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Home care can be challenging, requiring commitment, training, research, management skills and a considerable output of energy from the home care giver.  Care need levels change over time.  Individuals being cared for may suffer declines in their ability to walk, bath, dress, groom themselves, eat, use the toilet, and transfer (to a commode, a wheelchair, etc.)  They may need increasing levels of caregiver help with meal preparation, shopping, housework, use of the telephone, money management, administration of medication, and decision-making.  They may need companionship, safety supervision, socialization and recreation. 

 All these needs including mental health must be regularly assessed and addressed.  Assessments involve systematic observation by home care-givers in cooperation with health practitioners.  Home assessments need to be made to determine if they are safe and properly equipped. Assisted Living, Nursing Home and Hospice decisions may need to be made and planned for in advance.

Legal issues may arise.  Many of these are accompanied by financial issues.  Guardianship, durable power of attorney, wills, and other legal documents and procedures may be required.  Legal consultations may be needed to determine available benefits through government agencies. Accessing insurance benefits including long term care insurance benefits is often complicated and can require legal assistance.  Often people involved in home care can find themselves involved in difficult negotiations and law suits.

Caregivers are likely to face personal challenges including: stress; depression; less time with family and friends; sleep disruption; lack of exercise; and poor eating habits; substance abuse; inattention to their own preventative care; and the failure of many health practitioners to recognize health risks facing home caregivers and provide guidance.  Caregivers need to be made aware of the existence of caregiver support services and encouraged to try them.

Respite for caregivers is likely to be needed.  Respite is a temporary break from care-giving responsibilities.  Caregivers may obtain respite through in-home care services, adult day care services, and brief stays in an assisted living facility or a nursing home.

Qualitative research indicates that caregiver support programs have a chance to improve caregivers’ health if they do at least one of the following:

• Save caregivers’ time
• Relieve them from care-giving responsibilities for periods of time
• Reduce their levels of stress
• Make them feel cared about, valued