As a visiting nurse, you’re in a unique position to be able to interact with a patient and family in their own surroundings – where they are most comfortable, and where they spend most of their time.  Home care patients depend on family caregivers and, due to medical advancements and shorter hospital stays, home care providers are seeing an increasing burden of responsibility falling on family caregivers.  In fact, it is estimated that 44 million people are providing care to family members in our country, and many of these caregivers have taken on their role suddenly, with little preparation or training.  As a result, caregivers are finding themselves at higher risk for emotional difficulties, such as fatigue, anxiety, and depression, and report higher rates of physical ailments, such as heart disease, cancer, diabetes and arthritis at nearly twice the rate of non-caregivers.  It’s important that home care clinicians recognize caregivers who may be at risk for emotional and physical burnout, so that they can get the help they need.  Here are some tips for dealing with your patients’ caregivers:

• Try to schedule your home visit for when your patient’s family member is present.   This will give you a chance to talk with the caregiver about the patient’s plan of care and get a sense of how the caregiver is faring.  Even if it’s not the very first visit, it’s important to meet the caregiver as soon as possible during the episode of care.
• If the caregiver works, try to get a phone number and, if time permits, make a phone call to introduce yourself and open lines of communication so that they know who to call should they have a question or concern.
• Ensure that family caregivers know they are an integral part of the health care team.  Tell caregivers that you depend on them to report what they see with the patient when you’re not there.  Many family caregivers have concerns, but are reticent to raise them with you because they are intimidated, and know you’re busy.  Assure them that their insights are critical for helping you stay on top of their family member’s health.
• Assess the family caregiver’s ability to carry out your instructions, but also how they are feeling, both physically and emotionally.  The OASIS assessment includes a Caregiver Strain Index that you can access any time.  There are also other tools you can give to family caregivers to enable them to perform a self-assessment.  One such tool is from the United Hospital Fund and can be found here.  The good thing about this assessment tool is that it measures a caregiver’s worry levels, as well as identifies areas where they might need training.

Most of all, remember:  A supported and healthy caregiver is in the best position to provide the necessary assistance to your patient.

Judy Santamaria, Director of Caregiver Support
Visiting Nurse Service of New York