By Nameeta Dookeran, MD National Medical Director of Behavioral Health Care Solutions at Emcara Health
Approximately 44 million American adults serve in a caregiving capacity for a family member or friend who is older, chronically ill and/or living with a disability. As more and more older adults are interested in aging at home, the number of people who find themselves serving as a caregiver is only going to increase.
Caregivers are important members of a patient’s care team. Unfortunately, the healthcare system doesn’t have the best track record when it comes to effectively integrating them into patient care plans or sufficiently equipping them with the information and support they need to be successful. Consider a JAMA study that showed family caregivers are almost never asked if they need help by healthcare workers.
Caregivers play an exceptionally critical role when we think about individuals who are medically complex and also struggling to overcome SDoH-related needs. As more healthcare is being delivered in the home to support these individuals, we have an opportunity to engage caregivers like never before.
If you properly train caregivers and provide them with resources, they can help keep their loved ones on track with prescribed care plans and also identify emergent issues earlier. They can serve as an extension of the care team to improve quality of life while preventing unnecessary utilization of the healthcare system. They provide an extra set of eyes and ears in the home.
Individuals who are acting as caregivers are being asked to take on more responsibility for managing the care of loved ones. From shorter hospital stays to expansion of home health technologies, we are seeing increases in the amount of care being managed outside traditional care venues. At the same time, caregivers are typically not well prepared for the expectations of caregiving, the load they will bear, and the strain it may place upon them.
Caregivers expend a significant portion of energy and time caring for loved ones while also trying to balance the other demands of their daily lives. This can take a serious toll on an individual’s mental and even physical wellbeing.
In fact, up to 70 percent of caregivers exhibit symptoms of depression; a quarter of these caregivers meet the diagnosis criteria for major depression. Additionally, caregivers are more likely to suffer from depression and other mental health challenges than peers who are not caring for a loved one.
So, how do you effectively engage and support caregivers when you are delivering care to individuals who are medically complex?
From the beginning, it is important to recognize the importance of the caregiver and to make sure that individual is plugged in and feels like part of the patient’s care team. Educating the caregiver on the treatment plan and clearly outlining the role they can play in support of the patient’s care are helpful actions to take. Also, establishing a strong line of communication with the caregiver is key.
Caregivers can make the life of care teams easier, or harder. We all know it is important to build trust with patients to motivate and influence them. This is also true for caregivers. To work effectively with a caregiver, you must build trust. This includes making them feel included and involved. It means demonstrating value by showing them you are there to help. The care team is there to provide quality care to their loved one, to help the caregiver navigate the system AND to support the caregiver’s own wellbeing. Make this abundantly clear from the very beginning.
There is a lot of discussion about more holistically supporting patients, i.e., addressing their physical, behavioral, and social needs. We should consider expanding the definition of holistic care to also encompass the health of caregivers. One simple application of this mindset is to make sure care teams are assessing the well-being of caregivers and looking for red flags that might suggest caregiver strain, in addition to assessing the well-being of their patients.
Assessing how caregivers are coping with their responsibilities is a very useful exercise. What you’ll find is that some caregivers are struggling with financially-driven pressures, others with stress related to social isolation. Some are plagued by generalized stress as a result of attempting to navigate the healthcare system. Sometimes, all of these factors are in play. Being able to identify issues such as these can help you head off negative outcomes for the caregiver and ultimately the patient.
Once you have assessed what stressors are most prevalent for a caregiver, you can help them respond more effectively. This means helping them feel more confident in their role as a caregiver, equipping them with tools and support to help them manage their own health and life balance, specifically when it comes to stress, anxiety, depression and other mental health challenges. This might include support from the care team, but also could involve helping to connect them to resources available through their health plan or local community.
It is in our collective best interest to be more proactive and to broaden our support for caregivers. These individuals are in the best position to optimize an individual’s care plan in the home and delay or avoid unnecessary costs. They also save the healthcare system a significant amount of money. It would cost an astronomical amount to replicate the care provided by these individuals. It would be untenable. Keeping them healthy and engaged in the home is therefore a massive priority. Yet in reality, available resources for caregivers can be limited. Available services are often not covered by health insurance or not easily accessible. This creates obstacles for caregivers and increases the likelihood of burnout and deteriorating health. As a system, we must do more. We cannot succeed with our helping our patients with their wellness goals, if we fail their caregivers.
Is your organization looking for better ways to support caregivers as you deliver care to patients in the home? Let’s connect.