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Training Caregivers for Older Adults in the Home: A Search for Curricula
Caregiving in America White Paper PDF
2007 Schmieding Center for Senior Health and Education Annual Report
Ozarks at Large - Elder Mental Health Series - July 27, 2007
Celebrate Grandparents Day! - Make Your Appointment To Produce Your Free Memory Video!
May Declared Older Americans Month!
Silver Summit Web Site
"Who Will Care for You?" by Robert N. Butler, M.D.
2006 Schmieding Center for Senior Health and Education Annual Report
Ozarks at Large - November 20, 2005
Ozarks at Large - June 11, 2005
Press Release
Presenters
The Age Boomer's Caregiving Dilemma
Eldercare
Home Caregiving Analysis
Issue Statistics
ElderStay@home
Dr. Wright's Welcome

Training Caregivers for Older Adults in the Home: A Search for Curricula

What curricula are used to train paid and unpaid individuals caring for older adults in the home? This paper presents the results of a four-month search to answer this question. The search was conducted in an effort to identify and categorize curricula from around the country which currently exist to meet the training needs of individuals giving care to older adults in home settings. As part of The Caregiving Project for Older Americans, this report represents data gathered to inform the enlisted experts and leaders asked to chart a plan for addressing the critical workforce shortage of the in-home caregivers of older Americans.

Click here to download the discussion paper in PDF format (418K). Viewing the document will require Acrobat Reader. Download the latest version of Acrobat Reader for free.

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Caregiving in America White Paper PDF

Click here to download the report in PDF format (1.5MB). Viewing the document will require Acrobat Reader. Download the latest version of Acrobat Reader for free.

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2007 SCSHE Annual Report

Click here to download the report in PDF format (5.3MB). Viewing the document will require Acrobat Reader. Download the latest version of Acrobat Reader for free.

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Ozarks at Large - Elder Mental Health Series - July 27, 2007

This NPR program with host Kyle Kellams approaches the question: "Why does popular culture so often make fun of older people?" as part of the Ozarks at Large series on elder mental health issues.

Click here to listen. Listening to this file requires an MP3 player. Download QuickTime Player or RealPlayer for free.

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Celebrate Grandparents Day! - Make Your Appointment To Produce Your Free Memory Video!

Make Your Appointment To Produce Your Free Memory Video!
Grandparents Day takes place September 9, but we want you to come celebrate with us all week - September 4th through the 7th! We're offering to produce Free Memory Videos for Grandparents all week. You must have an appointment, so call today. After all, wouldn't it be great to have a video record of your memories to share with your family? Here's how it works:

Call For Your Memory Session
Call Linda Kogelmann for your reservation at 479-751-3043 or 888-866-8991.

First Come, First Served!
Appointments will be made on the hour starting at 9 am each day, Tuesday-Friday, September 4-7, until all available time slots are booked.

Bring Your Own Interviewer or Come Alone
You can bring one person to ask you questions, or you can respond to a list of memory-provoking questions we will provide. (No more than 2 people will be allowed in the room during the recording session.)

Free Grandparents Memory Video!
You will leave with a precious gift of your memories for your family!

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May Declared Older Americans Month!

The President of the United States has again declared May to be Older Americans Month. This is a time to honor those persons who have helped to make this country a great nation. The debt we owe to this population is of astronomical proportion. Some of this group helped put people on the moon, fought many great battles to defend us, both on foreign soil and at home, discovered cures or medicines that now extend our lives and raised another generation to go forward with the tasks they started.

The Schmieding Center for Senior Health and Education in Springdale is delighted to stand with other community service providers in helping to provide for and protect independence and dignity for our older citizens. We are nationally recognized as a leader in the field of providing care for Older Americans, and we believe that older adults are a precious commodity and should be treated as such.

In honor of Older Americans' Month, the Schmieding Center for Senior Health and Education is hosting an Open House, with tours of our facilities and refreshments provided. Information provided below:

May 22, 2007
1:00-4:00 p.m.
Schmieding Center for Senior Health and Education
2422 N. Thompson, Springdale, Arkansas

No need to RSVP. Just drop by when it's convenient for you! Please come and join us as we celebrate Older Americans' Month and honor those whom we serve! For more information or questions, call 479-751-3043.

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Silver Summit: Planning for Peak Aging

The Silver Summit is designed to help the Baby Boomer generation of Northwest Arkansas grasp that the best part of their lives, Peak Aging, is a matter of choice and planning, not chance. Visit the Silver Summit online.

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"Who Will Care for You?" by Robert N. Butler, M.D.

America is facing a critical shortage of competent and compassionate caregivers. Right now about 40 percent of people over 60 and 1.9 million paid caregivers share the burden of providing home care for older or disabled Americans. This doesn't take into account the significant number of people who go completely without the help they need.

Click here to download the entire AARP article in PDF format (88K). Viewing the document will require Acrobat Reader. Download the latest version of Acrobat Reader for free.

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2006 SCSHE Annual Report

Click here to download the report in PDF format (4.8MB). Viewing the document will require Acrobat Reader. Download the latest version of Acrobat Reader for free.

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Ozarks at Large - ElderStay@home - November 20, 2005

This NPR program with host Kyle Kellams includes the story behind ElderStay@home's eldercare DVD and more.

Click here to listen. Listening to this file requires an MP3 player. Download QuickTime Player or RealPlayer for free.

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Ozarks at Large - WHCOA Solutions Forum on Eldercare - June 11, 2005

NPR program Ozarks at Large features the White House Conference on Aging Solutions Forum on Eldercare, an event co-sponsored by the Schmieding Center for Senior Education and the International Longevity Center. The White House Conference on Aging gives policy recommendations to the President of the United States and Congress to better assist the public and private sectors in promoting dignity, health, independence and economic security among our nation's elders.

Click here to listen. Listening to this file requires an MP3 player. Download QuickTime Player or RealPlayer for free.

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Press Release

FOR IMMEDIATE RELEASE
VIRGINIA THOMPSON
DIRECTOR OF COMMUNICATIONS
479-751-3043

NEW YORK, NY --October 5, 2004 -- More than 45 million Americans are today engaged in some form of caregiving for elders, and for the vast majority there are no trained home caregivers available to help them.

The Baby Boomers, now the Age Boomers, are approaching 60 and are the largest generation ever–77,000,000 strong. By 2030 all of the Age Boomers will be past retirement age, and they will represent about 20 percent of America’s population–the fastest growing segment.

“This indicates the power of the Age Boom tidal wave that is eroding our old beliefs about aging and is an inevitable ‘storm warning’ of what is to come,” according to Dr. Larry D. Wright, a leading geriatrician whose work is focused on the development of home-centered long-term eldercare. Dr. Wright, in his presentation to the International Longevity Center’s 2004 Age Boom Academy, pointed to four megatrends that are coming together to re-shape aging in America:

More Elders–The Baby Boomers are now Age Boomers; they will double America’s 65 plus population over the next 20 years.

Elders Living Much Longer–An added new stage of aging has emerged: the vast majority of Age Boomers will outlive most members of earlier generations by as much as 30 years.

Elders Developing More Chronic Diseases–The need to manage chronic diseases to improve the functional independence of elders is growing exponentially.

Inevitable Geriatric Manpower Shortage–To meet the growing demand, the nation must double or triple the number of physicians, nurses, mental health, and personal care workers who know how to care for older adults over the next 20 years.

“Age Boomers are challenging and changing the rules of aging,” Dr. Wright said. He spoke of the case of Jesse Fitchett, as related in the AARP Bulletin. Jesse wanted to leave his nursing home and receive help that would allow him to live alone, but the nursing home said, “no.” So Jesse filed a groundbreaking class-action lawsuit against the city of San Francisco to enforce a U.S. Supreme Court ruling that affirmed the right of elders to receive homecare assistance. Jesse Fitchett won and lived out his life in his own home.

“Today’s elders don't believe they are irrelevant, frail and helpless little old ladies and men, and they simply refuse to be institutionalized while they wait to die. They insist on actively living their lives at home, even as it requires increasing levels of help. These elders are breaking the old rules, expecting more, and necessitating a new paradigm of caregiving,” Dr. Wright explained.

“Frankly, we don't have any choice in this matter. We literally must change our approach by adopting an entirely new way of looking at eldercare. We must change from an almost exclusive emphasis on acute care that focuses on cures and putting people in institutions. Only by focusing on the treatment of the chronic conditions that accompany aging can we improve the quality of life of elders. The economics and trends demand it, but more to the point, the Age Boomers insist upon it. They won't go away quietly,” Dr. Wright, who is Director of the Schmieding Center for Senior Health and Education in Arkansas, added.

Dr. Wright said that the Schmieding Center is developing a new home-centered approach to long-term care that “we believe is as a key ingredient to the solution of the impending ‘perfect storm’ of aging.”

Dr. Beth Vaughan-Wrobel, Associate Director of the Schmieding Center, said that research shows there is a general absence of professionally trained and certified home caregivers available nationally to anyone not receiving Medicaid.

“At the Schmieding Center we have developed a training program to help remedy that lack. It is called ElderStay@home®, and it meets all federal guidelines. In addition, we are developing a national home caregiver certification organization that will certify graduates of this training,” Dr. Vaughan-Wrobel said.

“The ElderStay@home® training program is available to interested organizations nationwide, including colleges, teaching hospitals, nursing schools, and independent training facilities. We will work with the training organizations to make sure that quality standards are met,” Dr. Vaughan-Wrobel explained. “The ElderStay@home®, program also offers required continuing education to keep caregivers up to date in their training,” she added.

In addition, Dr. Vaughan-Wrobel said, a family version of the ElderStay@home® training program with an accompanying DVD is being produced and will be made available through books stores and by other channels nationwide. “This will make valuable training materials available to family members as well as to professional home caregivers,” Dr. Vaughan-Wrobel indicated.

Dr. Wright said, “There are further hurdles we are working to overcome. Currently, there is no easy way for families to find professionally trained home caregivers. This must change for us to meet the demands of home-centered long-term eldercare.”

“Regulations from state-to-state are such a hodge-podge that no one can sort them out. Some states actually forbid the professional training of homecare workers. There is a mountain of work to be done to correct this situation,” Dr. Wright added.

“Finally, there is simply no financial assistance available for homecare to anyone other than those elders who are eligible for Medicaid. So, an elder who needs some financial help for home help-care must spend down his or her assets in order to get caregiving help to stay home. Somehow that has to be addressed, too,” Dr. Wright said.

Both Dr. Wright and Dr. Vaughan-Wrobel concluded by noting that finding workable, appropriate solutions to the issues will require the collective efforts of healthcare professionals, non-profit eldercare-focused foundations, health care institutions, government, and private families.

Dr. Larry Wright addressed the annual Age Boom Academy, which is sponsored by the International Longevity Council (ILC). The ILC works to identify issues and address policy matters that affect aging and the care of elders. The Age Boom Academy is a weeklong series of presentations and seminars for professional journalists underwritten by the New York Times Foundation.

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Presenters

Larry D. Wright, MD, FACP, AGSF

Dr. Larry Wright is Director of the Schmieding Center for Senior Health and Education of Northwest Arkansas and Medical Director of the Senior Health Center of Northwest Health System. Dr. Wright serves as Assistant Professor at the University of Arkansas for Medical Sciences, Donald W. Reynolds Department of Geriatrics. Dr. Wright has been actively involved in developing geriatric medical programs for over 20 years in Northwest Arkansas hospitals. He obtained his M.D. degree from the University of Arkansas for Medical Sciences in Little Rock, Arkansas, with residency training in internal medicine at St. Louis University School of Medicine in St. Louis, Missouri. He completed fellowship training as a resident physician in geriatric medicine at the Long Island Jewish Medical Center in New Hyde Park, New York. Dr. Wright is a Fellow of the American Geriatrics Society and the American College of Physicians.

Beth C. Vaughan-Wrobel, EdD, RN, FAAN

Dr. Vaughan-Wrobel is Associate Director and Director of Education of the Schmieding Center for Senior Health and Education of Northwest Arkansas. She is also a nursing instructor for the Area Health Education Center-Northwest and Professor of Nursing at the University of Arkansas for Medical Sciences. Dr. Vaughan-Wrobel completed a baccalaureate and master’s degree in nursing at Texas Woman’s University and a doctoral degree in education at Texas A & M University–Commerce. She also has served in numerous leadership roles on the national and international level of Sigma Theta Tau, Inc., the honor society of nursing. Dr. Vaughan-Wrobel is a published author of several books and articles on nursing and is a frequently requested speaker on leadership issues related to geriatric health care at regional and national meetings.

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The Age Boomer’s Caregiving Dilemma

Case Histories from the Schmieding Center
Statistics show that at least 6.4 million people age 65 or older need long-term care.* Such care is provided when an elder can no longer independently carry out essential everyday activities like eating, bathing, dressing, and so on. Many of today’s families are scattered across the country, and most family caregivers are working outside the home. Often, regardless of good intentions, caring for a loved one full-time can overwhelm even the most devoted family member. As a result, more family caregivers must turn to outside resources to solve their dilemma—because they can no longer meet the conflicting demands of their home caregiving needs and the realities of their personal and social lives.

* Planning for Long-Term Care United Seniors Health Council
The following case histories are examples of caregiver needs with which the Schmieding Center for Senior Health and Education has assisted:

A caregiver in the home prevents nursing home placement.
Pam called the Schmieding Center to ask about counseling for a caregiver. She was 58 and caring for her husband Earl, who had had a major stroke at the age of 52. Earl was then 60 years old. Pam had been working two jobs, getting up at 4:30 in the morning to care for Earl, going to one job, coming home to help Earl eat his lunch and address his personal needs, then going to a second job, coming home at 7 p.m. to again provide care for Earl. She was now asking for help to plan for nursing home care.

After discussing Pam’s needs and assessing the financial resources, the Schmieding Center social worker informed Pam of the Alternatives Program, which provides payment for a caregiver in the home. After three weeks of the application process, Earl was approved. A male Schmieding caregiver graduate accepted the five-hour-a-day assignment and not only cared for Earl, but cooked dinner to be ready for Pam when she came home from work. The trained caregiver also worked with Earl to exercise and regain functioning that he had lost due to inactivity. Earl’s physical condition improved significantly, and his signs and symptoms of depression due to social isolation and stress were relieved.

With the help of a professional home caregiver, a nursing home placement was prevented, a husband and wife were able to stay together in their home, and a wife who was exhausted after eight years of care was now mentally and physically healthy.

A daughter expresses hopelessness after years of caregiving.

Molly retired early to return to Arkansas to care for parents, ages 89 and 91. After three years of care, both parents needed physical assistance for activities of daily living (toileting, dressing, bathing, eating, etc.), and Molly found herself unable to leave the home even for grocery shopping due to their needs for care. She had promised her parents that she would care for them and never place them in a nursing home. After five years of caregiving, Molly was emotionally and physically exhausted. Her parents refused to allow any help to come into their home to assist in caregiving or housekeeping.

Molly read about the family caregiver training class at the Schmieding Center and attended the eight-hour session. She received information that helped her provide care but also learned about the trained caregivers on the Schmieding Center Caregiver Directory. She called the Schmieding social worker and asked for assistance to create a care plan that her parents would accept. It was first necessary to provide supportive counseling to Molly and to role-play her presentation to her parents so that she could respond to their objections. Molly did present a care plan to her parents and firmly presented her need for assistance. The three of them interviewed possible caregivers, and Molly’s father immediately liked one. The care plan grew to include one full day a week that Molly was free of caregiving, one half day for errands and a full weekend once a month to have time for herself. Molly is still caring for her father, now age 97, after her mother’s recent death. She is now a mentally and physically healthy caregiver and accepts her role as caregiver, as promised, until her father’s death.

At 75, still managing a business and caring for a spouse who has Alzheimer’s disease.

Mr. Carr is 75 and owns a business to which he attends each day. His wife, age 74, has moderate dementia and stays at home by herself. Mr. Carr is very tired and worries constantly about his wife and business. His secretary told him to call the Schmieding Center. During three telephone calls, Mr. Carr gradually asked for help in planning for care for his wife. A very private man, he was reluctant to discuss his wife’s illness with anyone outside his immediate family. The social worker suggested Mr. Carr come in with his two daughters to review his wife’s needs for care. During the interview it was obvious that Mr. Carr could afford daily care for Mrs. Carr and that his daughters were supportive of this plan. Mr. Carr interviewed home caregivers from the Schmieding Directory and found a woman experienced in dementia care. She now spends each day with Mrs. Carr, taking her out for drives, picnics, walks, and helping her play with her dog. The caregiver observed Mr. Carr’s stress and inability to manage a big household took charge of shopping and cooking. Mr. Carr is now attending the Dementia Caregiver Education and Support Group, where he talks to other husbands and wives who care for a spouse with dementia. He now laughs, talks openly about his caregiver role, and says he enjoys going to work now that he does not worry about his wife and how they will manage.

For access to interview caregivers, contact:
Virginia Thompson
Director of Communications
2422 N. Thompson, Suite B • Springdale, AR 72764
Phone: (479) 751-3043 • Fax: (479) 751-3249 • Cell: (479) 283-8263
E-Mail: virginiat@elderstayathome.org

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Eldercare

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Home Caregiving Analysis

HOME HEALTH REGULATIONS FOR HEALTHCARE ASSISTANCE APPLY TO MEDICARE AND MEDICAID FUNDED SERVICES ONLY; THEREFORE HOME CAREGIVING ASSISTANCE FOR A MAJORITY OF AMERICANS IS NOT REGULATED NOR IS THERE ANY FINANCIAL ASSISTANCE AVAILABLE.

DEFINITION OF TERMS
Every state defines some version of a home care aide, but the nomenclature varies greatly state to state. Terms include:
Homemaker
Housekeeper
Home Care Giver
Chore Workers
Personal Care Assistants/Attendants
Home Helpers
Companions
All of these home caregivers, regardless of title, provide caregiving services only; they do not provide healthcare.

LICENSURE AND TRAINING REQUIREMENTS
There are no states that require licensure of home care aides. States that specify training requirements usually require between 15-20 classroom hours and between 5-10 practical hours. This training is specified only for aides that provide services paid for by Medicare or Medicaid. Curriculum requirements vary, but most refer to the federal regulations.

REGULATIONS
In all states, agencies that provide care paid for by Medicare or Medicaid are charged with enforcing standards for nomenclature, training requirements, and reimbursement.

Individual caregivers are supervised by the agency that employs them. There are no regulations for caregivers working independently.

Case management (planning of care) is unregulated except for those who are eligible for Medicare and Medicaid, and then, only for a very limited time. For the majority of the population, effective case management is difficult to find, unregulated, and there is no financial assistance available.

The above findings are based upon proprietary research that investigated health and home health regulations governing all 50 states. These findings are drawn from those parts of each state’s legal codes that regulate home healthcare services. The references and sources vary widely by state.

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Issue Statistics

Boomer Statistics

There are 77,000,000 Age Boomers who by 2030 will all be past retirement age and will represent about 20% of America’s population—the fastest growing segment.

The first Boomers reach 65 in less than seven years. When they reach retirement age, the Boomers will double the number of elders alive in America today.

The poverty rate for Boomers was 7.3% in 2000 (lower than any other segment of the population). The poverty level has decreased significantly from 1993 when 9.6% of Boomers lived below poverty. Younger Boomers have a higher percentage in poverty than the older Boomers (8.2% and 6.4% respectively). Individuals age 65 and over had a poverty rate of 10.2%.

Baby Boomer households account for approximately 48% of U.S. families.

In the 2000 Presidential Election, approximately 59% of Baby Boomers voted. Older Boomers were more likely to vote than younger Boomers 69% to 56%. The 55-64 and 65-74 age groups had the highest turnouts at 70.01% and 72.2% respectively.
U.S. Census Bureau Voting and Registration February 2002

LONG-TERM CARE
More than 6.4 million people age 65 or older need long-term care, with one in two over age 85 requiring care. At least half of the population who are 85+ will need help with activities of daily living.
Planning for Long-Term Care United Seniors Health Council
Insurance experts estimate that about one-third of all long-term care services are paid for by individuals out of their own savings or investments. The funds may come from pension plans, employee stock ownership plans, single premium annuities, the cash value of life insurance or savings.

MEDICARE AND MEDICAID
Medicare is the federal government’s health insurance program for the disabled and those 65 years and older. Many Americans believe Medicare will pay their long-term care bills, but in fact it pays for a small percentage of all nursing home costs. At present, it may cover skilled care in a nursing home for the first 20 days (and a portion of the cost for the next 80 days) if admission follows a three-day hospital stay. The biggest gaps in Medicare’s long-term coverage are:
• No coverage for custodial care, either at home or in a nursing home
• No coverage in a nursing home without prior hospitalization
• No coverage for nursing home care after 100 days
• Coverage only in a Medicare-approved facility
Medicaid is a joint federal/state program that pays for health care for people with limited income and assets. More than half of all nursing home costs are picked up by Medicaid. To be eligible for Medicaid reimbursement, nursing home care must be provided in a Medicaid-approved facility. To receive Medicaid you must meet federal poverty guidelines for income and assets and may have to “spend down” or use up most of your assets. Some assets, such as your home, may not be counted when determining Medicaid eligibility.

FAMILY CAREGIVERS
At least 25% of American adults care for a loved one, yet don’t view themselves as “caregivers” until they reach an undeniable crisis.

More than 40% of family caregivers are men.

Long-distance family caregivers include more men (58%) than women (42%). The average age is 51, with 27% reporting a child under age 17 living at home.

Despite an average distance of 450 miles and 7.23 hours of travel time one-way, long-distance family caregivers reported substantial regular personal contact with the person they were helping; 51% reported visiting at least a few times a month spending an average of $392 per month on travel and total out-of-pocket expenses.

Sources

Unless otherwise noted: MetLife Mature Market Institute.

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ElderStay@home

PROFESSIONAL HOME CAREGIVER TRAINING
ElderStay@home® is a unique home caregiving training program aimed at making available a new generation of professionally trained and certified compassionate, caring, and competent home caregivers. ElderStay@home® trains caregivers who value elders not as patients, but as people who are able, engaged, independent, worthy of respect, and choosing to remain at home for life and to live lives of meaning, even as they require increasing levels of assistance.

ElderStay@home® certified caregiver training is divided into three levels, each building on the previous skills.

Elder Pal–providing companionship, safety and support for individuals who need minimal assistance with the activities of daily living, such as assistance with bathing, dressing, walking, light house-keeping, meal preparation, and running errands.
Personal Care Assistant–providing hands-on personal care for individuals needing minimal to moderate assistance. In addition to the listed Elder Pal skills, they work with the individual to achieve the goal of maximum independence under family or medical supervision.
Home Care Assistant–providing hands-on personal care for individuals needing moderate to maximum assistance, providing the services covered under Elder Pal and Personal Care Assistant, but also including nursing/therapy procedures under the direction of a medical professional.
Continuing Education–HomeCare Plus is a new program consisting of twelve continuing education programs for nursing assistants. Completion of a continuing education program is required each year to maintain certification.

FAMILY CAREGIVER TRAINING
In addition to the home caregiver training, ElderStay@home® is launching a family caregiving training program, which will provide information, support, and resources for those caring for a family member at home. ElderStay@home® will also provide home-care centered training programs devoted to mental health, quality of life and Alzheimer's issues that will be made available both as part of the professional training program and as family training.

PROFESSIONAL CERTIFICATION
A national certification organization is being developed to assure the capabilities of graduates of the program. This certification will allow those who retain the services of ElderStay@home® graduates to be assured that they are receiving care from professionally trained caregivers who have proven their competence. The national certification organization will also certify graduates of other caregiver training programs as they are created and accredited.

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Dr. Wright's Welcome

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Schmieding Center for Senior Health and Education for additional information at info@schmiedingcenter.org or 479.751.3043, or call toll-free at 888.866.8991.