National Strategy Needed to Support Invisible Heroes of Health Care—Family Caregivers of Older Adults

TF-cropped-photo-by-andy-camp-webTerry Fulmer, PhD, RN, FAAN, AGSF
President, The John A. Hartford Foundation

(This post also appeared on The John A. Hartford Foundation blog.)

For far too long, the nearly 18 million family caregivers of older adults in the United States have been largely invisible to policymakers and our health care system, despite filling an absolutely essential role. The contributions these modern-day heroes make to the care of older adults is indispensable, and often comes at a significant cost to their own health, well-being, and financial security.

Families Caring for an Aging Americathe sweeping new report from the blue-ribbon committee convened by the prestigious National Academies of Sciences, Engineering, and Medicine, offers a clear, comprehensive, and compelling rationale for creating a national strategy to elevate the position of family caregivers within our health care system.

As the report indisputably documents, we have a growing population of older adults living longer than ever before with greater needs for assistance.  We have family members and friends performing increasingly complex care tasks for their older relatives and friends with little or no training.  We largely marginalize and ignore caregivers, which puts them and their loved ones at risk for harm.

If we are truly to reform health care, we must expand the idea of “person-centered care” to “person and family-centered care.” As a geriatric nurse, I have seen the need for a family-centered approach first-hand.  Too often family members, with little or no training or support, are thrust into the position of being responsible for everything from navigating the labyrinthine health care system to performing complicated medical tasks. This might be medication management and wound care, tasks that are normally provided by trained doctors and nurses.

Ensuring that caregivers not only receive the support and training they need, but have a role and a valued voice in decisions affecting their loved ones, are critical to improving care for older people. Continue reading

Integrating Community Programs in Healthcare: A Personal Experience of Health Professionals Sharing a Lot More than Lunch!

Michael Malone, MD
Professor of Medicine and Section Head of Geriatrics
University of Wisconsin School of Medicine and Public Health
Medical Director

Aurora Senior Services and Aurora at Home

Two years ago, members of Milwaukee’s Aurora Health Care geriatrics program where I work began doing something different for lunch. The geriatrics fellows (who are learning to be experts at caring for older persons with multiple chronic illnesses) started to share meals once a week with the nurses, social workers, and teaching doctors who also work with the patients we serve. The fellows and faculty enjoyed helping each other overcome struggles in providing “best care” for vulnerable older individuals. Over shared meals, physicians started reaching out to social workers and others at the table to get input, feedback, and recommendations. This was particularly helpful, as many of the challenges our doctors have encountered centered on the social aspects of a patient’s needs and where and how to find appropriate support.

Creating a Network to Achieve “Best Care”
Gradually, we started to use these lunches to discuss cases more formally. We would discuss patient needs in five specific areas: 1) medical needs, 2) medications, 3) social needs , 4) psychological needs, and 5) how patients understood and perceived their own illnesses. The in-person discussions have given our physicians, nurses, and social workers a chance to develop working relationships with one another. We’ve all developed a better understanding of programs provided by the ADRC, and our patients are better served as we work together.

Importance of the Older Americans Act
As I reflect on how our clinic serves older individuals in Wisconsin, I’m struck by the importance of integrating community programs into health care. The Older Americans Act (OAA), for example, provides for caregiver support, health promotion, meals, and transportation for vulnerable elders. Our sharing and learning together during lunch has resulted in a better understanding of the whole person (physical, mental, social needs), and how that person supports and is supported by a community shaped in one way or another by initiatives like the OAA. Reauthorizing the OAA represents an important opportunity to help modernize and improve the aging services network to meet the needs of our nation’s older adults.

Among other objectives, the bill aims to address

  • Elder abuse;
  • The importance of evidence-based care;
  • The effective coordination of services at the federal, state, and local levels; and
  • Several other challenges confronting older Americans and their health providers.

These are topics I hope to discuss at lunch with colleagues for many years to come not only because they are important but also because they can be addressed—effectively, reliably, and equitably—through sustained support of the OAA. I’d encourage you to do some digging of your own regarding legislation that supports older Americans—you might be surprised at just how expansive public support for healthy aging has become, but also how vital it will be to ensure this support not only remains constant but also shifts to reflect new realities as more and more of us turn 65.

The Older Americans Act Reauthorization Act of 2015 was approved by the U.S. Senate last week and has now been sent to the House of Representatives for a final vote.  You can help support swift passage of this important legislation by writing to your Representative to encourage her to stand behind the important services that the OAA provides.  Visit the Health in Aging Advocacy Center for more details.

About the Author
Dr. Malone is the Chair of the AGS Public Policy Committee.