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Teaming Up with Caregivers

In the second webinar of the inaugural Caregiving NOW series, Julian Harris, MD, MBA, recounted a recent experience with the caregiver of a person with diabetes, advanced kidney disease, and an amputation.
JULY 7, 2022

by Lucy Andersen, OCN, BSN

In the second webinar of the inaugural Caregiving NOW series, Julian Harris, MD, MBA, recounted a recent experience with the caregiver of a person with diabetes, advanced kidney disease, and an amputation. Although the patient was on 16 medications, the caregiver “knew every single medication, she knew which condition it was for, she knew the doses, she knew the times of day. And it was just extraordinarily impressive.”

Dr. Harris was inspired to appreciate and support caregivers as he watched his grandfather care for his grandmother, a retired schoolteacher and community leader who developed Alzheimer’s disease. In a wide-ranging conversation with Mary D. Naylor, PhD, RN, FAAN, director of the NewCourtland Center, Dr. Harris highlighted opportunities to “sit side by side” with caregivers to help them navigate an increasingly complex and fragmented health care system. He drew on his experience as CEO of ConcertoCare, which provides multidisciplinary in-home care and support to older adults with complex care needs, as well as his previous roles at various health systems, Cigna Health, Google Ventures, the federal Office of Management and Budget, and Massachusetts Medicaid.

Dr. Harris proposed a holistic approach that sees caregivers as assets and leverages their expertise as key partners in patient care. Both paid and unpaid caregivers can help clinicians manage chronic conditions more effectively, if they are integrated into the broader care team. To optimize that role, caregivers need help navigating across primary care, behavioral health, long term services, and personal care, which mostly operate as separate “silos” of care. Dr. Harris described the value of a “quarterback”—someone designated to coordinate care across these sectors, something he was able to implement in Massachusetts for people dually eligible for Medicaid and Medicare. Quarterbacks can improve the patient’s quality of life and independence, and reduce the considerable burden and strain on caregivers as well.

A recent systematic review and meta-analysis provides evidence that integrating caregivers can improve patient outcomes. The study identified caregiver engagement as a key feature of interventions that reduce rehospitalizations among chronically ill adults transitioning from hospital to home. Dr. Harris noted that strategies that help caregivers navigate the complexity of patient care, including arranging specialists, durable medical equipment, and personal care services, may also pay dividends in terms of potentially reducing the need for expensive post-acute stays in skilled nursing facilities.

While the Massachusetts One Care model and experimental value-based plans integrating caregivers hold promise, they will not immediately shift the caregiving landscape. Dr. Harris and Dr. Naylor discussed the need for practical solutions, or low hanging fruit, to increase the ability of caregivers to access existing resources through their insurance plan or communities. This includes respite care, available as a supplemental benefit through some Medicare Advantage plans. Increasingly, employers and commercial insurers are recognizing the burdens and very real costs of caregiving among their employees. Dr. Naylor noted that about 60% of caregivers also have full-time jobs, with significant impacts on caregiver workplace productivity and health care costs. In response, many employers now offer Employee Assistance Programs, which may include preferred rates for part-time caregiving services, mental health support, wellness or coaching benefits, and educational resources.

These conversations about caregiving come at a critical moment, amidst a current and looming national shortage of paid caregivers. Dr. Harris noted that by 2030 we will have a shortage of 150,000 direct care workers. In keeping with his practical solutions, Dr. Harris suggested improving caregiver access to technologies, such as telehealth and remote monitoring, that can increase their efficiency, and providing a more attractive career path for direct care workers. On a broader policy level, Dr. Harris called out the potential for immigration policies to increase the caregiving workforce in the United States.

Looking forward, Dr. Naylor and Dr. Harris discussed the need for better data on caregiver financial strain, the caregiver’s personal health, and access to care coordination resources. Equally important is the need to test specific interventions and technologies that can improve care coordination and lessen caregiving burden. By helping caregivers navigate the complexity of our fragmented health care system, we can leverage their expertise and gain valuable insights to improve patient care.


Caregiving NOW! with Julian Harris


It’s clear from these conversations in Caregiving NOW that improving the caregiving landscape will take a multi-faceted effort from employers, insurers, clinicians, and communities, as well as larger-scale policy changes. Be sure to sign up for the next conversation on September 21, 2022, featuring Dr. Fayron Epps of Emory University. Dr. Epps is the principal investigator of the Faith Village Research Lab, founder of the Alter Program—a nurse-led dementia-friendly congregation program, and creator of the CaREgiving While BlackTM online education course.