Issue Date: October 1, 2004
Needs of caregivers a priority in funding for elderly
By ARTHUR JONES
The National Council on the Agings Howard Bedlin believes that
the United States can afford health insurance for the uninsured. It can
also afford its programs for the elderly. Its just a question of
political will and priority, he said.
There isnt much evidence of either in the national political scene
at present. Bedlin, who tracks the Older Americans Act as the councils
public policy and advocacy head, was discussing its two best known programs,
Meals on Wheels and the more recent National Family Caregivers Support
Annually, he said, even these two popular programs face a constant
battle for inflation-adjusted appropriations.
It is this latter program, however, caregiver support, that could within
the next decade or so change U.S. sociopolitical priorities, he said. The
pressure point is caregiver burn-out.
Said Bedlin, the burnout will occur as baby boomers increasingly join
the caregiving generation and realize there are millions of families
where 65-year-olds are taking care of 95-year-olds. Its from those
boomers the politicians are going to receive a major-wake-up call,
The caregiver pressure is atop the boomers already increasing
sensitivity to the parlous state of Medicare and Social Security (NCR,
April 30). Theyll add to it pressure for more home and community services
and other Older Americans Act programs that keep people independent. And if
politicians do not support these programs, said Bedlin, theyll be
voted out of office.
Shawn McDermott with the National Association of Area Agencies on Aging
explained that while the $195 million Family Caregivers program seems to
be one thing politicians will get behind -- almost everyone knows someone who
is giving care to a relative, other Older Americans Act programs
dont have the same advantage. Transportation is an example.
Its a critical issue for the elderly, she said. Everyone has
a car, yet they dont realize how dependent you are without that
vehicle. Transportation funding is hard to come by.
By the time Older American Act monies trickle down to the local level,
support for Family Caregivers isnt much, but its a lot better than
That can be seen through the Elk Grove, Ill., Alexian Brothers Medical
Center (noted in a 2004 U.S. News and World Report survey as one of the
nations top hospitals for geriatric care). The centers Alexian
Older Adults Institute has three different support groups for the elderly and
their caregivers. It mediates family meetings, provides individual and family
consultations on resources, and also helps individuals to tap into such
community resources as respite care.
In the course of the year the institute deals with literally
thousands of older people and their caregivers, said director Pam
Schwartz, but it doesnt administer National Family Caregiver funds
directly. It refers families to two local agencies, including Catholic
Charities, that disburse the funds.
The amount of money is meager, she said, but it can provide a break for
stressed-out caregivers: short-term in-home help, a hired caregiver for a
couple of hours or a couple of days. The funds can also be used for short-term
adult care center attendance.
Said Schwartz, We take care of the patients and family
members, and those family members, she said, increasingly are
people my age, in their 50s, and in their 60s. That bears out
Bedlins contention that boomers are quickly moving in larger numbers into
the caregiver category. The boomers parents are moving into the
fastest-growing segment of the aging population: 85 and older.
Arthur Jones is NCR editor at large. His e-mail address is
|Care of aging presents ethical dilemmas
The eldercare field has its own ethicists, for it has its own
Sister of St. Joseph of Carondolet Jean DeBlois taught at the Center for
Ethics on the faculty of St. Louis Medical Centers department of internal
As a clinical ethicist at the Catholic Health Association, she got
hooked on issues affecting the elderly through a friend studying
gerontology, and is now on the Aquinas Institute faculty in St.
She spends time, too, at her provinces retirement center for the
sisters, which is also open to lay people. There is both assisted living and a
nursing home. And ethical issues to weigh. DeBlois gives a feeding
The mom is admitted because she cant take care of herself.
In the nursing home for a couple of years, she becomes increasingly frail,
slight dementia but not severe. She starts to lose weight, has trouble
swallowing, gets pneumonia, the family is concerned. She is sent to the
hospital. The doctors ask: A feeding tube? The son says yes.
Hold it right there, DeBlois said. Is the son acting out of
concern for his mother, or himself? Oftentimes, when people look at aging
parents whose life may be coming to a close, they make decisions not about
whats good for Mom, but Whats good for me?
That ushers in more tube dilemmas, she said. Is Mom competent? Do
people lose the right of making decisions just by virtue of getting old? If, on
the other hand, the institution states as an alternative to the tube,
well give her the kind of foods she can eat, then she
continues to lose weight -- are we telling her that we dont put tubes
Add to that, said DeBlois, sometimes its not the family
thats most conflicted; its the physician.
So, they put in the tube. Mom recovers from pneumonia and is back
in the nursing home, and demands the tube be removed. More questions to
weigh, until the final dilemma is arrived at, said DeBlois: If you put
the tube in, how are you ever going to get it out? In the state of Missouri if
the person loses the capacity to make that decision, thats almost
And thats it: one example of the ethical issues played out almost
daily in any of the 1,500-plus Catholic continuing care ministry facilities
-- Arthur Jones
|Catholic institutions focus on retaining employees
The term caregiver also has an institutional guise, that of the
assisted living and long-term care facilities
paid employees, its nursing assistants and aides.
Caring for those caregivers -- retaining them as employees, improving
their skills and keeping them on track and motivated -- is an area where
Catholic care facilities are expending much effort. Typical is the
Education Bridge Center established earlier this year at the Notre
Dame Long Term Care Center in Worcester, Mass.
There, nursing assistant employees, for example, can take courses toward
becoming registered nurses. Entry-level employees are catered to with job
skills training and further education -- the first steps to moving further up
the career ladder.
So vital is this motivational effort that the Catholic Health
Association has published a 42-page guide to Finding and Keeping Direct
Care Staff: Employer of Choice Strategy Guide for Catholic-Sponsored Long-Term
Care and Home Care Providers, produced by the Paraprofessional Health
Institute. The associations annual gathering usually features at least
one workshop on some element of the topic.
A variation on these themes is the work of the Avila Institute of
Gerontology, in Germantown, N.Y. It is operated by the Carmelite Sisters for
the Aged and Infirm, a 75-year-old order founded by Mother Angeline Teresa
(Brigid McCrory, a former Little Sister of the Poor).
The institute stresses teamwork through a system-wide nine-state
traveling workshop for the sisters 23 U.S. long-term care facilities.
Theres also one in Ireland.
Avilas director, Carmelite Sr. M. Peter Lillian Di Maria, will
take the workshop to 17 locations in 2004. This years theme,
promoting positive solutions focuses on the dementia patient.
Its a five-hour regional workshop for as many people as the facilities
can send -- physicians, nurses, aides, rehab specialists. Somewhere between 40
and 80 people usually attend.
Di Maria and two outside experts help staff develop better ways to
communicate with the dementia patient, to identify the behavior theyre
trying to help manage, and to resolve conflicts among staff.
The Avila Institute also offers an annual one-and-a-half day retreat in
Germantown that attracts 80-100 employees from the two-dozen facilities.
They learn how important their position is -- that its more
than just a job, its a vocation. We affirm them.
prayer service to bless their hands and thank them for carrying out not just
work, but Mother Angelines form of Jesuss healing
Its also caring for the caregivers.
-- Arthur Jones
National Catholic Reporter, October 1, 2004