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Summary Points
Contents:
  1. Workplace Mental Health - Caregiving
  2. Research, Practice, Policy
  3. The Family Challenge of Caring for the Chronically Mentally Ill: A Phenomenological Study
  4. Table of contents

While there he worked with Mrs. Rosalynn Carter and former President Jimmy Carter on public and international mental health issues and policy. Fricchione has published more than journal articles and has co-authored five books. He has overall responsibility for the clinical, educational and research missions of BHI. Benjamin G.

Druss is working to build linkages between mental health, general medical health, and public health. He has published more than peer-reviewed articles on this and related topics, including the first randomized trial of an intervention to improve medical care in this population in Hersh New Investigator Award. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Buy eBook.

Buy Hardcover. Buy Softcover. Fricchione, Gregory, editor. Druss, Benjamin G. Contents Foreword; Rosalynn Carter Chapter 1. Elmore Chapter 3. Chapter 4. Gladstone Chapter 6. Holland Chapter 9. Research in Caregiving; Elizabeth A. McDaniel Part II. Beardslee and Tracy R. Myers and Melanie C. Harper Part III. Schachter and Jimmie C.

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Smith and Mary G. Milano Part IV. Crocco and Carl Eisdorfer Part V. Summary Caring for the ill, disabled, very old, or very young requires a labor-intensive commitment that is not only essential to the well-being of individuals and to society as a whole, but also fraught with physical, financial, and psychological risks. And despite the critical nature of their job, caregivers rarely have avenues of support. Learn more. Family caregivers provide the vast majority of care for individuals with serious illness living in the community but are not often viewed as full members of the healthcare team.

Family caregivers are increasingly expected to acquire a sophisticated understanding of the care recipient's condition and new skills to execute complex medical or nursing tasks, often without adequate preparation and support, and with little choice in taking on the role. Although aspects of family caregiving can be rewarding, the role also has a substantial impact on physical, mental, social, spiritual, and financial health. Since the s, hospitals and payers have reduced acute care costs by shortening length of stay and shifting care into the home and community, with individuals with serious illness becoming more dependent on family caregivers to address gaps in care.

Taken together, upcoming challenges in serious illness caregiving for older adults necessitate new approaches to integrate family caregivers more formally into the workforce and support their vital role.

Workplace Mental Health - Caregiving

Projections of the number of needed caregivers over time are lacking for the population of older adults with serious illness. This highlights a significant research gap because these less studied intervention types align directly with caregiver needs in serious illness. Family caregivers need ongoing support from the healthcare team to adapt their role to the care recipient's changing needs across the serious illness care trajectory.

Family caregivers remain relatively invisible during healthcare encounters and are rarely identified in the care recipient's health record; moreover, if identified, usually one person is named, rather than the entire unit of support. This resulted in the successful enactment of the Recognize, Assist, Include, Support, and Engage RAISE Family Caregivers Act, requiring development of a national strategy to support family caregivers led by the secretary of Health and Human Services in conjunction with public and private sectors, state and federal policymakers, employers, consumers, and advocates.

Further, the Veterans Administration provides financial support for family caregivers of veterans with complex needs, depending on eligibility. The Medicare coverage of durable medical equipment and assistive technologies can reduce the physical toll on caregivers by assisting mobility and improving functional capacity for older adults with serious illness.

Research, Practice, Policy

Full policy implementation requires mechanisms for training and ongoing assessment of benefit, along with regular service and replacement. US health policy is generally not keeping pace with supporting family caregivers in their vital roles. In a recent review of legislative proposals to support family caregivers, the most common focus was on attempting to expand support services that were provisions of the Older Americans Act, for example to respite and support services included in the National Family Caregiver Support Program, initiated in There is great variability across the states in supports for family caregivers.

Information about resources and relevant policies and supports is difficult to find and interpret, both for family caregivers and for healthcare professionals. This scorecard specifically focused on supports for family caregivers in the latest evaluation and revealed some improvement but ongoing disparities across the nation.

Eleven states have mandated paid sick days for caring for a family member, and 12 have expanded availability of the Family and Medical Leave Act to additional family members beyond the federal law. Seven states allow family caregivers to retain assets during care for a Medicaid recipient, protecting against subsequent bankruptcy.

The Family Challenge of Caring for the Chronically Mentally Ill: A Phenomenological Study

Enhanced delegation for registered nurses and scope of practice for nurse practitioners NPs further support family caregivers, by enabling more flexibility in sharing the care with professionals. Sixteen states allow nurse delegation that enables family caregivers to rely on unlicensed personnel to assist with some tasks, and 21 states allow full practice authority for NPs, supporting better access and enhanced chronic disease management and supports. At the state level, family caregivers in five states may be paid to provide personal care, offsetting the economic loss of reducing outside employment.

Persons receiving care must be eligible for Medicaid and reside in a state where a waiver exists to allow payment for family caregivers. States vary in the extent to which this concept operates, with differing eligibility requirements and outreach efforts.


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The CARE Act requires that hospitals identify a family caregiver when there is one, record this in the electronic health record, notify the family caregiver of discharge, and provide instruction regarding the tasks expected of the caregiver. This highly successful strategy translated research into state policies across 40 states within 3 years.

Although the CARE Act focuses on hospital admission and discharge, it raises awareness of the family caregiving role in serious illness care.

Table of contents

This growing consortium of interested organizations focuses on improving supports for family caregivers through resource development and identifying and then disseminating innovative practices for family caregivers and the professionals who support them. Another important policy arena to support family caregivers of persons with serious illness is the workplace.


  1. The Family Challenge of Caring for the Chronically Mentally Ill: A Phenomenological Study.
  2. The human complement system in health and disease.
  3. Caregiving.
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  5. Be Frank with Me;
  6. Narrative, Space and Gender in Russian Fiction, 1846-1903;
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  8. Policies in this setting are guided by federal and state law, and they also include discretion at the level of the employing organization. Workplaces that provide such policies recognize the hidden costs of working caregivers in terms of turnover, absenteeism, and distraction.