Computational Modeling of Caregiver Stress
depicts the adaptational outcomes related to the stressors of caregiving based on the appraisal , coping responses , and social support of the individual caregiver . Stressors experienced by family caregivers of people with Alzheimer ’ s disease and other dementias include the specific stage of the disease ( depicting the severity of cognitive impairment ), behavioral problems such as wandering and aggressive behavior , and the inability to perform activities of daily living ( ADLs ) ( Haley , Levine , Brown , & Bartolucci , 1987 ).
The caregiver ’ s appraisal of the level of stress he / she is experiencing , the ability to manage the stress appropriately , and the level of social support that is available determine a caregiver ’ s decision to move a family member from community-based care to a long-term , institutional caregiving environment such as nursing home placement . In particular , crisis situations can create a sudden increase in stress that is beyond the caregiver ’ s ability to cope . Interventions that assist the caregiver and prevent inappropriate or unwanted nursing home placement may contribute to sustainable solutions that enhance the quality of life for the individual with dementia and the family caregiver .
There are many factors coming into play as family members consider the need for increased care for frail family members . Ihara , Horio , and Tompkins ( 2012 ) conceptually grouped variables into two domains — motivation and capability — in their study of grandchildren opting to provide care for their grandparents . They defined capability as a family member ’ s discretionary time and proximity to the frail older family member and motivation as the desire and sense of obligation to provide care after considering the costs and benefits . For the current study , a model was developed to explore public policy options to support family caregivers providing longterm , family-based , in-home caregiving .
Policy Options
For our model , possible interventions include increasing options that will support family caregivers . Policy options such as increased respite care availability , tax incentives , work place policies , and adult day health services may support aging-inplace ( Chen , 2014 ). Some of these options are currently available through public laws such as ( 1 ) the Family Medical Leave Act ( P . L . 103-3 ), provisions under Title III , ( 2 ) Part E of the Older Americans Act related to the National Family Caregiver Support Program ( P . L . 109-365 ), and ( 3 ) the Lifespan Respite Care Act ( P . L . 109-442 ) ( Ihara , Horio , & Tompkins , 2012 ).
Unfortunately , home- and community-based services ( HCBS ) are often out of reach for near-poor older adults who may not qualify for publicly funded services . Provisions for long-term care under the 2010 Patient Protection and Affordable Care Act ( P . L . 111-148 ) have provided several expansions of HCBS under State Medicaid Programs , including the Balancing Incentives Program , the Community First Choice state plan option , and the Home Health state plan option ( O ’ Shaughnessy , 2013 ). These and other programs such as the Community Innovations for Aging in Place program help promote aging in place ( Greenfield , 2012 ), but the growing need for services may not match the availability or ability of state and local communities to meet all the demands .
In 2009 , the National Alliance for Caregiving reported that more than half of caregivers who responded to a survey asking them to rate six potential policies or programs indicated that a $ 3,000 tax credit would be either their first or second choice
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