Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp. 22-23
In January 2002, CMHA completed a national study of the mental health needs of Canadians aged 65+ and the role home care can and does play in meeting these needs. Karen Parent and Malcolm Anderson of Queen’s University conducted the national research and four local community research sites held a series of meetings with seniors and others to look at the issues. Meetings were held with clients and caregivers, both formal and informal.
In January 2003, CMHA National will publish two manuals based on the research report: a Policy and Planning Guide for home care planners and policy-makers, and a Service Delivery Guide for organizations that deliver services.
The article below summarizes the views of informal caregivers who participated at the Kelowna research site. Participants were asked to share their perspectives on mental health and give their input regarding how home care services can contribute to their own mental health and to that of their loved ones. The piece is reprinted from CMHA National’s “Seniors’ Mental Health and Home Care Newsletter” (Vol 1, Issue 3), January 2002 . See www.cmha.ca for more information on this project.
Seniors who are caregivers in Kelowna told us that they require as much support as the care receiver. “When under stress as a caregiver, your own mental health is at risk too,” [said one participant.]
Participants in our focus groups spoke about a need for emotional support and counselling. There is a need for an assessment that “goes beyond the diagnoses to explain what you [the family member] are going to face in these changes.” It was suggested that home support providers also be trained in grief counseling.
Some senior caregivers referred to the personal sacrifices they had to make, such as giving up a job, to provide support to their elder spouse. The informal support of a friend in a similar situation (i.e., also a caregiver) helped them “survive this experience.”
Minimization and Isolation
Caregivers reported that an elderly person receiving care may minimize or mask the real need in order to hide their shame, embarrassment or preserve their dignity regarding the losses they face. The impact on the caregiver can be very intense, beginning with inaccurate assessments of service needs due to the minimization, up to isolation of the caregiver and the client as the senior pulls away from social contact.
Caregivers would like more of a focus on prevention strategies and programs that address the care receiver’s social and emotional needs such as security, support, a sense of belonging and self-worth. It was thought that home care workers are often focused on doing “the job” and may not address these basic human needs.
A Personal Touch
It comforts both the caregiver and the senior when services focus on personal interests, likes and dislikes of a client, and when service providers formally acknowledge the importance of social contact, feeling secure, kindness, hugs, assistance to write letters and read the newspaper. In this way, the role of the caregiver is respected and the importance of these aspects of care can be taken into consideration when the person being cared for must be separated from their caregiver for respite or the longer term.
Transitions in Care and Advocacy
Caregivers reported specific challenges that impact mental health during care transitions. [One participant stated that] “difficulty getting help and someone to believe me nearly killed me.” The transition from home to facility care was reported as “the most horrendous” [since] the familiar support services are severed and “care goes haywire” [and therefore the] family member is “forced to be there as an advocate.” The need for advocacy was also noted for issues related to affordability and access to service, transportation and information, and help during and after a crisis.
Caregivers reported that the needs of a psychogeriatric client pose [unique] challenges, often requiring specialized services. They observed that for families who care for the psychogeriatric client, many needs go unmet. For example, respite options are more restrictive if the senior who needs this service presents with disruptive behaviour, yet the senior spouse is expected to provide this care and support in the home environment. The informal caregivers suggested that the psychogeriatric mental health team should be the main set of people involved with these specialized care/service needs.
What’s needed are:
more respite beds
education and caregiver support groups
more involvement with the caregiver during the home care assessment process
affordable and user-friendly transportation services
affordable programs that address the specific needs of the psychogeriatric client
an advocate to lobby the government for more funds to support family home care and preventative mental health work
and a single service where all information can be accessed.