Closing the Home Care Case: Clinicians’ Perspectives on Family Caregiving

Abstract

Focus groups revealed five inherent conflicts that affect home health care clinicians’ interactions with family caregivers: (a) Services often depend on caregivers’ participation, but the home care system does not give them formal status or consideration; (b) clinicians must balance competing priorities within a short time frame; (c) clinicians recognize that families have unmet emotional and training needs, but benefits are not designed to address them; (d) clinicians face conflicting professional roles as patient advocates and service gatekeepers; and (e) agencies reserve social work services, a key to caregiver access to community resources, for their most difficult cases. Building a more rational system will involve raising awareness about the system’s limitation, providing more training and support for caregivers and the professionals who interact with them, and aligning financial incentives with the realities of what it takes to prepare caregivers to care for patients with complex needs when formal services end.

Closing the Home Care Case: Home Health Aides’ Perspectives on Family Caregiving

“…Similar concerns were expressed in the focus groups conducted with home health care clinicians (Hokenstad et al, 2005).…”

“…Findings from the panel survey and the clinician focus groups have been previously reported (see Albert & Levine, 2005;Hokenstad, Hart, Gould, Halper, & Levine, 2005).…”

“This Case Is Closed”: Family Caregivers and the Termination of Home Health Care Services for Stroke Patients

“…Finally, the study asked family caregivers about their burdens at different time points. We also conducted focus groups of clinical home care staff (Hokenstad et al 2005) and home care aides (Hokenstad et al 2006), and a series of in‐depth interviews with a subsample of the family caregivers in the study to learn more details than disclosed in the survey questionnaire. Some of the information from the focus groups, case studies, and interviews is discussed here.…”

“…They acknowledged, however, that this message was often lost on family caregivers who were dealing with major life changes. One nurse in a focus group explained, “You are supposed to be the patient's advocate, and here we are on the first day [emphasizing] that Medicare is short term.” And a social worker in a focus group observed, “It's very hard to explain to somebody whose mother is sick and really does need help that this isn't the kind of help we offer, that this is a skilled service and what she needs is custodial care” (Hokenstad et al 2005, 392).…”

“…Third, CHHAs should train home care workers to communicate more effectively with family caregivers, to teach the family caregivers methods of care when needed, and to offer information when needed . Home care aides particularly need this training, as they spend the most time with patients and family caregivers but are not well informed by the CHHA about patient and caregiver circumstances or trained to help with case‐closing procedures (Hokenstad et al 2005).…”