Saturday, January 26, 2013

Case Study - Caregiver Burnout


“Amy” is a sandwich generation caregiver who has reached a critical pointing her caregiving – “caregiver burnout” and has become short-tempered and desperate and misses many days from work trying to care for her mom, “Margaret.” The following information details how we could help support Amy and her family so Amy doesn’t lose her job, and Margaret continues to receive good care.
            On the Family Caregivers Alliance website, there is a page on working caregivers[1] with helpful questions we can ask Amy.
  1. Firstly, we have Amy consider what she needs help with and the times she needs the help. We know Amy has a job, and may benefit from being able to return to work, secure in knowing her mother will be well cared for, or able to attend doctor’s appointments in her absence.
  2. Second, we have Amy consider what level of care is needed for her mom, Margaret. Amy may like someone to prepare her mom meals, keep the house clean, or simply drive Margaret to and from appointments so Amy doesn’t have to miss work.
  3. Next, Amy needs to consider what type of in-home care Margaret’s Medicare or health insurance covers. For costs exceeding the insurance, we must consider how much Margaret can afford to pay, or perhaps how much her siblings are willing to split with her.
  4. Lastly, we need to help Amy to locate elder care resources near her home.
In considering that Amy has used up most her sick leave, and may be in jeopardy of losing her job, we start focusing on bringing in help for Margaret so Amy can continue working. Amy decides against a full-time live-in caregiver; costs can range from $700 to $3,000 weekly[2].  Since cost is a concern, we have Amy consider hiring in-home day help for Margaret. We ask Amy to consider an agency like “Visiting Angels[3] or “NW Senior Resources,[4]” where private caregivers can be hired to help out in the home. Amy will determine how long and for how many days of the week. We make a suggestion for Amy to start with hiring in help 2 to 3 days a week and that any and all appointments for Margaret will be scheduled to take place on those days so Amy does not miss work for them. The hired caregiver, will be given notes from Amy to take to the doctor, and a recording device to record the medical visits so Amy is able to catch up on what she misses.
            Next we help Amy look at Margaret’s Medicare benefits to determine coverage for in-home caregiving help. BenefitsCheckUp.org[5] is a good starting point for Amy. Here she can complete a questionnaire to find out what programs exist for assistance as well as benefits that may be covered for Margaret’s in-home care. We have Margaret complete the questionnaire entitled “For Older Adults and Families Raising Children”.[6] The questionnaire considers veteran status, abilities, housing, employment, programs of interest, finances (including monthly income for the household), assets, and the number of children in the household.
            Once Margaret’s Medicare benefit is confirmed. We help Amy consider how many days of care this will cover. Although we would ordinarily have a family consider the 50-50 rule, “the idea that adult siblings should divide caregiving responsibilities 50-50[7], for Amy’s two siblings who live over 1,000 miles away, this is impractical. For the remaining caregiving costs, we suggest that Amy negotiate a payment plan with her siblings so they can instead equally share the financial burden. Another alternative would be to split caregiving costs and time based on what each sibling may have to give. “One sibling may have a good income but live at a distance. This sibling could contribute more financially, while another sibling who makes only enough money to get by on can help by providing hands-on parent care that may keep down some of the costs. A third sibling may do a little of each.”[8] If Amy and her siblings are unable to reach an agreement, we may need to connect them with a family mediator to negotiate a caregiving plan.[9] Together, in a family meeting the mediator may be able to help them make a written agenda, listen, get specific about needs, divide up tasks and not to expect total equality.[10]
            Once payment and Medicare coverage is ironed out, we have Amy interview and select an in-home caregiver. After this process is completed, we help Amy to locate a volunteer for respite care to give Amy a break at least once or twice a week so she can recover and feel renewed. If Amy is unable to secure a good in-home respite caregiver volunteer, we help her to locate Adult Day Care services for Margaret. Perhaps just on Saturdays, Amy will have Margaret attend a local Adult Day Care so she can have Saturdays off.  According to “Sarah Care” adult day care is the most affordable type of senior care.[11] With Margaret at day care, Amy would have a bit of respite to rest and have some personal time.
We also want Amy to connect with other caregivers, and since she’s free in the evenings, we search support groups so she can share with others like her. Unfortunately the support groups we find in Portland, all run during Amy’s work hours. In Multnomah County, there are caregiver support groups that run from 2:00 – 3:30pm, 3:00 – 4:30pm.[12]  In Washington County, the caregiving support groups also run during business hours (2:00 – 3:30pm, 4:00 – 5:30pm, 3:30 – 5pm, and 10:30am – 12:00pm.)[13] We therefore help Amy decide that she may instead find a more convenient support network in a place like “Caregiver Village” online. “Caregiver Village members connect with friends, participate in book clubs with celebrity authors, journal, play mystery games, solve puzzles, and learn valuable information about caregiving.”[14] With an online support group, Amy can get started sharing with others right away, until she is able to locate a local support group that operates after business hours or on weekends.

Have you ever experienced caregiver burnout? How did you overcome your stress and did you have support?



No comments:

Post a Comment