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Recognizing the Important Role of Family Caregivers

Posted 2/9/2012 Categories: chronic care, home health, caregiving, dementia, hospice, respite, alzheimer's

Guest post by Stien Vandierendonck, Manager of Programs and Communications at the National Alliance for Caregiving.

Did you know that over 65.7 million Americans provide care for a family member, friend or neighbor? That’s nearly three in ten people age 18 or older1. Family caregivers nevertheless remain under-recognized and under-resourced.

Most American caregivers are female and on average 48 years old. They typically take care of a relative, most often a parent, for an average period of 4.6 years.1 The estimated economic value of their unpaid contribution was on average $450 billion in 2009.2

In addition to helping the care recipient with everyday activities, surveys reveal that many family caregivers also provide financial assistance. A study the National Alliance for Caregiving published on caregiving out-of-pocket costs indicates that caregivers spend on average $5,531 each year on caregiving responsibilities. Since the annual median household income is $43,026, you realize that this is a significant burden for many. The highest costs are related to medical, food, and household expenses. For caregivers with limited incomes, it is even harder to cope.3 Another study suggests that caregiving for an older relative is an important factor in the health, medical care expense, and productivity of employees across all age groups. The additional health cost to employers is 8 % more compared to non-caregivers.4

Besides the financial costs, the health of the family caregiver is also a subject of concern. There are studies that indicate that the health of family caregivers (most often a spouse) may be adversely affected, especially as their caregiving continues for an extended period of time and becomes more intense. A study we released in November on caregivers of people with Alzheimer’s disease (AD) shows a significant decrease in family caregiver health over time as their care recipient’s dementia increases. This study also specifically examined the use of formal health services in a large sample of AD caregivers. The strain of caring for someone with AD can cause family caregivers to use health care services (ER visits, hospital visits and doctor visits) at higher rates than non-caregivers of the same age, at an average annual cost increase of $4,766 per caregiver in personal healthcare expenses.5

The expenses of the impact to personal health of the caregiver, combined with the expenses of caregiving responsibilities, shows the significant economic impact of caregiving on personal costs in this country – especially for older caregivers on fixed incomes.

Health professionals can play an important role in identifying caregivers at risk of having their own health decline, by using assessments that may help mediate costs. These assessments look at the caregiver’s health, ability and willingness to do what tasks may be required, as well as the caregiver’s need for support. For example, when an initial diagnosis of dementia is confirmed, it is recommended to conduct a caregiver assessment at the same time as an initial diagnosis of dementia. That way the family caregiver is integrated into the caregiving team, right from the beginning. As the care recipient’s health declines or dementia increases, the family caregiver assessments should be repeated to ensure that the caregiver is getting the support he or she needs. In addition, such assessments can serve to identify potential stress or even physical strain. The “Caregiver Self-Assessment” is such a tool, which can be downloaded from the American Medical Association or from the National Alliance for Caregiving. A caregiver assessment can also be integrated into the new annual Medicare Wellness Visit.

The efforts that family caregivers make are tremendous and the impact on different aspects of their lives is significant. That’s why we emphasize the importance of supporting the family caregiver, by integrating them from the beginning in the professional caregiving team as a part of the patient centered care – a relatively new, but vitally important, concept in health care. Employers can serve the best interest of their employees by anticipating and responding to the challenges of eldercare for their employees by offering eldercare benefits and wellness programs.4 For the family caregiver themselves, they need information, education and training. Information about the medical condition of the care recipient; coping skills and other relationship issues; better communication; community services; and long-term care planning. Education and training can be given through video, audio, workshops, and one-on one sessions.6

Last but not least, family caregivers want and need respite care so that they can be relieved from the extraordinary and intense demands of ongoing care, thereby strengthening the family’s ability to provide care. It doesn’t have to mean going on a vacation. Taking a break before extreme stress and crisis occurs, can also be simply going to a movie or concert or listening to your favorite music, while someone else cares for your loved one.7


  1. National Alliance for Caregiving. Caregiving in the U.S., 2009.
  2. AARP Public Policy Institute Report: Valuing the Invaluable: 2011 Update, The Growing Contributions and Costs of Family Caregiving.
  3. National Alliance for Caregiving. Evercare® NAC Caregiver Cost Study, 2007.
  4. National Alliance for Caregiving. The MetLife Study of Working Caregivers and Employer Health Care Costs, 2010.
  5. National Alliance for Caregiving. Alzheimer’s Caregiver’s Healthcare Costs Increase as Person with Dementia Declines, 2011.
  6. Schmall, VL, Family Caregiver Education and Training: enhancing self-efficacy, Journal of Case Management, 1995 Winter, 4 (4): 156-62.
  7. Family Caregiving 101. Respite.

About the National Alliance for Caregiving

Established in 1996, The National Alliance for Caregiving is a non-profit coalition of national organizations focusing on issues of family caregiving. Recognizing that family caregivers provide important societal and financial contributions toward maintaining the well-being of those they care for, the Alliance’s mission is to be the objective national resource on family caregiving with the goal of improving the quality of life for families and care recipients.

If you are a part of a caregiving coalition and would like to join NAC’s efforts or share information, please contact stien@caregiving.org or if you are a professional with an interest in family caregiving issues, please join the Caregiving Coalition Listserve to receive the Caregiving Exchange Newsletter and information on caregiving events, research, public policy and programs.

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New CMS Rule Allows Physician Collaboration in Face-To-Face Encounters

Posted 1/3/2012 Categories: home health, face-to-face, CMS

A new rule by the Center for Medicare and Medicaid Services (CMS) adds a little flexibility for physicians ordering home health for their patients following a hospitalization or other facility stay.

Effective Jan. 1, 2012, CMS regulations for face-to-face encounters allow the patient's primary care physician to take information from a physician who had a face-to-face encounter during a patient's acute or post-acute facility stay. The certifying physician may then document the face-to-face encounter and certify the patient for home health based upon the reported information.

  • Upon discharge from a hospital or post-acute facility, the attending physician can inform the certifying physician regarding their encounter with the patient to satisfy the face-to-face encounter requirement, much like a non-physician practitioner currently can.
  • The certifying physician can then complete the 485 order for home health, including documentation of a face-to-face encounter, based upon the information received from the acute/post-acute facility physician.
  • The flow of information should occur in a way that works best for the two health care professionals involved.

CMS announced the new face-to-face flexibility as part of Rule CMS-1353-F.

Face-to-Face Quick ReferenceWe've put together a face-to-face quick reference card to help you document the CMS requirements efficiently. You can print it and keep it at your desk, or save it to your mobile device for convenient access.

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Holistic Palliative Care for Alzheimer's/Dementia Patients

Posted 1/3/2012 Categories: chronic care, palliative care, dementia, hospice, webinar, alzheimer's

Alzheimer’s disease is the sixth leading cause of death in the United States and accounts for the largest percentage of dementia cases. For patients with end-stage Alzheimer’s disease and other forms of dementia, palliative and hospice care professionals can achieve optimal results by providing holistic end-of-life care services.

As part of their interdisciplinary topics series, the National Hospice and Palliative Care Organization (NHPCO) is hosting a webinar to discuss the importance of interdisciplinary team collaboration in assessing and holistically treating these patients and supporting their families.

Amedisys Chief Medical Officer, Dr. Kevin Henning, and China Phillips, Nurse Practitioner at Columbus Hospice, will:

  • identify pharmacological and non-pharmacological treatment options
  • discuss behavioral issues associated with patients with dementia
  • offer strategies with a focus on nursing and other interdisciplinary team member interventions to help families adapt to the day-to-day challenges of caring for a loved one with advanced dementia.

For more info and registration:

January Interdisciplinary Topic Holistic Palliative Care for Alzheimer/Dementia Patients
January 12, 2012 - 2:00 pm - 3:30 pm ET
CE/CME Offered: Counselor, Nurse, Physician, and Social Work

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Bring Health Care Home

Posted 12/8/2011 Categories: healthcare reform, home health, independence at home, chronic care

In his New York Times opinion article, Bring Health Care Home, Dr. Jack Resnick makes a compelling case for bringing health care home, where a network of coordinated care givers serve patients in a familiar, comfortable setting.

Care of chronic conditions is more often effectively managed in the home setting rather than in a hospital. The coordinated home health care models of today, which feature a broad network of highly-skilled clinicians ranging from physical therapists to physicians, work with the latest communication technologies to offer the best of old and new forms of medical treatment.

A home based primary care program introduced by the Veteran’s Administration more than 30 years ago has reduced hospital stays by 62 percent and led to a 24 percent drop in overall medical costs. The home health care industry can help produce better patient outcomes if more people, especially doctors, are more informed about health care at home options.

About the Author

Michael Fleming, MD, FAAFP is the Chief Medical Officer for Amedisys, and Past President of the American Academy of Family Physicians and the Louisiana Academy of Family Physicians. Dr. Fleming has served as Speaker of the Congress of Delegates of the AAFP and as Board Chair of the AAFP Board of Directors. He serves as an assistant clinical professor in the Department of Family Medicine at the LSU Health Science Center and in the Department of Family and Community Medicine at Tulane University Medical School.
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Four Drugs Linked to Two-Thirds of Medication-Related Emergency Hospitalizations

Posted 12/1/2011 Categories: heart health, medication management, side effects, coumadin, diabetes, hospitalizations, insulin, warfarin, chronic care

Researchers from the Centers for Disease Control and Prevention just published a report finding that most drug-related emergency hospitalizations result from a few common medications, not those typically thought of as "high-risk" drugs. The four medications or medication classes that were most frequently linked to hospitalizations were:

  • Warfarin (also called Coumadin)
  • Insulin
  • Oral anti-clotting drugs
  • Oral hypoglycemic drugs for diabetics

Patient education and improved medication management are critically important to help prevent emergency hospitalizations. Sixty-five percent of these hospitalizations were the result of unintentional overdoses. It's easy to be confused and make a medication mistake: the average Medicare patient with a chronic condition (like diabetes or heart disease) fills over 20 prescriptions a year. And a patient with five or more chronic conditions (which includes 20% of the Medicare population) fills an average of 49 prescriptions per year.

If you or your loved one aren't sure what to do if you miss a dose of medicine or what side-effects to watch out for, be sure to talk with your home health nurse. They're trained to help you understand your medications and take them safely, and may have resources - like drug guides, medication trackers and pill boxes - to help you manage your medications. Or if you're not receiving home health care, be sure to talk with your doctor.

The study, Emergency Hospitalizations for Adverse Drug Events in Older Americans, was published on November 24 by the New England Journal of Medicine.

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