Caregiving FAQ
Supporting family caregivers can reduce the total cost of care for frail elders while improving their quality of life. It’s a win-win situation that’s good both for our hearts and our pocketbooks.
Institutional care, whether in a nursing home or hospital, comes at a high cost often paid for by Medicaid or Medicare.[1] The expense of nursing home care will soon become unsustainable for state Medicaid budgets as our population ages. Seniors over age 65 will double[2] and those over 85 will triple by the year 2050.[3] Supporting family caregivers is one of our best options to keep costs down while helping seniors live independently, which is what most of them want.
We have evidence that supporting caregivers has positive benefits for everyone. For example, a review of research literature provides encouraging indications that supporting people who care for someone with dementia often has positive effects on the care recipients’ behavior, function, and the length of time they remain at home.[4] Interventions adapted to the individualized needs of both dementia patients and their caregivers help to reduce caregiver burden and prevent or delay elders’ institutionalization.[5]
Medicare does not cover the cost of nursing homes. The largest share of Medicare spending is for hospital services.[6] Supporting family caregivers is crucial in that arena too. Family caregivers help elders avoid hospitalization by overseeing physician visits, nutritional needs and medication schedules. Should their care recipient need to be hospitalized, a critical link in transitional care will be the family caregiver, though they are commonly thought of mainly as “visitors” rather than a crucial part of the care team.[7]
Preventable hospital readmissions are a big part of unnecessary medical spending. Hospital readmissions cost Medicare $26 billion annually and $17 billion is considered avoidable.[8] Transitions between care settings are critical points where breakdowns in communication can result in readmission to the hospital. Substantial savings could be realized if hospitals, doctors, and community programs worked together with caregivers to create a clear caregiving plan at the time of hospital discharge.[9]
Simply recognizing the economic impact of family caregiving would help us realize that the care system can’t function without it. About 40 million Americans provide unpaid care for a family member or friend who is ill, disabled or aged.[10] This invisible workforce carries out its tasks as a labor of love, expecting little in return. Family members help with activities of daily living, coordinate health care services and perform complex medical tasks that used to be relegated to nursing. While the sense of connection caregivers provide for loved ones may be priceless, their service has a great economic impact. The hours of care they supply has been valued at approximately $470 billion.[11]
Despite best intentions, caregiving can be daunting, especially when recipients have complex health conditions or cognitive impairments like dementia.[12] In a recent national study examining the experiences of family caregivers of older adults, caregivers reported feeling exhausted, having too much to do, and little time for themselves.[13] One study found that the chief risk of institutionalization is not a decline in the health of care recipients, but a decline in the health of their caregivers.[14] It therefore makes sense, both economically and as an act of human decency, to provide support for caregivers so they can continue to keep their loved ones at home, an option most would prefer.
Footnotes
[1] Reaves, E L, and M B Musumeci. “Medicaid and Long-Term Services and Supports: A Primer.” Kaiser Family Foundation. May 8, 2015. (Accessed November 3, 2015). http://kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/
[2] “Administration on Aging: Aging Statistics.” U.S. Department of Health and Human Services: Administration for Community Living. (Accessed August 19, 2015.) www.aoa.acl.gov/Aging_Statistics/index.aspx [This source is no longer available but has been replaced by https://acl.gov/aging-and-disability-in-america/data-and-research]
[3] “Selected Long-term Care Statistics” Family Caregiver Alliance. (Accessed August 19, 2015.) https://caregiver.org/selected-long-term-care-statistics
[4] “Dementia: A NICE-SCIE Guideline on Supporting People with Dementia and Their Carers in Health and Social Care; NICE Clinical Practice Guidelines, No. 42.” Social Care Institute for Excellence. Leicester (UK): British Psychological Society: 2007. (Accessed November 3, 2015). http://www.scie.org.uk/publications/misc/dementia/dementia-fullguideline.pdf
[5] Brodaty, H, A Green, and A Koschera. “Meta-analysis of Psychosocial Interventions for Caregivers of People with Dementia.” Journal of the American Geriatric Society 51, no. 5 (2003):657–664. (Accessed November 3, 2015) http://www.ncbi.nlm.nih.gov/pubmed/12752841
[6] Blum, J. “Testimony on Improving Quality, Lowering Costs: The Role of Health Care Delivery System.” Presentation to the US Senate Committee on Homeland Health, Education, Labor and Pensions, November 10, 2011. US Department of Health and Human Services. (Accessed November 3, 2015) http://www.hhs.gov/asl/testify/2011/11/t20111110a.html
[7] Reinhard, S, L Feinberg, R Choula, and A Houser. “Valuing the Invaluable: 2015 Update; Undeniable Progress but Big Gaps Remain.” AARP Public Policy Institute. July 2015. (Accessed November 3, 2015) http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf
[8] Lavizzo-Mourey, R. “The Human Face of Hospital Readmissions.” Health Affairs Blog. March 14, 2013. (Accessed November 3, 2015) http://healthaffairs.org/blog/2013/03/14/the-human-face-of-hospital-readmissions/
[9] Gibson, M J, K A Kelly, and A K Kaplan. “Family Caregiving and Transitional Care: A Critical Review.” October 2012. Family Caregiver Alliance. (Accessed November 3, 2015) https://www.caregiver.org/sites/caregiver.org/files/pdfs/FamCGing_TransCare_CritRvw_FINAL10.31.2012.pdf
[10] Reinhard, S, L Feinberg, R Choula, and A Houser. “Valuing the Invaluable: 2015 Update; Undeniable Progress but Big Gaps Remain.” AARP Public Policy Institute. July 2015. (Accessed November 3, 2015) http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf
[11] Reinhard, S, L Feinberg, R Choula, and A Houser. “Valuing the Invaluable: 2015 Update; Undeniable Progress but Big Gaps Remain.” AARP Public Policy Institute. July 2015. (Accessed November 3, 2015) http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf
[12] Reinhard, S, L Feinberg, R Choula, and A Houser. “Valuing the Invaluable: 2015 Update; Undeniable Progress but Big Gaps Remain.” AARP Public Policy Institute. July 2015. (Accessed November 3, 2015) http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf
[13] Spillman, B C, J Wolff, V A Freedman, and J D Kasper. “Informal Caregiving for Older Americans: An Analysis of the 2011 National Study of Caregiving.” U.S. Department of Health and Human Services; Office of the Assistant Secretary for Planning and Evaluation. April 2014. (Accessed November 3, 2015) http://aspe.hhs.gov/report/informal-caregiving-older-americans-analysis-2011-national-health-and-aging-trends-study
[14] Talley, R C, and J E Crews. “Framing the Public Health of Caregiving.” American Journal of Public Health 97, no. 2 (February 2007):224-228 and corrected 97, no. 3 (March 2007):393, doi:10.2105/AJPH.2004.059337. (Accessed November 3, 2015) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781412/
