Families are the backbone of caregiving in the U.S. Anyone is potentially a caregiver. Spouses, friends, grandchildren, children, nieces, and nephews are all caregivers in growing numbers. A report from AARP “estimates that the approximately 34 billion hours caregivers contributed in 2017 were worth $470 billion — more than total out-of-pocket spending on health care in the U.S. that year ($366 billion) or all money spent on paid caregiving in 2016 (also $366 billion).”
Along with the billions of hours of caregiving is the loss of income from being a caregiver. Although plenty of men are caregivers, women are more often take on that role. They experience lost income, job displacement, and difficulty re-entering the workforce.
Not every family can take advantage of some of these alternatives, but they are worth exploring. Each of these alternatives also has the potential of COVID risk. We will discuss the relative risk of each alternative. The pandemic might be the beginning ofusing routine universal precautions for all clients and patients, even after the danger of COVID has passed.
In-home caregivers are a viable alternative to family caregiving, but families have to budget the amount they can afford to pay each week. Even a couple of hours, one or two days a week, can help. States vary in terms of what in-home caregivers can do, but generally, these are the tasks that most can assist with:
- Transportation. Taking the client on outings or grocery shopping and picking up medications.
- Assistance with activities of daily living. Help with bathing, grooming, and hygiene.
- Reminders. To take medications, do physical therapy exercises, drink water, and eat.
- Companionship. To decrease isolation and provide stimulation.
- Cooking. Prepare meals and snacks.
- Supervision. Especially for people who are prone to wandering or have other safety concerns.
If a client has a long term care policy, many plans include a daily rate for in-home caregivers. There is often a 90 day elimination period where care has to be paid for out of pocket before benefits start. The risk of COVID is low due to strict agency safety protocols. Ask for a copy of the COVID protocol to ensure that your client and their family are comfortable.
Respite care takes many forms. Caregiver respite is available through volunteer programs, state and local resources, and faith-based programs. A good place for clients to start is with the National Association of Area Agencies on Aging. Area Agencies on Aging are excellent sources of information on any paid or volunteer respite programs.
Again, ask about the safety protocols before making a decision about whether to use this service.
Adult Day Care
Adult Day Care is not available in every community, but where it is, it can be a big help to a family caregiver. Adult Day Care is a program for older adults who need supervision and stimulation during the day. The cost averages about $75 a day, but will vary across the country.
Adult Day Care Centers offer the following services:
- Health Screenings
- Medication Management
Not all states license adult day centers, so clients need to evaluate any place under consideration. Some programs will accommodate a half-day schedule and offer transportation to and from the center for a fee.
Adult day care probably has a high risk of COVID. Even with strict directives like mask-wearing and social distancing, these may be very difficult to enforce due to the number of participants who have memory problems.
VA Aid and Attendance
For qualified veterans and their spouses, the Aid and Attendance program can provide monthly cash payments used toward approved caregivers. There are strict income guidelines for participation in the program. If someone thinks they may qualify, there is no downside to applying since the benefit can help defray the cost of in-home or nursing home care. Clients can apply on their own or use a private company to apply. Private companies usually charge a flat fee for this service.
Since Aid and Attendance is a federal program, aides will have been instructed in safe care procedures. The risk of COVID is probably low.
It is not unusual for one family member to be the primary caregiver. Reasons include proximity, the nature of the relationship, or just the luck of the draw. Sometimes the primary caregiver needs to be encouraged to ask for help. Some suggestions:
- Small tasks can make a big difference. Other family members are often very willing to pick up medications, go grocery shopping, or make phone calls.
- Recommend your client ask for a couple of hours of respite a week. This is just enough time not to be a burden on the other family member but can give a much-needed break to the primary caregiver.
- Don’t overlook the help that grandchildren can give. One of the benefits of having grandchildren involved is the opportunity for sharing and closeness.
Family caregiving can work well during COVID as long as everyone follows the same safety rules. If there are several family members caring for someone, the risk increases. College-aged young people are accounting for more cases of COVID, so even if they aren’t caregivers, visits would require strict protocols.
Home health is underutilized as a short term support for families. Although it is time-limited, medical home health services can provide a bridge to more extended care solutions. Home health covered by Medicare requires a physician’s order. The other main criteria are that the client must be homebound and have a nursing need. The services covered under home health include:
- Nursing up to three times a week.
- Physical and occupational therapy.
- Speech therapy, as needed.
- Aides are available up to three times a week for bathing, dressing, hygiene, and transfers. Under Medicare, aides can’t cook, clean, provide companionship or transportation. Many families augment home health with paid in-home caregivers to do these tasks.
Home health is going strong during the pandemic, and companies are using personal protective equipment and strict safety measures. The risk of COVID would be low.
Relief for Family Caregivers
Much needs to be done on a national level to help struggling family caregivers. What this will look like is anyone’s guess. Meanwhile, encouraging people to investigate all possibilities might provide some much-needed relief.