Paid In-Home Care: IMPROVING THE LIVES OF FAMILY CAREGIVERS

Transcription

1 Paid In-Hme Care: IMPROVING THE LIVES OF FAMILY CAREGIVERS A W H I T E PA P E R F RO M

2 Sectin I ABOUT HOME INSTEAD SENIOR CARE Hme Instead Senir Care is a U.S.-based internatinal franchise netwrk that prvides high quality, nn-medical hme care fr lder adults. The Hme Instead Senir Care netwrk cnsists f mre than 900 independently wned and perated franchise ffices that help senirs and their families thrugh the hme-care stage f aging. Franchise ffices are lcated thrughut the United States and in Canada, Australia, Austria, Finland, Germany, Ireland, Japan, New Zealand, Prtugal, Puert Ric, Suth Krea, Switzerland, Taiwan and the United Kingdm. Hme Instead franchise ffices emply mre than 65,000 prfessinal, trained CAREGivers SM wh, in 2010, prvided mre than 40 millin hurs f elder care services thrugh mre than 60 hme-care activities. In situatins in which a client has aging-related medical needs beynd the capabilities f nn-medical hme-care wrkers, referrals can be made t Hme Instead s partners in the healthcare industry. Hme Instead Senir Care was funded by Paul and Lri Hgan in 1994 in Omaha, Nebraska, and began franchising in June It was Paul s wn family experience caring fr his grandmther fr 12 years that influenced his realizatin f the need fr nn-medical hme-care and elder-cmpaninship services t help senirs live independently at hme. By 1998, the Hme Instead Senir Care netwrk had grwn t 99 franchise ffices and was recgnized by Entrepreneur magazine as ne f the 100 fastest-grwing franchise cmpanies in the United States. In 2000, Hme Instead began internatinal expansin by establishing a partner relatinship with Duskin C. in Osaka, Japan. The Hme Instead Senir Care Fundatin was created in 2003 t further the philanthrpic missin f franchisees. The fundatin s bjective is t prvide financial assistance t nn-prfit rganizatins specializing in prjects that imprve the quality f life fr senirs. Hme Instead Senir Care has been cited fr its business success by the Internatinal Franchise Assciatin and by several publicatins including TIME, The Wall Street Jurnal, The New Yrk Times, Entrepreneur and Franchise Times. Cmpany Funder and Chairman Paul Hgan has als taken n several advisry rles n aging issues, including serving as an at-large delegate t the White Huse Cnference n Aging. 2

3 Sectin II METHODOLOGY This Hme Instead Senir Care-cmmissined research prject entitled the Value f Caregiving at Hme study examined the perceptins and experiences f U.S. caregivers fr senirs by cnducting a survey amng adults (aged 18 and lder) wh were prviding and/r arranging care fr an lder adult (aged 65 r lder). T ensure the integrity, independence and validity f this paper, an expert panel cmpsed f medical prfessinals and academics, as well as senir-care and research experts, guided and apprved bth the methdlgy and survey instruments. Additinally, bth methdlgy and survey instruments were reviewed and apprved by the Western Institutinal Review Bard, a fully-accredited cmmercial institutinal review bard that reviews health and healthcare-related research prjects accrding t FDA regulatins and ICH guidelines. Tw separate samples were used: ne invlving caregivers whse care recipients were receiving paid in-hme nn-medical care; and a secnd grup f caregivers whse care recipients were nt receiving this care. The data was cllected using a natinal panel f mre than three millin cnsumers wh have agreed t take part in surveys cnducted by prfessinal researchers. A detailed screening prcedure identified qualified respndents, wh then participated in this survey vluntarily. T be eligible, respndents had t be respnsible fr prviding and/r arranging care (either ttally r partially) fr smene aged 65 r lder wh was nt capable f cmplete self-care; and wh was nt living in a nursing hme, assisted-living facility, r grup hme. After qualifying as a caregiver, respndents were then apprpriately classified int paid in-hme nn-medical care r nn-paid in-hme nn-medical care grups. The definitin f nn-medical care was stringent, t include n registered r certified medical prfessinals whatsever. Fr the purpses f this reprt, medical prfessinals will be thus defined as physicians; physicians assistants (PAs); nurse practitiners (NPs); registered nurses (RNs); licensed practical nurses (LPNs); licensed vcatinal nurses (LVNs); physical therapists (PTs); ccupatinal therapists; r any ther registered therapists. Sme respndents were using bth medical and paid, in-hme nn-medical care; hwever, thse relying slely upn prfessinal medical care were excluded frm this study. The nline survey instrument cnsisted f three cmpnent questinnaires designed t be administered sequentially. These questinnaires cntained sectins that allwed the fllwing: demgraphic prfiling f care recipients and caregivers; identificatin f the types f care prvided; detailed descriptin f the health status f the care recipient and the caregiver; assessment f the quality f life f bth the care recipient and caregiver; and the cllectin f data related t caregiver emplyment. Six-hundred and ninety-seven caregivers with paid in-hme nn-medical care cmpleted all three surveys, alng with 934 caregivers wh were nt using paid in-hme nn-medical care yielding a ttal f 1,631 study respndents. Only thse participants wh cmpleted all three surveys were retained in the survey-analysis prcess. Data cllectin ccurred thrughut January

4 Sectin III CAREGIVING: THE DEMOGRAPHICS Accrding t the Natinal Alliance fr Caregiving and AARP, mre than 43 millin caregivers aged 18 r lder abut 19 percent f the cuntry s adult ppulatin are prviding care t an adult family member r friend wh is at least 50 years ld. 1 Many f the recipients f this care have already turned 65, and millins mre will reach this milestne in the near future. Specifically, sme 78 millin men and wmen were brn between 1946 and 1964 the generatin knwn as the Baby Bmers. In 2011, the first f the Bmers will turn 65, and they will d s at a rate f mre than 8,000 a day. By year s end, the natin s senir ppulatin will have grwn by almst 3 millin, t a ttal f nearly 49 millin. By 2025, then, the U.S. senir ppulatin, which was 35 millin in 2000, will have mre than dubled t 72 millin. The number f family members and friends wh are cast in the rle f caregiver fr an lder adult will almst certainly grw in equally large numbers. It will be ne f the greatest scial changes in the natin s histry, and it is abut t begin. Sectin IV 43 millin family caregivers THE PRESSURES ON FAMILY CAREGIVERS Prviding care t a senir can be a rewarding and enriching experience. It als can be extremely taxing physically, mentally and emtinally. 4

5 Fr several years, Hme Instead Senir Care has cllected data frm caregivers acrss the U.S. n its caregiverstress.cm Web site. They cite the fllwing reactins r prblems: 90% 83% 77% 77% 56% 56% have experienced episdes f anxiusness r irritability. say caregiving is very demanding. describe the needs f their senirs as verwhelming. say caregiving is taking a tll n their family lives. say they were falling ill mre frequently. say caregiving takes a tll n their jbs. These caregivers need help. They need it almst frm the very beginning f their caregiving rle. And the need almst always intensifies as the recipients age. Frtunately, the care cntinuum fr U.S. senirs has expanded t include a new ptin: paid in-hme nn-medical care, which can reduce the burdens n caregivers while helping them prvide mre and better care t their senir lved nes. 5

6 Sectin V THE BENEFITS OF PAID IN-HOME NON-MEDICAL CARE Recent Hme Instead Senir Care research has shwn that the use f paid in-hme nn-medical care is assciated with imprtant persnal and prfessinal benefits fr family caregivers benefits that als wrk t the advantage f the senirs fr whm they care. In-hme nn-medical prfessinals wrk with senirs wh have reached a pint in life when they need sme help with daily and weekly rutines. This may include assistance with trips t the dctr; reminders t take the right medicatin at the right time; meal preparatin; light husekeeping; errands; shpping; and even Alzheimer s and dementia care. The result is cmpaninship that allws senirs t feel safe and independent while they age in place in the hmes they ve lived in fr years. Caregivers wh used paid in-hme nn-medical care fr their senirs reprted having better verall health than did their cunterparts wh did nt make use f such care; 78 percent f thse in the first grup rated the verall quality f their health as gd r very gd, while 72 percent f thse in the secnd grup rated their verall health at the same levels. Furteen percent f caregivers wh did nt use paid in-hme nn-medical care reprted that their health was wrse than it had been a year befre, while nly 10 percent f thse using paid in-hme nn-medical care cited wrsening health. And, 25 percent f caregivers wh did nt use paid in-hme nn-medical care reprted needing sme type f utpatient hspital care during the previus year, cmpared with 19 percent f thse using paid in-hme nn-medical care. Extraplating these findings acrss the natin s entire ppulatin f caregivers clearly indicates that the expanded use f paid in-hme nn-medical care can cntribute t imprved health and a better quality f life fr millins f Americans wh care fr lder adults. 6

7 A Mre Demanding Demgraphic The Hme Instead Senir Care findings are particularly significant in light f the fact that mst paid in-hme nn-medical care is being used by lder senirs with very demanding needs. The study fund that the recipients f such care tended t be lder, with 75 percent abve the age f 80, and they were ften sicker r therwise mre limited in their daily rutines: 61 percent were characterized as having mbility prblems. 48 percent were dealing with frailty, which the American Geriatrics Sciety defines as a cnditin characterized by three r mre f the fllwing: muscle weakness; slw walking speed; exhaustin; lw physical-activity levels; r unintentinal weight lss percent had Alzheimer s and 43 percent were suffering frm ther dementias. 22 percent were cntending with the after-effects f strke. Health Benefits fr Alzheimer s Caregivers The finding that family caregivers wh make use f paid in-hme nn-medical care have better persnal health than thse withut such help was even mre prnunced amng study participants wh tk care f senirs suffering frm Alzheimer s disease r ther dementias unquestinably ne f sciety s mst challenging caregiving scenaris. When caregivers fr recipients with mre serius dementias (as rated by the caregivers themselves) were asked if their persnal health was wrse than a year befre, nly 14 percent f thse wh used paid in-hme nn-medical care said yes, cmpared with 25 percent f caregivers in the grup withut such care. Amng thse caring fr senirs with less serius dementias, the numbers were 12 and 16 percent, respectively. Similarly, when asked if they had received utpatient hspital care ver the past year, nly 18 percent f caregivers using paid in-hme nn-medical care fr senirs in the mre serius categry had dne s, cmpared with 40 percent f thse in the secnd grup. In the less serius categry, the numbers were 18 percent and 24 percent, respectively. Accrding t the Alzheimer s Assciatin reprt Changing the Trajectry f Alzheimer s Disease, The number f Americans age 65 and lder wh have this cnditin will increase frm 5.1 millin tday t 13.5 millin by mid-century. 3 7

8 Sectin V The Benefits f Paid in-hme Nn-Medical care (Cntinued) The Hme Instead Senir Care findings clearly indicate that in light f the extrardinary grwth in the number f Alzheimer s sufferers, paid in-hme nn-medical care shuld becme a majr ptin fr bth senirs with this disease and their family caregivers. The Benefits fr Wrking Caregivers The strain f hlding a jb while caring fr a senir can take a serius tll n a caregiver s career. Accrding t research frm the Natinal Alliance fr Caregiving and AARP, in 2009, 68 percent f emplyee-caregivers wh were surveyed said they had made accmmdatins in their wrk status as a result f their caregiving respnsibilities. The accmmdatins included taking time ff r ging n leaves f absence; lsing benefits; r even quitting the wrkplace entirely, either by leaving a jb r taking early retirement. 4 Hme Instead Senir Care s research shws, hwever, that the use f paid in-hme nn-medical care can help family caregivers remain in the wrkfrce and may help mitigate sme f the financial sacrifices assciated with being an emplyee-caregiver. The study fund that f thse family caregivers using paid in-hme nn-medical care, 71 percent were emplyed 51 percent f them full-time. The numbers were lwer fr caregivers nt using such care: 65 and 49 percent, respectively. S, paid in-hme nn-medical care apparently makes it easier fr family caregivers t wrk utside the hme. In additin, while mst f the caregivers studied had lst earnings because f jb changes they had made, thse using paid in-hme nn-medical care had sacrificed less than thse wh did nt use such care. Specifically, an identical 81 percent f caregivers in bth grups indicated that at sme pint they had lst wages as a result f changing jbs t accmmdate their caregiving respnsibilities a testament t the hardships f serving as a wrking caregiver. But thse using paid in-hme nn-medical care did almst 25-percent better in terms f maintaining their previus incme levels than did thse in the ther grup. Even thugh serving as a family caregiver may have a negative effect n an individual s earning pwer, the use f paid in-hme nn-medical care may help mitigate the lsses. 8

9 Mre Care & Better Care Family caregivers make persnal accmmdatins and suffer financial lsses primarily t help prvide the best care they can fr their senir lved nes. It is highly significant, therefre, that prbably the single-greatest benefit f using paid in-hme nn-medical care is that it allws lder adults t receive mre care and presumably better care n a regular basis. The Hme Instead Senir Care research shwed that per week, recipients f paid in-hme nn-medical care typically receive mre verall hurs f care including paid and unpaid care, medical and nn-medical care than d lder adults wh d nt have such services. Hurs f care per week Senirs Using Paid In-hme Nn-medical Care Senirs Nt Using Paid In-hme Nn-medical Care In fact, the cmparisn is rather startling. The senirs with paid in-hme nn-medical care received an average f 87.9 hurs f ttal care per week, cmpared with 35 hurs fr the secnd grup. Put anther way, in any given week, lder adults wh have such care will receive abut tw-and-a-half times as much assistance as the senirs wh d nt. It is imprtant t remember that these numbers represent the cllabrative effrts f bth family caregivers and paid in-hme nn-medical persnnel. The family caregivers cntinue ding their extrardinarily imprtant part. Hwever, the additin f paid in-hme nn-medical services makes a dramatic difference in the amunt f care and therefre, it is reasnable t assume, the quality f care that their senirs receive. Caregivers Recgnize This The caregivers wh participated in the Hme Instead Senir Care study cnfirmed the mre care equals better care finding when they used a 1-t-5 scale t rate the verall quality f in-hme care received by their senirs. Fr the lder adults whse care bundles included paid in-hme nn-medical services, 78 percent f caregivers rated the verall quality f care at a 4 r 5 level that is, very gd r excellent. In cntrast, caregivers fr senirs nt using paid in-hme nn-medical care assigned a 4 r 5 fr care quality in 70 percent f cases. With the cmbined help f family members and paid in-hme nn-medical care, senirs are healthier and happier in the familiar surrundings f their wn hmes. 9

10 Sectin VI CONCLUSION The Hme Instead Senir Care research demnstrates that family caregivers derive imprtant persnal and prfessinal benefits when they supplement their senir caregiving with paid in-hme nn-medical services. Amng these: Better persnal health. Better quality f life. Mre help with senirs wh make greater care demands, especially thse with Alzheimer s and ther dementias. Help in staying in the wrkfrce. Help in reducing the financial sacrifices that caregiving ften impses. Help in delivering mre care and better care t their senirs. As the number f lder Americans rapidly expands, s will the cuntry s need fr senir care. At least initially, much f this demanding burden will fall n yunger family members, many f whm are already busy with wrk and children. Thus, paid in-hme nn-medical care can play a vital rle in shring up a U.S. caregiving system that is already stretched thin, and that will be far mre strained in cming years. It is imperative fr plicymakers t determine hw t make safe, affrdable in-hme nn-medical senir care accessible t families that need it. The senirs and their families must take ultimate respnsibility fr their well-being, f curse. But a natinal strategy that brings paid in-hme nn-medical care within their reach can prduce great persnal, prfessinal and scietal benefits. BETTER QUALITY OF Life 10

11 Sectin VII RECOMENDATIONS Given the grwing imprtance f paid in-hme nn-medical services and their ptential t imprve the quality f senir care natinwide, a series f steps t encurage their grwth and develpment is in rder: Natinal Senir-Care Plicy Establish a cmprehensive natinal senir-care plicy t prvide ptimal care fr senirs, and ensure gd stewardship f the limited human and financial resurces available t prvide care t an aging ppulatin. An Educatinal Campaign Develp a cntinuing natinwide prgram t educate senirs and their families abut the chices that are available alng the healthcare cntinuum and hw t g abut making the best decisins at each stage f the aging prcess fr example, prviding nn-medical care in the senir s hme rather than institutinalizing him r her in a nursing hme. The campaign culd be munted by a calitin invlving public senir-service agencies and the private-healthcare cmmunity. Tax-Plicy Changes Create a natinal study cmmissin t review the impact f the current tax cde n senir care decisin-making and recmmend adjustments t the cde that wuld encurage hme care and persnal respnsibility fr senir care. A Yuth Crps Create a crps f yung vlunteers wh wuld be trained t wrk fr, say, three years as in-hme nn-medical wrkers, perhaps using reductins in cllege-lan debts as an incentive. A Senir Crps Sme f the best in-hme nn-medical wrkers are ften senirs themselves. Scial plicies shuld be develped t encurage this trend. New Senir-Care Optins Offer federal grants t test innvative new prgrams in senir care, especially prgrams that will enable lder adults t age at hme, a chice nearly 90 percent say they prefer. Surces: 1. Online at 2. Online at 3. Online at 4. Online at 11

12 hmeinstead.cm Califrnia Street Omaha, NE Each Hme Instead Senir Care franchise ffice is independently wned and perated Hme Instead, Inc. 12