Caregivers and children in grandfamilies face physical and mental health callenges to a greater degree than the general population.[1] Compounding these challenges are barriers limiting access to health care.
Caregivers’ Health
Caregivers are frequently stressed because they are caring for children at a time in their lives they did not expect to be and they are often socially isolated from their peers. They may feel a sense of shame and guilt about their own adult children who are unable to parent. Grandparent caregivers have been found to frequently suffer health problems like depression, diabetes, hypertension, insomnia, and gastric distress.[2] Furthermore, they are often unable to attend to their own medical needs due to a lack of daycare, respite care or adequate health insurance.
Children’s Health
Unlike the several studies concerning relative caregivers, there have been relatively few about the overall well being of children in relative care. The existing findings show that these children exhibit a variety of physical, behavioral, and emotional problems to a greater degree than the general population of children, often due to the difficult situations that caused them to be placed in a grandparent’s care. They have frequently been exposed to drugs or alcohol in utero and many of the children have special needs.[3]
Access Issues
Approximately 127,000 children live with relatives in foster care and for these families, access to services, such as health care, can be easier than for the 2.5 million children with grandparents and other relatives not in the formal system.[4] The state generally has legal custody of the children in foster care, so caseworkers and judges help with obtaining necessary health insurance and physical and mental health services. In order to support the caregivers outside the system and their tremendous contributions towards keeping families together, access to services, such as health care, needs to be improved dramatically.
One of the reasons access issues are prevalent outside of foster care is because many of these children do not have a legal relationship, like legal custody or guardianship, with their caregivers. They lack such a relationship for many reasons. Often their caregivers may have difficulty finding an affordable lawyer or they may not want to go through the expense, delay, and trauma of suing the birth parents for such a relationship. See the care and custody analysis on this website for more information about legal relationships.
Without a legal relationship, caregivers often cannot consent to medical and mental health treatment. Because of malpractice, liability, and confidentiality issues, health care providers may refuse to treat a child without the consent of a parent, legal custodian or guardian even when the child has insurance to cover the cost of the health care.
State Responses
Some states are effectively responding to the access problems by enacting consent or power of attorney laws, which allow relative caregivers who do not have a legal relationship to the children in their care to access health care on behalf of the children without going to court:
- Health care consent laws generally allow a caregiver to complete an affidavit under penalty of perjury that they are the primary caregiver of the child and are authorized by the parent to consent to treatment.
- Power of attorney laws specific for this purpose allow parents to complete a form or handwritten document that states what type of authority they are giving the caregiver.
Both these types of laws typically shield the health care providers from liability due to their reliance on the documents.