Improving Outcomes for Ethnically-Diverse Family Caregivers of Older Adults in an Urban Setting
The number of Americans aged 65 and older will reach 88.5 million by 2050; racial and ethnic minority elders will account for the greatest increase. Nearly 49 million Americans provide care to older relatives at an estimated value of $450 billion. Caregiving, while having positive aspects such as increasing life’s purpose, can also be burdensome, particularly among racial and ethnic minorities experiencing reduced access to resources. Their family caregivers are also more likely to be poorer, less educated, underemployed, and in worse mental and physical health than their White counterparts. Aware of these complex needs, eight agencies and a social work professor developed, implemented and evaluated the Caregiver Ombudsman Outreach Program (Co-Op), a supportive intervention for ethnically-diverse older adults and their caregivers in an under-resourced New York City area.
Building on research noting that multifaceted, individualized interventions have the strongest impact, through the Co-Op, one MSW and one BSW practitioner completed thorough assessments of each caregiver-care recipient dyad. Tailored information and referrals based on the dyads’ needs and existing environmental resources were subsequently offered. Caregivers could contact the social workers as needed throughout the project for additional information and support.
Methods
Program participants were recruited using extensive outreach to institutions such as health centers, churches, and pharmacies. One hundred and eighty-one caregivers (72% female; 49% African American or Black, 36% Latino, 9% White, and 6% multiracial) participated. Given the realities of implementation and evaluation in real-world settings we employed a quasi-experimental, pre-posttest design without a control group. Initial and follow-up assessment tools including the Caregiver Risk Screen (CRS), and the Caregiver Burden Inventory (CBI) were utilized to obtain demographic information about caregivers and care recipients, understand the nature and quality of their relationship, and assess caregiver burden and stress. Data were analyzed using the statistical package R. We computed frequency distributions, averages, comparisons, confidence intervals, correlations, and linear regressions. Key methods were descriptive statistics on the characteristics of caregivers, and before-after comparisons of caregiver risk and burden. We also performed correlations of these summaries and regression analyses to see if any pre-treatment variables were predictive of the post-treatment outcomes.
Findings
Co-Op participants experienced statistically significant reductions in stress and sense of burden from initial to follow-up assessment. For caregivers completing a follow-up CRS, the average score declined from 11.2 to 10.1, a decline of 1.1 with standard error 0.5 (t-test, p<.05). For the 125 caregivers completing a follow-up CBI, the average caregiver burden score declined from 5.8 to 5.1, a decline of 0.7 with standard error 0.3 (t-test, p<.05).
Conclusions and Implications
Ethnically-diverse caregiver-care recipient dyads often experience significant psychosocial stressors, and need and respond well to social work’s biopsychosocial approach. Furthermore, especially in challenging real-world settings, social workers can take a leading role in assessing interventions. Thus, given the critical role family caregivers play in the well-being of older adults, caregiving programs such as Co-Op offering a range of services, from emotional support to care alternatives, and demonstrating positive outcomes should be available in all communities.