Family caregivers for people with dementia are sometimes called “the invisible second patients” because of the often-disastrous effects that caregiving has on their lives – emotionally, socially, and financially. Many studies have concluded that caregivers are as vulnerable to mental health issues as they are essential to the care of the patient.
Frequently, the family or “informal” caregiver is all that stands between the patient and a skilled nursing facility. This is why keeping family caregivers in place is rapidly becoming not only a critical aspect of home care for dementia patients, but a global economic imperative as dementia rates escalate worldwide.
Before caregivers burn out, qualified home care services that provide education, coaching, and time off from caregiving duties may be able to keep family caregivers doing the invaluable work they perform every day.
Assessing the caregiver: Symptoms and studies
Caregiver burnout has been well documented and carefully analyzed. It includes greater risk of health problems, social isolation, financial stress, and emotional, cerebral, and spiritual depletion among other known consequences.
The symptoms of dementia affect caretakers in a variety of ways. Patient anger, aggression, and hallucinations, for example, have been specifically connected with caretaker burnout. Yet many informal caregivers try to endure for too long before seeking help. A 2011 Canadian report on caregiver burnout said “resources are allocated only after things have been going badly for some time. Until – and unless – they exhibit signs of ‘distress’….caregiver support needs are neither systematically assessed nor addressed.”
Building on this knowledge, researchers have identified types of caregivers who may be more susceptible to key stressors. Models for formal caregiver assessment have been developed as well. What seems self-evident is that dementia caregivers benefit from help. The question then becomes: What kinds of assistance are most effective?
Compared to Other Caregivers
Well-being & Physical Health
A 2009 study published by Dialogues in Clinical Neuroscience/NIH reported that “levels of psychological distress and stress are significantly higher, and levels of self-efficacy, subjective wellbeing, and physical health significantly lower, in dementia caregivers than in other caregivers.” Home care support for caregivers, it follows, can play a significant role in alleviating these factors.
4 effective interventions: From education to meditation
Some recent work has been done to answer the question.
Psychoeducation. Caregivers cope better when they learn 1. How to identify the causes of problem patient behavior. 2. How to alter dysfunctional thought patterns and increase engagement in enjoyable activities. 3. How to manage anger (the patient’s and their own).
Counseling & Psychotherapy. Cognitive behavioral therapy is being joined by the newer approach of “acceptance and commitment therapy” (ACT) for caregivers, which focuses on adaptation to present circumstances rather than “challenging and changing.” Multicomponent interventions that involve individual and family counseling with trained social workers also report success in reducing caregiver depression.
Mindfulness-based interventions. This category of caregiver support involves stress-reduction measures such as meditation and yoga. Studies are promising but rely on small samples without examination of long-term outcomes.
Technology. Psychoeducation, behavioral modification (to boost positive activities), and building caregiver communication skills have all been delivered effectively by phone and computer. When combined, efficacy in reducing depression and stress increases further.
Caregiver Education & Skills Training
A 2011 study by the American Medical Association/JAMA of dementia among veterans found that a 2-hour per day “break” for caregivers resulted in significantly reduced caregiver depression and frustration. Not surprisingly, 96% of caretakers agreed that the program should be more broadly implemented. This indicates the potential for qualified home care services to play a vital role in supporting dementia caregivers, thereby keeping dementia patients at home.
The overarching narrative: Caregiver support must be customized
The Current Psychiatry Reports study quoted above concludes that “more work needs to be done to tailor interventions to meet the specific needs of each caregiver and to strengthen the family as a caregiving unit.”
This is where qualified home care services may make a contribution. A home care team experienced in helping patients with dementia is positioned to deliver precise relief to both patient and caregiver. Further, when a home care team is familiar with the personal history of the patient and the dynamics of the family they can make their work more relevant and meaningful.
The integrated care management model by SeniorBridge
Home care services vary widely in the services they provide.
SeniorBridge offers an integrated care management practice model that involves two components:
1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.
NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.
For more information on dementia home care support services, contact SeniorBridge.
National Library of Medicine /NIH/Dialogues in Clinical Neuroscience (2009)
Taylor Francis/Clinical Gerontologist (2017)
Wiley Online Library/Health and Social Care in the Community (2011)
National Library of Medicine/NIH/Dialogues in Clinical Neuroscience (2009)
National Library of Medicine/NIH/Current Psychiatry Reports (2019)
JAMA Network (2011)