Caregiver support key to improved health, fewer nursing home placements, Jefferson researchers find

November 30, 2006

(PHILADELPHIA) Helping caregivers take care of themselves is key to enabling them to better deal with family members with dementia, a recent study by Thomas Jefferson University researchers shows. In fact, those caregivers who were provided extra, individualized support had less depression and were able to keep family members in adult day services - and out of nursing homes - much longer than those who did not get the extra attention.

According to Laura N. Gitlin, PhD, director of the Center for Applied Research on Aging and Health (CARAH) at Thomas Jefferson University in Philadelphia - who led the study in conjunction with Karen Reever, former executive director of Mid County Senior Services in Newtown Square, PA - one goal of adult day services (ADS) is to reduce nursing home placements. Families caring for older adults with impairment often use ADS, where their family members can receive meals and participate in therapeutic activities throughout the day. Some ADS centers offer some support for family members in the form of education workshops, but there is no systematic approach to offering caregiver support.

"Research shows that family members who use adult day services often still experience depression and feel burdened because, despite the respite that ADS offers, the caregiver still does the bulk of the work," says Dr. Gitlin. This burden of work can lead to caregiver burn-out, which often results in the need to place the older adult in a nursing home.

Dr. Gitlin and Ms. Reever, along with a team of service providers wanted to see whether providing systematic care management for the family caregiver as part of the daycare service would benefit the patient and family. They looked at three adult day service centers, with two of the centers offering the Adult Day Services Plus (ADS Plus) program, which involved extra services for caregivers. "We worked with Mid County to design and evaluate a program that would be cost-efficient by building on the existing ADS staff," explains Dr. Gitlin. Caregivers were interviewed at the time of registering for adult day services, and their own needs were assessed. Services were tailored for the individual needs of caregivers.

Such services included targeted education, referral for counseling or other services, strategies for caring for oneself, and strategies for managing complex problematic behaviors, such as resistance to care, verbal abuse, and agitation due to confusion.

The findings, reported in The Gerontologist, "were positive and immediate," says Dr. Gitlin. "The caregivers appreciated that they could always call or see the social worker at the adult day center. They said that the program offered them 'a safety net' and shared comments such as 'you were there for me' and 'I felt comforted.' There was an increase in caregiver confidence in managing problematic behaviors and less depression. The care manager succeeded in introducing effective strategies and addressing the caregivers' own needs.

"It will behoove adult day services to pay more systematic attention to the needs of family caregivers as a way to further support the impaired older adult," says Dr. Gitlin.

The study also found that nursing home placement dropped and ADS use increased in those families that received the ADS Plus program. "Older adults are generally in adult daycare for a short time, maybe as a last step before the family finds they need to place their loved one in a nursing home," explains Dr. Gitlin. "A major finding of this study was that over time, participants who received the ADS Plus program used 37 more days of ADS than those without it. As a result, twice the number of patients in the control group entered a nursing home compared to those in the study groups. Increased use of the ADS centers yields enhanced quality of life for both the caregiver and the patient, and it also means increased revenue for the center itself."The next steps for this research will involve a larger multi-site research demonstration project. "We want to find out if the ADS Plus Program can work in settings that service different families from diverse socioeconomic and cultural backgrounds," says Dr. Gitlin. "There is national interest in exploring these issues. Implementing the ADS Plus program in existing adult day services would not take much effort. "The costs include brief training of existing staff and reshuffling staff hours to enable a systematic approach to working with the family caregiver. After an initial assessment of the family caregiver, most contact can occur by telephone, at the time the family caregiver drops off their family member at the center or via mail. It would require little training and resources to have a great impact."

Thomas Jefferson University

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