Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial

Abstract

Background:Hospital discharge of older people receiving care at home offers a salient opportunity to identify and address their family caregivers' self-identified support needs. Objectives:This study tested the hypothesis that the extent to which family caregivers of older people discharged home from hospital felt prepared to provide care at home would be positively influenced by their inclusion in the new Further Enabling Care at Home program. Design:This single-blind randomised controlled trial compared outcomes from usual care alone with those from usual care plus the new program. The program, delivered by a specially trained nurse over the telephone, included: support to facilitate understanding of the patient's discharge letter; caregiver support needs assessment; caregiver prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports. Setting and participants:Dyads were recruited from the medical assessment unit of a Western Australian metropolitan public hospital. Each dyad comprised a patient aged 70 years or older plus an English speaking family caregiver. Methods:The primary outcome was the caregiver's self-reported preparedness to provide care for the patient. Data collection time points were designated as: Time 1, within four days of discharge; Time 2, 15 to 21 days after discharge; Time 3, six weeks after discharge. Other measures included caregivers' ratings of: their health, patients' symptoms and independence, caregiver strain, family well-being, caregiver stress, and positive appraisals of caregiving. Data were collected by telephone. FECH and caregiver impacts 2Results:Complete data sets were obtained from 62 intervention group caregivers and 79 controls. Groups were equivalent at baseline. Needs prioritised most often by caregivers were: to know whom to contact and what to expect in the future and to access practical help at home. Support guidance included how to: access help, information, and resources; develop crisis plans; obtain referrals and services; and organise legal requirements.Compared to controls, preparedness to care improved in the intervention group from Time 1 to Time 2 (effect size=0.52; p=0.006) and from Time 1 to Time 3 (effect size=0.43; p=0.019). These improvements corresponded to a change of approximately 2 points on the Preparedness for Caregiving instrument. Small but significant positive impacts were also observed in other outcomes, including caregiver strain. Conclusions:These unequivocal findings provide a basis for considering the Furthering Enabling Care at Home program's implementation in this and other similar settings. Further testing is required to determine the generalisability of results. KeywordsAged, community health care, family caregivers, hospitals, patient discharge. FECH and caregiver impacts

The cost-effectiveness of a telephone-based intervention to support caregivers of older people discharged from hospital

“…The study was conducted using a parallel group randomised controlled trial design and the study staff recruiting participants and collecting data were blinded to group assignment [8,13]. Power calculations were based upon the primary outcome measure, preparedness to care as reported by family caregivers using the Preparedness for Caregiving Scale [15].…”

“…A previous investigation by members of our team determined that caregivers of older patients discharged home from one acute medical assessment unit (MAU) felt underprepared to provide appropriate care after the discharge [6]. Although hospitalisation of the person receiving care can be experienced as a challenge to the caregiver [7], it also provides an opportunity for the hospital staff to determine and address needs for caregiving support [8]. If utilised in this way, the health of the caregiver may be maintained, unnecessary returns to hospital may be averted, and the long term sustainability of the home care situation enhanced.…”

“…We have previously published findings of a trial to determine the outcomes for family caregivers of older people from being included in an interventionthe Further Enabling Care at Home (FECH) programupon discharge from hospital of the older person for whom they were providing care at home [8]. The FECH program is a telephone-administered intervention in which a specially trained nurse determines the caregiver's understanding of the patient's discharge letter, advising how to obtain further clarification if required, and facilitates the caregiver's determination and prioritisation of their caregiving and support needs, providing guidance regarding access to support.…”

A person-centred approach to family carer needs assessment and support in dementia community care in Western Australia

“…The CSNAT's effectiveness and utility have been tested with FCs of patients with cancer at end of life (Aoun, Deas, et al., ; Aoun, Grande, et al., ; Aoun, Toye, et al., ) showing a decrease in carer strain. Results of a trial with FCs of older people discharged home from hospital showed that FCs in the intervention group were significantly more prepared to provide care and reported reduced carer strain and distress compared to FCs in the control group (Toye et al., ). However, the CSNAT suitability with FCs of people living with dementia in the community across the caring experience has not been tested yet.…”

“…The CSNAT's effectiveness and utility have been tested with FCs of patients with cancer at end of life showing a decrease in carer strain. Results of a trial with FCs of older people discharged home from hospital showed that FCs in the intervention group were significantly more prepared to provide care and reported reduced carer strain and distress compared to FCs in the control group (Toye et al, 2016).…”