Caregiver support programs and policies: A mixed methods evaluation of implementation efforts in 50 states.

摘要

The value of long-term care provided by informal caregivers is an estimated ;This mixed-methods exploratory study examined the implementation of the NFCSP in 50 states and the District of Columbia using the Communications Model for Intergovernmental Policy Implementation (Goggin et al., 1990) as a conceptual framework. Quantitative and qualitative data were analyzed to explore associations between state characteristics (demographic, historical, political, organizational) and the extent of implementation in a state, defined as the level of service units delivered in each state in four service categories (information, assistance, counseling/support groups/trainings, and respite).;Data sources included survey data from the National Center on Caregiving at Family Caregiver Alliance, service utilization data from the U.S. Administration on Aging, demographic data from the 2000 U.S. Census, and historical records from internet searches. Bivariate and multivariate (ordinal regression) statistics examined associations between state level characteristics and the dependent variable. Through content analysis, inducements and constraints experienced by administrators implementing caregiver support policy and programs were examined.;Findings suggest statewide implementation of the NFCSP is related to: increased awareness of caregiver issues, with recognition of caregivers as both clients and contributors of long-term care services; coordination and collaboration, organizationally through the use of a single-entry point for home and community-based services, or politically through public education or advocacy efforts; and appropriately targeting more intensive services at more intensive needs. Although innovative, this study faced limitations such as a cross-sectional design, small sample size, and limited validity of measures. While the study did not identify the optimal model for predicting successful implementation of caregiver support statewide, it was a first step in using a theoretical approach to do so. Further research will help policymakers, program administrators, direct service providers, and especially caregivers, meet current and future needs of an aging population.