Cathy Cress

Expert in Aging Life and Geriatric Care Management

Whole Family Approach = Caregiver Assessment

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Although family and informal caregivers make up 78% of the long-term care system in the United States, geriatric care managers and aging professionals have not focused on them . The actual backbone that supports the the aging client is the unpaid  family caregiver .

Family caregivers’ are overwhelmed by caregiver burnout, stress and overload. Aging professionals and geriatric care managers need to begin to see caregivers and care receivers as one organism. Caregivers are part of a homeostatic system including the care receiver and one cannot be separated from the other. If the caregiver’s functional and psychosocial needs go unmet then the whole care plan falls apart. So the aging professional needs to take a whole-family approach  and see that they have multiple clients, including the older person and the family caregivers. This they need to do a caregiver assessment

Areas to Cover in Whole Family Approach -Religious and Cultural Issues

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Religious and Cultural Issues – Expectations based on religious and/or cultural practices, rituals, and differing belief systems between family members all need to be considered in the “ Whole Family Approach “

Are the expectations of the adult children and the parents consistent? Oftentimes, conflicts will emerge due to differing life experiences. As intermarriage becomes more common, the attitudes within the family towards religious and cultural differences have created new challenges, particularly among the different generations.

In our You Tube series on whole family  tools cultural issues are key because this Danish born aging mother brings a cultural tradition of the “ “dutiful daughter” with her. This is a long tradition in her homeland where a daughter is chosen to care for the mother until she dies.

This conflicts with the American “here and now” because her 2013 daughter is an attorney with two teenage daughters who cannot exclusively care for her aging mother.

The geriatric care manager http://www.caremanager.org/ is able to assess these cultural differences using the Whole Family approach and find a solution that meet mother and daughter’s needs and get the care the aging mother needs at the same time

 

Areas to Cover in Whole Family Assessment- Sandwich Generation Issues

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Sandwich Generation Issues- Many family caregivers have multiple generations requiring their attention and care. In 1981, Dorothy Miller coined the term sandwich generation to refer to inequality in the exchange of resources and support between generations.

Specifically, Miller was referring to a segment of the middle-aged generation that provides support to both young and older family members yet does not receive reciprocal support in exchange. Miller emphasized the unique stressors of multigenerational caregiving and the lack of community resources available to assist the middle generation. Because multigenerational caregivers are most often women dealing with the complex role configurations of wife, mother, daughter, caregiver, and employee, some researchers use the phrase women in the middle interchangeably with the sandwich generation.

In 2013 this is more and more an issue with men – adult sons as well. I am now helping a family where the 93 old Dad is home dying at his son’s home with Hospice and an excellent geriatric care management agency Livhome supplying 24 hour care. The adult son has four grown sons and three grandchildren. In all we have 4 generations sandwiched together helped thankfully by an excellent Hospice and terrific geriatric care management agency. These agencies together and in unison help unlayer the sandwich and allow the whole family  to come together to bring joy to all their lives while they surround this great grandfather through his death . That’s the grace of the whole family approach to me .

Six Areas to Cover in a Whole Family Assessment

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Using the whole family approach with an aging family means doing a psychosocial assessment. In this approach you are generally focusing on two or more people in the family- your elderly client and their primary caretaker (whether doing hands on care or managing the caregiving). What are the  areas you must probe in this psychosocial assessment of a whole family ?

•Past trauma– family history

 

•Sandwich Generation issues

 

•Religious and cultural issues

 

•End of life issues

 

•Quality of Life issues –

 

•Relationship to money

 

 

GCM Tools for the Aging Family

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Geriatric Care Managers (GCM’s) solve the problems of older people and aging families with tools of geriatric assessment and care plans. They unravel the changing needs of older clients and their family and private and family caregivers by regularly monitoring and assessing their needs.

GCMs have what I call a “ Whole Family” approach. With the “Whole Family” tool, the GCM serves the older client but also organizes the aging family and midlife siblings to work as a team to support the older person. Now that the family is no longer Ozzie and Harriet and  has morphed into the extended family ( Modern Family)- this is vital. Stepsibling adult children can cut off other siblings or step parents and fracture the potential  to field a family team This takes viewing the family system  with an assessment labeled a family genogram, which can measure who is relating to whom and who is cut off from whom.  GCM’s then help reorganize the aging family to support them to share the care for the older person.

This support to the family by the GCM is especially given to the designated family caregiver, as they provide direct care to the older client and may make decisions about care. GCM’s also may also oftem provide support  a long distance care provider .Giving direct hands on care  or long distance care can spiral into caregiver stress and burnout. A GCM will use a caregiver assessment tool to measure caregiver strain, which often spins an aging family into chaos.

 

 

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