-aged individuals and high for the old-aged.
For people over age 65, the average need for care is probably only 2 to 4
years before recovery or death. With the aged there is a constant turnover of
new cases replacing those who die or recover. With the mentally impaired, the
need for care may drag on for scores of years. There is less turnover due to
death or recovery and these unfortunate people tend to accumulate in number.
Although many of these people are cared for at home under supervision of
their family, many more are cared for in special facilities licensed for this type
of care. Both formal and informal caregivers are supported by government
programs to help relieve the financial burden this type of caregiving can
impose.
Custodial Care versus Skilled Care
Custodial care and skilled care are terms used by the medical community and
health care plans such as health insurance plans, Medicare, Medicaid and the
Veterans Administration. They are used primarily to differentiate care provided
by medical specialists as opposed to care provided by aides, volunteers,
family or friends. The use of these terms and their application is important in
determining whether a health care plan will pay for services or not. Generally,
skilled services are paid for by a health care plan and custodial services, not in
conjunction with skilled care, are not covered. However, custodial services are
almost always a part of a skilled service plan of care and by being included,
custodial services are paid by the health care plan as well. Many people have
the misconception that only skilled services are covered. This is simply not true.
According to the American College of Medical Quality:
" Skilled care is the provision of services and supplies that can be given
only by or under the supervision of skilled or licensed medical
personnel. Skilled care is medically necessary when provided to improve
the quality of health care of patients or to maintain or slow the
decompensation of a patient's condition, including palliative treatment.
Skilled care is prescribed for settings that have the capability to deliver
such services safely and effectively.
Custodial care is the provision of services and supplies that can be given
safely and reasonably by individuals who are neither skilled nor
licensed medical personnel. The medical necessity and desired results of
skilled care must be clearly documented by a written treatment plan
approved by a physician. A patient may have skilled and custodial needs
at the same time. In these circumstances, only those services and
supplies provided in connection with the skilled care are to be
considered as such. The treatment plan must include:
• The applied therapies;
• The frequency of the treatment which is consistent with the
therapeutic goals;
• The potential for a patient's restoration within a predictable period of
time, if applicable;
• The time frame in which the prescribing physician will review the case
for the purpose of evaluating a patient's status and before reassessing
the medical necessity of ongoing treatment; or
• The maintenance, palliative relief, or the slowing of decompensation
in a patient's status, if applicable.
Determinations of the medical necessity of skilled care must be based
on the applicable standard of care."
Writers and advisers who are not part of the medical community often confuse
custodial care and skilled care with specific care activities. For example help
with the activities of daily living and many of the items on the list in the previous
section are care activities thought to be by definition custodial care. Whereas
the monitoring of vital signs, ordering medical tests, diagnosing medical
problems, administering of intravenous injections, prescribing and dispensing
medicine, drawing blood, giving shots, dressing wounds, providing therapy and
counseling are all activities normally associated with skilled care.
But many non-medical advisers and writers don't know that skilled and
custodial refer to the people who deliver the care not the actual care
given.
A skilled care provider can also provide services normally thought to be
provided by custodial caregivers. Such things as help with activities of daily
living and so-called instrumental activities of daily living are often furnished by
skilled providers in the course of their treatment. Or a skilled care plan may
call for services that can be delivered by a custodial caregiver but it would still
be under the skilled plan of care for that individual. On the other hand people
who deliver custodial services may from time to time perform those activities
supposedly reserved for skilled providers. Such things as taking blood
pressure, administering medicines, giving shots or changing wounds might be
provided under certain circumstances by a custodial provider.
Please remember that the terms skilled and custodial do not refer to
specific types of long-term care services but rather who delivers those
services. Also the delivery of skilled services must be done under a written
plan of care which often includes custodial care services.
Does Medicare Cover Custodial Care?
Of course it does. Medicare routinely pays for custodial care in every skilled
care setting for which it provides payment. Medicare will not pay for custodial
care in the absence of a skilled care plan.
Medicare covered nursing home stay
A patient receiving skilled care in a nursing home from Medicare not only
receives care from skilled providers such as nurses, therapists or doctors but
also receives care from custodial providers such as aides or CNA's. This care
usually consists of help with bathing, dressing, ambulating , toileting,
incontinence, feeding and medicating. Medicare does not exclude the custodial
services but pays the entire bill because custodial care is a necessary part of
the skilled care plan in a nursing home.
Medicare covered home care
Custodial care is always a part of a skilled care plan for home care. The
patient receives skilled care from a nurse or therapist and custodial care from
an aide for help with bathing, dressing, ambulating , toileting, incontinence,
medicating and possibly feeding. Medicare pays for both types of services.
Medicare hospice care
The hospice team consists of a doctor, a nurse, a social worker, a therapist
when needed, a counselor and an aide to provide custodial care. Help with
activities of daily living is provided at home or in a Medicare approved hospice
facility. Custodial care is always a part of a hospice plan of care and Medicare
routinely pays for these services.
Please note that there is no such thing as a custodial nursing home. All
nursing homes are by definition skilled care facilities because they have nurses
who are skilled care providers. Also be aware that not all states license
intermediate care facilities which might provide less than 24 hour registered
nursing care. "Skilled care patients" in nursing homes are referred to as such
because they are receiving payment from Medicare or sometimes payment
from private health insurance plans. Practically all nursing home residents
have medical needs but Medicare and other insurance plans will only pay for
patients that have certain acute medical needs where recovery is anticipated.
Patients with chronic medical problems are typically not covered by Medicare
but would be covered by Medicaid.
The confusion with understanding the term "skilled nursing care" probably
comes from Medicare itself. To be a certified Medicare nursing home and
receive payments from Medicare a nursing home must meet the Medicare
definition of a "skilled nursing facility". This means there must be registered
nurses on duty 24 hours a day, there must be a doctor on call at all times and
there must be ambulance service to a local hospital. Medicare may also
require additional staffing and facility arrangements to receive certification. It is
unfortunate that the word "skilled" is used in this definition. All nursing homes
whether they meet the definition of a "skilled nursing facility" or not provide
services from a nurse, doctor or therapist and this meets the medical definition
of skilled care. Many states have adopted the same federal criteria for
licensing their nursing homes. In some states the "skilled" definition is the only
option for a nursing home. But in some states facilities with lesser services can
receive different licensing classes. These might be called intermediate care
facilities or "small nursing homes".
Formal Caregivers
Formal caregivers are volunteers or paid care providers associated with a
service system. Service systems might include for-profit or nonprofit nursing
homes, intermediate care facilities, assisted living, home care agencies,
community services, hospice, church or charity service groups, adult day care,
senior centers, association services, state aging services and so on. More
detail on the services, availability and costs of nursing homes, assisted living
facilities and home care agencies are provided in other sections of this site.
During 1998, in the U.S., 9.5 million patients were served by home health
agencies and 576,000 by hospice care. This care was provided by
approximately 13,000 agencies, nationwide. The percent distribution of
disorders requiring home care were: diseases of circulatory system–25.2%,
injuries and poisoning–9.9%, muscle and skeletal disease–8.8%, respiratory–
8.4%, cancer–7.3%, endocrine, nutrition, metabolic, immune–5.4%, nervous
system– 4.3%, others–balance of distribution. Of the patients served by
hospice, about 76% had cancer or heart disease.
In 1997, there were about 17,000 skilled and intermediate term nursing homes
in the US serving 1,609,000 residents. About 1,465,000, or 91% of residents,
were age 65 and older. Out of those 1.5 million elderly patients in nursing
homes in 1997, as a percent of the total, help was provided with 1 or more
activities in the following categories: bathing or showering–96.2%, dressing–
87.2%, using toilet room–56.2%, eating--45%, transferring to chair or bed–
25.4%.
As of the year 2000, an estimate by NatWest Securities places the total
number of assisted living beds nationwide at 1,387,836 beds with total
revenue of $33.1 billion. Although assisted living facilities (ALFs) are regulated
by the state health departments, data for utilization and cost don't show up in
national statistics. And although Medicaid covers some cost for ALFs, the
costs of numerous waiver systems used by states aren't shredded out
separately.
The numbers of people using ALFs are included in those 9.5 million receiving
care in the community. A 1996 survey by the American Health Care
Association reveals that 59% of ALF residents are admitted from their homes
and the other 41% come from nursing homes, hospitals or other ALFs.
Some ALFs have found a niche in providing care to Alzheimer's patients and
many ALFs are exclusively dedicated only to Alzheimer's residents. This
disorder requires constant supervision but not necessarily from the more costly
skilled medical staff found in nursing homes. And since at least 5% of those
over 65 and 46% of those over 85 suffer from mental impairment, this provides
a potentially large market for ALF Alzheimer's facilities
Not all residents of ALFs need care or assistance. Many are there because
they want a simpler lifestyle without the worry of maintaining a home and they
seek the companionship of other people their own age. They have chosen
assisted living because they may need some minor help with IADLs but they
anticipate a time when they may need the more intensive care available with
an ALF.
As of 1996, ALF residents who were independent with ADLs (needing no
assistance) were as follows: eating--88%, transferring--84%, toiletting--78%,
dressing--58%, bathing--49%. A recent survey of assisted living administrators
estimated that 24% of their residents received assistance with 3 or more
activities of daily living, such as bathing dressing and mobility. They estimated
that about one-third of residents had moderate to severe cognitive impairment.
Informal Caregivers
Informal caregivers are family, friends, neighbors or church members who
provide unpaid care out of love, respect, obligation or friendship to a disabled
person. These people far outnumber formal caregivers and without them, this
country would have a difficult time formally funding the caregiving needs of a
growing number of disabled recipients.
Depending on the definition of caregiving, estimates of the number of informal
caregivers range from 20 million to 50 million people. This could represent
about 20% of the total population providing part-time or full-time care. The
typical caregiver is a daughter, age 46, with a full-time job, providing an
average of 18 hours per week to one or more of her parents.
Among adults aged 20 to 75, providing informal care to a family or friend of
any age, 38% care for aging parents and 11% care for their spouse. About
two-thirds of those caregivers for people over age 50 are employed full-time
or part-time and two-thirds of those–about 45% of working caregivers–report
having to rearrange their work schedule, decrease their hours or take an
unpaid leave in order to meet their caregiving responsibilities.
A recent study estimates these people lose about $660,000 in wage wealth
over their lifetime because of work sacrifices. And estimates of productivity
losses to businesses because of time off for caregiving range from $11 billion
to $29 billion yearly. The average amount of time informal caregivers provide
assistance is 4.5 years but 20% will provide care for 5 years or longer.
Understanding the Progression of Care Commitment
The chart below illustrates the relationship of informal care to formal care. As
care needs increase, both in the number of hours required and in the number
or intensity of activities requiring help, there is a greater need for the services
of formal caregivers. Unfortunately, many informal caregivers become so
focused on their task they don't realize they are getting in over their heads and
they have reached the point where some or complete formal caregiving is
necessary. Or the informal caregiver may recognize the need for paid,
professional help but does not have the money to pay for it.
It is the job of a care manager or a financial adviser or an attorney to
recognize this need with the client caregiver and provide the necessary
counsel to protect the caregiver from overload. An overloaded caregiver is
likely to develop depression and/or physical ailments and could end up needing
long-term care as well. Or the consequences of not being able to cope with
caregiving might even result in an early death for the caregiver.
Intermittent Care
This would require the occasional attention of an informal caregiver but there
may also be a medical condition that may require expertise the informal
caregiver does not possess. As a general rule most people receiving this kind
of care would probably be in their own home and the caregiver would be living
or working close by and stop only for occasional visits.
There is, however, a growing trend where the only family caregivers may be
living hundreds or thousands of miles away from their loved one. In this case, a
care manager would be hired to arrange for the intermittent care for the loved
one.
Part Time Care
This could still be furnished by an informal caregiver assuming there is no
extensive medical condition requiring frequent attention. It is more likely under
this scenario the care-recipient and the informal caregiver would be living
together. Or with no caregiver available a decision would have to be made
whether it would be in the best interest of the care-recipient to receive formal
care in the home or to go to a care facility. Oftentimes a care facility can offer
a better environment at a lesser cost. On the other hand, many care-recipients
prefer to remain in their homes at all costs. And for long distance caregivers,
hiring a care manager is still the best option.
Full-Time Care
Full-time care can often be offered by informal caregivers living with the care-
recipient. But this arrangement is not always in the interest of the caregiver.
Because of the demand on a caregiver's time and attention, this arrangement
will often result in the caregiver suffering from severe depression, social
isolation and the development of medical ailments. Again, the decision is often
dictated by the lack of funds to pay for professional care. But when the need
for care has progressed to a fulltime basis, advisers or family should be
looking to implement formal care delivery either in the home or in a facility. As
with the other care options above, a care manager could prove invaluable in
selecting the setting and the care providers.
Depending on what causes the need for long-term care, a care-recipient could
start out at any point on the curve below. For instance a stroke, injury or
sudden illness may result in the immediate need for part time or fulltime care.
On the other hand the slowly progressing infirmity of old age, the slow onset of
dementia or a progressively deteriorating medical condition may only require
occasional help; beginning with intermittent care from an informal caregiver but
gradually progressing to the need for fulltime, formal care.
One of the biggest concerns of elderly Americans is the high cost of medical
care. There are 35 million people over the age of 65 in this country and they
comprise 12.8% of the population.
Despite the fact that the elderly comprise only 12.8% of the population, they
consumed at least 24% of all health expenditures in 1997 in the form of
Medicare and Medicaid outlays. This demonstrates that health care for the
elderly is costing more per year on average than for younger age groups.
A 1996 survey by Medicare reveals average yearly total health care costs
(service, insurance premiums and drugs) as follows: ages 65 to 69--$5,864,
ages 70 to 74--$6,744, ages 75 to 79--$9,414, ages 80 to 84--$11,256, ages
85 and older--$16,465. For these older ages, the primary reason for the 3 fold
increase in cost from age 65 to age 85 is the cost of caregiving.
It is estimated that only about 9% of 65 to 69 year-olds are receiving help
from a caregiver whereas about 50% of the age 85+ are receiving care. About
half of all nursing home residents are 85+. And use of home care for the very
old is also higher. Between 1998 and 1999, home health agencies made 2,350
visits for every 1,000 enrollees aged 65 to 74, compared with 12,709 per
1,000 for enrollees aged 85+.
It is the high cost of long-term care that should worry older Americans more
than the cost of medical services, drugs or health insurance premiums. In 1996
older Americans living in nursing homes incurred $38,906 in annual health care
expenditures on average, compared with $6,360 among older persons living in
the community. Nursing home accounted for 64 percent of total expenditures
of the institutional population.
The need for receiving long-term care increases as a person ages. And the
probability of needing care becomes very high for the very old. It should also
alarm elderly Americans that the ranks of the very old are growing at
astronomical rates. Those over age 85 are the fastest growing population
group in the nation.
From April 1, 1990 to July 1, 1998, this age group increased 34.1% by more
than 1 million people as compared to the entire population which grew at a
rate of 8.6%. At this rate of growth, in another 50 years, this age group would
be about two-thirds as large as the current total US elderly aged 65+ of 35
million people. With a high probability of caregiving demand, this group would
wipe out the current government programs design to pay formal caregivers.
Most elderly people in this country focus on providing the means to pay the
high cost of medical services and drugs but tend to ignore the 6 fold times
higher potential cost of long-term care. With the probability that government
programs may not help them in the future, elderly Americans should shift their
focus to providing the means to pay for the high cost of long-term care.
In 1997, the national cost for home health care was $32 billion while the cost
of nursing homes was $83 billion. This amounted to 10.5% of the total $1.1
trillion in health care costs for that year. This percent is projected to remain
fairly stable through the year 2005.If we go back and add to the formal cost of
care the estimated cost of $197 billion for informal care, we have a whopping
24% of the national health care budget devoted to caregiving.
Currently the government pays close to 40% of formal caregiving costs. If
there were a future decline in the amount of available informal care
accompanied by increase in demand for that care the government would be
forced to absorb a great deal of those added costs. To put this in perspective
bear in mind that Federal funding for Medicare is expected to run into deficit in
the next few years and that state governments are already strapped in
meeting public health care needs.
In 1997, Federal outlays for Medicare, Medicaid and other health programs
were $367 billion. Adding in $140 billion in state and local spending, total
government costs for health care in 1997 were $507 billion–about 46% of all
health care cost, private and public. Payments for formal care absorbed $51.5
billion or 10% of government outlays already in that year. Had the government
been forced to absorb the cost of informal care as well, it would have
amounted to 35% of the budget and would have severely hampered the quality
of other health services for 40 million Medicare recipients and millions more of
Medicaid participants.
Could this happen? Is there currently a trend away from unpaid informal care
towards paid formal care that could destroy the current public health care
system?
Demographic trends over the past 50 years suggest that not only is the ratio
of informal caregivers to those needing care getting smaller, but the availability
of caregivers (living within the same community or state) in some regions of
the country is also becoming a problem.
The national birthrate has been declining year over year while simultaneously
the total number and percent of the population over 65 has been steadily
increasing. From 1950 through 1999 the annual birthrate has declined from
24.1 per 1,000 to 14.5 per 1,000. At the same time the age adjusted death
rate went from 5.9 per thousand in 1980 to 4.7 per thousand in 1998.
These statistics reveal that the younger population is growing more slowly
while the older population is growing more rapidly. By the year 2050 the
population over 65 is projected to grow from 12.8% of the total to 20.3%.
Simple logic would show that the number of young caregivers is declining in
proportion to a larger older generation that will inevitably need care. There is
also a growing trend towards more households headed by single individuals.
This will eventually reduce the number of healthy spouses available for
caregiving as well.
As we learned from the section on cost of care, the need for caregiving
increases with age. Compounding the challenges outlined above is the rapid
growth of the very old age group which already accounts for over half of all
nursing home residents and a large proportion of those needing community
care. By the year 2050 this group will have grown from 4,333,000 people,
today, representing 1.5% of the population to about 20,000,000 people,
representing 4% of the population. Since this group has the greatest need for
care, this trend will further deplete the numbers of available, future informal
caregivers.
Finally, many potential caregivers have moved away and are not able to
provide care for family or friends. This is particularly a problem for farmbelt
states and rural communities where young people have left for better
economic opportunities in urban areas. This trend shows no signs of reversing
and the resulting lack of caregivers is putting great stress on affected
communities and government programs.
If no solution is found for the loss of informal caregivers, much of the burden of
providing care will shift to government-funded programs since no viable private
sector alternative now exists. The added strain to an already underfunded
senior health program could lead to a failure of the entire system.
Caregiving can be very stressful and demanding. In the case of a healthy
spouse or a child living with the disabled person at home, caregiving can be a
24 hour, 7 day a week commitment. But even for the caregiver not living in the
home, looking after a loved-one or friend can consume all of the caregiver's
free time.
Surveys and studies consistently show that depression is a major problem with
full-time informal caregivers. This is typically brought on by stress and fatigue
as well as social isolation from family and friends. If allowed to go on too long,
the caregiver can sometimes break down and may end up needing long-term
care as well.
A typical pattern may unfold as follows:
- 1 to 18 months--the caregiver is confident, has everything under control
and is coping well. Other friends and family are lending support.
- 20 to 36 months--the caregiver is taking medication to sleep and control
mood swings. Outside help dwindles away and except for trips to the
store or doctor, the caregiver has severed most social contacts. The
caregiver feels alone and helpless.
- 38 to 50 months--Besides needing tranquilizers or antidepressants, the
caregiver's physical health is beginning to deteriorate. Lack of focus and
sheer fatigue cloud judgment and the caregiver is often unable to make
rational decisions or ask for help. It is often at this stage that family or
friends intercede and find other solutions for care. This may include
respite care, hiring home health aides or putting the disabled in a facility.
Without intervention, the caregiver may become a candidate for long-term
care as well.
Since most people go into informal caregiving without training or counseling
they often aren't aware of the possible outcome described above. It is
therefore extremely important to receive counseling and to formulate a plan of
action prior to making a caregiving commitment. In 1965, Congress passed the
Older Americans Act which provides guidance and funding to the States to
give help to caregivers. All states offer programs at no cost or very low cost
which might include: counseling, caregiver training, respite care, adult day
care, meals, support groups and much, much more. IT IS VITAL FOR THE
HEALTH AND LONGEVITY OF ALL CAREGIVERS TO MAKE USE OF
THESE SERVICES.
We have seen that most caregiving in the US is provided in the community by
unpaid, so-called informal caregivers. There is a growing trend towards fewer
available caregivers trying to support a rapidly growing number of people
needing care. This trend will require the use of more paid or formal caregivers
and may greatly affect the ability of government to keep up with growing
demand for paid care. Citizens should plan for ways to fund care for
themselves. Finally, many don't know the effects that caregiving can have on
mental and physical health. States offer help programs that include counseling,
training and caregiver services.
About the Author,Thomas Day
Thomas Day specializes in the area of long term care planning. As director of the
National Care Planning Council and chief spokesman for the Utah Elder Care
Planning Council he maintains a busy schedule conducting workshops, making
presentations and giving advice to concerned caregiving families. He is also
responsible for maintaining several Internet sites one of which,
www.longtermcarelink.net is a frequently visited and popular site for long term care
issues. Tom is also busy writing articles and completing two new books on long term
care planning to be published by the National Care Planning Council.
For many years, prior to becoming involved with long term care issues, he taught
retirement planning seminars at two local colleges. As a result of this effort he began
practicing fee-based financial planning. He was also a registered investment adviser.
A particularly trying experience with long term care with both of his parents and with
the parents of his wife, Susan, convinced him that most people fail to plan for one of
the greatest crises in their lives, long term care. For the past 10 years he has
devoted his practice exclusively to helping people plan for long term care or as it is
more commonly called eldercare.
Tom graduated from the University of Utah with a BA in physics and math and an
MBA in finance. He holds a CLU designation from the American College. Tom and
his wife Susan live in Centerville, Utah. They have seven children and 17
grandchildren.
Please contact Tom at (801) 298-8676 or tomday@longtermcarelink.net
| Thank You Janet L. Heitzig, CLU, ChFC, CLTC for sharing this ariticle with us. Janet L Heitzig, CLU, ChFC, CLTC Principal Financial Group 14755 N Outer 40-Ste 110 Chesterfield, MO 63017 Phone 636-449-0734 Fax 1-866-488-0903 Securities and advisory products offered through Princor Financial Services Corporation, 800/247-4123, member SIPC, Des Moines, IA 50392. Senior Strategies, L.L.C. is not an affiliate of Princor. e-mail Heitzig.Janet@principal.com Princor Registered Representative, Financial Advisor, Financial Representative, Principal Life Insurance Company. |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
This article reprinted with permission from the National Care Planning Council for non-commercial use. Find original article at this webaddress: http://www.longtermcarelink.net/eldercare/caregiving.htm |
