What is the marginal benefit of payment‐induced family care? Impact on Medicaid spending and health of care recipients

Norma B. Coe; Jing Guo; R. Tamara Konetzka; Courtney Harold Van Houtven

doi:10.1002/hec.3873

Ethical Issues in Family Care Today

Annual Review of Nursing Research ◽

10.1891/0739-6686.34.67 ◽

2016 ◽

Vol 34 (1) ◽

pp. 67-87 ◽

Cited By ~ 2

Author(s):

Patrick Barrett ◽

Mary Butler ◽

Beatrice Hale

Keyword(s):

Lived Experience ◽

Family Caregivers ◽

Ethical Issues ◽

Family Care ◽

Well Being ◽

Formal Caregivers ◽

Care Recipients ◽

Practical Concern ◽

Social Scientific ◽

Caregiver Role

The abstract consideration of ethical questions in family and informal caregiving might rightly be criticized for ignoring the lived experience of people. This chapter seeks to avoid such oversight by reflecting on ethical issues in family care in a way that is based on careful social scientific inquiry into the well-being of caregivers. The chapter draws on our research and experience in working with family caregivers, both professionally and personally. We step back from a practical concern with policies to support the well-being of caregivers to consider ethical issues associated with their typically hidden role. The chapter begins by noting the growing reliance on family care today. It proceeds to outline the dynamic experience of moving into and out of the caregiver role, before discussing key ethical issues associated with family care. Many of these stem from the risk that caregivers can come to share in the reduced circumstances and vulnerability of those for whom they care. Critical ethical issues are related to the typically "unboundaried" responsibility of family caregivers for the well-being of the cared-for person, something that can be contrasted with the more boundaried and intermittent responsibility of formal caregivers. Additionally, all too often, family caregivers encounter situations where their responsibilities exceed their capacities, but where a choice to not provide care will result in harm to the cared-for person. In discussing these issues, this chapter seeks to make the case for developing more responsive forms of support that promote positive benefits for both caregivers and care recipients.

Non-pharmacological interventions a feasible option for addressing dementia-related sleep problems in the context of family care

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00851-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Rosemary Gibson ◽

Anthony Dowell ◽

Linda Jones ◽

Philippa Gander

Keyword(s):

Sleep Disturbances ◽

Sleep Problems ◽

Treatment Options ◽

Family Care ◽

Bright Light ◽

Light Therapy ◽

Future Research ◽

Family Carers ◽

Pharmacological Interventions ◽

Care Recipients

Abstract Background Sleep disturbances are challenging symptoms associated with mild cognitive impairment or dementia (MCIoD). This study assessed the feasibility of sleep monitoring and non-pharmacological interventions to improve the sleep of New Zealanders with MCIoD and their family carers. Methods A 5-week multi-modal intervention consisting of timed bright light therapy, physical activity, and sleep education was piloted. Sleep was monitored for a week at baseline and conclusion of the trial using actigraphy, diaries, and questionnaires alongside additional health and wellbeing information concerning both care recipients and carers. Results Fifteen pairs participated, 9 completed the trial. Patterns of attrition and participant feedback are discussed. Case studies showed that six of the care recipients had minor improvements to sleep efficiency. Some also had improved subjective sleep ratings and quality of life. Changes did not clearly translate to family carers. However, five of them also showed some improvements in sleep status and mental health. Health deterioration of care recipients may mask the effects of the intervention. Conclusions It is feasible to use non-pharmacological sleep interventions for people with MCIoD and their family carers. Given the limited treatment options, further consideration of such interventions in future research and clinical practice is warranted. Trial registration As this study was to assess the feasibility of proposed methods, it was an observational study without case-control groups nor a medical-based intervention, clinical registration was not required. A future full version of the trial would be registered with the Australian New Zealand Clinical Trails Registry.

A Systematic Review of Interventions That Reduce Family Caregiving Time

Innovation in Aging ◽

10.1093/geroni/igab046.1034 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 269-269

Author(s):

Eric Jutkowitz ◽

Joseph Gaugler ◽

Zachary Baker

Keyword(s):

Systematic Review ◽

Family Caregivers ◽

Family Caregiving ◽

Family Care ◽

Care Gap ◽

Health Trends ◽

Care Recipients ◽

Multicomponent Interventions ◽

Published Research

Abstract Due to multiple long-term sociodemographic and health trends contributing to the impending family care gap, there likely is no single policy or intervention that could increase the number of family caregivers in the U.S. to the levels required to fill such a gap. However, the amount of time that a family caregiver spends providing assistance is potentially mutable. Given the pressing concerns of the family care gap, identifying interventions or approaches that could reduce existing caregiving time is of considerable importance. This presentation provides the results of a systematic review of published research to identify the effects of interventions on the amount of time family caregivers spend on their caregiving tasks. Pharmaceutical approaches directed to care recipients, technology interventions, case management, multicomponent interventions, and care settings all appeared to reduce caregiving time. Improved operationalization, study design, and similar factors will help guide future intervention research to reduce caregiving time.

Predictors of Family Caregiver Burden in Shanghai

Journal of Applied Gerontology ◽

10.1177/0733464820951029 ◽

2020 ◽

pp. 073346482095102

Author(s):

Jun Li

Keyword(s):

Caregiver Burden ◽

Family Caregiver ◽

Functional Disability ◽

Economic Status ◽

Family Care ◽

Ordinary Least Squares ◽

Urban China ◽

Policy Implications ◽

Care Recipients ◽

Family Caregiver Burden

This study explored predictors of family caregiver burden against the backdrop of the rapidly aging population and gradually weakening family care in urban China. It used a unique sample from the 2017 survey on older adults with functional disability and their family caregivers in Shanghai, China. A multi-pronged approach and ordinary least squares (OLS) regression were employed to identify predictors of family caregiver burden. Statistical analysis revealed that approximately 25% of caregivers felt stressed. Many independent variables related to caregivers, care recipients, their relationship, and social support had statistically significant impacts on caregiver burden. This study also found that caregiver educational level, caregiver family economic status, and the number of other caregivers had significant moderating effects on the correlation between older people’s ability to perform activities of daily living (ADL) and family caregiver burden. Policy implications derived from those findings were also discussed.

Conclusion

Taking Care of Our Own ◽

10.7591/cornell/9781501751448.003.0008 ◽

2020 ◽

pp. 126-142

Author(s):

Sherry N. Mong

Keyword(s):

Health Care Professionals ◽

Family Care ◽

Positive Change ◽

Care Recipient ◽

Work Process ◽

Home Support ◽

Care Recipients ◽

Medicaid Waivers ◽

The Relationship ◽

Support Family

This chapter proposes how positive change can be made for families who are enacting skilled medical labor. Caregivers' journeys with care recipients reflect varied experiences in interactions with medical professionals and in the training they receive. Though many caregivers experience feelings of anxiety and worry, they say they “do what they have to do” to provide care for those they love. It is the relationship with the care recipient that motivates their labor, and despite some ambivalent feelings, many have strong feelings against institutionalization. Positive change can be made for families who are enacting skilled medical labor and improve the work process for caregivers, care recipients, and nurses alike through robust national policies that support family care work are in order. Home support would also increase the confidence of caregivers and reduce emotional burdens by having credentialed nurses and health care professionals make regular home visits and providing more in-home support are essential. Adequate work leave policies for families should also be in place. The financial needs of caregivers should be considered, including their loss of jobs and income. The existing policies have been fragmented, state driven, targeted only to certain care recipients and their caregivers, and highly dependent on complicated Medicaid waivers. It is time to recognize and compensate caregivers for the work they do and to make sure that care recipients also have adequate support.

A Systematic Review of Interventions That Reduce Family and Friend Caregiving Time

Innovation in Aging ◽

10.1093/geroni/igaa057.1126 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 350-350

Author(s):

Zachary Baker ◽

Eric Jutkowitz ◽

Joseph Gaugler

Keyword(s):

Case Management ◽

Care Setting ◽

Family Care ◽

Cross Sectional ◽

Term Care ◽

Care Gap ◽

The Public ◽

Care Recipients ◽

Quasi Experimental

Abstract The decreasing number of family/friend caregivers available to help the rising number of older adults is creating a critical family care gap. For this reason, there is a growing need for interventions that reduce family/friend caregiving time. We systematically reviewed five electronic databases to identify randomized trials, case control, quasi-experimental, and cross-sectional studies that evaluated a modifiable element that could be targeted for interventions with care recipients 65+ and/or their family/friend caregivers and reported on an outcome of time spent caregiving. We excluded studies without a comparison, broadly defined. The initial search included 1,812 unique records. Following abstract and title screening 311 full-texts were reviewed. Fifty-five studies published between the years of 1990 and 2019 met inclusion criteria. Studies predominantly focused on care recipients with dementia (58%) and were largely conducted in western countries (91%). The categories of interventions reviewed included pharmaceuticals (25%), public long-term care financing (7%), case management (7%), care setting (16%), technology (7%), multi-component interventions (9%), skills building (15%), additional formal expertise/care (9%), and other (5%), with one study falling into multiple categories. Pharmaceuticals, case management, care setting, and multi-component interventions demonstrated promising evidence to reduce family/friend caregiving time. Methodologically, studies were inconsistent in measurement and ascertainment of caregiving time. Given the public health concerns of reduced availability of family/friend caregivers for older persons in the upcoming decades, caregiving interventions should consider measurements of caregiving time as key outcomes.

Non-pharmacological Interventions a Feasible Option for Addressing Dementia-related Sleep Problems in the Context of Family Care

10.21203/rs.3.rs-58103/v1 ◽

2020 ◽

Author(s):

Rosemary Gibson ◽

Anthony Dowell ◽

Linda Jones ◽

Philippa Gander

Keyword(s):

Sleep Disturbances ◽

Sleep Problems ◽

Treatment Options ◽

Family Care ◽

Bright Light ◽

Light Therapy ◽

Future Research ◽

Family Carers ◽

Pharmacological Interventions ◽

Care Recipients

Abstract Background: Sleep disturbances are challenging symptoms associated with mild cognitive impairment or dementia (MCIoD). This study assessed the feasibility of sleep monitoring and non-pharmacological interventions to improve the sleep of New Zealanders with MCIoD and their family carers. Methods: A five-week multi-modal intervention consisting of timed bright light therapy, physical activity, and sleep education was piloted. Sleep was monitored for a week at baseline and conclusion of the trial using actigraphy, diaries, and questionnaires alongside additional health and wellbeing information concerning both care recipients and carers. Results: Fifteen pairs participated, 9 completed the trial. Patterns of attrition and participant feedback are discussed. Case studies showed that six of the care recipients had minor improvements to sleep efficiency. Some also had improved subjective sleep ratings and quality of life. Changes did not clearly translate to family carers. However, five of them also showed some improvements in sleep status and mental health. Health deterioration of care recipients may mask the effects of the intervention. Conclusions: It is feasible to use non-pharmacological sleep interventions for people with MCIoD and their family carers. Given the limited treatment options, further consideration of such interventions in future research and clinical practice is warranted. Trial registration: As this study was to assess the feasibility of proposed methods, it was an observational study without case-control groups and therefore did not require registration. A future full version of the trial would be registered with the Australian New Zealand Clinical Trails Registry.

The Socioeconomic Covariates of Violent and Property Crime Rates in Azerbaijan

Comparative Sociology ◽

10.1163/15691330-bja10039 ◽

2021 ◽

Vol 20 (4) ◽

pp. 501-529

Author(s):

Ingilab Shahbazov ◽

Zaur Afandiyev

Keyword(s):

Poverty Alleviation ◽

Family Care ◽

Property Crime ◽

Social Benefit ◽

Socioeconomic Indicators ◽

Muslim Population ◽

Care Recipients ◽

Industrialized Nations ◽

Crime Types ◽

The Relationship

Abstract The majority of the studies exploring the relationship between socioeconomic factors and crime levels are confined to major industrialized nations. As a post-Soviet, transitional economy with a predominantly Muslim population, Azerbaijan provides a different setting to explore how socioeconomic indicators affect police-recorded violent and property crime levels across cities and districts. This study finds a positive relationship between GRP per capita, the proportion of pupils admitted to university and population size property crime levels. The relationship was linear in all cases. The geographical units with more social benefit (pensions, disability, and family care) recipients had lower acquisitive crime levels, though the significance was marginal. The higher the number of targeted social assistance recipients for poverty alleviation is, the higher the rate of violent crime is, which differs from the findings of similar previous studies. Overall, socioeconomic predictors were significantly better in explaining variations for offences against the property (r=.481) than violent crimes (r=.073). These findings suggest that different crime types are better explained by different economic indicators in the Azerbaijani context. Furthermore, the study shows that most of the covariates function in ways which are observed in the societies covered by the literature.

Characteristics of care-givers and care recipients influencing the impact of paid care services on family care-giver burdens

Ageing and Society ◽

10.1017/s0144686x13000081 ◽

2013 ◽

Vol 34 (8) ◽

pp. 1314-1334 ◽

Cited By ~ 2

Author(s):

YOSHINORI NAKAGAWA ◽

RINA YAMADA ◽

SEIGO NASU

Keyword(s):

Family Care ◽

Entire Sample ◽

Social And Emotional ◽

Care Services ◽

Care Givers ◽

Care Recipients ◽

People With Dementia ◽

Male Care ◽

Specific Care ◽

The Impact

ABSTRACTIn the last few decades, a number of researchers have attempted to identify the effects of paid care services on alleviating the sense of burden of family care-givers, especially care-givers to people with dementia. However, few researchers have considered the possibility that paid care services alleviate the sense of burden only among those care-givers who possess specific characteristics. Without considering this point, the impact of paid care services would be averaged over an entire sample, and one might overlook the effects on these specific care-givers. With this background, this study examines the relationship between family care-givers' sense of burden and the amount of paid care services in Japan and identifies groups of care-givers among whom these services are significantly associated with a lesser sense of burden. The sense of burden of 339 family care-givers to older care recipients with dementia was measured using a modified version of the Caregiver Burden Inventory. In order to examine their association with the amount of paid care services received, logistic regression analysis was individually applied to groups of care-givers who exhibit specific characteristics. The results suggested that paid care services alleviated two out of five components of burden, provided the groups to which the analyses are applied are appropriately defined. In particular, two subsets of the entire sample, comprising young care-givers aged 49 or below, and including male care-givers, indicated that their overall sense of social and emotional burden were alleviated by the use of paid care services. The practical implications for policy makers are discussed.