Strengthening the Direct Care Workforce
for Long-Term Services and Supports
Suggested Approaches From a National Panel of Experts
Panelists expressed the opinion that in order to meet the training needs of family caregivers, substantial attention and a plan of action will be required. As evidence of the need for family caregiver education, findings from a national survey showed that fewer than one in five caregivers reported receiving formal training for their role, and 78% said they needed more information on a variety of topics related to caregiving (National Alliance for Caregiving, 2009).
In this regard, training in the use of assistive technology could be leveraged to address projected increases in the number of older adults with disabilities and shortages of DCWs, especially in rural areas. In recent national surveys about assistive technology use and the home environment, funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services, investigators found that about 25% of adults age 50+ were able to manage their personal care using devices, and another 25% could benefit from home modification (Freedman, Agree, & Cornman, 2006). Thus assistive technology could benefit both caregivers and care recipients.
Panelists stated that families could benefit from hands-on training to gain skills in areas such as body mechanics, lifting, transferring, bathing, using assistive devices, managing medications, and recognizing signs and symptoms for common diseases, including dementia and Alzheimer's disease. Training for family caregivers could take place either in a formal setting like a classroom or on-site, such as in senior housing units. In the latter case, a panelist noted that conducting training in this type of setting could benefit family members who do not self-identify as caregivers. Another panelist described a program in Baltimore County that trains family members caring for older adults age 60+ and grandparents who are the primary caregivers of grandchildren, through a grant from the National Family Caregiver Support Program. Mention was also made of the District of Columbia 's Caregivers' Institute, a centralized training, education and support resource for caregivers experiencing financial burden due to caregiving for an older adult with low to moderate income.
In addition, it was suggested that on-demand (as opposed to scheduled) training for family caregivers would be useful, perhaps in the form of 24-hour hotlines operated by ADRCs, SUAs and/or AAAs offering information, consultation and counseling on care-related problems. In this context, it would be important to develop core competencies for professionals in the Aging Network who work with and support family caregivers. AAAs and ADRCs could also promote the use of validated caregiver assessment tools aimed at identifying training, service, and support needs, and their administration at critical points when the assistance needs of care recipients increase or change (e.g., prior to discharge from hospital, rehabilitation unit, or nursing home).
For family caregivers and care receivers involved in consumer-directed programs, it would be helpful to offer training in fiscal management and effective supervision of DCWs. For example, family members, especially adult children and spouses, might be called upon to act as a “case manager” in a medical home model of care delivery. Because the medical home is a comprehensive approach to coordination of care, a family caregiver could play an important role by reinforcing the focus on disease prevention, disease management and patient-centered care.
A toolkit of evidence-based training programs for family caregivers was seen as having substantial benefits. Although some panelists said that the selection criteria for scientific evidence were not very stringent, they noted that a list of such tools is maintained by the Rosalynn Carter Institute for Caregiving. The development of innovative training programs and evidence-based programs could be supported by AoA using a variety of funding mechanisms and partnerships, including Older Americans Act Title III funds from the National Family Caregiver Support Program.
Approaches to Improve the Readiness of Family Caregivers
4.1 Support demonstrations and evaluations of hands-on training programs for family caregivers that include training on skills such as body mechanics, lifting, transferring, bathing, and use of assistive devices, and include them in AoA's toolkit of evidence-based training programs.
4.2 Determine the capacity of ADRCs, SUAs and AAAs to provide 24/7 hot lines for caregivers to receive information, consultation and counseling on care-related problems they encounter.
4.3 Through the AAAs and/or ADRCs, promote the use of validated caregiver assessment tools aimed at identifying training, service, and support needs and their administration at critical points when the assistance needs of care recipients increase or change (e.g., prior to discharge from hospital, rehabilitation unit, nursing home).
4.4 Develop core competencies for professionals in the Aging Network to implement in their work with and support of family caregivers.
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