In my previous post, Public Health and the Elderly, I highlighted a few issues that family therapists could inquire about during clinical sessions. A very important issue facing the elderly is caregivers. The CDC has made caregiving a public health priority. The CDC has recognized the discrepancy between those who will need caregiving and those who are caregivers. The Administration on Aging has published a profile on older Americans since 1999 simply called, Profile of Older Americans. The current profile (2009) has projected future growth, through the year 2030, in the USA will have approximately 71 million adults over the age of 65 which is a growth of 2.3% per year. Yet, Mack and Thompson (2001) of the Center on an Aging Society reported that family members available to be caregivers will only grow at a rate of 0.8%. This means that there will be less familial caregivers leading to an increased population in nursing home and/or increased stress for familial caregivers.
This is especially so for ethnic minority populations for two reasons. First, caregiving as a cultural responsibility is more prominent for African Americans, Latinos, and Native Americans. This results in an informal network of support (e.g., friends, neighbors, family) rather than formal network (e.g., nurses, nursing homes). For example, California Health Advocates highlighted a study in which White elders were morel likely to utilize the Medicare hospice benefit. Second, exposure to health disparities over a lifetime, ethnic minority elders tend to have higher issues of morbidity in the final months of their lives.
Another concern is the gender inequity in caregiving. California did a survey in 2003 called, A Profile of Family Caregivers (this link will open the report) and found that 75% of family caregivers were women with an average age of 51 AND 31% had a child under the age of 18 living at home (nationally this number is higher, 41%). A recent New York Times article She Works. They’re Happy suggested that the rise of women in the workplace has had an effect of heterosexual marital stability. One has to wonder how this stability will be maintained if she has to care for her or his parents. This should not read as women needing to leave the workforce but instead men need increase their engagement around familial caregiving.
The data all point to one fact, there are not going to be enough caregivers leading to significantly more stress for families (especially for ethnic minority women). There is already evidence that caregivers of today have more mental and physical health problems when compared to non-caregivers. Family therapists have an opportunity to begin the conversation with their clients about caregiving. If possible, this conversation should occur prior to the need. Have families had conversations about caregiving? Who is going to be the primary caregiver? With whom will the person needing caregiving live? How will siblings contribute to caregiving? How will couples share the responsibility? How will caregivers recognize they are “over their heads” and need help from more formal networks? This conversation can take place during an initial assessment, while constructing a genogram, or be part of therapeutic thread. Below is a list of resources for family therapists as well as a number of resources to share with clients. If you have any suggestions, comments, or stories you would like share, please leave a comment. Take care.
Administration of Aging Programs (A number of Federal Programs funded under the Older Americans Act)
California Healthcare Advocates (Focuses on Medicare Issues in California but has some interesting research)
Family Caregiver Alliance (This is a very rich resource for therapists and clients)
Many States have an Office of Aging. Google “Office of Aging” to find you local office.