serving caregivers before crisis rhonda j. v. montgomery, ph.d. university of kansas
TRANSCRIPT
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Serving Caregivers Before CrisisServing Caregivers Before Crisis
Rhonda J. V. Montgomery, Ph.D.
University of Kansas
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Diversity of BurdensDiversity of Burdens
Difficult tasks/Physical Health Time for other responsibilities Task Overload Privacy Loss of Roles Isolation Financial Burden Guilt
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Differences translate to Differences translate to need for different types of need for different types of
supportsupport
Education/Information Support Groups
Respite care Care Management
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Rationale for SupportRationale for Support
Burden
CareExhaustion
Abuse
Placement
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Rationale Rationale forfor Support Support
Burden
CareExhaustion
Abuse
Placement
Support
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Does this Rationale Hold?Does this Rationale Hold?
Care does not always lead to burdenDiversity of burdensSupport does not always reduce
burdenNot all caregivers will use support
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Relief Comes When:Relief Comes When:
COST < or = RELIEF
COST = Time + Physical Energy +
Emotional Energy
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Maximize Relief With Optimal ServiceMaximize Relief With Optimal Service
EducationCounselingCare ManagementSupport GroupsRespite Care
• In-home• Day Care• Residential
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Maximize Effectiveness with Maximize Effectiveness with Optimal DosageOptimal Dosage
QuantityFrequencyTiming
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The caregiving career is a The caregiving career is a process of identity changeprocess of identity change
Wife to CaregiverHusband to CaregiverDaughter to Caregiver
Son to CaregiverFriend to Caregiver
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An optimal change process:An optimal change process:
Continuous - not abrupt Accelerates the period between
self identification (#2) and seeking service (4)
Lengthens the period between seeking service (#4) and nursing home placement (#6)
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Optimal supports facilitate Optimal supports facilitate identity shiftidentity shift
Teach caregivers about the caregiving roleInform caregivers about options for care
behaviorsInform caregivers about options for
supportsTeach caregivers to use supports
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010203040506070
0 1 2 3 4 5
Years
Hours
Bank Shop/Trans Household Other Tasks . Personal
Caregiving career: child
#4
#2
#3#4
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010203040506070
0 1 2 3 4 5
Years
Hours
Bank Shop/Trans Household Other Tasks . Personal
Caregiving career: child#6
#2
#3
#5 #6#4
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Caregiving career: child
010203040506070
0 1 2 3 4 5
Years
Hours
Bank Shop/Trans Household Other Tasks . Personal
#2
#3
#5 #6#4
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Education ProgramsEducation Programs
Children:– Disease Process
– Community Based Services
– Legal and financial information
Spouses– Coping skills
– Behavior management
– In-home supports
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Support GroupsSupport Groups
Children– Extending support
network
– Knowledge of community services
– More easily attend if offered at the right time of day
Spouses– Changes in marital
relationships
– Encourage seeking and using supports
– Options for respite care
– Coping with grief and guilt
– Self care
– Often need transportation and respite care to attend
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Three Patterns of Respite UseThree Patterns of Respite Use
Brief use: 2 months or fewerAverage Users ( 9 to 12 months)Long Term Users (18 or more months)
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Brief Users compriseBrief Users comprise
30% of Clientsfamilies who seek services that do not meet
their needDissatisfied Consumers
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Brief Users Cost MoneyBrief Users Cost Money
Add to turnoverIncrease need for marketing effortsIncrease staff timeTake up spaces that others could benefit
from
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Day CareDay CareBest for clients with
– limited disabilities
– who are non-aggressive
– who do not engage in problem behaviors
Well used by minority groups when– appropriately targeted
– appropriately marketed
Not easily used when care needs are high
Preferred by working caregivers when– Hours match work
schedules
– Available daily
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In-Home Respite Most Used In-Home Respite Most Used
Recipient resides with Caregiver
Most impaired clients
White
Caregiver is a Spouse
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Implications for ProvidersImplications for Providers
Not all services meet the needs of all people.Day Care programs can reduce the number of brief
users by • Appropriate marketing• Relating clear expectations to clients
In-home programs best • when they are staffed by paid staff • who can provide personal care and • Assist with health needs.
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Implications for Delivery of Implications for Delivery of ServicesServices
Identify the “Serviceable Moment”• clear expectations
• respect
• flexibility
Communicate
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Remember the client is the Remember the client is the familyfamily
Support means help for the caregiver that is more valuable than the cost of using the service.
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ReferenceReference
RJV Montgomery & K.D. Kosloski,
“ Change, Continuity and Diversity Among Caregivers”
http://www.aoa.gov