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Spring 2025
Spring 2025 Issue Trained to Care How Physicians Can Play a Critical Role in Supporting Family Caregivers As much as 14% of the US population, 37.1 million people, provide unpaid elder care, according to the Bureau of Labor Statistics.1 But many of these family members are thrust into the caregiving role for a loved one who is aging without any support or training, left to figure out important issues like medication management, fall prevention, and assisting with activities of daily living (ADLs) on their own. With the growing number of older adults requiring care, the number of inexperienced caregivers is likely to grow as well. This is why elder care physicians need to be able to provide effective guidance for these family members to give proper care to their loved ones. This article will explore the difficulties of family caregiving, as well as how physicians can help make the transition to this role a little easier, with advice skills to discuss in meetings and potential training opportunities. The Caregiver’s Reality Patricia F. Harris, MD, geriatric specialist at UCLA Health, has always been drawn to older people and is passionate about supporting the aging population. With a focus on home-based primary care, Harris offers unique insight into a wide range of home situations and what caregivers need to successfully support aging in place. “The fact that about 20% of full-time workers also care for an aging relative is further evidence that older people generally need some help at home,” Harris explains. “Geriatricians can serve as educators for these caregivers, advise them on issues on which to focus, and guide them away from unnecessary stressors (eg, if Mom wants to wear stripes and plaid every day, or if Dad wants to sleep in his street clothes, does it matter?), and of course, try to consolidate their medical care as much as possible.” According to Harris, if an older person does not have a loved one or a neighbor who is willing to assume some of the day-to-day tasks required to live in the community, that person is at risk for poor health and institutionalization. Family caregivers are important as they help keep valuable members of the aging population in intergenerational communities where everyone can benefit from their presence. Aging in place also serves to protect elderly patients’ health and well-being. Family caregivers collaborate closely with physicians to achieve the best possible outcomes for their patients—most often with no compensation. Family Caregiving Challenges Caregiver burnout is another common struggle family caregivers experience, with one person often taking on the brunt of the caregiving load without much in the way of respite or support from other family members. Difficult family dynamics, chronic physical and emotional stress, and sleep deprivation also top the list of daily challenges faced by family caregivers. While physicians, nurses, and professional caregivers receive ample training to understand aging and illnesses, family caregivers have no such background. Not knowing what to expect as their loved one ages or as an illness progresses can lead to unnecessary stress and worry. There are many nuances to caregiving that come with experience, and physicians can help family caregivers navigate these microskills. For instance, “Older people react more slowly to situations, and may need lots of extra time to do the simplest of tasks,” Harris reflects. “Older people may say things that are considered impolite, and caregivers need to ignore these words. They also need to understand the difference between the necessary and unnecessary—a pill for high blood pressure really should be taken every day, but perhaps skipping a bath once in a while is okay.” From developing patience and flexibility to learning to avoid diminutive terms like “sweetie” and “dear,” opting to respectfully use their given name instead, there are many little lessons that caregivers learn along the journey to increase their efficacy and the ease of their day-to-day responsibilities. These things can take time to learn and understand, but physicians can help ease this educational transition. Training Family Caregivers Hermes Florez, MD, PhD, MPH, endowed chair and executive director of the Medical University of South Carolina (MUSC) Center for Healthy Aging, is a public physician scientist and geriatrician who has focused his service on training the workforce to provide better care through innovation and education. “I enthusiastically embraced the call to facilitate the training of family caregivers,” Florez says. Personally, having trained his own mother and brother to provide compassionate care for his dad, who lives in South America and has a traumatic brain injury, Florez believes that family caregiver training should include information about respite care, caregiver health and well-being, connection, and social support, as well as practical skills for delivering patient care. But what skills are important to impart when equipping family caregivers for the job? Here are a few to consider addressing in conversations with family caregivers: • Medication administration, skincare, and nutrition. Proper medication management is crucial in caring for patients at home, so make sure family caregivers are clear on the instructions related to any prescriptions given to their loved ones during their medical appointments. Skincare is another challenge that often sneaks up on caregivers, particularly in regard to pesky bed sores, dryness, and yeast infections. Proper skincare and basic wound care skills can work wonders in preparing caregivers to handle these issues. Nutrition is essential when it comes to aging well. Equip caregivers with information on how to provide a balanced diet for their loved one, including proper hydration, as well as any special dietary considerations that they need to know in managing conditions like heart disease and diabetes. • Navigating hearing, vision, mobility, and/or cognitive deficits. As a loved one ages, hearing and vision loss are often gradual changes that family members must adapt to, especially when providing care at home. Discussing ways to communicate effectively with patients experiencing significant hearing loss, or how to keep a loved one with vision loss safe in their home is important, as is training family caregivers to help patients achieve mobility safely, depending on their current ability to get in and out of bed, walk to the bathroom, etc, and what to do if their level of independence changes. Understanding and responding to any cognitive deficits that might result from Alzheimer’s or dementia is also critical to empowering family caregivers with the information they need to appropriately provide care. • Understanding the aging process. Many of us are unaware of the natural changes the body endures as it ages. The more family caregivers know what to expect, the more confident they will be in knowing when to call the medical office for assistance. • Communicating effectively with their loved ones. Particularly for patients unable to direct self-care or who exhibit challenging behaviors, ensuring effective, compassionate communication can be hard to navigate. Walking family caregivers through scripts they can use to inspire cooperation can be empowering and make ADLs feel easier for both patient and caregiver. • Negotiating with others on the family care team. Encourage family caregivers to advocate for much-needed support and respite from the other family members in the patient’s life. Share ideas for how to ensure everyone involved is doing their share in order to avoid caregiver burnout and make sure the patient’s caregiver has a self-care plan in place. In addition to advising family caregivers on the basic skills necessary to manage their loved one’s condition(s) at home, health care professionals can carefully screen their patients to ensure their safety. “Older adults are vulnerable and prone to faster decline, particularly if they have several chronic conditions (age-related diseases) that limit their ability to function independently,” Florez explains. “Geriatricians can screen to detect geriatric syndromes (ie, cognitive decline and dementia, depression, mobility problems, falls, etc) and assess ADLs and instrumental ADLs to determine if a particular older adult and caregiver requires assistance or full support, as well as to prevent visits to the emergency room and hospitalizations.” Furthermore, caregiver self-care should also not be ignored. When treating an elderly patient, know that their caregiver’s health is equally important. “Caregivers should be able to take care of themselves, preserving their physical and mental health,” Florez urges, “while they provide support to their loved ones on basic issues such as adherence to medications prescribed by members of their health care team and adoption of a healthy lifestyle.” There are three ways that geriatricians can make a difference in improving the quality of care provided by family caregivers. First, they can offer as much training as possible during home or office visits with the patient-caregiver duo. Second, “Geriatricians can advise caregivers [with] what is available locally and online to help them succeed in the caregiving role,” Harris says. Third, geriatricians can become their patients’ best advocates by pushing for policy changes that will better support family caregivers’ efforts to keep the aging population healthy and happy at home in the community. “Ideally, geriatricians would all be advocates for their patients in the larger arena,” Harris continues, “writing or calling their representatives to remind them that the ‘silver tsunami’ is here and that we need to provide support for the people that care for them.” Medicare Part B Help 1. The training focuses on helping the patient meet the health and treatment goals they set with their doctor or other health care provider. 2. The patient needs a caregiver’s help for their treatment to succeed.2 If the patient’s health care provider determines that caregiver training is appropriate for the patient’s treatment plan, the caregiver can get individual or group training sessions from the provider without the patient present. This can be a valuable avenue for busy physicians to offer more intensive training to family caregivers. Training covered by Medicare Part B can be provided by doctors, nurse practitioners, clinical nurse specialists, certified nurse-midwives, physician assistants, clinical psychologists, and/or therapists, including physical and occupational therapists and speech-language pathologists. Family caregivers can request training from their loved one’s physician, or ask for a referral to another provider in the community who offers this kind of training. Additionally, as of January 1, 2024, health care providers can bill Medicare for time spent training family caregivers, including education on managing medications and performing medical tasks. Caregivers of patients with serious conditions such as cancer, dementia, and HIV/AIDS are entitled to additional training. These initiatives are all part of the executive order signed on April 1, 2023, by then-President Joe Biden, including more than 50 directives to federal agencies in an effort to better support the nation’s family caregivers.3 GUIDE Model Dementia affects more than 6.7 million Americans and is on the rise in the aging population, with 14 million projected cases by 2060.4 The standard approach offered through the GUIDE program aims to allow people with dementia to remain safely in their homes longer by preventing or delaying nursing home placement and improving quality of life for both people with dementia and their unpaid caregivers.5 Florez looks forward to MUSC’s participation as a GUIDE site. MUSC will begin enrolling patients with dementia in July, and dementia care navigators will be employed to help with caregiver education. A database of GUIDE program sites can be accessed online at CMS.gov. Final Thoughts — Heather Rose Artushin, LISW-CP, is on a mission to make a difference, one word at a time. Learn more at https://heatherrosewriter.com.
ADDITIONAL RESOURCES • The American Caregiver Association offers family caregivers a comprehensive online course that prepares them for the tasks involved in the caregiving process and culminates in a certificate. There is a $99 fee associated with this program: https://americancaregiverassociation.org/caregiver-certification • The VA Caregiver Support Program offers supportive resources to family caregivers caring for military veterans: www.caregiver.va.gov • The Caregiver Action Network provides a database of articles that caregivers can access using basic search tools by caregiver experience level and patient condition: www.caregiveraction.org/toolbox • AARP offers caregivers a listing of resources by state: https://tinyurl.com/nhyt3k6a
References 2. Caregiver training services. Medicare website. https://www.medicare.gov/coverage/caregiver-training-services 3. Lankford K. New ways Medicare is supporting family caregivers. AARP website. https://www.aarp.org/health/medicare-insurance/info-2024/medicare-support-family-caregivers.html?msockid=2bae1ce9a46d6cb52c7708caa58d6dbc. Published May 20, 2024. 4. Youngblood Gregory S. Understanding dementia risk, from lifestyle to genetics, medication and everywhere in between. Mayo Clinic Press website. https://mcpress.mayoclinic.org/healthy-brain/understanding-dementia-risk-from-lifestyle-to-genetics-medication-and-everywhere-in-between. Published August 7, 2024. 5. Guiding an Improved Dementia Experience (GUIDE) Model. CMS website. https://www.cms.gov/priorities/innovation/innovation-models/guide |
