FEDERAL POLICY EFFORTS TO SUPPORT FAMILY CAREGIVERS: PAST, PRESENT, AND FUTURE

Abstract Family caregivers are major providers of long-term care and support for family members with age-related decline and disability. Caregiving is a demanding and complex undertaking that has demonstrated extensive physical, emotional, relational, and financial burden on families. These factors underscore the urgency of addressing the needs of family caregivers at the policy level. This presentation focuses on the origins, goals, and mandates of federal policy efforts that support family caregivers. This includes an analysis on how federal support for caregivers has evolved over time, most notably through the National Family Caregiver Support Program, part of the Older Americans Act. It will also discuss the passage of more recent legislation (e.g., RAISE Family caregiver Act and the Grandparents Raising Grandchildren Act) that will contribute to a national strategy to support family caregivers. Moreover, through the discussion of these policies, we will articulate specific areas where gerontology research and public policy can and should intersect in order to optimize the effectiveness of policy efforts to support family caregivers.


EXPLORING THE HEALTH BURDEN AND SOCIOECONOMIC COSTS OF DEPENDENT ELDERLY CARE IN NSUKKA, NIGERIA Peter C. Ezeah 1 , 1. NNAMDI AZIKIWE UNIVERSITY, AWKA, ANAMBRA, Nigeria
It is projected that by 2030, 6 percent of Nigeria's present population of 180 million will be 60 years and above.However, the extent to which the traditional systems of family support and security can manage the care of the increasing number of older people in the country is not clear as limited studies are available in the country regarding the health burden and Socioeconomic costs of caring for dependent older people.This study is therefore aimed at assessing the health burden and costs of caring for dependent older people in Nsukka, Nigeria.This cross sectional survey involved 1030 randomly selected elderly persons in Nsukka,Nigeria (Mage=70.15,SD=12.23).Structured questionnaire and Focus Group Discussion Guide (FGD) provided the data for the study.The qualitative data were analyzed with descriptive statistics, while regression analysis formed the basis for predicting effects of the variables in the study.The qualitative data from the FGD were analyzed thematically.The findings show that the Nigeria government was largely uninvolved in the care and support for older dependent people; leaving families to negotiate a 'journey without maps'.Families carried the health burden of care for the elderly with attendant socioeconomic costs.The traditional role of female relatives as caregivers was beginning to give way to paid caregivers.An innovative policy frame work targeted at the needs of older persons in health care, social protection and other forms of intergenerational support is required to supplement inputs from families of the aged in Nigeria.

WORK-RELATED OPPORTUNITY COSTS OF PROVIDING UNPAID FAMILY CARE Stipica Mudrazija 1 , 1. Urban Institute, Washington, District of Columbia, United States
Older Americans living in the community who need help with basic activities of daily living overwhelmingly rely on unpaid care provided most commonly by working-age family members.Because unpaid family care limits the demand for nursing facilities and reduces expenses paid by Medicaid and other government programs, previous estimates of its economic value have mostly focused on estimating the benefits of unpaid family care.However, to assess accurately the overall economic value of unpaid family care and define better the scope for policy intervention, it is also important to account for the costs of such care, yet our knowledge of their magnitude remains limited.This study assesses the impact of unpaid family caregiving on the likelihood of working and hours worked for caregivers, and calculates the related cost of forgone earnings today and in 2050.To do so, it matches family caregivers from the National Study of Caregiving with non-caregivers from the Panel Study of Income Dynamics, and uses projections from the Urban Institute's DYNASIM microsimulation model to inform calculations of future costs of foregone earnings.Results suggest that the cost of foregone earnings attributable to caregiving is currently about $67 billion.By mid-century, it will likely more than double, outpacing the growth of disabled older population as the share of better-educated caregivers with higher earning capacity increases.Policymakers can use these results to inform their current and future policy efforts aimed at assisting family caregivers who are facing the challenge of balancing work and caregiving responsibilities.

UNDERSTANDING THE ROLE OF SOCIAL SUPPORTS AND SOCIAL NETWORK FOR DEMENTIA CAREGIVERS' MENTAL HEALTH
Carmen Morano, 1 daejun park, 2 and Andrea Savage This paper explores the associations of depressive symptoms with social supports and social networks among dementia caregivers.It has been well documented that dementia caregivers are at greater risk of experiencing negative mental health and poorer physical health than non-caregivers.This paper describes a collaborative process between two universities and a community-based provider in designing a Social Network Analyses to examine the network structures used by dementia caregivers participating in a community-based support program.The relationship between the caregiver support networks and depressive symptoms, were analyzed using multivariate regression models.Given the small sample size and missing data multiple imputation was applied to the data.The findings suggest the effects of a variety of supports in the caregiver network on mental health and depressive symptoms.Among the findings it was found that the presence of financial support (B= -0.58; p = .01)and frequency of contacts (B = -0.58;p = .01)support resulted in a decrease in depressive symptoms and better mental health than for caregivers without similar supports in their networks.This paper will conclude with a discussion of potential uses of social network analysis to better understand how the structure of caregivers' network can address the concrete physical, emotional and financial needs of dementia caregivers.

FEDERAL POLICY EFFORTS TO SUPPORT FAMILY CAREGIVERS: PAST, PRESENT, AND FUTURE
Lauren R. Bangerter, 1 Nicole Ruggiano, 2 Joan M. Griffin, 1 and Kelly A. O Malley 3 , 1. Mayo Clinic, Rochester, United States, 2. University of Alabama, Tuscaloosa, Alabama, United States, 3. New England GRECC, Boston VA Healthcare System, Boston, Massachusetts, United States Family caregivers are major providers of long-term care and support for family members with age-related decline and disability.Caregiving is a demanding and complex undertaking that has demonstrated extensive physical, emotional, relational, and financial burden on families.These factors underscore the urgency of addressing the needs of family caregivers at the policy level.This presentation focuses on the origins, goals, and mandates of federal policy efforts that support family caregivers.This includes an analysis on how federal support for caregivers has evolved over time, most notably through the National Family Caregiver Support Program, part of the Older Americans Act.It will also discuss the passage of more recent legislation (e.g., RAISE Family caregiver Act and the Grandparents Raising Grandchildren Act) that will contribute to a national strategy to support family caregivers.Moreover, through the discussion of these policies, we will articulate specific areas where gerontology research and public policy can and should intersect in order to optimize the effectiveness of policy efforts to support family caregivers.Few studies have examined caregiver reactions to their loved ones receiving the results of an Amyloid PET scan which can be indicative of Alzheimer's disease.Therefore, we examine: 1) What are care partner's reactions to their loved one receiving negative or positive amyloid PET scan results?, and 2) To what extent are scan results and diagnostic category (dementia vs. mild cognitive impairment) associated with care partner depressive symptoms (PHQ-2) and anxiety (STAI-6)?Using data from 1,799 care partners in the CARE IDEAS study, we applied a sequential mixedmethods design and explored the reactions of 192 care partners who answered open-ended interview questions after learning about the Amyloid PET scan results.We first conducted qualitative content analysis of transcripts from open-ended questions to explore caregivers' emotional responses after their loved one received an Amyloid PET scan result.The qualitative data suggest that when the scan results fit care partner's expectations, i.e. positive scan when the patient has dementia and negative scan when the patient has mild impairment, care partners report satisfaction with this information and relief, rather than shock and frustration.Adjusted logistic regression models of survey responses support this finding; having dementia and a positive scan both increased the likelihood of care partners having high levels of anxiety, and a significant interaction indicated that a positive scan was associated with high anxiety among care partners of patients with mild cognitive impairment but not dementia.Only lower education and higher impairment in everyday cognitive function were associated with high depressive symptoms.Most older adults express the preference to die at home, but the desire for home death may go unfulfilled when the dying process become burdensome.Little is known about the congruence between older adults' and their caregivers' desired locations at death.The purpose of this study was to explore how the congruence between caregiver-care recipients desired and actual location at death influenced well-being in bereavement.This exploratory study utilized simultaneous qualitative and quantitative methods.Interviews were conducted with 108 bereaved caregivers about 4 months after the care recipient died while receiving hospice care.Care recipients' ages ranged from 43-101 (M=79.6);caregivers from 32-88 (M=61.5).Quantitative data included categorical variables about demographics, advance care planning and location at death.The Core Bereavement Items and CDC HRQOL-14 "Healthy Days Measure" scales were used.Qualitative data involved open-ended questions about the illness trajectory, desired location and perceptions of care at life's end.Quantitative analysis included comparison of group differences using both Independent Samples t-tests and One-way ANOVA.Of the 92 care recipients who had an advance directive, N=49 (45%) were in the location they desired and for N=49 (45%) there was caregiver/care recipient congruence about location.Caregivers who experienced incongruence reported poorer physical and emotional well-being and higher, more intense bereavement symptoms.Three overarching themes illuminated caregivers' experiences: (1) Caregiver-recipient congruence; (2) Caregiverrecipient incongruence; (3) Incongruence-influenced bereavement.Results suggest that incongruence between desired and actual location of death affects well-being in bereavement.Implications: Communication about location at death is an essential consideration.

DOES CAREGIVING MATTER? THE RELATIONSHIPS BETWEEN CAREGIVING EXPERIENCE AND ADVANCE CARE PLANNING IN OLD AGE
Huei-wern Shen 1 , 1. Graduate Institute of Social Work, National Taiwan Normal University, Taipei, Taiwan Advanced care planning (ACP) is encouraged as the completion of ACP increases the likelihood for patients to receive their preferable end-of-life care and for caregivers to be less stressed.Common approaches to increase the engagement of ACP target on intervention or information provision to patients in the very late stage of life.Arguing that caregiving experience may influence how people plan their own end-of-life care, the present study focuses on caregiving roles.Using seven waves of data (2002, 2004, 2006, 2008, 2010, 2012, and 2014) from the Health and Retirement Study (HRS), 863 older people who were 65+ and alive in 2012 but passed away prior to 2014 were included in this study to examine the relationships between an individual's caregiving experience (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) and his/her completion of ACP (2014).Findings from logistic regression showed that caregiving experience did not influence older adults' (65+) ACP completion in 2014.When considering BEREAVEMENT Deborah P. Waldrop, 1 and Jacqueline M. McGinley 2 , 1. University at Buffalo School of Social Work, Buffalo, New York, United States, 2. Buffalo State College, Buffalo, New York, United States