If caregiver abuse is suspected, a caregiver assessment is a critical immediate tool. This is a situation where the GCM must contact Adult Protective Services, following their own state’s laws. In most states you are a mandated reporter .Elder abuse can be triggered by caregiver stress and depression in some situations. Depression that reaches a clinical level in a caregiver can be predictive of elder abuse.
What are red flags for caregiver abuse that should be picked up in a psychosocial assessment in the beginning of the case and should trigger a caregiver assessment immediately?
ØFears that he/she will become violent
ØSuffers from low self esteem
ØPerceives that she is not receiving
Adequate help or support from others
ØViews care giving as a burden
ØExperiences emotional and mental burnout
Depression or anxiety
ØFeels “caught in the middle” by
providing care to children and elderly
Family members at the same time
ØHas “old anger” toward the care
receiver that can be traced back to
their relationship in the past
Caregivers frequently neglect their own health and balk at a caregiver assessment. How does a care manager sell this needed product to a family caregiver ? The care manager must make the link between the needs and health of the caregiver and the health of the care receiver crystal clear. Underscoring that the caregiver cannot care for the client if they themselves are ill or unhealthy is often a good way to approach this.
You can meet their resistance by emphasizing that this is all about making them strong and healthy enough to continue to render care. This means being convinced you as a GCM that the caregiver assessment is a needed product. You can’t sell this to the Family caregiver unless you believe in it yourself. You have to understand that if your caregiver falls apart, your care plan also falls apart. Assessing the care provider means an intact care plan, no unnecessary placement, and less chance of hiring expensive but critically needed needed private home care because the caregiver fell mentally or physically ill from caregiver stress.
How do you measure caregiver burden? It’s a simple equation. You start with a functional assessment of the care receiver. The care manager then should do a functional assessment of the caregiver imbedded in the caregiver assessment. This will begin to measure the caregiver’s burden. Next you should look at the caregiver’s tasks through the care plan you did in the functional assessment and the care receiver. Quite simply, if the caregiver ‘s task is to lift and turn the care receiver- her husband and she is in her early 80’s and cannot do this, their burden is so heavy they cannot do the job. Then, you see, the care receivers needs exceed the caregiver’s ability to do the task. You should probably hire a private care provider, get another family member or consider placement.
Another example is the care receiver’s has Alzheimer’s and one of the symptoms is she is walking out and getting lost. The family care provider, the daughter, has repeatedly walked, driven and searched frantically to track her down. The distraught daughter is now burning out from the job. She calls the care manager who does a caregiver assessment. The care manager might suggest tracking devices to lighten the burden like Project Lifesaver, Mind ME, and GPS Shoe that will make it easy to track the Alzheimer’s patient, to lighten the caregiver’s burden
The University of Utah Gerontology Department has an excellent Caregiver Burden Scale that can be used to measure whether the burden of care exceeds the caregivers ability to give it.
If you do a caregiver assessment you need professional expertise. You have to track roles and stressors. What’s that? Primary stressors come from the person they are caring for –says he or she staying up late at night so the caregiver can’t sleep.
Secondary stressors cascade then flood into other areas of the caregiver’s life.
The caregiver suffers role strains or secondary tensions and conflicts that arise in maintaining other roles in their life such as employment and family relationships.
Take caregiver Ms. Handy . Ominously, she was in trouble at work for missing so many days of work, to care for her Dad. Out of sick and vacation, Mrs. Handy was being docked for every day she took off, which was going to impact her and her family financially. Termination might be the next step.
The other conflict was with her “mother” role and “ wife role”. The school was reporting her oldest child was falling behind because Ms. Handy could not help with homework. Her kids were feeling neglected. In addition her husband was frustrated because her lack of sleep and odd sleeping hours was affecting their intimacy as a couple.
The care manager tracked the roles that Ms Handy had, which were wife, mother and employee in addition to caregiver. This multitasking gone insane.
So the secondary stressor of Ms. Handy’s role of mother, wife and employee has spilled over into other areas of her life. with terrible consequences These role stressors overwhelmed her by the time she called the care manager to do a caregiver assessment.She was going to put her Dad in a nursing home when he did not belong there and would be on Medicaid as payment. That equals very poor care as opposed to paying privately.
By then she was so burnt out she was thinking seriously of placing her father in a nursing home. Thus caregiver assessment and the skills to do it really well to relieve all this stress and allow the caregiver to juggle all these roles.