A Primer on Managed Care: Multiple Chronic Conditions

Through service assessments and time spent with caregivers during programming, social service providers can identify red flags to care- givers’ and care recipients’ health and recom- mend follow up with healthcare providers. There also are benefits to recipients when caregivers receive support. Interventions for caregivers have demonstrated the ability to delay a care recipient’s placement in a nurs- ing home (Foldes et al., 2017). Further, an older adult with a neurodegenerative disorder (e.g., Alzheimer’s), who receives assistance from a caregiver with poor mental health experiences earlier mortality and is at a greater risk of expe- riencing elder mistreatment (Lwi et al., 2017; Wiglesworth et al., 2010). Intervening early in the caregiving process may be one way to pre- vent negative outcomes. Still, community-based caregiver support programs are stretched for resources. Multi- session psychoeducational programs—thought to be the most effective interventions—cost hun- dreds of dollars per dyad to administer. These ser- vices also must engage in extensive outreach to meet community needs. Many family members— especially those in the early stages of taking on the caregiver role—are more likely to think of them- selves as “husband,” “daughter,” or “friend,” and may overlook services targeted at “caregivers.” With an annual budget of just $126 million (Administration for Community Living, 2017), the National Family Caregiver Support Pro- gram is ill-equipped to robustly meet the needs of family caregivers who are caring for older adults. And while not all caregivers need formal services, changes in care recipients’ health and caregiver turnover drive the need for support. How Health Service Providers Can Meet Family Caregivers’ Needs In light of these challenges family caregivers face, in 2015 the California Legislature passed ACR 38 (California Taskforce on Family Care- giving, 2015) to create the California Taskforce on Family Caregiving; Taskforce members pro-

‘The negative consequences associated with caregiving are not inevitable.’ screen for a caregiver’s support needs. In recent years, many state legislatures have acknowl- edged the important role health services can play in supporting family caregivers by passing versions of the Caregiver Advice, Recognize, Enable (CARE Act) legislation (Coleman, 2016). The law requires healthcare providers, in the hospital setting, to identify patients’ caregivers and add caregivers to patients’ health records. A benefit of this law is that by identifying family members as “caregivers,” family members may be more willing to relate to the term “care- giver” and be better able to find community ser- vices intended for them. Healthcare providers in hospitals can enhance the benefits of new and forthcoming CARE Act requirements by promoting imple- mentation of a caregiver needs assessment when the caregiver is identified, and checking that the caregiver is willing and has the capacity to pro- vide care. In doing so, at-risk caregivers can be discovered earlier so that appropriate supports can be implemented and-or alternative sources of care can be determined. In recent years, commu- nity organizations have compiled tools to assess at-risk caregivers. Notably, Alzheimer’s Greater Los Angeles has compiled several screening tools Screen early for caregivers’ support needs, capacity, and willingness to provide care Visits to healthcare settings often demarcate the beginning of or a significant change in the care- giving role, and are ideal places to identify and vided policy recommendations to better support the state’s 4.5 million family caregivers (final recommendations were released in July 2018 and are available at The following recommendations are based on those found in the Taskforce’s final report and on our own experiences.

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