A condensed version of this article originally appeared on Insurance Thought Leadership
The latest census shows that the number of Americans over 65 in the U.S. has increased by 34.2% over the last decade. Thanks to COVID-19, the economy, and various other factors, more and more of this demographic are choosing to age at home. While some thrive, many have physical and mental health challenges that burden those who care for them.
I experienced the challenge of caring for a loved one with a debilitating illness when my mother-in-law was diagnosed with stage four lymphoma. My wife and I decided to care for her ourselves, allowing her to remain in familiar surroundings. While it was a labor of love, we had to give so much of ourselves that it felt as if our lives were crumbling down around us. In many ways, they were.
Searching for hope, I stumbled across a self-assessment tool designed by researchers at the University of Wisconsin. I took it, thinking it would probably just recommend I place my mother-in-law in hospice care. Imagine my surprise when it advised marriage counseling because my risk factor for burnout was the toll caregiving was having on my marriage. They identified a church just three blocks from our house that offered free family counseling sessions on Saturday mornings. The relatively simple, free solution gave us the strength to provide my mother-in-law with the care she needed while preserving our sanity and our marriage.
My family is not alone in this experience. The fact is, one in four Americans is caring for a loved one with a debilitating illness or other special needs. COVID-19 amplified the problem. People were afraid to leave their loved ones, especially the elderly, in congregate living settings, such as nursing homes or assisted living facilities.
As an entrepreneur, I saw an opportunity for more people to benefit from the solution I found via the university's online tool. In developing a solution, my goal was to get to the root cause of caregiver burnout rather than providing temporary relief.
During the development of the TCARE solution, it became clear that support for caregivers is usually discussed in the insurance industry in terms of providing homecare, respite care, or placement in a facility. The hundreds of primary caregivers we’ve interviewed also tend to think about it that way because they usually don’t know what other options are available. However, a care receiver can often benefit from staying in their home longer and being in close contact with loved ones and familiar surroundings.
Solving the root problem of addressing caregiver burnout offers tremendous benefits for both the care receiver and the caregiver, and the caregiver doesn’t feel as if they’re letting their loved one down. While the lives of caregivers may be significantly altered, with the right support, they don’t have to feel as if they’re being destroyed.
Addressing Insurers’ Needs
To fully assess caregivers’ needs, we opted to create a motivational interview process. During this process, we identified that working with insurance companies would help us reach the most people in the most productive way. Partnering with organizations like RGAX, we were able to explore how preventing caregiver burnout would allow insurers to improve their cost structure by decreasing long-term care service utilization and delaying nursing home or assisted-living facility placement.
While the business case was compelling, insurers had some critical concerns. First, patient privacy was a high priority for insurers. Since our solution isn’t about the insured individual, but about the caregiver, patient data is not shared with us.
Second, we didn’t want to increase the burden on case managers, as they already have enough on their plates. Once we know who the primary caregiver is, we partner with insurers to do outreach, letting customers know they’re eligible to use the TCARE service at no cost to them. If they agree, we conduct a roughly 25-minute interview that gets to the root cause of burnout and assigns a score to the individual’s risk. In collaboration with TCARE’s AI and ML technology, the TCARE Specialist will create a care plan and identify interventions and local and virtual resources, many available at no cost. The care plans also include emergency cards with their TCARE Specialist’s contact info. Caregivers are encouraged to reach out directly when in crisis.
Each TCARE Specialist is a certified, licensed social worker. Currently, we have three dozen on staff, and each caregiver is supported by their own TCARE Specialist to help build trust. After the initial counseling session, caregivers are sent weekly automated text messages to see if there has been a change in their caregiving situation in the past week. If there has, our system alerts the TCARE Specialist to reach out to the caregiver and adjust the care plan as needed. These alerts facilitate crisis prevention rather than crisis intervention. Reassessments are also done every 90 days if we don’t hear from the caregiver in the meantime. They allow TCARE to measure the effectiveness of each intervention so that the TCARE Specialist can create a new care plan based on the change in burden scores and the overall caregiving situation.
Real World/Real Problems
Below are a couple of examples to illustrate how TCARE has helped real people (Note, names have been changed for anonymity):
Charlotte’s mother had dementia and was struggling to provide her with the care she needed. She was taking considerable time off work to provide for her mother’s basic needs, which was taking a toll on her career. When Charlotte was laid off and family financial resources grew strained, she reached out to a TCARE Specialist.
Charlotte’s TCARE Specialist let her know that Medicare could help her pay for some of her mother’s basic needs. The TCARE Specialist set her up with weekly food deliveries and transportation services to help get her mother to and from her weekly appointments. Afterward, Charlotte wrote to tell us that although she has a professional career and considers herself intelligent, she had no idea what she would have done if TCARE had not been there for her.
When Daniella’s husband committed suicide, she was left to care for their child with special needs by herself. The day-to-day struggle became overwhelming, and she started having suicidal ideation thoughts herself. When she reached out to TCARE, the Specialist quickly transitioned the scenario from crisis prevention to crisis intervention, a situation TCARE Specialists are highly trained to handle. The 25-minute interview became a 2-hour-long conversation. Daniella was in the red zone and needed someone to talk to.
In Daniella’s case, respite care services were what she needed most. After taking care of her immediate mental health needs, the TCARE Specialist set Daniella up with respite services, which include overnight services, so that she could have the time she needed for self-care. The TCARE specialist connects with her regularly to make sure she is stable and finding time to take care of herself.
A Problem That Demands a Solution
One in four Americans currently cares for a loved one with special needs, and with more people living longer, this will likely increase. At TCARE, we’re confident we’re making a difference in people’s lives. Thanks to our partnership with RGAX, we’ve been able to get this solution to market faster than we ever thought possible.