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Back in 2009, Pallimed created one of my favorite podcast posts titled “Top 10 Contemporary Palliative Care Songs“. In it, they made a list of “contemporary” songs from many different genres that have palliative themes. For todays podcast, we aim to update this list with songs that inspire, move, or make us think about geriatrics or palliative care.

As with the Pallimed post, this is all personal preference. So we would love to hear from you. What one song would you have included in this podcast if you were sitting in the studio? Put it in the comments section of this post!

by: Eric Widera (@ewidera)

We don’t have a transcript for the podcast today, but here is the list of songs picked by our studio audience:

Alex Smith: Dennis Kamakahi – Wahine ‘Ilikea

Jen Olenik: Let It Be by the Penn Med Ultrasounds

Emily Taplin: Nick of Time by Bonnie Raitt

Kai Romero: Florence + The Machine – Stand By Me (yes, not the Ben E King version)

Anne Kelly: Warren Zevon – Keep Me In Your Heart

Eric Widera: I picked I Don’t Want to Die in the Hospital from Conor Oberst and the Mystic Valley band. I first heart it when I attended a great session at the 2008 AAHPM meeting titled Palliative Themes in Music: An Educational and Self-Care Exercise where I fell in love with it.

Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, who do we have with us today?

Alex: Today, we are delighted to welcome from Hopkins Chanee Fabius, who is a gerontologist and assistant professor at the Johns Hopkins Bloomberg school of public health. Welcome to the GeriPal podcast Chanee.

Chanee: Thank you.

Alex: And we’re also delighted to welcome Halima Amjad, who’s assistant professor of medicine in the division of geriatrics at Johns Hopkins and studies, dementia care and health services research. Welcome to the GeriPal podcast, Halima.

Halima: Thank you. Thanks for inviting us.

Eric: So we’re going to be talking about all things caregivers, in particular, two articles that we’ll have links to in our show notes. One from the Journal of the American Geriatric Society, and another one from the gerontologist. It’s going to be super excited to get in both of those. But before we do, do you have a song request for Alex?

Halima: Yeah. So when I think of caregiving that came to my mind was Lean On Me. So that’s our song request for today.

Eric: Great choice.

Alex: (singing).

Eric: That’s excellent, Alex. Let’s dive in the topic at hand. I’m going to start off with the question we always start off with all of our guests is, how did you get interested in this as a clinical or research passion? Chanee, let’s start off with you. So, caregivers, why did you get interested in this?

Chanee: Oh, well. I have personal experience as a caregiver first and foremost. I was a caregiver or helped caregive for my grandfather who had dementia throughout high school and early on in college. And I also helped my mom when I returned home from college, provide care for her. She was ill as well. And I’ve enjoyed working with older people. I’ve always enjoyed being around older people. I love their stories. I love everything. The generativity aspect. The passing down of stories and all that. And with my grandfather in particular, he received home care services. We are originally from Connecticut. He received home care services to help him stay home for as long as possible without going to a nursing home. And that’s sort of why I really got into being interested in caregiving so much so that I became a care manager for older adults.

Chanee: So, I’m interested in both family and unpaid caregivers, as well as the paid direct care workforce that provides care for people in the community. And so I was a care manager for a few years, saw and noticed some of the racial disparities and preferences for care, excess, what people could afford, and decided to go back to school and figure out if there was a gap or issue and what I can do about it. And so, when I got my PhD at Yukon in Human Development and Family Studies. I went to Brown for my post-doctoral fellowship in gerontology, and then I ended up at Hopkins. And so since I’ve been here, I’ve been working with large data, looking at experiences of caregivers, both paid and unpaid caregivers, and also working with a direct care agency. So I understand the experiences that their workers have in caring for older adults, including people with dementia.

Eric: Yeah. And we’ll be talking about some of that research that you’ve done. I’m wondering, going back to your personal role as a caregiver, did you feel supported by healthcare system? Did you feel like you are also an important member of this healthcare team in your early experiences as a caregiver?

Chanee: It wasn’t until I became a care manager that, I mean, I felt like I was part of the team, but it’s because I immediately knew to put on my care management hat when I was talking to people. I knew that as a family member I was present and communicated that I know a little bit of something about managing my mother’s care. At least that I would probably get better results than folks had prior. So, I was very involved in her care as a care manager, like that head on in terms of finding her the right nursing home, or the most appropriate nursing home. Helping her get set up with Medicare & Home Health, and things like that. So, I think my experience is very unique in that most people do not have the professional background that I had. So they get lost and transition because there’s just not a lot of information and direction, right? For caregivers to be able to navigate those transitions. So I think that for me, it worked out, but it’s not always the case for most people.

Eric: Yeah. We’ll talk a little bit more about it. Alex, do you have a question?

Alex: I wanted to ask Chanee what a care manager is. Is this a geriatric care manager, and what the training is like to be become one?

Chanee: Yeah. So, care manager essentially helps facilitate home care services for people with disabilities, older people in my case to receive home care services at home. So I worked, like I said, I’m originally from Connecticut. In terms of training, a master’s degree typically is required either in social work, in my case, human development gerontology. And the potential clients, I would assess their level of care, their level of need. Whether they would be eligible for waiver services through our Medicaid waiver programs that required people to be nursing home eligible. Or if they needed a lower tier of care that would just help maintain things at home.

Chanee: I would connect them with the home care agencies that would be providing these services. And then those home care agencies would deploy direct care workers, providing personal care, companionship, transportation, medication reminders to older people. I also help people transition out of long stay nursing home stays. And back into the community, help set up new apartments or living arrangements. Help facilitate the installation of home modifications, ramps, grab bars and bathrooms. Things like that, but really help put together the care plan that would help people receive the home care services that they needed at home.

Alex: Mm-hmm (affirmative). You were in some sense, the glue person who holds everything together.

Chanee: Well, thank you. Ideally, that’s what it should be, but sometimes things don’t stick as well as they should.

Alex: Yeah. Yeah. Well put.

Halima: Thank you for asking that question because I will say I’m a little embarrassed as a clinician that I don’t necessarily always know what their background of the care managers are.

Eric: Who pays for a care manager?

Chanee: So for us, we were paid by the State of Connecticut, either through Medicaid. I mean, some smaller care management agencies are not connected sometimes to state agencies, but we were connected to the Connecticut home care program for elders.

Eric: Great. How about, same question for you Halima? How did you get interested in caregivers as a subject of either clinical or research interests?

Halima: Yeah. So my broad interest is in dementia care, and I think we all know that in dementia care, the caregiver or the care partner is an integral member of the team. And my interest there is also very personal. So my dad is living with early onset dementia of frontotemporal dementia, specifically, primary progressive aphasia. And he was diagnosed actually just as I was graduating from medical school. And so I think subconsciously, that experience of going through his diagnosis and his care drove me to geriatrics. But then specifically got me interested in dementia care, the caregiver and the family surrounding the person living with dementia, and thinking about the medical care and the care we provide throughout the dementia journey.

Halima: And so, when I think of caregiver, the first person I picture is my mom who’s been his primary caregiver now for 12 years. He’s actually been on hospice for two years now. I actually thought of him when I didn’t listen to the whole episode yet, but I know you guys had an episode thinking about hospice and dementia and people who get discharged from hospice care. And it’s certainly something I’ve thought about in our family’s case.

Alex: Frontotemporal is, I mean, all dementia is tough, right? It’s hard to single out one as being tougher than the other, but boy, is that challenging often?

Halima: Yeah. It certainly has additional challenges in some ways, even in frontotemporal dementia. I think those of us who are dealing with primary progressive aphasia still say, “Oh, it’s better than behavioral variant even if we still deal with behavioral issues.” And I certainly think early onset disease comes with its own host of challenges that we may not see in some of our older or the oldest old patients living with dementia.

Eric: So I guess, the start off, we can go in a lot of different directions when we’re talking about caregivers. There’s a lot to talk about. But what do we know about who are the caregivers that are out there? Chanee, I’m going to turn to you for that question. Who are they?

Chanee: Yeah. So these caregivers are family, children, spouses. They are roughly, I think, best estimates a few years ago, about 18 million caregivers that are providing care to older adults. They are providing assistance with multiple activities. Be it personal care, money management or financial management, medication management, providing care with transportation. And they’re very diverse. I mean, a lot of them, I’m sure many people have heard of the sandwich generation. They are caring for their own families or young children. They are working, right? So they are wearing multiple hats. Spouse caregivers are many times living with their own chronic conditions or health conditions and providing care simultaneously to their partners. And so they are a very diverse group with unique challenges and sets of experiences that they bring to care giving.

Eric: So you just published an article in the Gerontologist.

Alex: Eric, you just muted yourself.

Eric: Oh, oops. I was pressing the space bar for my mute. So Chanee, you just published an article in the Gerontologist, not too long ago, maybe several months ago, looking at health disparities around caregivers and maybe some of the racial disparities and outcomes in different groups. Can you describe a little bit about your research?

Chanee: Yeah, sure. So, we were interested in taking a look at the national landscape of black and white caregivers of that or a family and unpaid caregivers that are providing care to older adults with disabilities. And so we looked at a couple of outcomes that included caregiver. Some effects of caregiving. Positive effects of caregiving, negative effects of caregiving as well as what we call participation challenges or participation restrictions and valued activities. So, if an activity is important to you, does providing care for this person or for the care recipient limit you or prevent you from participating in this activity and a few other things. And so, I was really interested in this because we know through smallest studies, convenience samples that from a long history of research that has looked at these racial disparities among caregivers that black caregivers generally have more positive feelings about caregiving, but they are experiencing or dealing with greater challenges.

Chanee: And we found that to be the truth in our study too that was a nationally representative study of caregivers is that, the takeaway point was that black caregivers are more likely to report positive effects of caregiving, have positive feelings about caregiving, but they’re more often caring for older adults with dementia. They’re more often caring for older adults who have more functional needs. They’re more often caring for people who are Medicaid enrolled. So there’s a financial piece there. And part of what we also at was whether the receipt of paid help or supportive services for caregivers did anything to moderate the effect of race on… Or the association between race and these outcomes. And we did not find that to be the case. But what we did find was that in people who received supportive services, they are more likely to report participation restrictions.

Chanee: So rather than seeing this supportive piece that was going on, we saw that people who are receiving supportive services are in fact still experiencing some of these social engagement challenges regardless of race. And so it really spoke to strengthening the formal supports that we have available, whether that be Medicaid, home and community-based services, or family caregiver initiatives, such as the RAISE Family Caregivers Act, or the National Caregiving Program that has been in existence for a number of years. But yeah, so we saw some confirming things in that paper, but also some really interesting things around the use of supportive services, I guess.

Alex: Mm-hmm (affirmative). And just backing up for a sec. These were family and unpaid caregivers, correct?

Chanee: Correct.

Alex: And we should just make sure our listeners are clear that this sort of caregiving field is divided into caregivers who are so-called formal caregivers, which are caregivers who are paid generally, if I’m understanding this right.

Chanee: Yes, I’m smiling because the language is up for debate always. People don’t really like all the time the formal versus informal sort of comparison because it implies that unpaid or family caregivers are not providing “formal care”.

Alex: Got it.

Chanee: What is that really? But yes, you’re correct. We have folks that are paid for caregiving and folks that are not, and most times family members are falling into the unpaid care. They’re oftentimes providing similar care, right? So they may still be providing hands-on care as well as paid caregivers provide transportation and things like that. But in terms of the buckets that people get put in, researchers go back and forth in terms of terminology often.

Alex: And Chanee, your results you described as counter-intuitive. Tell us, if you could unpack these a bit, what was surprising to you about the findings?

Chanee: Well, you would think that people who are caring for folks with more needs and have fewer financial resources were not going to be the people to report that they’re having more positive experiences associated with caregiving. But there has been research that has really linked the caregiving experiences to culture and cultural expectations and acceptance of caregiving among racial and ethnic minorities, for example, in black communities, just the obligation that people feel, which is not negative. But I’m honored to take care of my parents. This is what I’m supposed to do. The researchers just found that that is more present in racial and ethnic minority groups. And so, it is counter-intuitive on its face, right? But the research supports that the feelings associated with caregiving makes sense. The counter intuitiveness is, how can you feel so positively about an experience that you’re still under tremendous strain providing this care for people.

Eric: So, yeah, I got another question along similar lines. So, what do we know about, and maybe even larger than this study, whether or not any resources also modify that effect as far as how caregivers, their quality of life, or do they… Any resources that make them feel like there’s more positives instead of, that sounds weird even when it comes out of my mouth? What are some resources that we do have that can help modify those outcomes for care givers?

Chanee: Well, there are supports in place that are usually targeting the older adult. That’s, I mean, with the research that I’m familiar with has examined. So for example, in home care programs where everyone’s receiving the same thing. So that’s in terms of the program. I mean, this old adult may receive different services, but you may see some of the racial differences reduce in those cases, because everyone is receiving his home care program, whether it be… And I think, I believe we found that in our study that I worked on in Connecticut. But there’s been faith-based programs that have specifically targeted, for example, black caregivers and their experiences, and sort of tried to provide resources in that way. Other community based programs that have tried to target caregivers and moderate some of those differences, but it’s hard to pick what’s the modifiable piece there, right?

Eric: Sure.

Chanee: And what is the important outcome, because if you feel good about the experience that you’re having with providing care to the older adult or to your parent or grandparent or whoever it may be, what is there to fix? I mean, I have thoughts about that. I mean, there still needs to be equity in everything, but somebody might look at what I found and say, “Oh, well, they’re doing pretty good.” You know what I mean? So I think there’s some thinking through what the actual target should be.

Eric: And then you also published a paper in JAMA Network Open. I think Julia Burgdorf was their first author. But that paper showed that amongst folks who are hospitalized, caregivers were less likely to get this transitional care training if they were black. If they experienced financial difficulty or care for a black female or Medicaid enrolled older adult. Do you want to describe a little bit about what you found in that paper?

Chanee: Yeah. So Julia was interested. Julia is a recent graduate of our health and policy and management program here at Hopkins. And she is really interested in caregiver training. So, providing caregivers with the skills that they need to appropriately address the needs of their care recipients that they’re private [inaudible 00:22:29] care for at home. And so, she was interested in looking at folks that transition out of the hospital. At the time of that transition, did caregivers receive any training or preparation to return home from the hospital staff or anyone that would be discharging the patient. And so we saw that there were race differences and that racial and ethnic minorities were less likely to receive that training.

Chanee: And it’s hard to say why that is the case. It could be associated with some characteristics of the hospital, and the resources that the hospitals have. It could be associated with bias, or hidden bias. Things that few folks are unaware of in terms of assumptions about providing training and what people actually need. It could be that caregivers interpret the word training or the term training differently. So, people may not be saying, “Okay, we’re going to provide you with this training to return home, but it might just be that you receive a discharge summary, and some people actually sit down talk with the discharge planner.” So it’s really hard to pinpoint exactly the reason, but there are many healthcare utilization outcomes that we could look at and say that we see the same thing. And so, to me, it just points to the overall pattern of inadequacies and inequities and disparities and the receipt of these resources that vulnerable caregivers providing care to vulnerable older adults need.

Alex: Yeah. If I could provide my sort of high level, big takeaway messages from this research. In the United States, we spend a disproportionate share of federal dollars on long-term care and nursing home facilities. And whites are more likely to spend time in nursing home facilities than blacks. Older blacks are more likely to reside at home, cared for by family. Your research has demonstrated that black caregivers are more likely to utilize existing services and express positive aspects of caregiving. And so that demonstrates a way forward in terms of moving money into care to support caregivers who are providing support for people at home where most people want to be when they get older. And that we should be moving money towards services that are helping people, helping caregivers, helping older adults remain in their homes. And one of the ways to do that is to support community and faith-based organizations.

Chanee: Yeah. I mean, and then I’ll stop talking, but I know that we’ve also seen a shift over the last few decades in that spending where you do start to see probably about six, seven, eight years ago, a change in terms of more Medicaid dollars being funneled to home and community-based services versus nursing home care with exception, right? Every state is different, but I do think that to your point, the fact that black older adults and their family caregivers are using these services shows that that is a good place to, whether it be intervene or provide a bit more support to these caregivers. And again, these are black and white caregivers. We didn’t examine the other racial and ethnic groups, but I imagine that some of this still holds true in those as well.

Eric: Mm-hmm (affirmative). Thank you. Halima, going to your JAGS paper. When we think about caregivers, and caregiver interventions, how much does the caregiver influence the potential future care of the care recipient?

Halima: So, I think that’s the question we wanted to look at that when we look at older adult outcomes, we focus a lot on characteristics of the older adult or characteristics of the care that they’re receiving. Medical factors, but not as much to the caregiver, the care partner who is, like I said, an integral member of their team. And so what we wanted to look at is that, are some of the caregiving challenges or support services, rather than focusing on the effect of those on the caregiver themselves and their quality of life is, how does that affect the older adult themselves? And so what we did in our study was we took two nationally representative studies. One older study, and one newer study, the National Health and Aging Trends Study, and linked those studies to their caregiver surveys, as well as their Medicare claims data to look at, what are the effects of caregiver characteristics, caregiving circumstances, caregiving challenges, or supports on older adult hospitalization over one year? So one year from that survey.

Halima: And what we ended up finding was that there were a few caregiver characteristics as well as caregiving circumstances that were significantly associated with older adult hospitalization. It’s worth mentioning we did focus just on older adults who had a self care or mobility disability. So not people who just needed help with things like getting to doctor’s appointments or managing medications, but people who needed help with personal care or mobility within the home. Being able to transfer, get around in the room. So people who are more significantly disabled. And I think our biggest findings were that we found that newer caregivers or caregivers who have been in that role for less than a year, their older adult had a higher risk of hospitalization in the next year, compared to caregivers who had been in the role for four or more years.

Halima: And we also found that caregivers who were providing over 40 hours a week, so providing more care every week, their older adult was more likely to be hospitalized in the next year. And then we also found that caregivers who said they had to help with health care tasks. So, managing medications, giving say, insulin injections, wound care. Or if they reported physical strain as part of their caregiving experience, the older adult or their care recipient was more likely to be hospitalized in the next 12 months compared to people who weren’t helping with healthcare tasks or who didn’t report experiencing physical strain. So, as I said, we did find that there were a few select caregiving circumstances or challenges that have an association or may have an impact on older adult hospitalization.

Eric: Why do you think being a caregiver for less than a year versus more? Why do you think there was a difference there?

Halima: Yeah. So I will say that was definitely a finding that jumped out at me. I was thinking that, “Oh, somebody who’s been providing care for four or more years, the older adult must be more disabled or need more help and more likely to end up in the hospital.

Eric: Or maybe burnt out.

Halima: Yeah, exactly. So, I think we had a couple of theories there though of course, you’d have to do more research or more thinking to think through it. But I think some of it gets to that idea of caregiving training. So I was glad you brought up that paper is that over time, caregivers do report being more comfortable and confident in their duties. And so that they’re able to provide the care versus newer caregivers who one may not have identified themselves in that role before. There could have been more acute changes.

Halima: So, if you’re a long-term dementia caregiver versus your parent just had a stroke, and now you’re thrust into this role versus easing into it. And then the other piece that we of course didn’t look at, but we thought about is that it could be that the people who’ve been able to provide care for four or more years, that either there’s lower caregiving burden, or there’s something about that older adult that they were able to remain in the community longer. So potentially resilience on the part of the older adult or caregiver resilience. That they were someone who was able to do it for the long haul.

Alex: Mm-hmm (affirmative). I was just kind of thinking, if they’ve been doing it this long, they may be more comfortable caring for somebody who has some degree of illness in the home, as opposed to the sort of fresh caregivers. Ah, this is seems, I don’t know how to deal with this. Let’s call 911 to send you to the hospital.

Halima: No. And I will say, so we’ve definitely seen that in our family. Like my mom is the pro when it comes to giving care. When it’s like me or my brother or sister, we are definitely not as good at it. She’s giving us instructions on what to do. She knows the medications. We’re like pulling out the list to compare the pills to the list. And so, it definitely seems that experience provides increased confidence of the caregiver.

Eric: All right. I got a question for you. So over and over again, I always hear that caregivers of individuals with dementia, the outcomes for them are worse. Potentially, outcomes for their patients are worse compared to other caregivers of other diseases like cancer, heart failure. Did you find the same thing in this study?

Halima: So, we actually did not, which was surprising to me because like I said, my focus is actually dementia care. So most of my papers talk about how patients with dementia are more likely to be hospitalized. How there’s greater challenges with the cognitive impairment. But we actually found that within our older adult population, again, all of whom had a disability, the hospitalization rates were actually pretty similar. Not statistically different between the dementia and non dementia patients.

Halima: And interestingly, while it wasn’t the focus of our paper, we did confirm what other papers have found, which is that the dementia caregivers reported greater strain. They were in the role for a longer time. They were providing more care each week, yet we didn’t see that translate to greater hospitalization in those patients. So although they had more strain, more caregiving intensity, we didn’t see that translate to older adult hospitalization in at least this specific group.

Eric: Why do you think that is?

Halima: So, one thing we did see was that the dementia caregivers were actually more likely to be using supportive services. So the only supports we looked at specifically were using a support group and using respite care. That was more likely in the dementia versus non dementia caregivers. The other thing we didn’t look at, but other studies have looked at too, is the overall network of caregiving. So we focused on the primary caregiver, but in other aspect we had been thinking about is that again, dementia caregiving may go on for years, and there may be a larger network of caregivers surrounding that primary caregiver to provide support. And again, I think I mentioned this earlier, but that idea of they may have eased into that role versus people who got thrust into the caregiving role.

Eric: Chanee, I saw you on mute for a moment there.

Chanee: Yeah. I was going to say that, I wonder first, Halima, if some of those dementia folks are wrapped up in that longterm caregiving group as well. And I just wonder if… Because I was thinking about new caregivers and the new caregiving role is probably precipitated by whether it be a health status change or something that might require them to start considering themselves caregivers. Start with reporting that they’re helping with these, whether it be hospitalization or something. So that might be some of what you’re seeing.

Chanee: And the other things that I did not mention is that we found also that black caregivers were providing significantly more hours of care per week as well to their older loved ones. And so, I just wonder, if we were to look at some of what we looked at in terms of, the outcomes of interests, whether it be positive caregiving experiences, what have you, and your hospitalization outcome, what we might see. Like do positive caregiving experiences do anything to moderate or impact the healthcare utilization of older adults? So I was just thinking that as you were talking, is that there are also disparities in the amount of care that folks are receiving.

Halima: Yeah. And I did think about that a bit too, even though, so the use of a support group in our study, it didn’t come out to be a significant associated caregiving factor. But especially in people with dementia, there was a strong trend in that direction that caregivers who were utilizing support groups, their older adult trended towards lower rates of hospitalization or lower risk of hospitalization. And so they may be tapping into resources. And I think to your point, the support group in theory could be helping add that positive caregiving experience aspect to their caregiving.

Eric: I feel like the healthcare system completely relies on caregivers to care for individuals with disability, for older adults. Those caregivers prevent billions of dollars being spent in nursing homes, but we do little to support caregivers. I’m learning from each of your perspectives what we’ve learned in these different articles. What do you think we can do different both from a caregiver’s perspective and a equity perspective as well?

Chanee: I think that part of the challenge is that there is little incentive in for example, assessing caregiver needs. And one of the challenges with something like Medicaid home and community based service is that the client is the older adult, or the person with disabilities. And to the extent that you can… It’s almost like, “Well, what do you do about the issues that you identify?” And so, there’s little with caregivers. So there’s little assessment in terms of caregiver assessment for resources, be it social resources, be it a support group, be it something in that way. So I do think that there should be a more concerted to assess the needs of caregivers.

Eric: I’m always surprised in our EHR. I can find out who the next of kin is, which really only helps if somebody dies, but I can’t. There’s no place in our EHR, and most of the EHRs where you can quickly identify who the caregiver is. And who that person is, that’s going to be required. You need to talk to that person, do the training. So, especially when we talk about like post hospitalization, we’re not teaching those people how to do the tasks that we’re going to ask them to do. No wonder we get these terrible outcomes.

Alex: Yeah. Caregiver needs to be viewed as an essential part of the care team…

Eric: And a central part of the EHR, right?

Alex: Mm-hmm (affirmative).

Eric: It starts from that document, which completely fails for caregivers.

Halima: Yeah, I would agree. So I think from our study too, the things that jumped out were just recognizing the importance of the caregiver, knowing who it is. Thinking about, are there certain caregivers who need more coaching or training? Be it someone who’s new to the role or someone who needs to be more actively involved in medical care or health care tasks. And then I think the other piece that jumped out really was the systems issues. That if caregivers who are physically strained in their caregiving role or who are providing more than 40 hours a week, do they actually need support? Someone to actually come in and provide that care to help reduce some of that strain or help reduce some of those hours of care?

Halima: And I know we’ve been talking a lot about Medicaid, but of course, for patients, then the big question comes up is like, “Well, why is Medicare not covering this?” Because a lot of people of course fall into that sort of donut hole of, “We don’t qualify for Medicaid yet paying out of pocket for these services is really expensive.” And when we think about hospitalization, could Medicare save money on hospitalizations by increasing support and training for caregivers who are, like we said, providing this often unrecognized support and care for older patients?

Eric: Halima, I got a question for you. My last question. We’ll wrap it up, but if you had a magic wand, you can make one change right now. What would that change be in regards to care givers?

Halima: Just one?

Eric: The magic wand is running low on batteries. I can give you one. I can give Chanee one, but you’re limited to one.

Halima: It’s Medicare providing money and financial support for direct care for patients with disabilities.

Alex: Yeah. That’s a great one. Yeah, because Medicare currently doesn’t do that except in the post acute care setting after hospitalizations. But really, for the majority of in-home caregiving support is paid through by Medicaid or other sources of funding. Medicare should help pick up that tab because it helps reduce things like hospitalizations, and because it’s the right thing to do. That’s probably the first part.

Eric: All right, Chanee, my magic wand. It’s super low on batteries. You got one wish. One thing.

Chanee: Well, one of my wishes, this is probably, yeah. I have a few. But one of my wishes is that we could find a way…we spoke just briefly about this care team, this sort of phantom care team…what that even looks like. But if we could find a way to collaborate productively between all the players in that care team, be it the… Some of my work I mentioned earlier focuses on the direct care workforce. Be it the caregiver, be it the clinicians that are providing care.

Chanee: I think that would prevent a lot of what we see in terms of unmet needs of older adults and family caregivers. I think we would see some changes in healthcare use and overall improvements in quality of life for both caregivers and older adults. What that looks like, I don’t know. But I think that that would be a great thing if we could find a way to coordinate the care.

Eric: Mm-hmm (affirmative). Well, I want to thank both of you for joining us today, but maybe before we end, Alex, you want to take up the guitar a little bit?

Alex: (singing).

Eric: Chanee, Halima, a big thank you for joining us for this podcast.

Alex: Thank you so much, Chanee. Thank you, Halima.

Chanee: Thank you for having us.

Halima: Thank you for having us.

Eric: And thank you for all your amazing research as well.

Alex: We look forward to more.

Eric: Yeah. And thank you, Archstone Foundation, for your continued support. And to all of our listeners, thank you for supporting the GeriPal podcast.

Alex: Thanks everyone.

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