This entry in the Nonprofit Journal Project is part of a series of articles about how Michigan health care professionals are responding to the state's health care workforce shortage. It is made possible with funding from the Michigan Health Endowment Fund.

According to the Bi-partisan Policy Center, the U.S. has had a shortage of direct care workers for the past two decades. These workers include home health aides who help people with their daily activities — like eating meals, maintaining personal hygiene, dressing, or getting out of bed — as well as personal care aides, certified nursing assistants, and residential care aides who provide care in assisted living communities and nursing homes. While universities, health agencies, and the state of Michigan itself are working hard to recruit and retain more people to the direct care workforce, family members, loved ones, and friends who serve as unpaid caregivers are continuing to fill part of the gap.

A program of Detroit-based Henry Ford Health (HFH), the Patient as Caregiver project supports those caregivers. While the program does not center on workforce development, it does help unpaid caregivers carry on in their roles, reducing the amount of hired care needed and helping people age at place in their homes rather than go to facilities that may be experiencing staffing shortages.

We recently talked with Veronica Bilicki, manager of the HFH C.A.R.E. and Sr. Navigator programs, about the Patient as Caregiver project.

Q: What is the Patient as Caregiver program?

A: Our focus is to support family caregivers. We found that we had a significant group of patients, especially during COVID, that didn't even realize they were family caregivers. They're helping their spouse. They're helping their children. They're helping the neighbor. They're helping their parents. These patients were coming to the clinic because they were sick, or they were stressed, or they needed medication refills because they had been neglecting their own health. The Michigan Health Endowment Fund had funding available, so we decided to apply for a grant to work with the HFH Academic General Internal Medicine Division Clinic and help these patients self-identify as caregivers. It's a very large clinic. In 2023, they saw over 23,000 unique users. It is the perfect place to identify these patients who are caregivers and work with outside agencies to connect them with resources. One of those is the Detroit Area Agency on Aging.

Veronica Bilicki.
Q: How does the program reach caregivers?

A: The program helps the staff who work in the clinic recognize who the caregivers are. They may not even realize that their caregiving duties are what's stressing them out. We have educated the staff at all levels, starting from the customer service people you might see when you walk into the clinic, to the medical assistants, the doctors, the nurses, case management — anybody who could physically see that patient walking in.

We put up flyers in every patient room and in the bathrooms that say, ”Do you help someone with their pills? Do you help someone go to the doctor? Do you make meals for someone? You might be a caregiver.” On this flier, there's a QR code that goes over to a caregiver intensity index where they can take a quiz. It takes less than 10 minutes and helps patients identify things that are going well for them and things that are going maybe not so well or stressing them out. And then at the end of the quiz, the patient is able to click and come to our program. We contact them within 24 to 48 hours and just talk with them. If they don't want to talk with someone, they can click to view those resources.

Q: What do you talk about?

A: If they make contact with us, then we do a self-assessment with them. Sometimes, really all they need is that empathetic ear. Most of the time, caregiving is not something they signed up to do. Once we've listened to that caregiver, then we can offer them services like a support group that we run weekly online, educational classes that we offer, or community resources — we’re very tapped into our community. And our services are free.

Q: How many unpaid caregivers are doing work that the direct care workforce would otherwise need to absorb?

A: If you look at the AARP data, [in 2021] there was $600 billion in unpaid care in the US. In Michigan, they're estimating between 11 and 12.9% of people are unpaid caregivers. So, if you're looking at the 23,000 patients coming into our one clinic, even if you do 10%, that's 2,300 people who are potentially unpaid caregivers.

We know that outcomes for these family caregivers are not always the best. They tend to neglect their own health. There's the financial burden — they often cut their work hours. Our goal with this grant is really to help them self-identify that, yes, you are a family caregiver. There's a lot of blessings that come along with that. But there are stressors, too. Once they recognize that, then we can talk with them, see what their needs are, and help them.
 
Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photos by Steve Koss.