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Retooling for an Aging America: Building the Health Care Workforce
potentially beneficial for both older adults and caregivers. The Rosalynn Carter Institute for Caregiving has sought to do this by bringing paid and informal caregivers together to learn about caregiving issues, share ways to work together more effectively, and gain a greater understanding of each other’s perspectives. Informal caregivers place high value on both the emotional support that is provided through friendships with home-care workers and also these workers’ affirmation of their caregiver efforts (Piercy and Dunkley, 2004). Medicare reimbursement changes have been proposed that would create a more integrated system in which direct-care workers would be paid to assess the caregiving needs of families, observe their caregiving skills, and teach them to perform various, duties such as ambulation and comfort care (Seavey, 2005).
Taking on the role of informal caregiver has been found to increase the risk of elevated stress hormones (Kiecolt-Glaser et al., 2003; Vitaliano et al., 2003), make physical illness and psychological distress more likely (Emanuel et al., 2000; Pinquart and Sorensen, 2003), and raise mortality rates (Christakis and Allison, 2006). Caregivers may have to provide constant care day and night, may be unable to leave the recipient alone, and may even have to provide assistance despite their own physical illness or impairments; such requirements can affect the caregiver in various ways, including causing interrupted sleep, physical strain, and emotional and financial difficulties (Wolff et al., 2007). Longitudinal studies of spouses find that both the assumption of the role of informal caregiver and the continuing long-term provision of high-intensity care are associated with downward trajectories in terms of depression (Burton et al., 2003; Cannuscio et al., 2002), social participation, and quality of the marital relationship (Seltzer and Li, 2000). In spite of this, many informal caregivers are able to adapt and derive personal benefits from their role (Kramer, 1997; Stuckey et al., 1996).
Given the demonstrated importance of informal caregivers to older adults and to society, and given the personal costs that may accompany the role, there has been considerable interest in how it might be possible to improve informal caregivers’ experiences and outcomes. A large number of caregiver interventions have been developed, with a large range of strategies, services, and target populations. Programs have been established to provide caregivers with greater education and training, strengthened partnerships with the medical community, and a number of other types of aid including respite care, web-based monitoring systems, technologies that reduce physical strain, and financial supports. Several health services interventions targeted specifically at older caregivers have proven to benefit