Serving Caregivers Serving Caregivers Before Crisis Before Crisis Rhonda J. V. Montgomery, Ph.D. University of Kansas
Apr 01, 2015
Serving Caregivers Before CrisisServing Caregivers Before Crisis
Rhonda J. V. Montgomery, Ph.D.
University of Kansas
Diversity of BurdensDiversity of Burdens
Difficult tasks/Physical Health Time for other responsibilities Task Overload Privacy Loss of Roles Isolation Financial Burden Guilt
Differences translate to Differences translate to need for different types of need for different types of
supportsupport
Education/Information Support Groups
Respite care Care Management
Rationale for SupportRationale for Support
Burden
CareExhaustion
Abuse
Placement
Rationale Rationale forfor Support Support
Burden
CareExhaustion
Abuse
Placement
Support
Does this Rationale Hold?Does this Rationale Hold?
Care does not always lead to burdenDiversity of burdensSupport does not always reduce
burdenNot all caregivers will use support
Relief Comes When:Relief Comes When:
COST < or = RELIEF
COST = Time + Physical Energy +
Emotional Energy
Maximize Relief With Optimal ServiceMaximize Relief With Optimal Service
EducationCounselingCare ManagementSupport GroupsRespite Care
• In-home• Day Care• Residential
Maximize Effectiveness with Maximize Effectiveness with Optimal DosageOptimal Dosage
QuantityFrequencyTiming
The caregiving career is a The caregiving career is a process of identity changeprocess of identity change
Wife to CaregiverHusband to CaregiverDaughter to Caregiver
Son to CaregiverFriend to Caregiver
An optimal change process:An optimal change process:
Continuous - not abrupt Accelerates the period between
self identification (#2) and seeking service (4)
Lengthens the period between seeking service (#4) and nursing home placement (#6)
Optimal supports facilitate Optimal supports facilitate identity shiftidentity shift
Teach caregivers about the caregiving roleInform caregivers about options for care
behaviorsInform caregivers about options for
supportsTeach caregivers to use supports
010203040506070
0 1 2 3 4 5
Years
Hours
Bank Shop/Trans Household Other Tasks . Personal
Caregiving career: child
#4
#2
#3#4
010203040506070
0 1 2 3 4 5
Years
Hours
Bank Shop/Trans Household Other Tasks . Personal
Caregiving career: child#6
#2
#3
#5 #6#4
Caregiving career: child
010203040506070
0 1 2 3 4 5
Years
Hours
Bank Shop/Trans Household Other Tasks . Personal
#2
#3
#5 #6#4
Education ProgramsEducation Programs
Children:– Disease Process
– Community Based Services
– Legal and financial information
Spouses– Coping skills
– Behavior management
– In-home supports
Support GroupsSupport Groups
Children– Extending support
network
– Knowledge of community services
– More easily attend if offered at the right time of day
Spouses– Changes in marital
relationships
– Encourage seeking and using supports
– Options for respite care
– Coping with grief and guilt
– Self care
– Often need transportation and respite care to attend
Three Patterns of Respite UseThree Patterns of Respite Use
Brief use: 2 months or fewerAverage Users ( 9 to 12 months)Long Term Users (18 or more months)
Brief Users compriseBrief Users comprise
30% of Clientsfamilies who seek services that do not meet
their needDissatisfied Consumers
Brief Users Cost MoneyBrief Users Cost Money
Add to turnoverIncrease need for marketing effortsIncrease staff timeTake up spaces that others could benefit
from
Day CareDay CareBest for clients with
– limited disabilities
– who are non-aggressive
– who do not engage in problem behaviors
Well used by minority groups when– appropriately targeted
– appropriately marketed
Not easily used when care needs are high
Preferred by working caregivers when– Hours match work
schedules
– Available daily
In-Home Respite Most Used In-Home Respite Most Used
Recipient resides with Caregiver
Most impaired clients
White
Caregiver is a Spouse
Implications for ProvidersImplications for Providers
Not all services meet the needs of all people.Day Care programs can reduce the number of brief
users by • Appropriate marketing• Relating clear expectations to clients
In-home programs best • when they are staffed by paid staff • who can provide personal care and • Assist with health needs.
Implications for Delivery of Implications for Delivery of ServicesServices
Identify the “Serviceable Moment”• clear expectations
• respect
• flexibility
Communicate
Remember the client is the Remember the client is the familyfamily
Support means help for the caregiver that is more valuable than the cost of using the service.
ReferenceReference
RJV Montgomery & K.D. Kosloski,
“ Change, Continuity and Diversity Among Caregivers”
http://www.aoa.gov