"I was on the verge of depression. By taking this class, I now take care of myself by doing for myself.'
"If it hadn't been for this class, I would have gone over the edge'.'
What made a positive difference in the lives of the family caregivers quoted above was an innovative six-week educational program called Powerful Tools for Caregivers (PTC). Using a standardized, highly interactive curriculum, pairs of trained class leaders help caregivers develop and practice self-care "tools" in weekly 2 1/2-hour classes (see synopsis in box on this page). PTC supports family caregivers in a way that enhances their well-being as they care for relatives with chronic illnesses.
An abundance of education programs focus on how to care for a relative or friend who is chronically ill or has a disability. PTC, however, focuses on the caregiver's well-being with the assumption that when a caregiver practices self-care, the person receiving care also benefits. To date, the program has reached over 10,000 family caregivers and is being taught by class leaders in 15 states.
Modeled after the highly successful Chronic Disease Self-Management Program developed by Kate Lorig and colleagues at Stanford University, Legacy Caregiver Services of Portland, Ore., began to develop and test PTC with private funding in 1995. Pairs of class leaders use the scripted Class Leader's Guide and a variety of other teaching materials to show caregivers how to care for themselves, and participating caregivers receive The Caregiver Helpbook, a 300-page companion volume. Classes are held in such locations as senior centers, churches, adult day centers, retirement communities and nursing homes. Participants can be any family member or friend who provides any type of care for an older person with any chronic medical condition. Care recipients may live at home, in a care facility or a long distance from caregivers. Caregiving is broadly defined to include the full range of helping tasks, from occasional assistance with household chores to full-time supervision and personal care.
The six-week PTC program has been shown to have a positive impact on the health and well-being of diverse groups of caregivers, including racial and ethnic minorities-whether they are living in urban or rural areas, are adult children or spouses, or have provided care for a short time or for more than 10 years. Results of evaluations completed by participants indicate they experience:
* Increased self-care behaviors, such as physical exercise and use of relaxation techniques;
* Reduced depression, guilt and anger;
* Increased confidence in coping with caregiving demands;
* Increased use of community resources.
Grants from The Robert Wood Johnson Foundation, Northwest Health Foundation and Good Samaritan Foundation made it possible for Legacy Caregiver Services to disseminate PTC among underserved rural and ethnic minority communities in Oregon and translate many program materials into Spanish, Korean, Chinese and Vietnamese. A significant amount of time was necessary to develop relationships with key stakeholders to successfully implement PTC into these communities. However, PTC has proven to be appropriate for rural and ethnic communities as long as providers address cultural, language, economic and literacy barriers.
The success of PTC is in part due to strong links between numerous sponsoring organizations and committed individuals who serve as class leaders. Organizations often support leaders' time for training and teaching, assist in recruiting participants, and provide meeting space and audiovisual equipment for classes. Legacy Caregiver Services will continue to work with sponsoring organizations and individuals to sustain PTC in Oregon. To ensure widespread dissemination of the program, Mather Life Ways of Evanston, Ill., has assumed national leadership through a cooperative agreement with Stanford and Legacy. …