PUBLIC POLICY
The Essential Caregiver Program: An Idea Whose Time Has Come
By Sara Wildberger
The Essential Caregiver (EC) program is a simple concept: Allow a single person, a family member or loved one, to have a controlled visit and help someone in senior living, even during times of restricted visi- tation, in order to counter the often severely detrimental health effects of loneliness and social isolation. But the implementation of an EC pro-
gram takes some care, collaboration, and preparation. Processes and rules vary from state to state, and it can be tough to push change in a time of crisis. However, having a blueprint for an EC
program can make the process easier. As several states, including Indiana, Minne- sota, and Oklahoma established programs, they began to share their lessons learned. “As the pandemic continues, our con-
cerns about the health effects isolation has on residents have rapidly increased,” says James Balda, president and CEO of Argen- tum. “We saw the need to take the lead in addressing these significant mental health risks in older adults and offer guidance for consideration.” Argentum brought together a workgroup
to create guidance for states seeking to start an EC program, the Essential Caregiver Toolkit, downloadable at
argentum.org/ essentialcaregiver. Workgroup members from around the
country participated, including the Okla- homa Assisted Living Association and Oklahoma State Ombudsman Bill Whited.
Another participant was Dan Kenyon,
executive director of the Indiana Assisted Living Association. In an email interview, he shares some of the learnings from his state’s process—its program started in June—work on the toolkit, and challenges and solutions other states might face.
Q. What’s the genesis of the Essential Caregiver idea? A. In most cases there were no official pro- grams in place. People visited because they loved Grandma or Grandpa. Many of these family members would show up every day to help feed or care for them. The inability to visit resulted in increased
anxiety and depression for residents and loved ones alike. This was and is particu- larly burdensome for memory care because daily routines, which are very important to dementia residents, were disrupted. Community staff did and continue to do
an amazing job trying to “fill in” for family. Even with all these extra efforts, however, the need to find some balance between protecting these vulnerable seniors from the virus and the devastating effects of isolation was evident from the beginning. Various states and local communities at-
tempted to address this problem in different ways, such as making exceptions for end- of-life visits. Other states, such as Minnesota and
Pennsylvania, were also grappling with the same issue. Through discussions with our
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52 SENIOR LIVING EXECUTIVE NOVEMBER/DECEMBER 2020
Argentum partners, it was clear this was a national issue. Argentum took the lead and pulled together an Essential Family Caregiv- er Taskforce [which met virtually].
Q. What were some challenges in getting the program into practice? A. One of the main challenges was to edu- cate lawmakers and regulators to not man- date the use of essential family caregivers. In some areas, where community spread
is high, it is just not safe to implement this type of program without adequate testing, training, and personal protective equipment (PPE). We continue to stress this is not a one-
size-fits-all approach. It may work in one area or at one community but not at anoth- er location. Also, because of the ebb and flow of this
virus, what is working today may not be possible if residents begin testing positive. The other major problem is providing
proper infection control training, testing and PPE for the caregivers. This is an on- going battle. Much more funding is needed to adequately supply enough PPE and COVID tests for assisted living staff as well as for essential family caregivers. The Essential Family Caregiver approach
is best managed at the local level by the leadership at the community, working with families, health departments, and the state and local ombudsman. A key factor is to set the expectations up
front, before caregivers are given entrance to the community. Many community di- rectors sent letters and emails and posted requirements on their websites explaining exactly what is needed for a person to qual- ify and be able to care for a loved one as an Essential Caregiver.
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