How can cities improve systems and networks for family caregivers?

Rachel Smetana, City of Scottsdale, Office of the Mayor

"Until there is a cure, there is care."

- David Coon, Associate Dean, ASU Edson College of Nursing and Health Innovation


Family members are often unprepared to meet the complex demands of caring for a loved one who is aging or infirmed. There is much research published about the impacts of caregiving, and although it can be a rewarding experience, many caregivers feel isolated, emotionally and physically stressed, unsupported, financially taxed, and often report burnout and depression. There are many resources and services available, but Smetana's work with residents in the City of Scottsdale made it clear that access to this help and knowledge about where to find it needs improvement.

Originally, she planned to research best practices of public/private partnerships that provide high quality respite daycare for adults, and work to establish such a facility in her community. Fortunately, in June 2021, after years of advocacy, the City Council unanimously approved adding such a facility to the five-year capital improvement plan. As a result, Smetana pivoted her project to focus on other aspects of building resilience for caregivers. She used the resilience factors she learned about during her fellowship:  strengthening the awareness, adaptability, and community connectedness of family caregivers.

Research questions

  • Does my community have adequate systems thinking when it comes to family caregivers?

  • How can network connections be strengthened to add social value so that caregivers can build capacity to think about the future?

Methods and findings

Smetana held local focus groups with caregivers, city employees, educators and health professionals to learn more about their experiences and how the city could fill in the gaps to better loop in existing systems. She sat in on research performed by Dr. Coon and his team that offered tools and strategies for families with one member diagnosed in the early stages of dementia. She learned that caregivers simply need to know where to go or some other calm tether to information and assistance that they need. City employees needed the information consolidated in a usable way so they could help point people in the direction of help. Planning, information and a willingness to empathize with the stressors caregivers and the elderly are feeling would improve conditions and provide for a more resilient future.


  • Honor Health

  • AARP

  • Scottsdale Fire Department

  • City of Scottsdale Community Services

  • Scottsdale Community College


Scottsdale has embarked on an ongoing conversation about the value and importance of family caregivers. Information is available, programs are in place, and city staff and officials are learning how to help people find those supports. Smetana plans to continue building networks and systems that are embedded in our social structure, easily accessible, quickly mobilized and promote the ability of caregivers to manage shocks and stressors so that we can build a stronger community.


Smetana created a database of local resources for City of Scottsdale frontline employees at libraries, community centers, and parks. This is well curated on multiple topics potentially needed by caregivers or those aging at home. She intends to make this a public-facing database in the spring. During their partnership, Scottsdale Community College created a non-credit class for family caregivers. Scottsdale is an age-friendly community through AARP, and action-planning now includes public policies that respond to the needs of the family caregiver. Finally, the City of Scottsdale Human Resources department provided a webinar on navigating eldercare for insurance recipients through the “live life well” program.

Rachel Smetana

A Portrait of Rachel Smetana

Chief of Staff
Mayor's Office, City of Scottsdale

Community Fellow, 2021

Rachel Smetana is the Chief of Staff in the City of Scottsdale. She keeps busy as a mom of two wonderful teenagers and a menagerie of pets. Besides her work with the Scottsdale Historical Society, she enjoys being on the Scottsdale Community College President’s Advisory Board and various other volunteer activities. She’s worked for the City of Scottsdale in a variety of departments for nearly two decades and is truly grateful to serve her community.