Demand For Care Outpacing Supply of Caregivers

As the population of the U.S. ages, we are facing a shortage of trained caregivers to keep up with the demand on the health care system. Problems like dementia and Alzheimer's diease, and chronic medical conditions like diabetes that have co-existing depression, will require an understanding of effective behavioral approaches and the unique needs of the patient. This array of problems will also require training on how to recognize the underlying motivations, resistances, behaviors, and emotional conditions of these individuals, especially for family members who are facing an increasing burden of care.

Caregiving approaches should be individualized to the unique needs of the patient, focus on listening more than advising, and collaboration more than the usual "quick fix" from medications. These approaches will be more effective in the long run and more respectful of the person we are helping.

1. Individualized care means two-way communication

Patients must have an opportunity to ask questions, to voice their annxieties and fears about what can be expected in their future, and to have a say in what goals should be set in their care. One-way communication from the caregiver to the care recipient is a characteristic of an outdated health care model, and leaves much to be desired when it comes to engaging the patient in successful behavior change. Successful behavior change and compliance with the treatment plan comes after the care recipient has enough information to make informed decisions, and becomes part of the goal setting. When we overlook or minimize the patient's involvement in his or her own care, and don't take the time to really hear what the patient wants, compliance is likely to be superficial and temporary.

2. Individualized care means understanding the diversity of our patients

Cultural competence requires us to work with individuals from diverse cultures and with perspectives different from our own. How do factors like age, gender, socioeconomic status, education, place of birth, and length of residency in the US affect our views about our patients? How do we avoid stereotypes and biases that undermine our caregiving efforts? How well do we tolerate differentness in values, morals, lifestyle, and religious beliefs? Acknowledging this diversity allows us to understand the whole person before us, and better understand what factors will work in favor of or work against compliance with the treatment plan. This deeper understanding of our patients takes more time, but will prove to be more cost effective in the long run.

3. Individualized care means integrating bio-psychosocial-spiritual dimensions when planning care and setting treatment goals

Integrated care requires a familiarity with other caregivers' roles, a respect for differences in processes and beliefs among team members, sharing information, goals and development of a treatment plan, and implementing the plan in a collaborative manner. The more give and take there is among the various disciplines, the more the care is individually tailored to the patient.

Conclusion

It is essential to incorporate individualized caregiving approaches in our health care delivery with the older adult patient for two reasons. First, the geriatric workforce is in short supply and cannot keep up with the rapidly growing demand of patients in need. And, lasting behavior change and compliance with treatment plans will come only from engaging the patient in his or her own care and understanding how the patient's motivations, attitudes, and outlook impact the response to care.

Joseph M. Casciani, PhD, is a geropsychologist who has devoted his professional career to older adults and their caregivers. His company, Concept Healthcare, http://www.cohealth.org, offers educational modules to integrate behavioral health approaches in the health care of older adults.

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