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From Caregiving to Caresharing

Abstract and Keywords

With the growth in the older population, especially people in the latest years of life, the need for care provision by both formal and informal sources of support will need to increase and be more innovative in design. This article begins by tracing the roots of caring and examines diverse caregiving structures and social conditions. Drawing upon a concept first studied by Covan in Florida and augmented by European models, the authors articulate practice principles from a caresharing perspective. These models emphasize caresharing by combining strengths and resources from multiple sources; however, they are still under development. The article concludes by examining 16 principles that are aligned with practice from a caresharing paradigm.

Keywords: Caregiving, caresharing, interdependence, sandwich generation, filial behaviors, caregiving resilience

A primary function within family life is caring, which can be a temporary situation, such as looking after a new baby; or a long-term responsibility, such as tending to a physical or psychiatric disability of a son or daughter. While caring has been done by families through the ages, current changes are affecting U.S. patterns of caregiving, including diversity in family structures, as well as changing political, economic, and policy contexts. At the same time, social service systems have not kept up with these shifts, which results in situations where families do not receive the support that they need to fulfill their caregiving roles.

This article discusses these shifts, from caregiving for older adults and their families to caresharing practices among care collectives. It also describes how health and social services designs are being modified, necessitating innovative interventive strategies and ideas about social work practice. The hope is that these modifications will bring medical and psychosocial care closer together to provide a more comprehensive and effective experience in care provision.

The variations in design are both seemingly nuanced and substantial, and they take into account some of these following differences. For instance, does the design do the following:

  • Emphasize the promotion of self-determination or collective decision making?

  • Focus on the independence/autonomy of the care recipient or foster interdependence and connections?

  • Obtain resources through case management systems or through tailor-made strategies?

  • Consider consumer choice?

As seen in this article, the role of the social worker and the social service delivery system functions also vary based on the answers to these questions.

It should be noted that caregiving and caresharing are not diametric opposites. Rather, they share a common goal, which is to assure the safety and well-being of a person in need of attention for help with biopsychosocial difficulties. Generally, the differences between caregiving and caresharing involve the way in which psychosocial and medical care are interconnected and delivered. The aim of care in both instances is to foster the care recipient’s continued daily functioning and quality of life. In current Western societies, elements of caregiving and caresharing exist side by side, with some countries placing greater emphasis on particular aspects of care design.

Filial Behavior

Caregiving is part of all societies, and families are the primary source of support for older adults. There are 43.5 million Americans engaged in caregiving, with 34.2 million caring for older adults. A total of 60% of these caregivers are women (National Alliance for Caregiving, 2015). The caregiving literature, therefore, gives major attention to filial behaviors and how these influence the ability to carry family-centered care (Boszormenyi-Nagy & Spark, 1973; Brody, 1981, 1985, 1990; Greene, 2011; Silverstone & Burack-Weiss, 1983).

Normative Care and Stress

Because family members are the primary caregivers for older adults, it is necessary for social workers to understand select elements of filial behavior. For example, in a seminal lecture to the Gerontological Society of America in 1985, Elaine Brody contested the myth that adult children do not take as good care of their elderly parents as they used to in the “good old days.” On the contrary, she argued that social workers needed to be aware that parent care had become a normative but stressful event for many individuals and families.

Sandwich Generation

Brody’s research at the Philadelphia Geriatric Center found that the caregiving system was usually comprised of the mother-daughter dyad (at least in mainstream society). Daughters were often referred to as the sandwich generation because they were caught between caring for both children and parents. This could bring about work–family care conflicts, which still exist today and may be the focus of social work intervention.

Unsettled Debts

In an early study, therapists Boszormenyi-Nagy and Spark (1973) brought attention to the unsettled debt between parent and child. They contended that there is an earned indebtedness between generations (filial loyalty) that naturally brings about family care. However, this paradigm does not account for numerous factors that emerge within the family, such as the quality of bonds, level and intensity of need of the care recipient (e.g., Alzheimer’s disease), and rival demands on a caregiver’s time (e.g., employment, raising children, lack of financial resources). While some families seek help from formal care providers at times when there is an incongruence in caregiving ability and care needs, this is a risk situation that can result in negative outcomes such as physical/mental health problems of the care provider, or elder abuse or neglect. Therefore, the support that social workers provide to caregivers is an important factor in an elderly person’s ability to remain in the home environment and in maintaining the congruence between care needs and capacity.

Diversity in Filial Behavior

Although family caregiving is part of all societies, patterns of care differ by family context and culture. The predominant pattern of care in North America is by the spouse, daughter, and daughter-in-law in that order. The National Alliance for Caregiving (2015) provides a report on the status of caregiving in the United States. While sons are also involved in care, about 60% of caregivers are female. About half (49%) of care providers are assisting someone over 75 years of age. The average amount of time spent in care is about 24 hours per week. Clearly, these data indicate that caregiving is intense and complex for many care providers.

Patterns of care differ within other cultural contexts. In Korean families, for example, daughters-in-law are more commonly care providers than daughters and often assume the more complex and demanding caregiving tasks (Hong & Kim, 2008; Lee, Yoon, & Kropf, 2007). This pattern is attributed to the son having responsibility for parent care. Although the responsibility is assumed by the son, the actual caregiving tasks are assumed by his wife.

Changing cultural patterns affect the configuration of family caregiving. For example, Chinese patterns of care have been shifting with changing economic and social conditions. Especially in urban Chinese families, there is an emerging perception that the previous principles of filial piety are shifting with industrialization, labor force changes, and a more egalitarian social structure (Li, Long, Essex, Sui, & Gao, 2012; Zhan & Montgomery, 2003).

Within the United States, there are also diverse patterns and experiences of caregiving. Compared to white caregivers, for example, African Americans report fewer negative psychosocial outcomes such as stress and depression, and report greater rewards from their experience (Cuellar, 2002; Haley et al., 2004). In other comparisons between racial/ethnic groups, the following differences were found (Pinquart & Sörensen, 2005):

  • White providers employed a greater amount of professional support services than Asian American caregivers.

  • White caregivers were more likely to be of higher socioeconomic status, were less likely to receive support from family members and friends, provided lower levels of support, and had lower filial obligation beliefs than caregivers from other racial/ethnic backgrounds.

  • Caregivers from other racial/ethnic groups reported worse physical health than the white caregivers experienced.

Caregiving Overview

While caregiving is as old as society itself, with families around the world fulfilling this basic function, the origins of gerontology in 1903 (Martin & Gillen, 2013), provided a more scientific methodology for understanding caregiving.

Informal caregiving is unpaid support given by family or friends to children or adults who need assistance. Caring for others generally takes on three forms: instrumental, emotional, and informational caring. Instrumental caring includes those tasks that involve assistance or tangible support. Examples of instrumental caregiving tasks are helping with activities of daily living (ADLs), transportation, or medical requirements (e.g., wound care, medication management). Emotional support is related to the experience or subjective appraisal of the individual requiring care. Examples of emotional support are encouragement, connection, and sharing experiences or social ties. Support groups and friendly visitor programs are examples of interventions that address emotional needs. Information support is a source of knowledge or experience that is helpful within the caregiving context, such as psychoeducational interventions, hotlines, or sharing of experiences with others in similar situations. This can involve a person’s increase in what is known as medical literacy, or sufficient knowledge to attend to one’s medical affairs (Kobayashi, Wardle, Wolf, & von Wagner, 2016).

An important consideration in social work practice is to enhance the congruence between needs and support. A professional social work assessment evaluates this congruence or fit. A mismatch between what is needed and what is provided can result in an increased level of stress or burden for caregivers and their recipients (Cummings & Kropf, 2015). Therefore, the social worker’s role is to make interventions that better match the level and type of support and assistance desires of the care recipient.

Biopsychosocial Function

The care recipient’s caregiving needs emerge from multiple domains in functioning, and often require resources and services to sustain or shore up functional demands. Both caregiving and caresharing center on the biopsychosocial (and sometimes spiritual) factors that contribute to the functional capacity of older adults (Birren, 1969; McInnis-Dittrich, 2002). The gerontologist James Birren first brought attention to biopsychosocial processes as an aging phenomenon central to effective functioning in one’s environment. He defined biological age as physiological age-related changes and the functional capacities of organ systems that influence life expectancy (Birren, 1969). Psychological age encompassed how a person adapted to environmental demands over the life course, while a person’s role in a given social structure is called social age. For example, a person who identifies as gay or lesbian in later life may have experiences that similarly aged lesbian, gay, bisexual, transgendered (LGBT) individuals underwent earlier in their sexual identity process. All these areas need to be part of a thorough geriatric assessment process and to become integrated into a care plan.

Often, however, functional abilities are the primary reason for receiving care from others and the impetus to become involved in formalized services. After the assessment of a client’s functional age, the determination might be that the older adult needs assistance with ADLs, such as housekeeping, finances, transportation, preparing meals, or administering medication.

Case Management

The extent to which older adults can function in their environment is central to a geriatric assessment and whether there is a need for family and or professional involvement in care. Under these circumstances, the primary method of geriatric social work intervention may eventuate in case management, providing long-term services to facilitate autonomous functioning among older adults (as discussed further later in this article).

Case or care management is a social service design model that promotes the linkage of individuals and families to resources and sources of support. Traditionally, case management has included assessing, advocating, planning, implementing, coordinating, monitoring, and evaluating service provision. These tasks “extend” family caregiving to a community-based system of resources.

A family case management approach (see, e.g., Greene & Kropf, 2008; Greene, Cohen, Galambos, & Kropf, 2007) moves beyond an “identified client” to care and consideration of the needs of the family system that is providing care. In this approach, the case manager works to promote homeostasis within the family by addressing issues that can be challenged by care demands. When care is needed, relationships within the family system may require the attention of a case manager to help rebalance and promote functioning across different role relationships.

Besides addressing the service needs of the family and client, case managers also have a role in transforming social service systems (Greene et al., 2007). Case managers can help families receive support from nontraditional sources, such as postal workers who act as natural gatekeepers when mail is not retrieved at an older adult’s home. In addition, case managers can be part of community planning when there are unmet needs, such as respite care for families who have a member with dementia. Case managers also promote caresharing opportunities such as integrating neighbors into a care plan for an older adult who remains in his or her own home.

However, case management tasks are now in flux. They may be carried out by social workers or nurses at a single agency or multiple agencies. There is no required single point of entry, and consumers may be referred by multiple sources. Services are often health and insurance related and are under transition due to regulations found in the Affordable Care Act regarding discharge planning and hospital readmission policies (as discussed later).

By contrast, the European social care system has a different configuration of what we call case management. For example, the British system, has a single-entry online technology system that allows consumers to make their own choices (Careworks Ltd.). Local care is also more directly connected to policy-making initiatives.

Caregiver Burden and Resilience

Other key concepts in the caregiving literature include caregiver burden and resilience. Caregiving responsibilities have the potential to negatively affect the mental and physical well-being of the caregiver. These responsibilities can disrupt marital or family relationships, or cause problems in meeting work responsibilities (Zarit, Reever, & Bach-Peterson, 1980).

On the other hand, caregiver strain can be counterbalanced with resilience (Garity, 1997; Pierce, Lydon, & Yang, 2001; Raschick & Ingersoll-Dayton, 2004; Wagnild & Young, 1993). Those caregivers who are more resilient experience the joys and rewards of care without denying the very real stresses that are also present (Farran, Miller, Kaufman, Donner, & Fogg, 1999). The focus of social work intervention may be helping families to find this balance. Within the assessment process, a critical aspect is to determine the rewards and pleasurable aspects of caregiving, as well as those components that are stressful.

Caregiving and Caresharing Shifts

The primary drivers of the shift from caregiving to caresharing are changes in family structure, policy, and social system designs. The needs of the older population are becoming more complex and straddling multiple service sectors; in addition, older adults are becoming more savvy about the types of services that are acceptable and desirable. More innovative and responsive approaches to later-life problems are required. In addition, changing family structures also affect the type and availability of support for older family members.

Family Structure

The baby boomer generation—or those born between 1946 and 1964—has had unparalleled life experiences (Maugans, 1994, p. 1) that influence family function, structure, and expectations for intergenerational behavior. For example, baby boomers have experienced unique timing and tempo in human events (Corman & Kingson, 1996). As a generation, they have departed from a number of patterns from previous cohorts including being raised in a postindustrial society, being the last generation raised by housewives; and being the group who led 1960s and 1970s Vietnam and civil rights demonstrations” (Greene & Kropf, 2009). Baby boomers have postponed marriage and have a smaller family size, more dual-career marriages, and higher rates of preventing pregnancy and getting divorced (. In addition, baby boomers will have a smaller pool of family members due to falling birth rates.

According to Kiyak and Hooyman (1999), the mainstream family in the twenty-first century, rather than the traditional pyramid, is shaped more like a beanpole—long and thin, with great-grandparents still living, but with fewer children, grandchildren, and great-grandchildren. That is, these modifications in family structure will necessitate a reconsideration of caregiving needs to meet the alterations in household, family, and kinship arrangements. Another change among the baby boomers may be their sense of financial security, enabling them to afford a direct-pay model, in which families hire and supervise their own aides.

Within African American and Latino families and communities, however, there is evidence that a greater degree of caresharing exists. The larger and extended families of African American and Latino families may exhibit cultural differences in family structure important to social work practice (Tennstedt & Chang, 1998). For example, they are more likely than the general population to live with the care recipient and to provide care for more than one person (National Alliance for Caregiving, 2015). Minority populations are expected to increase to include close to half (47%) of the U.S. population by the year 2050 (Day, 6).

Same-Sex Families

In the area of same-sex families, the Supreme Court decision in Obergefell et al. v. Hodges, which legalized same-sex marriage federally, has provided equal rights and protections for gay and lesbian couples. However, the oppressive social conditions under which many older LGBT adults lived in earlier years is crucial to understanding the later life patterns of support and care. Most older adults have created families of choice, often as a result of nonacceptance from their biological families (Orel, 2004). Close friendship bonds in the LGBT community often include support and mutual aid during times of caregiving need.

Older cohorts of LGBT individuals are also involved in care provision roles. In research on the experience of care in older couples, care providers reported feeling emotional stress and strain (Fredriksen-Goldsen, Hyun-Jun, Muraco, & Mincer; 2009; Hash, 2006; Hash & Cramer, 2003). While these experiences are reported, they “often remain largely invisible due to fear of disclosure and discrimination” (Fredriksen-Goldsen & Muraco, 2010, p. 401).

Social Policy and Social Systems Design

International Influences

Every society includes ways to provide care for its members, yet these acts can take numerous different forms depending on cultural, social, and political factors. As Greene and Kropf (2014, p. 4) stated, “Care provision is organized differently in every society depending on the roles of various institutions, individual and family responsibility, values and ethics, and economic and political considerations.” European countries such as the United Kingdom, Ireland, and Sweden have long had a different culture of elder care called social care. For example, a Swedish social scientist proposed that “caregiving be seen as a form of social organization that includes the interpersonal relationships and the division of practical tasks: a truly collective action, depending upon direct and indirect contributions from a number of actors, including the cared for himself” (Daatland, 1983, p. 1). This approach also includes activities of family and friends, state programs, and services and is considered in the design and planning of community elder care.

In other parts of the globe, social care is an integral part of the social welfare and health systems. For example, Europe, Australia, and New Zealand all have different models of social care, and in some places, it is distinct from the profession of social work (Lalor & Share, 2013). Social care has been defined as “a profession committed to planning and delivery of quality care and other support services for individuals and groups with identified needs” (Irish Social Care Gateway, 2005, p. 4). Social care includes actions that assist people in accessing basic necessities in health care, social welfare, and other service sectors. In addition, social care practitioners work to prevent problems by improving social conditions and strive to promote social and economic justice (Sheafor, Horejsi, & Horejsi, 2012).

U.S. Caresharing Initiatives

In U.S. social work, practitioners often see caregivers and recipients when support is insufficient. In these cases, social workers and other informal and formal sources of support become part of the care system, offering additional aid as necessary. For example, the term caresharing was first used by Covan (1998) to describe a care collective or a communal effort in a Florida community that organized itself to minimize losses that might be associated with the aging process. These emerging caresharing models are a result of several factors, including sociodemographics and family structure, lack of capacity in long-term-care models to be effective in meeting the needs of older adults, and financial and administrative changes in long-term care (Lehning, Scharlach, Price Wolf, Davitt, & Wiseman, 2015).

Villages

Several trends have emerged as residential options. One model that has emerged is the village model, which capitalizes on the proximal residences of older adults (Scharlach, Graham, & Lehning, 2011). For example, Beacon Hill Village in Boston was founded to allow older adults in the neighborhood to “age in place.” This so-called consumer cooperative offers an organized, community-based program that allows people over 50 to remain in their homes through the provision of such support as transportation, household management, and yard work.

A similar goal of aging in place, known as the Community Innovations for Aging in Place Initiative (CIAIP), is espoused by the New York Jewish Philanthropy. Villages promote the involvement of older adults in their neighborhood and integrate services and activities for social engagement. While there are some challenges to cost containment and leadership sustainability (Lehning et al., 2015), this model promotes a caresharing experience for those who live in this type of residential setting.

The Green House Movement

Even long-term care has started to integrate more caresharing aspects into these settings. One example is the Green House (GH) movement, which is transforming skilled nursing facilities from institutional to home environment settings (cf. The Green House Project). Evaluations of this model indicate that GH residents had better quality-of-life outcomes than nursing home residents (Kane, Lum, & Cutler, 2007). In addition, a financial analysis reported that the costs of GH facilities compare favorably to those of nursing homes (Jenkens, Sult, Lessell, Hammer, & Ortigara, 2011). This model of smaller residential settings where there is a more intimate bond among the residents and the care providers is a transition to a caresharing paradigm within the long-term-care system.

Social Care Principles

According to Greene and Kropf (2014), the term social care takes social workers back to a time when they were more embedded in social welfare systems, and when they took action to ensure that people’s basic needs were met and to improve social functioning. The following principles provide a framework for social workers based upon a social care perspective.

  1. 1. The social worker builds a relationship with all members of the care collective. In this paradigm, the practitioner prioritizes establishing connections beyond the caregiver–care recipient dyad. This process also means that nonproximal members of the care collective (e.g., those who live in other locations) are included as vital participants.

  2. 2. The social worker is embedded in the collective (i.e., beside its members) and facilitates dialogue/discourse between them. In a caresharing perspective, the practitioner facilitates dialogue to construct an effective and operational process for care. Most often, this does not happen organically or spontaneously; instead, it requires discussions and negotiations within the care collective. The practitioner can help stimulate these discussions and deal with any issues that that may produce pain or anxiety. The result is opening a dialogue in which members of the care collective can discuss, negotiate, and decide issues related to care provision.

  3. 3. Care is a shared responsibility or communal effort involving many players. While some members of the care collective may identify how to contribute to a caresharing group, others may need support in considering ways in which they can be involved. Likewise, more involved members may need to build trust that others can effectively be part of supplying the care, therefore relinquishing some care-related tasks to others. In addition, the practitioner can help with coordinating the myriad of caregiving tasks that are taking place.

  4. 4. The network is comprised of traditional and innovative components, at both the micro and macro levels. Some aspects of the caresharing experience may be intuitive, such as health and medical assistance that is needed to deal with a chronic condition. In assessing the needs of the care recipient, however, the practitioner needs to consider the individual from a biopsychosocial/spiritual perspective. For example, an older adult who is a musician might enjoy playing music with others. A community member who is also musically inclined might become part of the care collective to come over and play with the older individual periodically. While this activity is not part of a medical plan, it directly relates to the quality of life and sense of continuity of the older adult.

  5. 5. Care is given within historical, societal epoch, political, economic, and policy contexts. As previous sections of this article indicate, caregiving is a dynamic social condition with a reciprocal connection to the particular era. As Stephanie Coontz (2005) discusses, marriage and family ties have evolved over time, with the most recent period being one of affective bonds. Historically, marriage and reproduction were aligned with other values, such as power, status, or accumulation of wealth. Similarly, expectations and patterns of care are related to cultural norms, historical expectations, and social policies. In a care collective, both current and past experiences must be understood as part of the caregiving experience. For example, research on care arrangements in the population of older LGBT adults indicates a level of discomfort in seeking care, reporting previous negative experiences based upon their sexual identity (Fredriksen-Goldsen ,et al., 2009). In spite of more accepting social and political conditions today, historical conditions and experiences of the older cohorts continue to frame their current perspectives in care provision.

  6. 6. The social worker’s role is to build and support connections, coalitions, and partnerships. Caresharing involves the creation of conditions that promote positive and productive exchanges among individuals and social institutions. In this way, the practitioner continues to span boundaries of service to look for ways to enhance the experience of care. An example is the CARE-NETs that have been established by the Rosalynn Carter Institute on Caregiving (Dodd, Talley, & Elder, 2004). These are community coalitions that focus on caregiving needs in different types of communities. Comprised of health, social, and community formal and informal supports, these coalitions exist to bridge disparate networks that exist in caregiving (e.g., disabilities and aging) to promote a more comprehensive approach to care.

  7. 7. Assessment is a collective narrative of the caresharing group. In a caresharing approach, the practitioner needs to include the perspectives of all members of the collective. As a narrative process, the voices of all members create a narrative that provides the foundation for care. This “story of care” often contains different plots or themes, which often may include tensions between the different members. For example, a family member who lives close to an older parent may voice the need to consider a more supportive living environment, noting deteriorating conditions in the home. The older individual and family members who live farther away may refute this by arguing that the person is doing fine living alone. The practitioner needs to integrate these disparate narratives into an assessment process to determine how to move forward at this seeming impasse.

  8. 8. Life transitions and changes in health needs are followed. Just as assessment needs to be a collective process, assessment also needs to be ongoing and dynamic. As health and social conditions change, caregiving needs to be reevaluated to determine efficacy and effectiveness. In dementia care, for example, the progression of the condition will necessitate different caregiving roles. For someone who starts to wander, neighbors may be integrated into the caresharing collective to be watchkeepers for this behavior. If someone observed the older individual outside the home, a safety plan would be enacted.

  9. 9. Intervention strategies are based on strengths, resilience, assets, and collective efficacy. Caresharing interventions address the needs of the care recipient but are based upon the individual and resources of the care collective. For those areas where informal supports are unable to meet caregiving needs, the practitioner assists by identifying other sources, such as services and mutual aid groups. A great example of a caresharing resource is the GrandFamilies house. This residential setting was established specifically for grandparents who are raising grandchildren. This type of residential arrangement promotes mutual aid of the grandparents and provides a safe residence for the children who interact with others in a similar family structure. This type of program promotes the strengths and resilience of custodial grandparents.

  10. 10. Multiple strategies of intervention are sought, and achievement of continuity of care is central. Caresharing interventions may be derived from multiple community-based programs. However, difficulties may emerge when this care is not coordinated. The role of the social worker is to ensure that care is not interrupted as new client needs emerge.

  11. 11. Caresharing interventions are aimed at protecting a balance between dependence and independence. A challenge in care provision is determining the appropriate level of care. While insufficient care is provided, unfulfilled needs may result. Yet providing unnecessary care can promote feelings of worthlessness or powerlessness in the care recipient. Unfortunately, service providers may enact care tasks for their convenience; that is, it may be easier to dress someone than to wait while the person gets dressed independently. In a caresharing perspective, the abilities and desires of the care recipient need to be firmly embedded within an intervention plan.

  12. 12. The intent of interventions is to support individual and group capacity and cohesion. From a caresharing perspective, interventions must address the needs of the care recipient but also promote the health and functioning of those within the care collective. Attention is also given to group functioning of the care collective. That is, what strategies can promote continued functioning of the group of care providers? These might include ways to share information efficiently among members of the care collective (e.g., an online calendar) or developing strategies that promote caregiving rewards for all involved.

  13. 13. The purpose of caresharing is to enhance the social functioning of the care collective with primary attention to the pivotal/frail client. Caresharing principles assume that the care collective is the client, including family, agencies, and social service delivery systems. However, primary attention is given to the functioning of the frail/less-functioning older adult.

  14. 14. The client’s right to self-determination is respected. The client is an integral part of the care collective, and the individual’s thoughts and desires about care are included in intervention decisions. As a cornerstone of social work practice, decisions about caregiving strategies should include input from the client to the greatest degree possible.

  15. 15. Caresharing activities are culturally sound. As discussed previously, caregiving is performed within particular cultural perspectives. Caresharing arrangements must be congruent with the individual’s and family’s cultural and spiritual systems. The practitioner needs to evaluate caresharing within the cultural lens of the client and family.

  16. 16. Caresharing designs are evaluated for their effectiveness. Within caregiving situations, evaluation is critical to determine effectiveness for the older adult, as well as the impact on those in the care collective. Questions to guide the evaluation of caresharing arrangements include: Are the needs of the older adult being adequately met? Does the caresharing arrangement comprehensively address the needs of the older adult (e.g., physical, social, emotional, spiritual)? Do the caresharing responsibilities compromise the functioning of anyone within the care collective? As care needs change, is the caresharing arrangement adequate?

Conclusions: Affordable Care Act

The 30-Day Reduction Legislation

One of the major difficulties in U.S. caregiving design systems that stands in the way of the effectiveness of caresharing is the separation of the provision of medical and psychosocial care. However, there are trends under way to ameliorate this situation. For example, the Affordable Care Act added section 1886(q) to the Social Security Act, which established the Hospital Readmissions Reduction Program, requiring the Centers for Medicare and Medicaid Services (CMS) to reduce payments to a hospital’s Inpatient Prospective Payment System (IPPS) that has excess readmissions. This regulation has brought about the use of social workers as transition personnel who seek to enhance community-based care following hospitalization.

Funding Opportunities

In addition, Hospital Readmission Reduction Programs have led CMS to announce new funding opportunities for healthcare models that emphasize the unmet societal needs of Medicare and Medicaid beneficiaries (c.f., https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html). This funding will promote access to screening and other treatments to reduce hospital readmissions. These initiatives also have the goals of reducing health-care related costs and improve patient-centered outcomes.

This announcement recognizes that a patient may encounter factors outside the clinical environment that affect health, such as access to stable housing. Finally, we can only hope that the gap between healthcare/medical care delivery systems and psychosocial community-based services can increasingly be closed.

Further Reading

Barrett, P., Hale, B., & Butler, M. (2014). Caring for a family member with a lifelong disability. In E. Hale, M. O. Butler, & P. Barrett (Eds.). Family care and social capital: Transitions in informal care (pp. 75–90). Amsterdam: Springer.Find this resource:

    Cluff, L. E., & Binstock, R. H. (Eds.). (2001). The lost art of caring: A challenge to health professionals, families, communities, and society. Baltimore: Johns Hopkins Press.Find this resource:

      Covan, E. K. (1998). Caresharing: Hiding frailty in a Florida retirement community. Health Care for Women International,19(5), 423–439.Find this resource:

        Greene, R. R. (Ed.). (2012). Resiliency: An integrated approach to practice, policy, and research (2d ed.). Washington, DC: NASW Press.Find this resource:

          Greene, R. R., & Cohen, H. L. (2005). Social work with older adults and their families: Changing practice paradigms. Families in Society,86(3), 367–373.Find this resource:

            Greene, R. R., & Kropf, N. P. (2014). Caregiving and care sharing: A life course perspective. Washington, DC: NASW Press.Find this resource:

              Greene, R. R., & Kropf, N. P. (2009). Human Behavior and the Social Environment. Transaction Press.Find this resource:

                Hash, K., & Netting, F. E. (2009). It takes a community: Older lesbians meeting social and care needs. Journal of Gay and Lesbian Social Services, 21(4), 87–94.Find this resource:

                  Karimli L, Ssweamala, F. M., & Ismayilov, L. (2012). Extended families and perceived caregiver support to AIDS orphans in Rakai district of Uganda. Children and Youth Services Review, 34, 1351–1358.Find this resource:

                    Lalor, K., & Share, P. (Eds.). (2013). Applied social care: An introduction for students in Ireland (3d ed.). Dublin, Ireland: Gill and Macmillan.Find this resource:

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                        Boszormenyi-Nagy, I., & Spark, G. (1973). Invisible loyalties. New York: Harper & Row.Find this resource:

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