The National Family Caregiver Support Program (NFCSP)
By Nancy Giunta

With the demographic shift of an aging population, the increased need for long-term care is combined with a decreased supply of informal care, thus making caregiver support a public concern. While informal caregivers provide the majority of long-term care in community-based settings in this country, they do so by facing potentially serious financial, emotional, and physical health risks. The monetary value of long-term care provided by informal caregivers is an estimated $306 billion per year. A paradigm shift is underway in which caregivers are being recognized not only as valuable providers of long-term care services, but also as clients in need of supportive services themselves. As social work educators and practitioners, this implies that we should be asking ourselves what effective services and interventions are available for family caregivers. States are increasingly recognizing family caregivers as a new client population within the long-term care system; however, significant variations exist across states in administrative structure, funding streams, and accessibility of services for caregivers.

In 2000, the federal National Family Caregiver Support Program (NFCSP) was introduced through the reauthorization of the Older Americans Act. The NFCSP was modeled after successful state programs in California, New Jersey, Pennsylvania, and Wisconsin and was designed with input from family caregivers nationwide. The NFCSP and Native American Caregiver Program (NACP) are administered federally by the Administration on Aging and at the state level by each of the State Units on Aging. Local Area Agencies on Aging and tribal organizations provide direct services to caregivers of older adults or contract with local service providers to provide services. There is no income eligibility requirement for these services.

The following types of services are available to caregivers under the NFCSP: information for caregivers about available services; assistance for caregivers in gaining access to these services; counseling, support groups, and training to help caregivers make decisions and solve problems relating to their caregiving roles; respite care to temporarily relieve caregivers from their caregiving responsibilities; and supplemental services, on a limited basis, to complement care provided by caregivers. In 2004, the Family Caregiver Alliance (FCA) published an extensive study documenting caregiver programs in all 50 states and the District of Columbia. The study report features state profiles which are accessible on the FCA Web site: www.caregiver.org.

My recent dissertation research examined whether successful implementation of the NFCSP at the state level was predicted by demographic, historical, political, or organizational factors within a state. It used the Communications Model of Intergovernmental Policy Implementation (Goggin, et al., 1990) as a theoretical framework. This study, the first to examine caregiver support policy using a theoretical framework, demonstrates the role of contextual factors in implementing caregiver support policy and programs statewide. Results suggest that statewide implementation of the NFCSP is related to the following contextual factors at lower levels of the implementation hierarchy: previous experience with and awareness of caregiver issues; political and organizational resources, including coordination and collaboration efforts; and appropriately matching services with identified needs. Further research is needed to provide a more comprehensive understanding of how policies can be successfully implemented, thus providing social work educators and practitioners with the tools and skills to administer programs. This understanding will help policymakers, program administrators, direct service providers, and especially caregivers, meet current and future needs of an aging population.

Nancy Giunta, MSW, PhD, recently graduated from the University of California at Berkeley, where she was a Hartford Doctoral Fellow. She is currently consulting with organizations seeking to improve long-term care through various community development initiatives. Her primary research interests include long-term care policy, community development and aging, and evidence-based macro practice. Her dissertation will be available soon on ProQuest.