EVALUATION OF CAREGIVING SUPPORT PROGRAM

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Families provide the majority of long-term care given to older persons in the home. Many family members, however, have little preparation for taking on the responsibility of caring for older persons. The long-term objective of this study is to improve the care provided by nurses to impaired older persons and their family caregivers by offering an individualized program of support to caregivers to supplement current levels of in-home care. The Caregiving Support Program (C-S-P) contains three components: 1) Preparation for Caregiving, 2) the Caregiving Advice Line, and 3) the Keep-in-Touch System. The proposed study builds on our previous work, and has two specific objective : 1) to determine whether the C-S-P has beneficial effects for the caregiver, care receiver, family, and health maintenance organization, and 2) to explore the extent to which the C-S-P interacts with individual and family characteristics in affecting the outcome of caregiving. We will conduct the study within the context of a large health maintenance organization in the Pacific Northwest. We will use a sample of 400 dyads (an impaired person 65 years of age or older and the family member or friend who cares for him/her). We will access the dyads when the care receiver is discharged from the hospital in need of prolonged help in one or more of the following areas: personal care, behavior management, protection, or medical management. Dyads will be randomly assigned to one of two treatment conditions. The control condition includes at least one home visit by a home health nurse, and additional visits consistent with current nursing practice in the HMO's home health agency. The experimental condition includes home health care comparable to that provided in the control condition plus the program of individualized interventions for the caregiver called the C-S-P. We will collect interview and questionnaire data from the participants at five points in time: a day or two prior to the care receiver's discharge from the hospital, and approximately 1, 5, 9, and 18 months following discharge. Dependent variables for the study include such concepts as: caregiver role strain, rewards of caregiving, and preparation for caregiving. We developed and pretested measures for these, and for other concepts of interest to us, in our previous research including the Caregiver Relief Study. We will use multivariate analysis of variance and covariance to compare the control and experimental groups on the measures of the dependent variables.