We should care more about caregivers

Caregivers in Canada need more support.
It’s time to strengthen support for the 28% of people who provide care for an ageing family member, friend or neighbour in Canada, argues an editorial in CMAJ (Canadian Medical Association Journal).

“Our ability to support informal caregiving remains one of Canada’s most pressing health care and societal issues,” says Dr. Nathan Stall, associate editor, CMAJ.The pool of caregivers in Canada is shrinking as the ageing population increases, while the need for caregiving will increase.

Caregiving has become increasingly demanding and stressful, as many untrained people provide medical and nursing care, help with daily living and navigate the complexities of the health and long-term care system. Many caregivers are stressed, which negatively effects their mental and physical health and can lead to increased risk of death.

More than one-third (35%) of the population is both working and providing caregiver support, with more women juggling both roles.

As well, caregivers often provide financial support to their loved ones and may miss out on full-time employment, raises and other monetary benefits. We must support these people by protecting caregivers from financial and retirement insecurity.

While financial support exists, mainly through tax breaks, it is difficult to access and varies by province.

“Addressing this pressing health care and societal issue is undoubtedly complex, but innovative, effective and potentially scalable programs and policies already exist in pockets across the country. It’s time Canada cared more about its caregivers,” he concludes.

Source EurekAlert! American Association for the Advancement of Science AAAS

Pauline Wong, right, has been caring for her elderly mother for several years. CBC News

Nathan Stall, CMAJ March 04, 2019

Every day, about 28% of Canadians provide care for a family member, friend or neighbour, and nearly half will do so at some point.[1] With 93% of older Canadians living at home, unpaid or informal caregivers provide up to 75% of care services, which equates to about $24–$31 billion in unpaid work annually.[2] We must and can to do more to acknowledge and support informal caregivers in bearing this burden.

Over the next 20 years, the number of older Canadians requiring assistance will double, yet there is a shrinking pool of informal caregivers.[1,2] Despite little to no training, they are expected to provide medical and nursing care in the home, navigate complicated health and long-term care systems, and serve as substitute decision makers.[5] Distressed caregivers experience a myriad of adverse outcomes, including deteriorations in mental and physical health, disruptions in social and family relationships, and increased risk of death.[3]

The Reitman Centre CARERS (Coaching, Advocacy, Respite, Education, Relationship, Simulation) Program at the Sinai Health System in Toronto, an exemplary intervention supporting those looking after people with dementia, includes group psychotherapy, problem-solving techniques and experiential learning through use of simulated patients for caregivers, while providing respite with an arts-based group for care recipients.

Participants show improved caregiving competence, ability to cope with stress, and mental well-being.[3] To supplement limited publicly funded home and community care services, many caregivers incur substantial costs for transportation, equipment and professional help. Caregivers may forgo wages and benefits, with many reducing their hours, missing work, turning down advancement opportunities or exiting the workforce altogether.[1,7]

Marie-France Beaudry voted for Premier François Legault because of his promise to make life easier for caregivers. ‘If they don’t deliver, we can be a serious rock in their shoe,’ she said. David Gutnick CBC

The most common form of financial support for Canadian caregivers is tax relief, yet only a small minority receive tax credits.[4] Eligibility for federal and provincial tax credits is generally restricted to caregiving relatives; Manitoba is notable for supporting anyone who assumes unpaid caregiving responsibilities.[4] In general, existing tax relief programs do little to support low-income caregivers; Nova Scotia stands out for providing low-income caregivers with a monthly benefit.

We should and can do a much better job of supporting informal caregivers in the workplace. Governments and employers should develop more flexible workplaces that accommodate caregiving duties and provide better access to paid leave and benefits.[4] Worthy alternatives exist in European countries such as Sweden, where some municipalities provide informal caregivers with direct allowances or reimbursements for caregiving activities.[8]

Addressing this pressing health care and societal issue is undoubtedly complex, but innovative, effective and potentially scalable programs and policies already exist in pockets across the country. It’s time Canada cared more about its caregivers.

We should care more about caregivers, Nathan Stall, CMAJ March 04, 2019 191 (9) E245-E246; DOI: https://doi.org/10.1503/cmaj.190204

Source Canadian Medical Association Journal

  References
  1. Portrait of caregivers, Sinha M. 2012. Ottawa: Statistics Canada; Cat no 89-652-X — no. 001. (accessed 2019 Jan. 31)
  2. Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada? Toronto: Health Council of Canada; 2012. (accessed 2019 Jan. 31) PDF
  3. Families caring for an aging America, Richard Schulz PhD. National Academies of Science Engineering and Medicine. Washington DC: National Academies Press 2016 PDF
  4. An Evidence-Informed National Seniors Strategy for Canada, Sinha SK, Griffin B, Ringer T, Reppas-Rindlisbacher C, Stewart E, Wong I, Callan S, Anderson G. 2nd ed. Toronto: Alliance for a National Seniors Strategy; 2016. (accessed 2017 Feb. 3)
  5. Dementia in Canada, Ottawa: Canadian Institute for Health Information; 2018. (accessed 2019 Feb. 6)
  6. Improving caregiving competence, stress coping, and mental well-being in informal dementia carers, Chiu M, Wesson V, Sadavoy J. World J Psychiatry. 2013 Sep 22;3(3):65-73. doi: 10.5498/wjp.v3.i3.65.
  7. Employer Panel for Caregivers. When work and caregiving collide: how employers can support their employees who are caregivers, Ottawa: Employment and Social Development Canada; 2015. (accessed 2019 Feb. 19)
  8. Informal caregiving for elders in Sweden: an analysis of current policy developments, Johansson L, Long H, Parker MG. J Aging Soc Policy. 2011 Oct;23(4):335-53. doi: 10.1080/08959420.2011.605630.

Who is Taking Care of the Caregiver? Sullivan AB, Miller D. J Patient Exp. 2015 May;2(1):7-12. doi: 10.1177/237437431500200103. Epub 2015 May 1.

Also see
More support needed for unpaid caregivers in Canada in Dr. Brian’s Blog CBC Radio
In Quebec, family caregivers are demanding real change. They just might get it in CBC Radio
Family caregivers in B.C. feeling more depressed, angry: report in CBC News British Columbia
60 Tips for Dementia Caregivers in The Reitman Centre, Enhancing Care for Ontario Care Partners Program

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