FCRP Policy Statement

Due to the transformations of the health care system, the length of hospital stays of the chronically ill elderly are shrinking as are the financial resources of our elderly population. According to the Michigan Department of Community Health, Medicaid comprised 8% of Michigan's budget in 1980, 10% in 1985, and 20% in 1995. Other states are likely to face the same crisis in financing health care. The increase in Medicaid spending reflects the increasing population of chronically ill elderly. As cuts in Medicaid occur, as hospital stays shorten, and as the population of the elderly grows, families are becoming more involved in health care provision. Demands of care include direct physical tasks of care (bathing and dressing) and medical tasks of care (administration of medications, catheter care), as well as managing the financial burden chronic illness can cause and ensuring the emotional health of the family unit.

Of great importance is how the health care consumer assessment process can address the availability, quality, and competence of informal support systems, including family caregivers and other care providers. Currently, the functioning of the informal care system (often family members or friends) is overlooked in various health care settings as patient care is of greater emphasis and immediate concern. Family caregivers are often elderly and have their own chronic illnesses. They also are at risk of suffering from the emotional and physical burden of care due to the daily performance of caregiving tasks, the necessity of adjusting employment and family roles, and the out-of-pocket costs of care (e.g., over-the-counter medications, treatment transportation costs). The health care status of the informal system - especially that of the primary caregiver - should be both included in patient assessment and evaluated apart from patient assessment.

Implications:

• Services should be delivered after consideration of the needs of both the patient and caregiver and with their input.
• Community resource consultants should be available to link family caregivers with resources available in their community after assessment of needs is completed.
• Support groups should be created to provide family caregivers with opportunities for peer support.
• Interaction and instruction, as well as communication and collaboration with professional caregivers will allow for modeling of the care provision processes and teaching of roles, routines, and practices.
• The family caregiving situation should be reassessed periodically, especially during care transitions such as discharge from acute care and the end of a treatment cycle.
• Programs need to be established to provide information and answer questions, to model and teach home care skills, and to provide support to family members providing care.

Assessment and Support in the Formal Health Care System

Assistance to families providing home care should be premised upon assessment of the patient's physical and cognitive deficits, changes in the patient's status over time, the current level of involvement of caregivers and other care providers, and the impact on caregiver physical and mental health.

The family caregiving situation should be reassessed periodically (e.g., during patient appointments with health care providers).

Guidelines do exist which allow for an individualized and accurate assessment of the health status of the caregiver of a chronically ill family members, but are not generally accepted. Of primary importance in the coming years is the development of guiding principles for practitioners from which plans of care can be developed utilizing assessment tools, intervention steps, and outcome measurements.

Sources: "Call for Ideas: Michigan Managed Long Term Care Initiative." (1996, October). Lansing: Michigan Department of Community Health. Hoppough, S., & Given, B. (1997). Positive caregiver reactions. Manuscript in process. Research supported by Family Home Care for Cancer -- A Community-Based Model, grant #RO1 NR01915, funded by the National Center for Nursing Research.