Beyond the Chi-Square Caregivers Are More Than Just Faceless Statistics A multitude of research studies have examined family caregiver stress and burden. For the most part. Results from these projects describe group characteristics in quantitative statistical terms. In many cases, this method of evaluation may diminish the intense emotional and physical toll caregiving has on the lives of individual caregivers and care receivers. Far fewer articles are devoted to the stories behind the numbers to focus on the individual mental and physical strain caregivers endure. This article translates statistical research into Benrose, realistic portrayals of the daily lives of overburdened caregivers. These illustrations can be utilized by case managers to provide more unique. Flexible, innovative, and diverse solutions to alleviate the intense emotional and physical stress experienced by caregivers. The development and reporting of research studies must achieve a balance between quantitative and qualitative methodology and provide an application for practical use. Read more
Planning for the Future Together in Culturally Diverse Families Making Everyday Care Decisions The stress of providing long-term care to a relative with a cognitive impairment (eg. dementia) is often compounded by the difficulties encountered when making care decisions on behalf of the individual (ie. care receiver). This article describes research within culturally diverse families that explores decision making in everyday care from the perspective of both the caregiver and the care receiver. Our findings suggest that persons with cognitive impairments are able to express preferences for care, and that there are more similarities than differences across culturally diverse families. Read more
Circumstances Leading to Placement A Difficult Caregiving Decision Due to advances made in medicine and healthcare, older adults are living longer but enduring problems with physical functioning and health over longer periods of time. In addition, the percentage of older adults with cognitive impairments is increasing. Caregiving duties, which decades ago lasted for months, now last for years. This long-term strain of caring for an older adult who is physically and/or cognitively impaired may lead many caregivers to feel frustrated, angry, overwhelmed, and isolated. As a result of this stress many caregivers resort to nursing home placement. The Caregiver Options Program and Evaluation research project was undertaken to provide service options to participating caregivers to alleviate some of the debilitating stress associated with caregiving and postpone institutionalization. Results of logistic regression indicate the predictors of nursing home placement were whether the caregiver felt she/he had provided good care, and whether the elder had a problem with household tasks and/or woke the caregiver or other family members up during the night. Findings suggest that elderly care receivers who are predominately low-to-middle income have a physical and/or cognitive impairment, along with their caregivers, need to be especially targeted for help by case managers early in the caregiving process before placement becomes the only alternative. Read more
Impact of Family Members on Nurse Assistants What Helps, What Hurts This qualitative study focuses on nurse assistant reports of both positive and negative behaviors exhibited by family members of cognitively impaired residents. The information reported is obtained from in-person interviews with 114 nurse assistants in 5 skilled nursing facilities (3 philanthropic, 2 proprietary) in Greater Cleveland, Ohio. Nurse assistants were predominantly female (89 percent), white (60 percent), with a mean age of 33, and had been caring for cognitively impaired nursing home residents for an average of five years. Content analyses of nurse assistants’ responses reveal five categories of family members’ positive behaviors and four categories of negative behaviors. This article focuses on these themes and suggests topics for educational interventions for family members and nurse assistants who care for cognitively impaired nursing home residents. Topics include coping with family members’ feelings of guilt and related behaviors, understanding longstanding family relationship issues, and understanding possible reasons for decisions family members make regarding care of their relatives. Read more
Decision-Making for Persons with Cognitive Impairment and Their Family Caregivers Despite the large number of persons affected by cognitive impairment, very little is known about how they and their families make choices and decisions about everyday living and long-term care. Moreover, few studies have examined the concept of consumer direction, particularly the ability of cognitively impaired persons to delegate decision-making to other persons. This study explored decision-making through personal interviews with 51 respondent pairs, or dyads (i.e., the cognitively impaired person and the family caregiver). Results suggest that persons with mild to moderate cognitive impairment are able to answer questions about their preferences for daily care and to choose a person, usually a spouse or adult child, to make a variety of decisions on their behalf. By recognizing both voices—those of the care receiver and the family caregiver—we can enhance future research and practice, foster the development of consumer direction in long-term care, and advance public policy to support caregiving families. Read more
Case Management for Caregivers This article originally was prepared as a resource guide to assist the nation's Area Agencies on Aging as they begin developing or expanding services for the caregivers of older adults. A seminal question they face is how to provide case management service for this particular target population. The article reviews the literature on case management service generally, including its goals, functions, models, and outcomes. Its primary purpose, however, is to explicate the specific issues for providers to consider when planning and implementing case management service for caregivers. The article concludes with recommendations based on the results of evaluation research to maximize the benefits of caregiver services. Read more
Caregiving as a Dyadic Process Perspectives from Caregiver and Receiver Most family caregiving research has relied on the perspective of the caregiver but has not systematically examined the views and opinions of the elder who is receiving care. The present study examined 63 caregiving dyads to determine how the responses of each member had an impact on the well-being of the other member of the dyad. Caregiver relationship strain predicted his or her own depression and negative health, but no significant association was found between caregiver and care recipient outcomes. Multilevel modeling was used to assess the level of dyadic discrepancy over the care recipient’s needs and appraisal of caregiving difficulties. Results indicate that there is little disagreement over the care recipient’s needs, but a significant amount of variation in how much the care recipient and caregiver agree on their appraisals of caregiving difficulties. Relationship strain perceived by the caregiver, but not the care recipient, was significantly associated with this disagreement. Read more
The Stress Process of Family Caregiving in Institutional Settings Purpose: This study adapts the Stress Process Model (SPM) of family caregiving to examine the predictors of depression in a sample of caregivers (n = 133) with demented relatives residing in suburban skilled nursing facilities. Design and Methods: We interviewed family caregivers of family members residing in skilled nursing homes using a variety of measures to assess primary stressors, secondary strain, nursing home stressors, and caregiver depression. We used block-wise regression analyses to determine the predictors of caregiver depression. Results: Results indicated that positive resident adjustment to placement was best predicted by the closeness of the resident–caregiver relationship and nursing home stressors. Caregiver strain, resident adjustment, and nursing home stressors best predicted caregiver adjustment. In turn, the best predictors of caregiver depression included caregiver age, caregiver adjustment to the nursing home, and nursing home stressors. Implications: These results suggest that caregiver depression is closely linked to how well both the resident and caregiver adjust to the nursing home environment. Results also indicate that by broadening the SPM to include stressors common to the nursing home experience, researchers will be able to understand more clearly the specific components of the stress process that may lead to depression in family caregivers of persons living in nursing homes. Read more
