Anne Marie Sirrine
| Guest Columnist
Recently, I met with a husband who had been caring for his wife since her Alzheimer’s diagnosis. Her needs were escalating quickly — appointments, medications, meals, personal care — and he was determined to keep her at home. But the cost to his own wellbeing was undeniable. He was sleep‑deprived, depressed, and beginning to experience cognitive decline himself.
As director of the Referral Education Assistance & Prevention (REAP) program at Seacoast Mental Health Center, which supports older adults and caregivers across New Hampshire in partnership with the CMHC’s across the state, I hear stories like his every week. And his experience is far from unique.
Across the country, 24% of adults are family caregivers. Here in New Hampshire, 281,000 adults provide this essential care, often with little preparation or support. Only 11% receive any formal training to manage personal care tasks — yet they are the backbone of our long‑term care system, helping aging parents, spouses, and loved ones remain safely at home. (AARP, 2025)
REAP provides short‑term counseling, education, and support for older adults, caregivers, and the professionals who support them. We address concerns around mental health, substance use and cognitive functioning. After 21 years working with caregivers, I have seen how inadequate support directly harms families. Caregiving takes a serious toll — emotionally, physically, socially and financially. Many experience depression, chronic stress, and increased risk of alcohol or medication misuse.
In REAP’s own data from 2024:
- 50% of caregivers reported moderate to severe depression
- 29% reported suicidal ideation in the past two weeks
- 25% screened positive for at‑risk drinking
Their responsibilities go far beyond tasks like medication management and meal preparation. They interpret moods, manage behavioral changes, ease emotional triggers, and create meaningful engagement for the person they love. Their world revolves around the care recipient — often leading to isolation, loss of identity, guilt, and ongoing grief.
The statistics reflect what I see every week. Nearly one in four caregivers feels socially isolated. Forty‑three percent experience moderate to high emotional stress. And 31% receive no outside help at all.
Compare that to healthcare workers, who work in teams, receive breaks, have coworkers who step in when overwhelmed, and are trained and compensated for their work. Even with these supports, burnout is common. Caregivers receive none of these protections yet are expected to shoulder the same level of responsibility — alone, unpaid, and unrecognized.
Senate Bill 608 in New Hampshire would finally begin to fill these gaps. The bill provides access to counseling, peer support, training, and caregiver assessment for family caregivers of individuals enrolled in two Medicaid waiver programs: Acquired Brain Disorder (ABD) and Choices for Independence (CFI). These services would address the very needs I see daily.
Professional counseling helps caregivers process the complex emotions of watching a loved one decline or manage the stress that comes with it. Peer support connects them with others navigating similar challenges. Caregiver assessment identifies individual needs before families reach crisis.
When caregivers receive the right support, everyone benefits. The care recipient receives safer, more compassionate care. The caregiver’s health stabilizes instead of deteriorating from chronic stress and neglect. And costly options, which many older adults want to avoid, are delayed or prevented.
There is a direct and measurable link between caregiver training and caregiver wellbeing. The spouse I mentioned earlier is proof. Through REAP, he received education about his wife’s diagnosis, guidance on communication and behavior, and strategies to manage his own stress. Within weeks, his depression decreased from moderate to mild without medication. He was sleeping through the night and thinking more clearly. His frustration with his wife dropped significantly because he finally understood what she was experiencing and how to respond compassionately.
The real question before lawmakers is not whether we can afford SB 608. It is whether we can afford to continue ignoring the needs of those who hold our care system together. In 1970, we had 31 caregivers for every one person needing care. By 2010, that ratio dropped to 7:1. By 2030, it is projected to be 4:1. Our caregiver supply is shrinking while needs continue to grow. Without meaningful support, our systems — healthcare, long‑term care, and community supports — cannot function. (AARP, 2013)
Caregivers don’t ask for much. They want to keep their loved ones safe, comfortable, and at home. They want to stay healthy enough to continue providing care. SB 608 gives them the tools to do exactly that.
I urge New Hampshire lawmakers to support SB 608 and stand with the 281,000 residents who are quietly holding our care system together. We cannot keep waiting until caregivers collapse to offer help. We must provide the support they need now — before the burden becomes too heavy to bear.
Anne Marie Sirrine, LICSW, CDP is a staff therapist and the director of the REAP (Referral Education Assistance & Prevention) program at Seacoast Mental Health Center.
