Maximizing Support for Family Caregivers of Aging Veterans: A Role for Social Work Care Managers and in-Home Digital Technology

Background/Purpose: Due to increased longevity, many of the nine million U.S veterans aged 65+ (US Census Bureau, 2012) are living with multiple chronic physical, cognitive, and behavioral conditions and require complex care which is typically provided by family members (AARP, 2013). Although training and support can reduce stress related to caregiving, many caregivers struggle to arrange time away from care-recipients to participate in community-based or VA programs. It’s even more challenging for caregivers of veterans in rural locations which are associated with greater poverty rates, fewer medical specialists, and limited transportation (USDA, 2013). To address this problem, this study examined multiple approaches of delivering caregiver support remotely.

Methods: Supporting Caregivers of Rural Veterans Electronically (SCORE), a randomized controlled mixed methods study, examined high and low technology approaches for delivering in-home support and education to family caregivers of veterans with dementia. After enrolling, participants (N = 194) were asked if they were comfortable using the Internet. Based on their responses, Internet-naïve participants were randomly assigned to a simple in-home digital device group (Intervention Group 1) or a phone support group (Attention Control Group 1) and Internet-savvy participants were randomly assigned to the Internet group (Intervention Group 2) or a phone support group (Attention Control Group 2).

All participants received an educational handbook and were assigned a care manager—a licensed clinical social worker—who provided one-to-one phone support, assisted with delivery of educational content, and evaluated risk throughout the study. Learning modules portraying the progression of dementia and instruction on caregiving skills were delivered to Intervention Groups digitally over 20 weeks. Pre-/post-surveys—which included scales measuring family composition, caregiver burden, social network, and caregiver efficacy—were administered. In addition, 118 participants completed semi-structured individual interviews at the end of the study.

Data reported in this presentation are based on qualitative analysis of the semi-structured interviews. Team coding and constant comparative methods were employed to identify and refine codes and categories as new themes and patterns emerged from the data.

Findings: Most participants were female spouses with a mean age of 68.8 (SD = 11.9). Data analysis revealed several themes regarding the program’s usefulness: educational information about dementia and its progression was most beneficial; access to a knowledgeable professional who could address complex caregiving concerns and connect caregivers to VA services/benefits was highly valued; and providing information at the time of need was preferred. Barriers to participation included: limited time to access content; the demands of caregiving; and caregivers’ own health problems.

Conclusions/Implications: A technology-based, in-home caregiver support program is a feasible approach to reach family caregivers in remote settings and social work care managers are well suited to address caregivers’ needs. Study findings contribute to the knowledge base regarding caregiving and highlight leadership roles for social workers in the development and implementation of evidence-based family-centered caregiving interventions. Findings also reinforce the need for social workers to advocate for federal policies that better meet the needs of aging Americans and their family caregivers and to translate our research to inform these policies.