Date Presented 04/05/19
Family caregivers are integral to our healthcare and long-term services and supports system. As such, effective collaboration must exist between OT and other healthcare providers and family caregivers when their loved ones are hospitalized and when they are discharged to home and community settings. We identify and describe types of interactions and barriers to these interactions, among healthcare providers, hospitalized older adults, and family caregivers.
Primary Author and Speaker: Beth Fields
Contributing Authors: Juleen Rodakowski
PURPOSE: Family caregivers assume responsibility for helping older adults with self-care activities and complex medical and nursing tasks after hospitalizations. Yet, caregivers often report dissatisfaction with their involvement in the hospitalization process and, in turn, feel ill-equipped to provide care post discharge. Occupational therapy providers are well-positioned to involve caregivers in hospitalization because of their ability to look broadly at the care-recipient abilities, environmental context, and occupational demands. However, types of interactions as well as the barriers among occupational therapy providers, hospitalized older adults, and their caregivers during an inpatient stay are not clear and poorly documented. It is critical to understand the ways in which caregivers are involved in hospital care for informing and targeting services that will equip them to fulfill the needs of their loved ones at home. We sought to characterize caregiver involvement in the hospital care process (i.e. admission, during stay, discharge) by answering the following: 1) what types of interactions are used with caregivers during hospital care?, and 2) what barriers exist to interacting with caregivers in hospital care?
DESIGN: We conducted an explanatory sequential mixed methods case study.
METHODS: Data collection occurred at a large academic medical center on three medical/surgical units. Direct observations occurred for three days, approximately 12 hours each day. Types of caregiver interactions were uploaded onto hand-held computers programmed with Coda/iCoda. Semi-structured interviews with occupational therapy and other healthcare providers were collected. Interviews provided in-depth perceptions on barriers to interacting with caregivers. Descriptive statistics of observation data were computed using Microsoft Excel and content analysis of interview data were completed using NVivo.
RESULTS: A total of 279 direct observations were collected. Caregivers and hospitalized older adults were present for 100 of those observations (36%). Frequency of family caregiver interactions varied across the hospital care process. Family caregivers infrequently acknowledged care tasks during admission (8%), during stay (7%), and discharge (6%). Asking questions was the most frequent type of family caregiver interaction observed (50%), followed by expressing concerns (28%). No needs assessment occurred with family caregivers at admission or discharge. Our observations demonstrate that multiple family caregiver interactions occurred during stay (29%) and discharge (13%) and did not happen at admission. Healthcare providers described three system and individual-level barriers to caregiver involvement in the hospital care process: care experience, time, and relationships. Illustrative quotes from healthcare providers’ interviews were expounded to further develop the understanding of these three barriers.
CONCLUSION: Many of our observations did not involve a family caregiver. Yet, we discovered that when family caregivers were present in the hospital, they interacted with healthcare providers. This finding suggests that caregivers want to be included in hospital care to better prepare for responsibilities post-discharge. However, findings generated a compartmentalized view of hospital care rather than a dynamic, coordinated process. Occupational therapy and other healthcare providers are encouraged to enhance caregiver engagement, increase caregiver assessment, and facilitate multiple interactions across the hospital care process with caregivers. These implications for practice will help close the gap in recognizing family caregivers in providing integral care and preparing them to provide necessary care for older adults.
References
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