In May, New York City-based Mount Sinai established the Steven S. Elbaum Family Center for Caregiving, a support center dedicated to the psychological needs of caregivers.
The center, made possible by a gift from Trudy Elbaum Gottesman and Robert Gottesman in memory of Ms. Gottesman’s brother, is being led by Allison Applebaum, PhD, a professor of geriatrics and palliative medicine at New York City-based Icahn School of Medicine at Mount Sinai.
Dr. Applebaum spoke to Becker’s about her top priorities for the program, and shared the ripple effects seen in care quality and outcomes when health systems prioritize caregiver support.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How does the Steven S. Elbaum Family Center for Caregiving plan to reshape how U.S. caregivers are supported in their roles? What role does national policy play in that effort?
Dr. Allison Applebaum: Our [center] has four different components to it, one of which is our clinical care model, the Caregivers Clinic. This is modeled after the service that I established at Memorial Sloan Kettering Cancer Center in 2011, which was the first targeted psychosocial care program for family caregivers in any U.S. cancer center.
We’ve now launched a similar Caregivers Clinic here at Mount Sinai. This is a mental health clinic staffed by psychologists, psychiatrists, social workers, psychiatric nurse practitioners and other mental health professionals providing care specifically to parents, partners, children, siblings and friends of patients within the health system. One of the important parts of the clinical model is that caregivers become unique patients of the healthcare system with their own medical record and their own medical record number. We bill their unique insurance for the care.
One of the primary goals of our Elbaum Center for Caregiving is to disseminate this model of care and to ensure that in the next 10 years, every cancer center in the United States has a Caregivers Clinic like the one that I established at Sloan Kettering. And ideally within the next 25 years, all healthcare systems will have Caregivers Clinics. That’s really one of our primary goals.
One important point to keep in mind — on the strengths of this model — is that the establishment of these clinical services is not contingent on our public policy landscape. All you need to start is one mental health professional who is motivated to support caregivers and has the ability to bill for services. With that one person, you can grow from there.
Q: What might this care model look like in practice?
AA: There are so many examples. We have a cancer center here at Mount Sinai. Let’s say there’s a patient newly diagnosed with an advanced pancreatic cancer and their spouse is visibly distressed during the first few visits with the oncologist. The oncologist can subsequently make a referral to our Caregivers Clinic.
They would meet with a clinical psychologist initially and undergo a thorough psychodiagnostic interview. In this process, we would identify what the specific challenges they are facing. For example, early on in a caregiving journey, one might be overwhelmed with the anxiety and trauma that comes with a life-altering diagnosis like pancreatic cancer. They may also be struggling to communicate effectively with their spouse and children about what’s happening. After that initial visit, we would develop a treatment plan to help target her ability to sit with uncertainty, to manage anxiety and to have effective conversations.
Most importantly, care is tailored to the specific needs of the caregiver and those can change, as can the drivers of caregivers’ distress. During the course of care, we re-evaluate whether goals are being met and if there are new goals that need to be addressed, especially because caregiving changes over time.
Q: In what ways can supporting caregivers improve patient outcomes and overall care quality within a hospital or health system?
AA: I was at Sloan Kettering for 15 years. We worked with thousands of caregivers there. I am very, very convinced that when caregivers feel supported — when their distress is addressed, when they’re getting support for trauma they might have — they are better able to provide care for patients. There’s a growing body of literature that says, and we see in the clinic anecdotally, that caregivers report feeling more confident and competent when they receive support. A well-supported, educated, trained caregiver whose distress is lower is more likely to feel confident to handle a medical emergency or even avoid taking a care partner to the hospital than one who’s highly distressed.
We know that when caregivers’ anxiety, depression and trauma symptoms are lowered, it translates into better outcomes for patients: better quality of life, symptoms, less hospitalizations, shorter hospitalizations and even improved overall mortality. To me, one of the reasons why this work is so important, and what differentiates it from other types of support out there, is the explicit focus on mental health. Yes, it’s important to provide caregivers with training on the medical and nursing tasks. Its critical caregivers understand the financial side of care and how to navigate case management responsibilities. But historically, what has been left unaddressed is mental health.
So it’s time that we really put mental health at the forefront of our care. That’s really my goal and my mission.
One of the other reasons why these programs are so important, is that caregiving can also provide caregivers with an opportunity to connect to meaning and purpose, to learn new things about themselves, and to experience what we call benefit finding or post-traumatic growth. But these benefits won’t be realized if they are drowning in distress. The type of support we provide not only addresses distress, but actually helps them to cultivate their strengths.
Most of us don’t choose to become caregivers. But if caregivers are going to be in the role, and they’re going to experience all the distress, then let’s also help them derive some of the benefits. That’s woven into what we do as well.
Our model also addresses a common existential question posed by caregivers, which is: Am I worthy of care? When we say, “You are a patient here. You are the focus of care,” we are saying “You’re not only worthy, you are critical to the care.”
Q: Are there any operational or cultural challenges hospitals and health systems typically face when trying to implement caregiver support programs?
AA: Where we are today in 2025 is very different from where I was in 2009. When I started doing this work, I felt like I had to fight to convince administrators and funders, not just within my own institution but across the country, that caregivers mattered. There was a basic argument there — that people were not buying at the time, but I think now many people agree — that caregivers are critical members of the healthcare team. That’s the cultural shift itself we’re seeing, which is really wonderful because it’s enabling the development of support programs for caregivers.
There are many caregiving programs popping up across the country. One of the main challenges that we face as hospitals and healthcare systems are issues of staffing. It can be a challenge to convince health system leaders to support one individual with their effort to devote to caregivers. But once that one person begins, the benefits are going to become so clear.
Additionally, Caregivers Clinics can become rich training ground for clinicians. While the Clinic requires a clinician who can bill for services to begin, there are many opportunities for trainees across clinical psychology social work and nursing to receive clinical training and provide care to caregivers, which is a win-win. So the model is not only an opportunity to deliver care to more caregivers, at the same time it allows us to build up the workforce of professionals who will be able to support caregivers in the future.
Q: What are your top priorities as the center gets off the ground?
AA: No. 1 is really disseminating this model of care through a variety of avenues. For example, we’re waiting on NIH funding, which would allow us to start by training 200 cancer centers to develop Caregiver Clinics, which would be incredible.
The second goal is training, education and building up the workforce in what we call caregiving science. There are maybe 50 of us across the country who are really steeped in this work from a research, clinical and advocacy perspective, but we need to train the next generation of caregiving scientists. We currently have one fellow in our postdoctoral fellowship program and we’re going to be starting to bring in two at a time next year. I hope our center becomes a national center of training for folks who are really interested in this area.
More broadly, one of our longer-term goals is to augment graduate medical education and so that eventually there is coursework for medical students on family caregiving. I think that we can make a very significant impact from the ground up.
It’s a lot more difficult when a physician has been out in the field for 30 years to change the way they practice. But if you have just begun your career in medicine and you’re already learning how important that family caregiver is, it’s going to shift how you approach care, and the care will become, ultimately, family-centered.
Editor’s note: This article was updated Monday, July 28 at 4:35 pm CT.
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