Transcript Grandparent Caregivers

Grandparents as Caregivers
Amanda Soong, MD
Assistant Professor of Pediatrics,
General Pediatrics and Adolescent Medicine
University of Alabama at Birmingham
Objectives
Define Grandparent Caregivers
Review the current demographics for this
population
Identify factors contributing to the increasing
prevalence of grandparent caregivers
Review the impact of being a Grandparent
Caregiver on the older adults’ health, as well as
the children
Explore the implication of Grandparent Caregivers
on how we practice
Grandparent Caregivers

For today’s talk, Grandparent Caregivers are
defined as grandparents that provide the majority of
care for their grandchildren under the age of 18.

This may include grandparents with formal or
informal custodial arrangements, or grandparents
that provide childcare for working parents.

Also included are other older relatives that may
have custody/provide care.
Grandparent Caregivers

Role of Grandparents in the US

In other countries, Grandparent Caregivers are an
integral part of society.
Grandparenting in the US

According to an article by Gratton and Haber
published in Generations, the role of grandparents
have had 3 distinct phases over the history of the
US.
Authority
Burden
Companion
Residency of Older Adults
70
60
Percentage
50
40
1900
1962
30
1975
20
10
0
Older Adults in Co-residency
Grandparenting in the US

There are currently 2 trends changing the role of
grandparents in the family.
Longer life spans
Increasing number of grandparent caregivers
The Numbers

According to the 2000 US Census:
 5.8 million people were identified as co-resident
grandparents
 2.4 million were Grandparent Caregivers.
 Among the caregivers, 39% had cared for their
grandchildren for 5 or more years

In 2011 the number had increased to:
 7 million co-resident grandparents
 Over 2.8 million Grandparent Caregivers
Grandparent Caregivers
2.8
Population in Millions
2.75
2.7
2.65
2.6
2.55
2.5
2.45
2.4
2.35
2.3
2.25
2000
2005
2009
2011
Children in the Care of Grandparent Caregivers (% by state)
Percentage of Children Cared for by Grandparent Caregivers
Why it Matters to Us….

This trend is important to any healthcare
professional who works with either older adults or
children.

Caring for grandchildren can affect the
grandparent’s health as well as the child.

These patients have special challenges that other
patients may not face.
Who Becomes Grandparent Caregivers

A study published by Minkler and Fuller-Thomson in
2000 found that Grandparent Caregivers were most
likely to be:
Female
Younger
African American
Not have completed high school
Etiology of Grandparent Caregivers

Awareness of Grandparent Caregivers grew in the
80s-90s with the crack cocaine and AIDS
epidemics.

More recently, the economic downturn has
increased the number of Grandparent Caregivers.
Etiology of Grandparent Caregivers
Percentage
Etiology of Grandparent Caregivers
30
25
20
15
10
5
0
Etiology of Grandparent Caregivers

As more children have been removed from parental
custody, DHR and state agencies have come to
prefer family placements for a variety of reasons.
Etiology of Grandparent Caregivers

In September of 2010, the Pew Research Center
released a report showing that the number of
grandchildren cared for by their grandparents rose
sharply from 2007-2008, the first year of the “Great
Recession”.

The increase was greatest among Caucasians.
Health Consequences for Grandparent
Caregivers

Being a Grandparent Caregiver has been shown in
multiple studies to have a negative impact on the
caregiver’s health.

Caregivers have higher incidences of:
Depression
Diabetes
Hypertension
Insomnia
Health Consequences for Grandparent
Caregivers

In the study mentioned previously in Harlem, NY,
Grandparent Caregivers were found on medical exam to
have frequent medical issues:
Frequency of Specific Issues
Asthma
Diabetes
Cardiac Conditions
Arthritis
Hypertension
0
10
20
30
40
50
60
70
Health Consequences for Grandparent
Caregivers

While caring for a young child takes a definite
physical toll, it also can lead grandparents to neglect
their own health.

A study published in 2008 showed that
grandmothers who had recently taken custody of
their grandchildren were more likely to skip their
own preventative services.
Health Consequences for Grandparent
Caregivers

The disparity of health in Grandparent Caregivers
vs. their non-caregiving peers is felt to be due to
several reasons:
 Not making/having time to tend to their own health
 Increased exhaustion
 Stress and depression
 Lack of respite care
 Limited financial means
Health Consequences for Grandparent
Caregivers

Despite the negative impacts on grandparent’s
health and the challenges that these families might
face, 90% of grandparents report that they would do
it again.
Health Consequences for Children

Children in their grandparent’s custody exhibit
greater rates of academic and behavioral problems.
Health Consequences for Children

These children may also be at higher risk for chronic
diseases such as asthma and anemia since they
are more frequently from lower income
environments.

The children may be behind on preventative care
measures such as vaccines due to poor or
disjointed medical care.

Families may have difficulty obtaining medications
due to financial issues.
Health Consequences for Children

Grandparents may have difficulty obtaining health
insurance for their grandchildren.
Many insurance plans will not allow grandchildren
to be added as dependents without established
legal custody.
Health Consequences for Children

Studies have shown that children tend to be safer
when in the care of their grandparents.

However, small survey sample of grandparent
caregivers in Birmingham, AL showed grandparents
have some important deficits in their child safety
knowledge.
Social issues

Becoming a Grandparent Caregiver can disrupt the
expected trajectory of the older adult years.
Economic Implications

The unexpected arrival of a grandchild to the
household can be difficult economically.
 Courts now favor placing children with relatives (most
often grandparents) and often relatives do not receive
financial benefits as do foster placements.
 GPs may have difficulty navigating the system to apply for
benefits when they are available.
 Since these arrangements often are not legal, GPs can’t
apply for benefits on their grandchildren’s behalf.
Economic Implications

For grandparents that are employed, the addition of
a child can strain finances.

The GP may not live in housing suitable for children,
or not have adequate space.
Economic Implications

Economically it is in the interest of the state to place
children with their grandparents.
A study in 1996 calculated the value of
grandparent provided care to be between $23.5
and $39.3 billion annually in terms of current
dollars.
Legal considerations

Studies estimate that only 20-50% of Grandparent
Caregivers have legal custody of their
grandchildren.

Lack of legal custody impedes the grandparent’s
ability to seek medical care, enroll the child in
school, and seek benefits that the child might
otherwise qualify for.

Grandparents can request to become a grandchild’s
guardian through the Probate Court as a means of
gaining legal status without terminating the parent’s
custodial rights.
Legal considerations

In some cases, children who are placed in a
grandparent’s custody may no longer be eligible to
receive food stamps due to the parent’s actions.

A child also may not be able to receive food stamps
based on who signs the court order to take the child
out of the parent’s custody.
DHR and Kinship Care

Grandparents may not receive any financial benefits when
gaining custody of grandchildren.

Sometimes benefits are given in the form of:
 Relative caregiver payment: 1 time payment to be used as
needed.
 Aid to Dependent Children may be available for these
children (AFDC)- $164/month
 Programs are being piloted in different states looking at
ways to provide some financial relief to kinship care
providers.
Impact to Our Practices

The growing incidence of Grandparent Caregivers
impacts both pediatric and geriatric care.

Being aware of the issues that influence our
patients’ lives can help us provide improved, familyoriented care.
Impacts to Geriatric Practice

When reviewing social history and noting who is in
the household, if grandchildren are mentioned, ask
a few more questions.
Is the grandchild there full time?
How does the patient feel about the arrangement?
Has the patient been able to keep up with his or
her health needs?
Does the patient have any unmet needs?
Impacts to Geriatric Practice

Grandparent Caregivers should be encouraged to
take care of their health so they can continue to
care for their grandchild.

GP Caregivers should be asked about end of life
plans.
The planning should include what will happen to
the children in the case of illness or death.
Impacts to Geriatric Practice

When discussing or prescribing medications, it is
important to stress medication storage.
Grandparents might not be in the habit of child
proofing and need a reminder of safe medication
storage.
Impacts to Geriatric Practice

Special attention should be paid to the
grandparent’s cognitive function.
Since the grandparent is caring for a young child,
even mild cognitive impairments could cause
significant problems.
If the grandparent lives alone with a young child, it
may be difficult to identify mild impairments.
Impacts to Geriatric Practice

The grandparent’s physician plays an important role
in assessing the grandparent’s health and level of
function, and can provide advice on how to meet the
challenges of raising a young child.

The physician may also identify factors which place
either the grandparent or child in danger due to the
current custodial arrangement.
Impacts to Geriatric Practice

Be aware of resources available in your community
to support Grandparent Caregivers.
Studies have shown that Grandparents can
benefit from having a network to help navigate
challenges and share experiences.
Impacts to Pediatric Practice

First and foremost, pediatric care providers should
be alert to patients cared for by Grandparent
Caregivers.

Be aware of the challenges that can face these
families.

Modify your history and guidance as needed to
address the family’s specific situation.
Impacts to Pediatric Practice

What is the financial situation? Does the child have
insurance?

Does the grandparents have the legal standing to
provide consent for services? Have they been able
to enroll the child in school?
Impacts to Pediatric Practice

Pediatricians need to be aware of the increased rate
of poor health literacy in the older adult population.
Impacts to Pediatric Practice

Pediatric providers should also encourage
Grandparent Caregivers to maintain their own
health and healthcare.

If the pediatrician suspects the grandparent might
have cognitive issues, they should encourage the
grandparent to seek evaluation and contact a social
worker and/or DHR, if indicated.
Conclusions

Grandparent Caregivers are increasing in
frequency.

Being a grandparent caregiver has impacts on
health and wellness of the grandparents, and
children in the care of grandparents may have
special health needs.

There are many social and legal ramifications of
grandparent caregivers and medical providers
should be aware of these challenges.
References

Children in Grandparent Care. The Urban Institute New Federalism National Survey of
America’s Families. 2003. Pages 1-8

Jendrek, Margaret. Grandparents Who Parent Their Grandchildren: Circumstances and
Decisions. The Gerontologist. 1994,Vol 34,No 2. Pages 206-216.

Hayslip, Bert et al. Custodial Grandparenting and the Impact of Grandchildren With
Problems on Role Satisfaction and Role Meaning. Journal of Gerontology: Social Sciences.
1998, Vol 53B, No 3. Pages S164-S173.

Dell’Aringa, Stefanie. Aging Caregivers. AAP News. March 1997. Page 2.

Nugent, Tom. When Grandma and Grandpa are the caregivers: tips for Pediatricians. AAP
News. Nov. 1999. Page 31

Hayslip, Bert and Patricia Kaminski. Grandparents Raising Their Grandchildren: A Review of
the Literature and Suggestions for Practice. The Gerontologist. April 2005;45, 2. Pages 262269.

Grandparents Living with Grandchildren: 2000. Census 2000 Brief. Issued October 2003.

Grandfacts: A State Fact Sheet for Grandparents and Other Relatives Raising Children.
AARP. Alabama, August 2007

Grandparents Raising Grandchildren: A Call to Action. Publication by the Administration for
Children and Families, Region IV. Department of Health and Human Services

AAP Committee on Medical Liability and Risk Management, 2009-2010. Clinical ReportConsent by Proxy for Nonurgent Pediatric Care. Pediatrics. Vol 126, N. 5, November 2010.
References

Minkler, M, Driver, D, et al. Community Interventions To Support Grandparent Caregivers. The
Gerontologist, 33( 6). 807-811.

Kelley, S., Whitley,D. Psychological Distress in Grandmother Kinship Care Providers: The Role of
Resources, Social Support, and Physical Health. Child Abuse & Neglect. 24(3) 311-321.

Minkler, M., Fuller-Thomson, E. The Health of Grandparents Raising Grandchildren: Results of a
National Study. American Journal of Public Health. 89(9) 1384-1388.

Minkler, M., Fuller-Thomson, E. Second Time Around Parenting: Factors Predictive of
Grandparents Becoming Caregivers for their Grandchildren. Int’l J. Aging and Human
Development. Vol 50(3) 185-200.

Gratton B. and C Haber. “Three phases in the history of American grandparents: authority, burden,
companion.” Generations 20.1 (1996): 7-12.

Smith , D 1982 “Historical change in the household structure of the elderly in economically
developed societies.” in Old Age in Preindustrial Society.

Livingston, G, Parker, K. Since the Start of the Great Recession, More Children Raised by
Grandparents. Pew Research Center, September 2010.

Grandparents Raising Grandchildren in the District of Columbia: Focus Group Report. AARP 2006
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