Are We Ready for the CARE Act?: Family Caregiving Education for Health Care Providers

The CARE Act, law in 40 states and territories in the United States, requires hospitals to identify and include family caregivers during admission and in preparation for discharge. Although the number of family caregivers has been steadily increasing, health care providers are ill-prepared to address their needs, and caregiving remains a neglected topic in health care providers' education. A market analysis was performed to explore the availability of and interest in interprofessional courses and programs focused on preparing health professionals to support family caregivers. Although nurses and chief nursing officers agreed on the importance of supporting caregivers, they were less likely to endorse formal educational preparation for this complex role. The current study elucidates a gap between what caregivers report they need and the preparation of health care professionals to advance family-centered approaches to care. [Journal of Gerontological Nursing, 45(3), 7-11.].

'Cautiously optimistic': Older parent-carers of adults with intellectual disabilities - Responses to the Care Act 2014

This article discusses potential opportunities for best practice in the United Kingdom that may be brought about by the Care Act (2014). Carers in the United Kingdom were given new rights within this legislation with a focus on needs led assessment. The underpinning philosophy of the Care Act is to streamline the previous legislation and offers a framework for carers and people in receipt of care, to enable a more personalized approach to care and support. Offering a discussion of likely opportunities brought about by provisions of the Care Act, this article draws on a small study involving older parent/carers of sons or daughters with intellectual disabilities. Exploring the extent to which such parents of adults with intellectual disabilities were aware of the details of this legislation and the potential impact it may have on their lives highlighted other significant areas, some of which are discussed below. Semi-structured interviews were conducted with five parents over the age of 60 of sons or daughters with intellectual disabilities in North West England. The study adds to the body of knowledge and understanding about parents of adults with intellectual disabilities and explores and provides a deeper understanding of parents' experiences of the implementation of this specific piece of legislation and their perception of the relevance of it to themselves. Findings include some awareness of the legislation and some feelings of optimism about its likely implications, although participants appeared less clear about the specificities and the impact of these upon them and/or their sons or daughters. Findings from the semi-structured interviews also showed parent's articulation of the extent of reciprocal care manifest between them and their son or daughter with an intellectual disability, as well as an awareness of the fragility of their own emotional well-being.

Maine's Bold Initiative: Homecare for All

A 2018 ballot initiative in Maine proposed universal home care and improved work conditions for home care workers.Although ultimately defeated, the innovative proposal received considerable support and laid the groundwork for an upcoming legislative campaign.It offers a framework for increasing access to home care and creating quality jobs for home care aides. This commentary reviews the problems addressed by the Homecare for All initiative, what was proposed, the campaign process and anticipated next steps, and implications for gerontological social workers.

Procedural Framework to Facilitate Hospital-Based Informed Consent for Dementia Research

Improving quality and delivery of care for people with Alzheimer disease and related dementias (ADRD) requires a comprehensive research agenda that encompasses the entire care continuum. Logistical and ethical challenges of informed consent for research participation of persons with ADRD include determination of capacity to consent, surrogate consent when capacity to consent is compromised, timely identification of the legally authorized representative (LAR) providing surrogate consent, and balancing residual autonomy with surrogate consent. Short stays; limited access to patients, caregivers, and LARs; and fluctuating influences of acute illness on capacity determination compound these challenges in the acute care setting. To address these challenges, we worked with the University of Wisconsin Health Sciences Institutional Review Board to develop a procedural framework for obtaining informed consent from hospitalized individuals with ADRD and their caregivers to participate in a minimal risk care intervention. The framework is specially designed for minimal risk situations in which rapid enrollment is a necessity and uses rapid identification of surrogates to consent for patients who lack legal capacity to make medical decisions, indicated by an activated healthcare power of attorney, and individualized formal assent procedures for patients who lack capacity to consent. These methods were proven effective in facilitating hospital-based recruitment in an ongoing randomized controlled trial and provide a basis for increasing access to acute care clinical research for persons with ADRD. Bolstering research participation through more easily used consent procedures during acute illness is critical to fostering improvements in the delivery of high-quality care to persons with ADRD. J Am Geriatr Soc 66:2243-2248, 2018.

Neglect by carers

There have been two widely reported criminal cases where informal carers, including family members, have been found guilty of the gross negligence manslaughter of the vulnerable person in their care. In this article, Richard Griffith considers the duty on informal carers when caring for a person and the duty on district nurses to protect vulnerable persons from harm.

Examination of the roles and capacities of duty bearers responsible for protecting the human rights to adequate food, nutritional health and wellbeing in Ugandan children's homes

BACKGROUND

The majority of Ugandan children face vulnerability and malnutrition. As a State Party to international human rights treaties, Uganda has legal obligations of guaranteeing the fundamental rights and the best interest of the nation's children. Despite being protected under international and national law, Uganda is not providing adequate child protection, including safeguarding children's food security. Numerous privately owned and unregulated children's homes face this problem. The overall aim of the study was to examine to what extent children's homes' operations are consistent with the right to adequate food, nutritional health and wellbeing of children.

METHODS

We performed a qualitative role- and capacity analysis of duty bearers with human rights duties towards children living in children's homes. We studied three groups of duty bearers: caretakers working in private children's homes, State actors working in government and its institutions, and non-State actors working in civil society organizations. A human rights based approach guided all aspects of the study. An analysis of the roles, performance and capacities of duty bearers was employed, with individual face-to-face structured qualitative in-depth interviews, self-administered structured questionnaires, and a structured observational study, as well as a desk review of relevant literature.

RESULTS

The State of Uganda's efforts to respect and realize its obligations towards children living in children's homes is inadequate. There are numerous capacity gaps among the duty bearers, and the concepts of human rights and the best interest of the child are not well understood among the duty bearers.

CONCLUSION

The efforts of the State of Uganda to realize its human rights obligations towards children in children's homes are lacking in important areas. Hence the State does not fulfill its minimum obligations under the International Covenant on Economic, Social and Cultural Rights to ensure all children freedom from hunger. There is a need for capacity development at all levels in the Ugandan state and the international society to delimit capacity gaps in order to realize these human rights' obligations.

Policy Measures to Support Palliative Care at Home: A Cross-Country Case Comparison in Three European Countries

CONTEXT

The proportion of people in need of palliative care worldwide is rising, and the majority wish to receive this care at home. Many countries have created policy measures to support palliative care at home.

OBJECTIVE

To list and compare existing policy measures designed to support palliative care at home in addition to available primary care services in Belgium, France, and Germany.

METHODS

A cross-country case comparison based on expert consultation, governmental policy documents, and relevant scientific literature.

RESULTS

All three countries have policy measures that allow informal caregivers to adapt their working patterns or take leave of absence to provide care without losing employee rights; however, only Belgium offers specific paid palliative care leave. All three countries offer various allowances to people who are dying at home and their caregivers. Cost-reductions for out-of-pocket expenses are available, based on the level of care dependency in Germany and on prognosis in Belgium, but are not provided in France. Mobile home support teams exist in all three countries and are free of charge for patients and caregivers; but only in Belgium and Germany, there are specialist multidisciplinary palliative home care teams. Belgium and Germany provide respite care for palliative patients.

CONCLUSION

European countries with similar contextual characteristics offer comparable policy measures to support palliative care at home in addition to the available primary care services. However, important differences exist in the criteria for access and the extent of what is offered.

Rights for carers

In April 2018, the Carers' Act comes into force in Scotland to ensure the rights of adult and young carers are recognised and upheld, and that they receive consistent and appropriate support to continue their caring role.

Protecting the Health and Finances of the Elderly With Early Cognitive Impairment

The projected expansion of the nation's elderly population necessitates the revision of health care and policy strategies for safeguarding the health and assets of this community. The elderly are at greatly increased risk for developing mild cognitive impairment and Alzheimer's disease. These conditions are associated with diminished complex decision-making abilities that adversely affect patients, their families, and society, even during early stages of Alzheimer's disease. We present three composite patient histories that demonstrate problems routinely encountered by families, health care providers, and legal professionals during the course of early AD and MCI. We review the prevalence of cognitive and behavioral symptoms associated with MCI and early AD. Obstacles to early detection of cognitive decline, limitations of current testing modalities and benefits of earlier detection are discussed. Central themes common to medical and judicial approaches toward capacity assessment are discussed. We argue that an emphasis on earlier detection will result in benefits for patient health and result in financial savings to patients and the country as a whole. Finally, we recommend national guidelines for the evaluation of task-specific decision-making capacities to reduce the variability of outcome and improve quality of evaluations found among medical professionals, forensic evaluators, and legal actors.

The FMLA and Psychological Support: Courts Care About "Care" (and Employers Should, Too)

The Family and Medical Leave Act ("FMLA") recognizes an employee's right to take leave to care for a qualifying family member. In light of the Act's remedial nature, the intended scope of the care provision is broad, but its definitional details are sparse. As a result of the attendant interpretive discretion afforded to courts, the Seventh Circuit announced its rejection of the requirement-- first articulated by the Ninth Circuit--that care provided during travel be related to continuing medical treatment. A facial analysis of the resulting circuit split fails to appreciate the fundamental difference between the Seventh and Ninth Circuits' considerations: the distinction between physical and psychological care. Whereas physical care is readily measurable, psychological care is less defined and, consequently, ripe to facilitate FMLA abuse. Efforts to combat this potential lead courts to impose judicially devised limitations on psychological care, but judicial discretion still infuses some uncertainty into proceedings. For employers, the best remedy lies in the FMLA's optional certification provision, which requires medical validation of an employee’s need for leave. In requiring certification, employers should distinguish between physical and psychological care, maximize the FMLA’s informational requirements, and implement complete and consistent request and approval procedures.

Family caregivers as partners in care transitions: The caregiver advise record and enable act

The objective of this Perspective was to provide guidance to hospitalists and hospital clinical leadership on how to implement the Caregiver Advise Record and Enable (CARE) Act, which has been passed into law in 30 US states and territories. Specifically, the objective is 3-fold: (1) increase awareness among hospitalists and encourage them to begin to prepare for implementation, (2) explore the impetus for this legislation, and (3) provide a list of suggested resources geared to both family caregivers and healthcare professionals that may be helpful in preparation for implementing the CARE Act. Journal of Hospital Medicine 2015;11:883-885. © 2015 Society of Hospital Medicine.

The Forensic Lens: Bringing Elder Neglect Into Focus in the Emergency Department

We present 2 case studies of older patients who were brought to the emergency department (ED) in severely debilitated states. Both presented with severe malnutrition, contractures, and decubitus ulcers, and were nonverbal, with histories of dementia and end-stage disease. Their primary caregivers, adult children, were uncooperative with Adult Protective Services and disregarded treatment recommendations. Although both elders had signs suspicious for neglect, a comprehensive review revealed many layers of complexity. We use these cases to illustrate an approach to the assessment of possible elder neglect in ED settings and how to intervene to ensure patient safety. We begin with a discussion of the differences between willful, unintentional, and unsubstantiated neglect by a caregiver and then describe when to suspect neglect by evaluating the elder, interviewing the caregiver and first responders, assessing the caregiver's ability to meet the elder's needs, and, if possible, obtaining medical history and information about the home care environment. These cases illustrate the importance of careful documentation in cases of suspected neglect to assist investigative agencies, reduce the risk of further harm, and improve patient outcomes.

Professional caregiver's knowledge of self-reported delinquency in an adolescent sample in Swiss youth welfare and juvenile justice institutions

Since an important goal of the youth welfare system is to prevent troubled adolescents from committing acts of delinquency in future, professional caregivers need to possess accurate knowledge about past behaviors in order to implement appropriate interventions. As part of a comprehensive study on youth in state care, adolescents at 30 residential care facilities in Switzerland were surveyed about past acts of delinquency, and their responses were compared to those of their professional caregivers to see how well they correlated. A sample of 267 male and female adolescents aged 11-18years completed questionnaires about the frequency, nature, and seriousness of different types of offenses, while a designated caregiver for each resident completed a corresponding questionnaire. The majority of residents (86.1%) reported having committed at least one offense, which confirms the prevalence of problem behaviors in this population and the need for strategies to prevent it. The overall rate of agreement between the residents and their caregivers was 77.2%, with both parties reporting that the resident had committed at least one offense in 69.7% of cases, and both reporting that no offense had been committed in 7.5% of cases. Agreement was substantially higher for offenses that were serious than for those that were minor or moderate. Cohen's kappa reached slight to moderate values with regard to individual and categorized offenses. Seriousness scales of delinquency for self-reports and caregiver reports were moderately associated. While the overall rate of agreement between the residents and their caregivers was high, increasing it still further might lead to improvements in strategies for the prevention of recidivism.

Social security income and the utilization of home care: Evidence from the social security notch

This paper exploits Social Security law changes to identify the effect of Social Security income on the use of formal and informal home care by the elderly. Results from an instrumental variables estimation strategy show that as retirement income increases, elderly individuals increase their use of formal home care and become less likely to rely on informal home care provided to them by their children. This negative effect on informal home care is most likely driven by male children withdrawing from their caregiving roles. The empirical results also suggest that higher Social Security benefits would encourage the use of formal home care by those who would not have otherwise used any type of home care and would also encourage the use of both types of home care services among elderly individuals.

Supporting Family Caregivers

(1) About 8,000 baby boomers reach age 65 every day. (2) Nearly 70 percent of people over age 65 will need some form of long-term services and supports in their lives. (3) AARP estimates the value of uncompensated care provided by family caregivers to be more than $450 billion annually.

Department of Veterans Affairs. Caregivers program. Final rule

The Department of Veterans Affairs (VA) adopts, with changes, the interim final rule concerning VA's Program of Comprehensive Assistance for Family Caregivers. VA administers this program to provide certain medical, travel, training, and financial benefits to caregivers of certain veterans and servicemembers who were seriously injured during service on or after September 11, 2001. Also addressed in this rulemaking is the Program of General Caregiver Support Services that provides support services to caregivers of veterans from all eras who are enrolled in the VA health care system. Specifically, changes in this final rule include a requirement that Veterans be notified in writing should a Family Caregiver request revocation (to no longer be a Family Caregiver), an extension of the application timeframe from 30 days to 45 days for a Family Caregiver, and a change in the stipend calculation to ensure that Primary Family Caregivers do not experience unexpected decreases in stipend amounts from year to year.

Impact of Mental Health Care Bill on caregivers of mentally ill: Boon or bane

BACKGROUND

To improvise the shortcomings of existing of mental health legislation (The Mental Health Act, 1987) of India, amendments have been made which ultimately conceptualized, to form the Mental Health Care Bill. Mental Health Care Bill has brought a revolutionary change in the existing mental health legislation which is in its final phase of approval.

METHOD

Many of the changes brought by the Mental Health Care Bill has been appreciated at different level, at the same time it has received robust criticism for over-legalizing and complicating the delivery of mental health care.

RESULT

Caregivers play a pivotal role in the management of psychiatric illness in developing countries like India and they face a lot of challenges for providing support to the mentally ill patients.

DISCUSSION

The social, economical, physical as well as the psychological wellbeing of the caregivers are significantly affected while providing care to the mentally ill. The forthcoming Mental Health Care Bill is likely to have a noteworthy impact on the caregivers. It's high time to analyze, its projected impact on the caregivers of patients suffering from mental illness.

The time-associated impact of the Newborn Influenza Protection Act on infant influenza rates in New York State

BACKGROUND

Influenza presents with increased morbidity and mortality in children ≤5 months of age. Vaccination of caregivers is indicated, but immunization rates are estimated at only 30%. The 2009 New York State Neonatal Influenza Protection Act (NIPA) mandated offering of influenza vaccine to caregivers during the post-partum hospitalization. The purpose of this study was to determine the impact of NIPA on infant influenza rates.

METHOD

Data on laboratory-confirmed influenza cases between 2006 and 2012 were extracted from the New York State Electronic Clinical Laboratory Reporting System (ECLRS). Data on infant cases were categorized by age (0-5 months) and location [New York City (NYC), outside NYC] based on reporting laboratory site. The total number of influenza cases and the percentage of total cases in the infant age group were normalized to the number of reporting laboratory sites. The χ2-test was used to compare the proportions of cases pre- and post-implementation. Year-to-year trends were assessed by linear regression. All tests of significance were two-sided and evaluated at the P<0.05 level.

RESULTS

During the 6-year study period, 3154 cases of infant influenza were detected. In bivariate analysis, 1707 (54.1%) of cases occurred prior to NIPA implementation and 1447 (45.9%) of cases occurred after (P<0.001). Of the 1422 total infant cases detected in NYC, the percentages of influenza cases pre- and post-NIPA were 54.6% (777) and 45.4% (645), respectively (P<0.006). Outside NYC, the percentage of infant cases was reduced from 53.7% (930/1732) to 46.3% (802/1732, P<0.02). Prior to implementation, there was a year-to-year increase in the number of infant influenza cases statewide (P<0.04 for trend). The ratio of infant influenza cases normalized per ECLRS site in NYC increased each year after NIPA passage (P<0.01 for trend). The ratio of infant cases outside NYC decreased annually (P<0.05 for trend). No year-to-year trends were seen in the percentage of total influenza cases in the infant age group compared to total cases across all age groups either within or outside NYC.

CONCLUSIONS

Comparison of three influenza seasons before and after NIPA suggests a total statewide reduction in infant influenza. However, the greatest driver of this reduction occurs from reduced disease in infants outside NYC. We speculate that, with increased crowding within NYC, parental immunization as encouraged by NIPA may not create cocoon immunity.

The Family and Medical Leave Act. Final rule

This Final Rule amends certain regulations of the Family and Medical Leave Act of 1993 (the FMLA or the Act) to implement amendments to the military leave provisions of the Act made by the National Defense Authorization Act for Fiscal Year 2010, which extends the availability of FMLA leave to family members of members of the Regular Armed Forces for qualifying exigencies arising out of the servicemember's deployment; defines those deployments covered under these provisions; extends FMLA military caregiver leave for family members of current servicemembers to include an injury or illness that existed prior to service and was aggravated in the line of duty on active duty; and extends FMLA military caregiver leave to family members of certain veterans with serious injuries or illnesses. This Final Rule also amends the regulations to implement the Airline Flight Crew Technical Corrections Act, which establishes eligibility requirements specifically for airline flight crewmembers and flight attendants for FMLA leave and authorizes the Department to issue regulations regarding the calculation of leave for such employees as well as special recordkeeping requirements for their employers. In addition, the Final Rule includes clarifying changes concerning the calculation of intermittent or reduced schedule FMLA leave; reorganization of certain sections to enhance clarity; the removal of the forms from the regulations; and technical corrections to the current regulations.

The importance of place and time in translating knowledge about Canada's Compassionate Care Benefit to informal caregivers

Canada's Compassionate Care Benefit (CCB), an employment insurance program designed to allow Canadian workers time off to care for a dying relative or friend, has had low uptake since its inception. Due to their role in working with family caregivers, social workers are one group of primary health care professionals who have been identified as benefiting from a knowledge translation campaign. Knowledge tools about the CCB have been developed through social worker input in a prior study. This article presents the findings of a qualitative exploratory intervention. Social workers (n = 8) utilized the tools for 6 months and discussed their experiences with them. Data analysis revealed references to time and space constraints in using to the tools, and demonstrated the impact of time geography on knowledge translation about the CCB. The results suggest that knowledge translation about the CCB could be targeted toward caregivers earlier on in the disease progression before the terminal diagnosis, and knowledge tools must be disseminated to more locations. These results may be valuable to policymakers and palliative care providers, as well as theorists interested in ongoing applications of time geography in knowledge translation and the consumption/production of care.

Grandfather caregivers: race and ethnic differences in poverty

We use data from the 2006 American Community Survey to examine race and ethnic differences in the effects of marital status and co-residence of the middle generation on the likelihood of poverty among grandfathers who have primary responsibility for co-resident grandchildren (N = 3,379). Logistic regression results indicate that race/ethnicity and household composition are significant predictors of poverty for grandfather caregivers: non-Hispanic white grandfathers, those who are married, and those with a co-resident middle generation are the least likely to be poor. The effects of race/ethnicity, marital status, and the presence of a middle generation are, however, contingent upon one another. Specifically, the negative effect of being married is lower among grandfathers who are Hispanic, African American, non-Hispanic, and non-Hispanics of other race/ethnic groups compared to whites. In addition, having a middle generation in the home has a larger negative effect on poverty for race/ethnic minority grandfathers than for non-Hispanic whites. Finally, the combined effects of marriage and a middle generation vary across race/ethnic group and are associated with lower chances of poverty among some groups compared with others. We use the theory of cumulative disadvantage to interpret these findings and suggest that race/ethnicity and household composition are synergistically related to economic resources for grandfather caregivers.

Hierarchization and segmentation of informal care markets in Slovenia

The article is the result of qualitative research of informal care markets in Slovenia in the field of childcare, elder care, and cleaning. The author assesses Slovenia's position in the “global care chain” and finds that “local care chains” prevail in the field of childcare and elder care, while a co-occurrence of female gender, “other” ethnicity, and poverty is typical in the field of household cleaning. The main emphasis of the article is on the analysis of hierarchization of the informal market of care work according to following two criteria: social reputation of individual type of care work and citizenship status of care workers.

Care of older people in migration contexts: local and transnational arrangements between Peru and Spain

Care arrangements for the elderly are becoming a main social process in contemporary societies due to socio-political and lifestyle changes over the last few decades. The family and the State play a basic role in the construction of care systems and in the establishment of strategies to access care resources. In the present context of migration, these resources interact at a transnational level, challenging family and State migratory regimes. These new realities need the recognition of basic international social rights, as the experiences of Peruvians living in a migration context in Spain show.