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Caring for Family Members: In Whose Hands Indeed

Posted By Dan Marlowe, Tuesday, July 31, 2012
The Institute of Medicine released a report earlier this month, as pointed out by Lauren N. DeCaporale in the comment section of Barry Jacobs previous post (check it out), entitled The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. You can find an abbreviated report, panel recommendations, and even read the full report online here.

In it the panel throws out some interesting figures: 1) the number of adults over age 65 will rise from 40.3 million in 2010 to 72.1 million by 2030- that’s an increase of almost 60%, 2) nearly 1:5 older adults have one or more MH/SU conditions, and 3) none of these figures take into account the elderly who are or will be dealing with a chronic illness (e.g., hypertension, diabetes, COPD, CHF). However, for me, the most concerning part of the report was something that all of us already know, which is how woefully unprepared we are as a workforce to handle the impending influx of patients and their families needing our services. While many of the recommendations were spot on in terms of things like increasing reimbursement coverage for MH specialties, training curriculum redesign , re-credentialing medical/psychosocial providers around caring for the elderly, and methods for making providers more accountable for outcomes, one recommendation stood out to me in particular:

"Recommendation 4: Congress should appropriate funds for the Patient Protec­tion and Affordable Care Act workforce provisions that authorize training, scholarship, and loan forgiveness for individuals who work with or are preparing to work with older adults who have MH/SU conditions. This funding should be targeted to programs with curricula in geriatric MH/SU and directed specifically to the follow­ing types of workers who make a commitment to caring for older adults who have MH/SU conditions:

  • Psychiatrists, psychologists, psychiatric nurses, social workers, MH/SU counselors, and other specialists who require skills and knowledge of both geriatrics and MH/SU.
  • Primary care providers, including geriatricians and other physicians, registered nurses (RNs), advance practice registered nurses (APRNs), and physician assistants.
  • Potential care managers for older adults who have MH/SU conditions, including RNs, APRNs, social workers, physician assistants, and others.
  • Faculty in medicine, nursing, social work, psychology, substance use counseling, and other specialities.
  • Direct care workers and other frontline employees in home health agencies, nursing homes, and assisted living facilities (including personal care attendants not employed by an agency).
  • Family caregivers of older adults with MH/SU conditions."

The last bullet of the fourth recommendation caught my interest because it seemed like a logical way of incentivizing family caregiving by helping recoup some of the lost revenue of providing care- a cost in the billions. Looking at this led me to think about two interrelated and important questions: 1) what other ways can we incentivize family caregiving for not only the elderly but for others regardless of age or disease demographic, and 2) even with the panel's acknowledgement of family caregiving, why does this still seem to be such a low priority in overall workforce development?

So, what do you all think? What other ways can we make family caregiving a more realistic and sustainable endeavor for both patients and their families? In the end it is never enough to only point out a problem without also offering a sensible and systemic alternative.


Daniel Marlowe

Dan Marlowe is the co-editor of the Growing MedFT Blog, and the Director of Applied Psychosocial Medicine for the Duke/Southern Regional AHEC Family Medicine Residency Program in Fayetteville, NC. He obtained his MS in Marriage and Family Therapy and PhD in Medical Family Therapy from East Carolina University in Greenville, NC.

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Barry J. Jacobs says...
Posted Sunday, August 5, 2012
In Sweden, family caregivers are paid a stipend that's a liveable wage. We are far, far away from that kind of backing in this country, but we are gradually realizing that family caregivers are our defacto long-term care workforce and that they need some degree of support. The IOM report is just another step in that direction. What would be best is for healthcare professionals and family caregivers to train side by side. In many places, family caregivers are actively involved in the training of physicians and mental health professionals as standardized patients and guest faculty.
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