Supporting Family Caregivers of Older Adults through Times of Stress - - PowerPoint PPT Presentation

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Supporting Family Caregivers of Older Adults through Times of Stress - - PowerPoint PPT Presentation

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Supporting Family Caregivers of Older Adults through Times of Stress and Isolation Audio and Platform Information

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April 30, 2020

Supporting Family Caregivers of Older Adults through Times of Stress and Isolation

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Overview § This session will be interactive (e.g., polls), with 60 minutes of presenter

  • led discussion, followed by 30

minutes of presenter and participant discussion § Video replay and slide presentation are available after each session at: https://www.resourcesforintegratedcare.com

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Support Statement

§ This webinar is supported through the Medicare

  • Medicaid Coordination

Office (MMCO) in the Centers for Medicare & Medicaid Services (CMS) to help beneficiaries dually eligible for Medicare and Medicaid have access to seamless, high

  • quality health care that includes the full range
  • f covered services in both programs. To support providers in their efforts

to deliver more integrated, coordinated care to dually eligible beneficiaries, MMCO is developing technical assistance and actionable tools based on successful innovations and care models, such as this webinar. § To learn more about current efforts and resources, visit Resources for Integrated Care at https://www.resourcesforintegratedcare.com and follow us on Twitter @Integrate_Care

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Introductions

■ Kathy Kelly, MPA

Executive Director, Family Caregiver Alliance

■ Erin E. Emery

  • Tiburcio, PhD, ABPP

Associate Professor of Geriatric and Rehabilitation Psychology and Geriatric Medicine and Co

  • Director of the Center for

Excellence in Aging Rush University Medical Center

■ Bryan Godfrey, MA, MSW, LCSW

Care Management Social Worker, UNC Geriatrics Specialty Clinic

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Learning Objectives

§ Describe the challenges facing caregivers of older adults, particularly those that may be present during the COVID

  • 19

public health emergency § Identify strategies for assessing and addressing caregivers’ emotional health and the supports they may need to manage stress, isolation, and new responsibilities § Describe practical tips for effectively linking caregivers to support services provided by health care and community- based organizations (e.g., telehealth, online classes, and webinars)

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Webinar Outline § Polls § Supporting Family and Friend Caregivers § Caregiver Mental and Emotional Health § Caregiver Assessment and Resources for Caregivers § Panel Discussion § Audience Q&A § Resources § Evaluation

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Kathy Kelly, MPA

Executive Director Family Caregiver Alliance

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Supporting Family and Friend Caregivers

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Family Caregivers of Older Adults

§ Over 34 million individuals in the U.S. provide unpaid assistance and support to an older adult (50+),1 including many individuals dually eligible for Medicare and Medicaid

§

60% of caregivers of older adults are female; over half are 50 years and

  • lder1

§

14% are friends, neighbors, or other non-relatives of the care recipient1

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Family Caregivers of Older Adults (cont.)

§ Complex caregiving tasks, including medical tasks, can have negative emotional, mental, and physical health effects on caregivers2,3

§

50% of all family caregivers perform complex medical/nursing tasks (e.g., administering multiple medications, changing dressings, handling medical equipment) in the home for individuals with physical, cognitive, or behavioral health needs3

§ Many caregivers, however, also report positive experiences from caregiving, including feeling a sense of giving back to a loved one and personal meaning and purpose4 § Support services, caregiver education, and respite can all help alleviate potential negative effects of caregiving on health2

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Impact of Caregiving on Caregiver Mental and Emotional Health

§ Stress: Caregivers have higher levels of stress than non

  • caregivers and

caregivers with chronic stress may be at greater risk of cognitive decline5 § Isolation: Caregivers who provide complex care, have fewer social connections, and are less satisfied with their social supports are at higher risk of strain, depression, sleep disturbance, and poor health6 § Depression and Anxiety: Caregivers report higher levels of depressive symptoms and anxiety than non

  • caregivers; 40 to 70% of caregivers

have clinically significant symptoms of depression7

§

Caregivers of individuals with dementia have higher levels of depression and emotional stress8,9

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Caregiving in the COVID

  • 19 Pandemic

§ In addition to their typical caregiving responsibilities, caregivers may now have other concerns, including:

§

Added financial difficulties

§

Extra measures for cleaning and disinfecting

§

Limited social interaction

§

Direct care precautions (e.g., personal protective equipment (PPE))

§

Disruptions in in

  • home support services, routine doctor’s appointments, and

respite care

§ Caregivers who have older relatives living in residential care facilities or assisted living may not be able to visit their loved one in person § Older adults may have moved in with loved ones for the duration of the COVID

  • 19 pandemic; these individuals may be taking on new caregiving

responsibilities

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Caregiving in the COVID

  • 19

Pandemic (cont.)

§ During the COVID

  • 19 pandemic, caregivers may need additional

supports and services, and virtual options for accessing such supports. Services and supports that may be the most helpful include:

§

Wellness check

  • in calls

§

COVID

  • 19
  • related care protocols, education, and supplies

§

Strategies for managing behaviors associated with dementia

§

Stress reduction techniques

§

Vouchers/gift cards for food, consumable supplies, transportation

§

Short

  • term counseling

§

Direct care skills training

§

Support groups

§

Strategies for adapting to new living situations, as relevant

§

Guidance around care (and changes in care) unrelated to COVID-19

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Connecting Family and Friend Caregivers to Resources during COVID-19

§ Health plans and providers can take the following steps to connect caregivers to resources:

§

Locate the local resource clearinghouse (e.g., Area Agency on Aging, Aging and Disability Resource Center, 211 or 311 information services) to refer for assistance with specific needs or services during this time

§

Connect with or start a resource sharing roundtable with your services network

§

Gather lists of resources for family/friend caregiver services and information and disseminate widely to caregivers (included in this presentation, slides 14 and 41)

§

Convert existing support groups to telephone or online

§

Seek alternative ways to provide caregiver education or training classes virtually, or contract with organizations or individuals who can do so

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Select Caregiver Resources

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Organization Name Resource Name and Link Family Caregiver Alliance Curated COVID-19 Resources and Articles for Family Caregivers Family Caregiver Alliance Family Caregiver Alliance YouTube Videos and Webinars AARP Home Alone Alliance Medical Tasks Videos for Caregivers Center to Advance Palliative Care Palliative Care COVID-19 Resources UCLA Health Coping Skills for Caregivers of Persons with Dementia Collaborative Action Team training for Community Health — Older Adult Network (CATCH-ON) CATCH-ON: A HRSA Geriatric Workforce Enhancement Program: Caregiver Section National Council on Aging Tools for Reaching a Remote Audience

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Erin E. Emery

  • Tiburcio

, PhD, ABPP

Associate Professor of Geriatric and Rehabilitation Psychology and Geriatric Medicine Co

  • Director of the Center for

Excellence in Aging Rush University Medical Center

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Caregiver Mental and Emotional Health

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Caregivers Confront Complexity and Differing Circumstances

The context of caregiving differs for each family; care recipients have a range of needs and each family has different social, economic, and psychological factors

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Sources of Caregiver Stress

§ Lack of control and predictability

§

Disease progression, unusual and unpredictable behaviors (e.g., severe mood swings, wandering, paranoia)

§ Loss of sources of support

§ Social support § Economic insecurity

§ Perception of things getting worse

§

As disease and aging progresses, new symptoms emerge

§ Feelings of not having what it takes to meet the next

  • bstacle

§ Helplessness

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Sources of Caregiver Stress: During the COVID-19 Pandemic

§ Lack of control and predictability

§ Virus spread, community closed – when will life get back

to normal?

§ Loss of sources of support

§ Social isolation due to physical distancing & shelter-in-

place

§ Perception of things getting worse

§ Virus spread, economy – will we ever recover?

§ Feelings of not having what it takes to meet the next

  • bstacle

§ Helplessness, fears about what happens if the caregiver

gets sick and is no longer able to provide care

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Social Isolation in Caregivers

§ Caregiving duties allow for less personal space and social interaction10

§ Often sharing a home § Work and community roles decrease § COVID

  • 19 shelter
  • in
  • place compounds these issues

§ Loneliness among caregivers is associated with powerlessness, helplessness, and a sense of sole responsibility; it also predicts depression in caregivers11,12

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Experiencing Loss as a Caregiver

§ Caregivers’ lives change when they become caregivers

§ For some, this is a welcome role change § Some may experience grief, as they give up aspects of their

lives to become caregivers (e.g., jobs, hobbies, financial security)

§ During the COVID

  • 19 pandemic, more individuals are taking
  • n caregiver roles, and people already in caregiving roles

may be taking on additional responsibilities

§ This may bring up additional feelings, including grief § Some may lose the person they are caring for to COVID-19

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Assessing Caregiver Mental Health

§ Assessment tools: critical to screen caregivers

§ Anxiety: What if?

§

Worry, chest tightness, shortness of breath, cold hands and feet

§

Generalized Anxiety Disorder Screening (GAD

  • 7) free online

§ Depression: Would’ve, Could’ve, Should’ve

§

Sad/flat mood, loss of interest, appetite change, excess guilt, low energy, poor concentration

§

Patient Health Questionnaire (PHQ

  • 9) free online

§ Grief: Ask about losses the caregiver has experienced since

COVID

  • 19 began

§

Social connection, job, death

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Interventions for Caregiver Mental Health

§ Routine

§ Physical activity § Healthy food § Sleep § Limit alcohol

§ Connection to others

§ Friends and family via video chat § Support groups

§ Skill building: Family Caregiver Alliance § Referral for psychotherapy

§ Many telehealth options during COVID-19

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Example Resource for Caregivers: FACE COVID

§ F = Focus on what is in your control § A = Acknowledge your thoughts and feelings § C = Come back into your body § E = Engage in what you are doing For people who want to learn more, watch this 5 minute video13 § C = Committed action § O = Opening up § V = Values § I = Identify resources § D = Disinfect and distance

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Caregiver Assessment and Resources for Caregivers

Bryan Godfrey, MA, MSW, LCSW

Care Management Social Worker UNC Geriatrics Specialty Clinic

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Case Study: Relearning the World

Care Recipient: Mrs. B, age 72

§ Lives with husband Bob § Daughter, Patricia, 20 minutes away § Generally healthy and active § Used to attend day program (now closed) § Bored and depressed at home § Increasing conflict with husband

Caregiver: daughter Patricia, age 53

§ Single mother of two children, ages 14 and 19 § Works as Certified Nursing Assistant (CNA) § Wants to help but worried about intervening and risk of COVID

  • 19 exposure

§ Increasing stress, trouble sleeping

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Assessing Family and Caregiver Needs

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Care Recipient: Mrs. B.

  • Something to do during the day
  • Time away from her husband
  • Mental health support
  • COVID
  • 19 education?
  • Mrs. B.’s husband, Bob
  • Time away from wife
  • Healthcare
  • Mental health support
  • Something to do during the

day?

  • COVID
  • 19 education?

Patricia’s Kids

  • Childcare support
  • Activities to do during the day
  • Mental health support
  • COVID-19 education?

Caregiver: Patricia

  • Reduced stress, improved sleep
  • Ongoing caregiver support
  • Mental health support
  • COVID-19 education?
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Addressing Caregiver Needs

§ Priorities

§ What issues must be addressed now? § What issues can wait, or not be addressed at all? § What might change? When should problems/decisions be revisited

?

§ Resources

§ What resources are present? Financial, social, community, etc. § What strengths does each person possess? § What has worked in the past

?

§ Values, Motivation, and Goals

§ What does each person want?

§

What are parties interested in or willing to try ?

§

What is required by your agency or the law?

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Addressing Family/Caregiver Needs

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Care Recipient: Mrs. B.

  • Find day activity
  • Time away from her husband
  • Mental health support
  • Care for her husband?
  • Mrs. B.’s husband, Bob
  • Time away from wife
  • Healthcare
  • Mental health support
  • Day activity?

Patricia’s Kids

  • Childcare support
  • Activities to do during the day
  • Mental health support?
  • COVID-19 education?

Caregiver: Patricia

  • Lower stress, improve sleep
  • Caregiver support
  • Mental health support
  • COVID-19 education?
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Learning About Local Resources

Contact…

§ Local Senior Center § Department on Aging § Department of Social Services § Veteran’s support organization ( va.gov or nvf.org) § Disease

  • specific support
  • rganization

− Alzheimer’s Association

(alz.org)

− Parkinson’s (parkinson.org) − Cancer (cancer.org)

§ Health plan (if relevant) § Work supports / EAP § Local 211 and 311 Helplines

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And ask about...

§ Aging

  • in
  • place supports

§ In

  • home services (companion, aide,

etc.) § Caregiver education and respite (support groups, home care, virtual

  • ptions)

§ Meals and socialization (Meals on Wheels, phone support lines, etc.) § Exercise/fitness programs (virtual

  • ptions)

§ Mental Health supports (virtual

  • ptions)

§ Home medical care and telehealth

  • ptions

§ Supports for finances, childcare, etc.

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Resources for Use during COVID-19

§ Free Physical Activity Resources: NIA Go4Life , Home Strong Arthritis Foundation Exercises, YMCA Exercise Classes , Planet Fitness Facebook page, Core Power Yoga website, Nike Training Club (mobile app), Walk at Home (YouTube ) § Mental Health: C

  • ordinate with the caregiver or care recipient’s

health plan, search online, or call NAMI (800

  • 950
  • 6264) to identify

psychotherapy or psychiatry options

§ Cognitive behavioral therapy (CBT) is available from sites such as

This Way Up and Free CBT-I

§ Try free mindfulness mobile apps such as Headspace, Calm, or

Simple Habit

§ Hotlines: Disaster Distress Helpline 1

  • 800
  • 985
  • 5990; National

Domestic Violence Hotline 1-800-799-7233

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Panel Discussion

Bryan Godfrey, MA, MSW, LCSW

Care Management Social Worker UNC Geriatrics Specialty Clinic 31

Kathy Kelly, MPA

Executive Director, Family Caregiver Alliance

Erin E. Emery- Tiburcio , PhD, ABPP

Associate Professor of Geriatric and Rehabilitation Psychology and Geriatric Medicine and Co

  • Director of

the Center for Excellence in Aging Rush University Medical Center

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How can providers support individuals who are new to the caregiving role or taking on new responsibilities?

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What recommendations might you have for providers to support caregivers who may be feeling isolated?

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How can supervisors and managers help staff who are supporting caregivers during times of stress and isolation?

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Daniela has been caring for her father, Mr. Ramirez, a 75

  • year
  • ld who has dementia, in their home with added

support from an adult day program, which is now closed. Daniela is still employed, working from home, but now has responsibility for daily caregiving tasks along with paid work . How can you help Daniela, and caregivers in general, cope with the stress of additional responsibilities? Are there specific recommendations for caregivers

  • f individuals with dementia with behavior

challenges?

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  • Mrs. Young has multiple chronic conditions and recently

had a fall. She currently lives at home and receives support from a part

  • time home care aide and her sister,
  • Miri. Miri recently moved in with her sister to help care for
  • her. Mrs. Young now needs a new care plan to address

her changing needs. How would you approach developing a care plan for

  • Mrs. Young, which also addresses Miri’s needs? And

how would this differ from in

  • person approaches?

What are the additional considerations for virtual approaches to supporting caregivers?

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Questions and Answers

Erin E. Emery

  • Tiburcio, PhD, ABPP

Rush University Medical Center

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Kathy Kelly, MPA

Family Caregiver Alliance

Bryan Godfrey, MA, MSW, LCSW

UNC Geriatrics Specialty Clinic

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Additional Resources

§ You can download our resource guide for caregivers related to stress and isolation here: https://www.resourcesforintegratedcare.com/Older_Adults/R esource_Guide/Supporting_Family_Caregivers_Stress_and_ Isolation § For resources for providers, health care leaders, and caregivers on emotional support, coping, and managing stress during COVID

  • 19:

https://www.resourcesforintegratedcare.com/COVID- 19/Emotional_Support_Coping_Stress_Resources_for_Provi ders_Health_Care_Leaders_Caregivers

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Thank You for Attending!

§ The video replay and slide presentation will be available at: https://www.resourcesforintegratedcare.com § Questions? Please email RIC@lewin.com § Follow us on Twitter at @Integrate_Care to learn about upcoming webinars and new products!

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Webinar Evaluation Form

§ Your feedback is very important! Please take a moment to complete a brief evaluation on the quality of the webinar. The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation. § We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources: https://www.research.net/r/MVGNWVJ

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Resources

§ AARP Family Caregiving How-To Video Series (medical/nursing tasks) § COVID-19 – Tips for Dementia Caregivers § FACE COVID – How To Respond Effectively To The Coronavirus Crisis video § Generalized Anxiety Disorder (GAD-7) Screening § Patient Health Questionnaire (PHQ-9) § SAMHSA – Tips for Social Distancing, Quarantine, and Isolation During an Infectious Disease Outbreak § Taking Care of YOU – Self-Care for Family Caregivers

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Sources

1. AARP Public Policy Institute. (2015). Caregivers of Older Adults: A Focused Look at Those Caring for Someone Age 50+. Retrieved from https://www.caregiving.org/wp-content/uploads/2015/05/2015_CaregivingintheUS_Care-Recipients- Over-50_WEB.pdf. 2. Family Caregiver Alliance. ( n.d. ). Caregiver Health. Retrieved from https://www.caregiver.org/caregiver-health. 3. Home Alone Alliance. (2019). Home Alone Revisited: Family Caregivers Providing Complex Care. Retrieved from https://www.aarp.org/content/dam/aarp/ppi/2019/04/home-alone-revisited-family-caregivers-providing-complex-care.pdf. 4. American Psychological Association. ( n.d. ). Positive Aspects of Caregiving. Retrieved from https://www.apa.org/pi/about/publications/caregivers/faq/positive-aspects. 5. Vitaliano , P.P., Echeverria, D., Yi, J., Phillips, P.E.M, Young, H. & Siegler , I.C.. (2005). Psychophysiological mediators of caregiver stress and differential cognitive decline. Psychology and Aging, 20, 402

  • 411. DOI: 10.1037/0882

7974.210.1037/0882-7974.20.3.4020.3.402. 6. Committee on Family Caregiving for Older Adults, National Academies of Sciences, Engineering, and Medicine. (2016). Families Caring for an Aging America (R. Schulz & J. Eden, Eds.). Washington, DC: National Academies Press (US). Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK396398/ 7. Zarit , S. (2006). Assessment of Family Caregivers: A Research Perspective. Caregiver Assessment: Voices and Views from the Field, 2, 12

  • 37. Retrieved from https://www.caregiver.org/sites/caregiver.org/files/pdfs/v1_consensus.pdf.

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Sources

8. Covinsky, K.E., Newcomer, R., Dane, C.K., Sands, L.P., & Yaffe , K. (2003). Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine, 18(12), 1006-

  • 14. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494966/.

9. Alzheimer’s Association & National Alliance for Caregiving. (2004). Families Care: Alzheimer’s Caregiving in the United

  • States. Retrieved from https://www.alz.org/national/documents/report_familiescare.pdf.

10. Vasileiou , K., Barnett, J., Barreto, M., Vines, J., Atkinson, M., Lawson, S., & Wilson, M. (2017). Experiences of Loneliness Associated with Being an Informal Caregiver: A Qualitative Investigation. Frontiers in psychology, 8, 585. Retrieved from https://doi.org/10.3389/fpsyg.2017.00585. 11. Beeson, R., Horton

  • Deutsch, S., Farran, C. & Neundorfer, M. (2000). Loneliness and Depression in Caregivers of

Persons with Alzheimer’s Disease or Related Disorders. Issues in Mental Health Nursing, 21(8), 779

  • 806. DOI:

https://doi.org/10.1080/016128400750044279. 12. Beeson, R. (2003). Loneliness and Depression in Spousal Caregivers of Those with Alzheimer’s Disease versus Non- Caregiving Spouses. Archives of Psychiatric Nursing, 17, 135

  • 143. DOI: 10.1016/S0883
  • 9417(03)00057
  • 8.

13. Harris, R. (2020). FACE COVID- How to Respond Effectively to the Corona Crisis. Retrieved from https://www.youtube.com/watch?v=BmvNCdpHUYM.

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