Contact several references who can support the caregiver. Also ask him questions about his character, his previous performance, and his interactions with his dependent family members. As a healthcare professional, you evaluate patients all the time. However, the patient's family caregiver is usually not evaluated, except to identify that person as a “resource” or “informal support” in developing a discharge plan.
In this traditional view, the family caregiver, who is neither a client nor a beneficiary nor an official part of the health care team, is generally outside the purview of professional responsibility. As with much of today's healthcare, that view is changing. More and more professionals “hand over very sick or disabled patients to family members who care for them after a hospital stay, a short-term stay in a nursing home or an episode of home care services”. In these transitions, especially when the patient is elderly or has a chronic illness, patients' continued health and well-being depends on the family caregiver.
That person must be willing and able to manage the patient's complex health, financial, legal and social needs. Sometimes these tasks are temporary, while the patient is recovering; in the case of elderly or seriously ill patients, the work may continue for months or years. Family caregivers include relatives, partners, friends, or neighbors who provide essential care to an adult or child with a chronic illness or disability, or to a frail older person or with cognitive problems. Some of the ways a family can respond include emotional support, alternative decision-making, financial contributions, care management, and practical care.
Family caregivers can provide or manage all or part of the care, whether part time or full time, and may or may not live with the person receiving the care. This definition, like many others in the field, is very broad and recognizes the complexity of modern relationships and family life. Not all patients need or have a family caregiver, and not all family members are caregivers. And it's possible that the person who actually cares for a family member doesn't identify themselves.
in that role. One way to identify the primary family caregiver is to ask the patient if they can answer: “Who helps you at home? or “Who do you trust most for help at home? If the patient is unable to respond, ask the family member who seems to be most involved if they live with the patient and care for them at home. Instead of asking, “Are you a caregiver? it's better to ask: “What are you doing at home for your family member? Do you do this all the time? Is there anyone to help you? Caregiver evaluations are important sources of information for providers and for caregivers themselves. Transitions from one care environment to another are risky.
There is substantial evidence that patient safety can be compromised by a lack of communication and the lack of adequate preparation of the staff of the new center to meet the needs of patients. When the receiving “provider” is an inexperienced and fearful family member, the risks multiply. Caregiver evaluation can identify areas of training and follow-up, as well as areas where the family caregiver is experienced. For family caregivers, an evaluation is an opportunity to talk about their own lives, perhaps for the first time in any meeting with the patient's healthcare team.
They can express concern about their own ability to provide certain types of care and about the reality of their own situations. In health care settings, evaluations will necessarily be brief, but they may raise questions that the family caregiver can discuss further with others and may suggest types of resources that may be available and useful. Some professionals are reluctant to ask questions about the types of help a caregiver may need, because they can't fill those gaps. However, most caregivers welcome any suggestions and attention given to them. Many different professionals can provide information that is important for evaluating the needs of caregivers. Physical therapists, for example, may ask questions about the home environment and the family caregiver's limitations in terms of strength or mobility.
Nurses can focus on whether the family caregiver knows how to change bandages or administer medications. Social workers can analyze the caregiver's perception of the burdens or rewards associated with providing care, as well as community rights and resources. Depending on the situation, all these emphases are important. However, we recommend that a professional, such as a social worker or nurse, be assigned responsibility for carrying out the evaluation.
More important than the professional status of evaluators are their attitudes and their ability to relate to the caregiver in a reflective and non-judgmental manner. Evaluations should be introduced as, and should be, a way of recognizing the family caregiver's perspective, not as a test and, of course, not as a technique that induces guilt. The evaluator must have good communication skills, including the ability to listen carefully, seek clarification and respect diversity in all its multiples forms. If the caregiver does not speak English, the evaluation should be performed by a trained interpreter.
Ideally, the evaluation should take place early enough during the patient's stay to be useful in the discharge plan. This can be more easily achieved during a short-term stay in a nursing home or during an episode of home health care than during a hospital stay. In these environments, evaluations can be repeated just before the actual discharge. But even in a hospital, if the evaluation is carried out as soon as possible after the patient's admission, you can present the discharge planning process to the family caregiver and establish certain reference information. The evaluation should be done in a place that is as private and quiet as possible, not next to the patient's bed.
Family caregivers have difficulty talking about themselves under any circumstances (evaluators should know that the conversation will quickly return to the patient). But it is practically impossible if the patient is in sight, even if he is sleeping or unable to communicate. The evaluation should be a conversation, not a mechanical exercise. The evaluator can annotate any response that suggests a need for further exploration and can supplement the evaluation responses with direct observations.
When presenting the evaluation process to the family caregiver, the evaluator must clarify the objectives of the evaluation and make it clear that all information (unless specified by the caregiver) will be shared with the health care team in order to develop a care plan. Caregivers should understand that a summary of the evaluation can be documented in the medical record and, perhaps, shared with the health care staff of the home care agency or skilled nursing facility. Therefore, if there is information that the caregiver does not want to be shared, this should be made clear to the person doing the evaluation. Family caregivers should be assured that the evaluation will not be shared with the patient or other family members.
The evaluator should also summarize the conversation so that the family caregiver feels that their concerns have been heard. The evaluator can first emphasize the positive aspects and then list the areas in which some questions have been raised and suggest a monitoring process. The family caregiver may also receive a copy of the AMA Caregiver Self-Assessment Tool for future use. Family caregiver evaluations are important tools to help obtain fundamental information about the person who will be responsible for the care and follow-up of patients after discharge from the hospital, a short-term stay in a nursing home, or an episode of providing home health services.
While widely used in community social service settings, they are a relatively new tool in healthcare settings. In addition to providing information in a systematic manner, evaluations recognize the importance of family caregivers as providers and managers of direct care, and provide them with an opportunity to identify themselves as caregivers and evaluate their strengths, limitations and needs. However, to be effective, caregiver evaluations must be conducted by professionals with good communication and relationship building skills. Evaluating caregiver performance is an essential process for ensuring the health and well-being of care recipients.
But how do you evaluate caregiver performance effectively? Next, we'll discuss the metrics and methods that can be used to measure the quality of care provided. Evaluating the quality of care involves looking at the caregiver's ability to meet the physical and emotional needs of your loved one. Are they compassionate, caring, and responsive? Measure this through direct feedback from the person receiving the care when possible and through their observations. Caregiver qualities, such as insight, commitment, honesty with self, creativity, flexibility, persistence, patience, sense of humor, ability to rethink experiences or circumstances, decision-making capacity, and analytical capacity, were considered evident in trained caregivers.
Qualified caregivers were said to have a wide range of qualities that helped them cope with caregiving activities, were goal-oriented and integrated their personal style into their caregiving approaches. They have intuition, introspective capacity, insight and observe when “things aren't going well.” They are flexible in their approach to life and their changing care responsibilities throughout the disease process. They are able to “withstand shocks”. Trained caregivers can reframe their experience and talk more about “blessings” than “burdens.” They analyze situations carefully, solve problems creatively and modify their behavior or situation accordingly.
The least skilled caregivers have a limited repertoire of qualities and may be more rigid or inconsistent in capitalizing on their own strengths. Less qualified caregivers have a harder time seeing options and changing their roles as the needs of family members with disabilities change, are less flexible, more inconsistent, and more rigid in their expectations and interpretations. They are more resistant to trying new approaches and are more likely to be “overwhelmed” by the responsibilities of caring for others. There are steps you can take to evaluate caregivers, such as babysitters or nursing homes, to reduce the risk of something happening to your loved one.
Knowing your responsibilities lays the foundation for a fair evaluation based on expected outcomes and standards of care.
