Family caregivers can be a vital part of an overall home health care strategy, especially as more baby boomers begin to age and the in-home care industry continues to deal with labor shortages.
Already, some acute care providers are engaging more with patients’ family members to help educate them about follow-up care in the home, including the availability of professional home care services. While the relationship between family caregivers and professionals can be complicated, home health and home care agencies agree that creating strong relationships brings clinical and business benefits.
In 2015, an estimated 43.5 million adults in the U.S. had provided care for an adult or child in the last 12 months, according to an AARP study, Caregiving in the U.S. On average, caregivers of adults have been in their role for four years, with a quarter providing care for five years or more.
Many home health nurses speak to the importance of family caregivers, according to Jinjiao Wang, assistant professor at the University of Rochester School of Nursing and an author of home health study “Home Health Nurses’ Perspectives and Care Processes Related to Older Persons with Frailty and Depression.”
“Caregivers. This was the word I heard repeatedly during the interviews [for the study]—engaging the caregivers, teaching the caregivers and making sure the caregivers know about the meds and the care plan,” Wang told Home Health Care News in an email. “Caregivers ensure that what we do within a home visit has a lasting impact between visits.”
A new model of family caregiver support
While they can play a pivotal role in providing support between home health visits, family caregivers sometimes feel unprepared and unsupported. Resources can still be difficult for caregivers to find.
Eight out of 10 caregivers state that they could use more information on caregiving topics, according to the AARP study. Most commonly, caregivers want information on keeping their loved ones safe and on dealing with their own stress.
It seems the health care industry may be trying help with that.
White Plains, New York-based Burke Rehabilitation Hospital recently opened The Marsal Caregiver Center. The hospital is a member of the Montefiore Health System, which developed the first medical center in New York to offer families a caregiver support center.
Burke is a 150 bed acute rehabilitation hospital. Bronx, New York-based Montefiore Health System is the academic medical center and university hospital for Albert Einstein College of Medicine.
“Our patients are on a journey, they’ve had a significant event—which changes the course of their lives and their families lives,” Carla Assenza, clinical social worker and director of Marsal at Burke, told HHCN. “And we know that preparing our caregivers for the challenges ahead is really preparing the patient [for better outcomes].”
The space—which Burke touts as the first of its kind in the nation at a rehab hospital—is specifically designed to support and offer resources, such as home care options for the future, to family caregivers. The center has been open since June and, so far, has received positive feedback.
“Our [family] caregivers are educated, supported and provided with a little bit of respite while they’re here at Burke,” Assenza said.
The center cost $700,000 to build and about $200,000 annually, Jeffrey Menkes, CEO at Burke, told Modern Healthcare.
Hospitals and home health providers alike are working to drive down readmissions. They believe that making the family caregiver a team player can be a part of that effort.
“If a family is better prepared, they know what to expect and they know how to handle their loved ones at home in a safe way then we are looking at lower readmission rates,” Assenza said. “That is what every hospital is looking for.”
However, administrators don’t always connect the support of caregivers to better outcomes such as reducing preventable emergency room visits or lowering readmission rates, Leah Eseknazi, operations director for the National Center on Caregiving’s Family Caregiver Alliance told Modern Healthcare. It’s difficult to show the same cost-benefit ratio that is used to add other services to a hospital, she said.
Not black and white
Despite widespread recognition of the value of family caregivers, it’s not always simple for a home health or private duty agency to work with them.
“Professional industry people combined with family caregivers can be a really powerful combination, if all the variables make sense,” Greg Solometo, CEO at Alliance Homecare, told HHCN.
New York City-based Alliance Homecare is a concierge home care services agency operating out of the lower nine counties in New York state. The company recently expanded to New Jersey as well. The company has about 150 clients and 50 internal employees who work out of three offices.
Other home care providers concur with Solometo.
“It’s very valuable when family members are involved in decision making because without the family members and family caregivers our job would be so much harder,” Lenny Verkhoglaz, CEO at Executive Care, told HHCN.
New Jersey-based Executive Care is a home care franchise company that employs roughly 1,000 people in 22 offices across 11 states. The company has several location in various stages of development.
Reaching out for professional care help can benefit family caregivers too, in that the professional can see some of the problems the family caregiver may have not been aware of, Solometo noted. For example, the professional may assess the physical environment of the home and be able to notice that there should be grab bars in the bathroom.
“Small changes can make a very big difference, but it takes a professional in the industry to illuminate what those things are and to execute and find the solutions,” Solometo said.
Providing care to an older adult can also put extra weight on the family caregiver. One out of every two caregivers that are looking after someone with a chronic or long-term condition, like mental health issues or dementia, report emotional stress, according to the AARP study. About one in five caregivers also report experiencing financial strain.
Home care professionals can help alleviate these strains but also have to be sensitive to the stress that family caregivers feel.
“We get plenty of phone calls from family caregivers and we can sense that it’s taking a toll on them,” Verkhoglaz said. “Family caregivers sacrifice a lot.”
Alliance also emphasizes the need for flexibility and understanding in working with family caregivers.
“It’s not black and white. It’s not always good and it is not always bad.” Solometo said. “Every family is different, every circumstance, every relationship … You’re dealing with personal emotions. You’re dealing with human engagement. Whenever you have such an intimate type of situation, especially one that occurs inside the home, it brings a lot of emotions to the forefront.”
Whether it’s complicated or simple, the in-home care industry may need to start relying on family members more.
“With the growing number of people that will need care, more and more families are going to need to get involved,” Solometo said. “If you have interested family members that want to be involved that’s, in my opinion, always a good situation. That’s a luxury.”
Written by Kaitlyn Mattson