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Case managers mobilize family networks to care for patients. Leave Act (FMLA) to accommodate caregiving, family members
Family medical leave can be a resource for case managers who can improve ﬂexibility and equality and reduce ﬁnancial strain.
seek to enhance resilience among family caregivers. The Family The practice of including family members in caregiving roles
Medical Leave Act, passed in 1993, was the ﬁrst U.S. policy to affects not only patients and their medical teams but also their
regulate employee leaves from work for family care purposes caregivers and the other family members. Nationally, it is estimated
(29 CFR 825.102). This policy offers family caregivers in- that family caregiving relationships grew from 7 million households
creased ﬂexibility and equality. Current and emerging policies in 1987 to 21 million households in 1997 (Wagner, 2001). Family
also can reduce ﬁnancial strain. The discussion examines how caregivers perform duties beyond providing direct patient care and
case managers can integrate family medical leave into best- assisting with activities of daily living, such as relaying informa-
practice models to support patients and family caregivers. tion to medical teams, administering medications, and providing
patient emotional support and education (Beitman et al., 2004).
More than half of the family caregivers are employed. Most care-
Keywords: resilience; family medical leave; case management givers who work outside the home report stress related to conﬂicts,
resource; family caregivers role strain, and ﬁnancial problems (Wagner, 2001). These caregiv-
ers are typically middle-age women caring for aging parents while
they care for their children and, in some instances, their grandchil-
dren (Conway-Giustra, Crowley, & Gorin, 2002).
Caregivers who balance their personal and family needs with
work demands demonstrate resilience. Resilience can be deﬁned
Family Medical Leave either as the ability to adjust to stress and to adapt over time
(McCubbin, McCubbin, Thompson, Han, & Allen, 1997) or as
the response to a single event (Hardy, Concato, & Gill, 2004).
as a Resilience Resource Smith (1999) expands the idea of resilience beyond responding to
stress by deﬁning resilience as a coping mechanism. Hardy et al.
for Family Caregivers (2004) deﬁned resilience among elderly as the capacity to remain
well, recover, or thrive, thus demonstrating that resilience was con-
nected to extended life expectancy. Ross, Holliman, and Dixon
(2003) found that family caregivers also demonstrate resilience
Jayme Swanke, MSW
by developing ways to cope with and adjust to the changing role
Laura Dreuth Zeman, LCSW, PhD demands. Therefore, both the elderly and their caregivers demon-
strate resilience as a coping mechanism developed as a response to
stress associated with the dependent and the caregiving roles.
ase management activities involve integrating services at It is important to understand the sources of caregiver stress
personal, community, and organizational levels in order in order to facilitate family caregiver resilience. Researchers who
to create unique interventions that facilitate the improve- examined caregiver stress have identiﬁed emotional (Waldrop,
ment of patient functioning (Schein, Gagnon, Chan, Morin, & Kramer, Skretny, Milch, & Finn, 2005) and ﬁnancial (Orthner,
Grondines, 2007). This includes mobilizing network resources, Jones-Sanpei, & Williamson, 2004) strain associated with provid-
such as family members, to care for patients. Schein and her col- ing and coordinating in-home care. Waldrop et al. (2005) also
leagues (2007) found that when case managers provide coping found that caregivers beneﬁted by observing the progression of the
assistance, such as mobilizing a network of family caregivers to disease. This enabled them to better understand the terminality of
improve resilience, patients tend to report improved function- their loved one’s condition. These ﬁndings indicate that the sources
ing. Likewise, case management patients with unhealthy fam- of stress and resilience among family caregivers