caregiver depression Archives ⋆ Cathy Cress

How Do Long Distance Families Cope with Elders Threatened by COVID-19

July 19, 2020

Caring for COVID-19 Risk From a Distance

Long-Distance Family caregivers are trying to get a handle of the new reality COVID 19 has on their lives. as caregivers, at a distance. For many families, the number one concern is the seniors in their family. As a Long-Distance Care provider, finding the balance between safety and well -being for seniors during the COVID 19 pandemic can be a new challenge added to the many overwhelming challenges that long-distance families face daily. Care managers can now overcome the distance with telehealth and Hipaa certified telehealth platforms.

Long-Distance Care Providers Already offer the Most Expensive Care and Now COVID-Care $

They already live far away from their loved one, a national average of 450 miles, and travel an average of 4-7 hours to give care. Long-distance caregivers have the highest annual expenses (about $8,728) compared to co-resident caregivers (about $5,885) or those who care for a loved one nearby.

The experience of a long-distance caregiver is much different from and more complicated than that of a caregiver who lives in the same town. It’s important to know the local resources and services. Long-distance care providers are either not familiar or have vague memories of stores and resources that have changed since they moved away.

Long-Distance Caregivers Suffer Depression, Anxiety and Now Fear of COVID

The crunch of caregiver demands frequently leads to depression, anxiety, and a feeling of helplessness. Caregiver overload is especially common among the long-distance sandwich generation, or those caring for their distant aging parents along with their own children and many times grandchildren. Long-distance caregivers are more likely to report emotional distress (47%) than caregivers either residing with their care recipient (43%) or residing less than one hour away (28%).

Neglecting Everyone in the family

When the long-distance caregiver tends to ailing parents, they feel they are neglecting their own family and work responsibilities. Yet when they tend to their family, spouse, or job, they feel they are neglecting their parents. They live in a double bind.

Keeping seniors safe yet socially connected

For most families, keeping senior loved ones safe coronavirus infection is their number one priority as it is with families that live locally. But Long Distance Families must do this remotely which means forgoing in-person visits and finding other ways to create a connection. These families their number one concern is the safety of the seniors among their families or friends. It is important to find a balance between safety to avoid contracting coronavirus and being able to maintain happiness through social interactions with family and friends.

Seniors and their concerned families want to avoid isolation, depressions, and hospitalization with COVID while sheltering in place.

Like any disaster but especially with this pandemic- you may not be prepared and are desperately seeking a plan.

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California Cuts Pushing Frail Elders into the Cesspools of COViD-19

May 22, 2020

Here in California, the frailest, poorest and oldest in the state are being potentially knifed in the back by slashing budget cuts to the very services that keep them out of nursing homes.

The Multipurpose Senior Services Program , one of the first geriatric care management programs in the nation, designed to keep fail elders out of nursing homes, is set to axed from the California State budget.

The Governor has also proposed elimination of $2.9 million of state funding and $3.9 million in federal matching funds for the 11 statewide Caregiver Resource Centers,

providing critical respite care and counseling to caregivers of adults with chronic and disabling health conditions.

Both programs were designed 4 decades ago to keep elders at home and out of more expensive nursing homes and staunch family caregiver burnout. They offer huge safety nets, designed to keep frail seniors in the community.

MSSP is of a daycare program providing rich social and health services to frail elders and their families. The Care Resources Program caregiver respite and support to overwhelmed family caregivers.

These programs save the state a bundle of money. Each of the MSSP clients is disabled enough to be eligible for nursing homes and poor enough to be eligible for MediCal. So instead of the state paying $80,000 or $90,000 per person per year in a nursing home, the State pays only on average a little over $5,000 for the person to be in MSSP.This makes the cuts both fiscally stupid and mystifying.

What California government is doing is ripping giant holes in this web plummeting 45,000 seniors into the cesspool of COVID-19 skilled nursing facilities, where almost half of California COVID-19 deaths occured.

Without the services and supports available through MSSP, and the Caregiver Resource Center, many older Californians will have no other choice but to be admitted to nursing homes, where nearly half of all deaths related to COVID-19 have occurred.

But the doors may be barred. Given the high risk of COVID-19 in nursing homes, owners are reluctant to take new patients. So, the elimination of the Caregiver Resources Center and MSSP is really a death sentence to frail elders. It leaves no fire extinguisher for caregiver burnout of the family caregivers who care for elders with the toughest disease: brain impairment- Alzheimer’s, stroke, dementia, Huntington’s disease, Parkinson’s other conditions that may cause memory loss or confusion.

This may cause a cascade effect- placement of these horribly demented elders, into the plague-infested nursing home or also to death’s door

Governor Newsome has been a national hero as the first governor to issue a stay at home order to close counties down in California. He slowed the spread of coronavirus and kept California in a safe zone compared to most other states. But this was at the cost of taxpayer dollars as 4.7 Californians were put out of work.

He finds himself in a double bind now with a chasm of a budget hole, that he is trying up to fill with cuts like the ones proposed to the senior program. But the cuts will lead seniors to nursing homes costing $80,000 a year instead of the $5000 for MSSP into those caldrons of coronavirus

California is always the canary in the coal mine- the innovator that most states follow. So, these cuts can be expected across the nationwide. Who is the real villain in these cuts, the Trump Presidency. 875 billion was approved in the House of representatives in the HEROES Act. Cutting both programs saves $119 million. But these cuts would be eliminated if Congress OKs this aid for state and local governments — a prospect many state lawmakers believe is unlikely as President Trump is threatening to veto the money to the states . This has spurred a cacophony of outrage from local legislators and senior advocates. angered state lawmakers from both

major political parties who say it’s irresponsible in light of the coronavirus pandemic that has spread through nursing homes across the state. It’s one of many conflicts emerging this week as lawmakers hold public hearings examining Newsom’s proposal before they must vote on a spending plan by June 15.

Want to help save these programs

PUBLIC COMMENTS – WRITTEN: Submit written public comments by email to: sbud.committee@sen.ca.gov

What Do Care Manager, Caregiver and Care Receiver Get From a Caregiver Assessment?

September 11, 2019

Identify Caregivers Problem

A caregiver assessment will allow the care manager to clearly identify the caregiver’s problems. This can be a duel fix. Often it is a way of solving the care receiver’s problems

Find Out the Ms Handy’s Caregiver’s Problems

Let’s take Mrs Handy .The care manager Ms. Helpmate is called by stressed-out family caregiver Ms. Handy, who is thinking of placing her Dad, who lives with her. Ms. Helpmate does a caregiver assessment and a geriatric depression assessment. Ms. Handy is depressed. Ms. Handy has a score of 17 indicating caregiver depression. That’s one of the 14 symptoms of caregiver overload

The care manager then suggests that Ms. Handy begin getting her Dad ready for bed at 10:00 PM.instead of midnight herself when her Dad goes to bed. Ms. Handy is exhausted= caregiver overload.

The daughter is reluctant because she is still locked in her old role of” I’m the kid and he’s the Dad”. She fearful to change her Dad’s routine, even though she is so tired, is actually 50, not a kid anymore. After months of this that she is at the breaking point.

Using the Caregiver Assessment to Coach Caregiver

After much coaching by the care manager, the daughter starts to stay up until 10:00, go through all the prompting to get her Dad changed then turns off the TV. The Dad is angry and resistant at first but gradually goes to bed at 10:00 PM.

The care manager coaches the daughter over the few weeks and the Dad slowly adjusts to this new routine, giving Ms. Handy encouragement to continue. Ms. Handy then is able to sleep all night pulling her off the edge of the cliff where her next step was nursing home placement, which she promised her Dad she would never do.

The caregiver assessment stops Mr. Wilson from staying up late and missing adult daycare and Ms. Handy from being so tired she can’t go to work one of her primary caregiver stresses.

Find out more about how to do a caregiver assessment in Handbook of Geriatric Care Management 4th edition in the Chapter, “Assessing and Supporting the Caregiver”.

Should a Depressed Caregiver Care for An Alzheimers Family Member

February 17, 2015

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If you are a care manager assessing a caregiver you should also do a functional assessment of the care receiver. This will measure the caregiver’s burden. This should be done to find out whether the caregiver could carry out the tasks that must be done to functionally care for the care recipient.

These tasks are ADL’s IADL’s, medication management. By identifying the care receiver’s health status and problems and then, through functional assessment, finding the functional skills needed in the caregiver’s job, the care manager can see if the caregiver’s abilities match the tasks.

For example if a caregiver reports during a family caregiver assessment that she has a bad back and is seeing the physician for this and the care receiver now needs to be lifted the tasks and the caregiver’s health abilities do not match. The solution for the care manager may be suggesting additional paid caregiver’s or placement.

The care manager should also assess the cognitive status of the care receiver to find out if the care recipient has memory loss, Alzheimers ,dementia, behavior problems or a mental health diagnosis.

This will also tell the care manager what mental health needs the care receiver has compared to the ability of the caregiver to render that care. For example, if a caregiver is given a Geriatric Depression Scale score s as very depressed herself this may be a barrier to caring for a dementia patient. The care manager might consider the care receiver seeing her own physician to evaluate for medication and bringing in other family supports as in the case of Ms. Handy.

Do Family Caregiver’s Caring for Dementia Have More Stress?

February 15, 2015

Care manager’s using a stress and appraisal model, can predict how caregiver’s can react to stress when providing care to a person with dementia. Using a model based on Pearlin they can see how personal characteristic increase or reduce depression and life satisfaction. . Caregiver Ms. Handy , whose Dad has dementia Geriatric Depression Scale score of 17. She was very depressed. Ms. Handy also believed her caregiving situation as a burden. This is part of secondary appraisal.

She was still getting her father to be bed at midnight when she had to awaken to do that. . Ms. Handy felt stuck in this very stressful routine, not able to call on relatives, change the bedtime to 10. She felt she did not have the skills to cope with the care of her father nor to change to the way she was handling the situation. The Stress and Appraisal Model based on research by Pearlin, then tells us if all this is true, the caregiver is likely to place a loved one in an institutional setting. The care manager who was called in found Ms. Handy poised to do this because she was so stressed.She did a caregiver assessment and reduced her stress by helping her calls siblings to help, change the bedtime to 10 PM and believe that she herself could change her situation and not place her father.