Introduction

From the moment they begin their professional training, healthcare practitioners are made aware of the importance of patient-centered care. Practitioners are taught that when they involve patients in healthcare discussions and take their values, needs, and desires into account when making decisions, they can achieve better health outcomes^1,2 . While this is undoubtedly fundamental in all aspects of healthcare, many patients – especially older adults being encouraged to age in place – aren’t living alone. The Caregiver Action Network reports that over 90 million Americans provide care for their loved ones³. If properly prepared for their role, these family caregivers have the potential to meaningfully promote aging in place, impact health outcomes, and reduce burden on the healthcare system by reducing preventable hospitalizations. 

Recognizing the Value of Family Caregivers

To help achieve these desired outcomes, scholars, researchers, and advocates have called on healthcare disciplines to recognize this huge population of family caregivers as equal members of the healthcare team^5,6. Parmar et al. (2019)⁶ developed a Caregiver-Centered Care Competency Framework designed to encourage healthcare practitioners to involve family caregivers in the planning and delivery of supportive services, as well as recognize and address caregiver needs and preferences to integrate them as partners in care. This framework specifically calls upon practitioners to foster resilience in family caregivers by enhancing their skills and abilities through education and support. 

When practitioners adopt and embody the principles of caregiver-centered care and work to enhance caregivers’ skills, they can actually help influence patient-related outcomes. For example:

• Weinberg et al. (2007)⁷ found that when caregivers felt more prepared to provide care as a result of coordination with healthcare practitioners, their loved one had decreased pain and improved functional status and mental health. 
• Rodakowski et al. (2017)⁸ found that when caregivers were included in the discharge planning process, such as being introduced to interventions in hospitals that continue after discharge, the risk of 90-day readmission is reduced by 25%. On an annual basis, this could represent a potential savings of $3B in Medicare spending⁹.
• We fielded our own study at Trualta in 2019 to find out the perspective of more than 60 frontline healthcare workers, and found that clinicians believed that approximately 4 out of every 10 caregivers refuse or delay discharge because they feel unprepared to cope with providing care at home¹⁰. 

What are the Implications for Healthcare Teams?

Healthcare teams are well positioned to enable caregivers to improve patient health and help prevent hospital readmissions. To do this, teams must supply caregivers with effective training to provide the necessary care for their loved ones, including hands-on skills. 

Training is more likely to be effective when caregivers’ preferences and needs are taken into consideration. Longacre (2020)¹¹ found that when asked, caregivers most frequently endorsed the training method of “being shown how to do a skill by a qualified person”. Whenever possible, training should also be specific and individualized to a caregiver’s needs and care situation. However, our findings indicate that clinicians are only spending 30 minutes or less educating family caregivers⁹. It is unrealistic and unsustainable to rely on current processes and team members to implement this change. Existing systems used to train caregivers add strain on healthcare team members who are already managing heavy caseloads. 

Hoping for “windows of opportunity” during busy days on top of other responsibilities to provide adequate training and education for caregivers is insufficient⁷. Instead, healthcare teams require sustainable solutions to enable family caregivers to be successful in their critical role as a member of the patient’s healthcare team. 

Want to Learn More?

Contact Leda Rosenthal, Director of Growth, at Leda@Trualta.com or 1-800-214-5085 ext 1 to learn more about how educating family caregivers can improve healthcare outcomes.

References

1. Mead, N., & Bower, P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Social science & medicine, 51(7), 1087-1110.
2. Stewart, M., Brown, J. B., Weston, W., McWhinney, I. R., McWilliam, C. L., & Freeman, T. (2013). Patient-centered medicine: transforming the clinical method. CRC press.
3. Caregiver Action Network. (2017). Home. https://www.caregiveraction.org/
4. Maslow K. et al. Measurement of Potentially Preventable Hospitalizations, a white paper prepared for the Long-Term Quality Alliance. 2012
5. National Academies of Sciences, Engineering, and Medicine. (2016). Families caring for an aging America. National Academies Press.
6. Parmar, J., Brémault-Phillips, S., Duggleby, W., Holroyd-Leduc, J., Pot, A.M. (2019). Caregiver-Centered Care Competency Framework. Covenant Health Network of Excellence in Seniors’ Health and Wellness. https://seniorsnetworkcovenant.ca/wp-content/uploads/2019-06-27-Competency-Framework_proofed.pdf
7. Weinberg, D. B., Lusenhop, R. W., Gittell, J. H., & Kautz, C. M. (2007). Coordination between formal providers and informal caregivers. Health care management review, 32(2), 140-149.
8. Rodakowski, J., Rocco, P. B., Ortiz, M., Folb, B., Schulz, R., Morton, S. C., … & James III, A. E. (2017). Caregiver integration during discharge planning for older adults to reduce resource use: a metaanalysis. Journal of the American Geriatrics Society, 65(8), 1748-1755.
9. Medicare Payment Advisory Commission. (2007). Report to the Congress: promoting greater efficiency in Medicare. Medicare Payment Advisory Commission (MedPAC).
10. Trualta Inc. (2019). Educating Families at Discharge: Using Skills-Based Training to Improve Outcomes. https://www.trualta.com/evidence-base/
11. Longacre, M. L., Weber-Raley, L., & Kent, E. E. (2020). Toward Engaging Caregivers: Inclusion in Care and Receipt of Information and Training among Caregivers for Cancer Patients Who Have Been Hospitalized. Journal of Cancer Education, 1-10.