Mount Sinai Researchers Study Caregiving in Homes and a Health Care Workforce in Transition
Studies published in Health Affairs examine spousal caregiving in last years of life and the adequacy of training and preparation for paid caregivers
As older Americans choose to remain in their homes late in life, shifting care away from the institutional setting, many questions are surfacing about how to ensure the best outcomes for them.
In the June issue of Health Affairs, focused on the “Aging Workforce,” Mount Sinai researchers share important background data on home caregiving for the elderly derived from two new studies. The issue comes out during a time of national debate about the role of caregivers and policy discussions.
The first study addresses the issue of spousal caregiving in “Spousal Caregivers Are Caregiving Alone In The Last Years of Life.” “Even with children living nearby, we found that more than half of spouses are acting as solo caregivers, and they’re working long hours that are both emotionally and physically demanding, often in isolation. We worry about these solo caregivers who are particularly vulnerable, as they themselves tend to be older, in poor health, and facing the challenging emotional and financial experiences of widowhood,” says lead author Katherine Ornstein, PhD, MPH, Assistant Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and Director of Research for Mount Sinai’s Institute for Care Innovations at Home.
Among spouses who received support, Dr. Ornstein and colleagues found, two out of three were helped by their children, 40 percent received paid help, and 11 percent received support from other family or friends. While some state and federal policy proposals aim to systematically recognize and assess caregivers, the authors conclude that further innovations in care delivery and reimbursement are needed.
The researchers were surprised to learn how often spouses were caregiving on their own, regardless of caregiver gender, presence of adult children, or patient diagnosis. “Our findings are an important reminder that health care providers need to recognize, assess, and address the caregiving situation and provide support for family caregivers of people with serious illness, especially as we increasingly move toward home-based care,” says Dr. Ornstein.
Finally, Dr. Ornstein and colleagues note the pressing need for the widespread availability of palliative care services for seriously ill patients living in their homes. For many people, the authors write, the availability of non-hospice palliative care outside the hospital setting is limited at best. The expansion of community-based palliative care is critical for older adults and their caregivers who wish to remain at home.
The second study, titled “Beyond Functional Support: Health-Related Tasks Paid Caregivers in New York State Perform in the Home,” examines the tasks paid caregivers (including home health aides, home attendants, and other direct care workers) perform as they care for older adults at home, and assesses the adequacy of paid caregiver training and preparation. Mount Sinai researchers conducted qualitative interviews with patients (or their proxies) and their paid caregivers in New York City.
“Paid caregivers are often tasked with helping older adults with functional impairment meet their basic needs, such as bathing and cooking. We found that in the course of this routine care, these caregivers perform a wide variety of additional tasks that support patient health, like recognizing acute medical problems, reporting patient status to health care providers, encouraging physical activity, and providing companionship and personal support. Yet formal training for paid caregivers may not include these topics. In fact, half of the health-related tasks performed by paid caregivers are not included in the basic training for Medicaid-funded paid caregivers in New York," says lead author Jennifer Reckrey, MD, Associate Professor of Medicine, and Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai.
"In light of our rapidly aging population, these findings speak to the important role that paid caregivers can play in the health of older adults living at home and the need for a wider scope of training to prepare them,” adds Dr. Reckrey.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.