April 17, 2012
As a health care professional, you assess patients all the time. And until recently you may not have been asked to assess the patient's family caregiver, except to identify that person as a contact or resource when developing a discharge plan.
Now more than ever, involving family caregivers is a necessary part of working with older people in all practice settings. As our population ages, more people with chronic and disabling conditions are choosing to live at home or in the community, requiring their family members and close friends to become caregivers.
Because caregiving for seriously and chronically ill people can carry physical, emotional, and financial risks, with consequences for the patient as well as the caregiver, it's important to assess and address a family caregiver's needs, strengths, and limitations before transitioning patients from the hospital or nursing home. During these transitions, especially when the patient is elderly or chronically ill, the patients' continued recovery and health depends upon the family caregiver. Ideally caregiver assessments should take place early enough in the patient's stay so it can become a useful component of the discharge plan.
What is Caregiver Assessment?
Family caregiver assessments are important tools to help obtain critical information about the person who will be responsible for patient care and follow-up after discharge from a hospital, short-term nursing home stay, or episode of home health care services. Although caregiver assessments are widely used in community-based social service settings, they are new tools in many health care settings.
Caregiver assessment is a process that requires gathering information that describes a caregiving situation and identifies the particular needs, resources and strengths of the family caregiver. It approaches issues from the caregiver's perspective, focusing on what support the caregiver may need while seeking to maintain the caregiver's health and well being.
Guidelines for Caregiver Assessment
Experts who work with family caregivers point to seven categories of information to include in a caregiver assessment.
- Background on the caregiver and the caregiving situation:
- Relationship to patient
- Physical environment (home versus facility)
- Household members
- Duration of caregiving
- Quality of family relationships
- Financial resources
- Employment status
- Caregiver's perception of health and status of patient:
- Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) performed without assistance
- Medications administered correctly
- Mental health diagnosis
- Memory loss or cognitive impairment
- Behavioral problems
- Medical tests and procedures required
- Caregiver values and preferences:
- Is the caregiver willing to assume the role of caregiver? Is the patient willing to accept care?
- Are there any cultural issues that might impact care arrangements?
- Does the caregiver(and the patient) have restrictions or preferences for the scheduling of care and services?
- Well-being of the caregiver:
- Health conditions or symptoms
- Depression or other emotional factors, e.g. anxiety
- Overall quality of life
- Consequences of caregiving:
- Financial strain
- Family relationship strain
- Difficulties with formal providers
- Caregiver skills/abilities:
- Caregiving confidence and competencies
- New skills or training required
- Appropriate knowledge of medical care tasks (wound care, etc.)
- Caregiver resources:
- Caregiver network and perceived social support
- Coping strategies
- Financial resources (health care and service benefits, entitlements such as Veteran's Affairs, Medicare)
- Community resources and services (caregiver support programs, religious organizations, volunteer agencies)
Conducting a Caregiver Assessment
Typically one professional, such as a social worker or a nurse, is assigned responsibility for conducting the assessment. However many different professionals can contribute important information in assessing caregivers' abilities and needs.
Keep in mind it is not the professional status of an assessor that matters but his/her ability to relate to the caregiver in a nonjudgmental and thoughtful way. Assessments should be introduced as a way to acknowledge the family caregiver's perspective and not as a subjective test.
In introducing the assessment process to a family caregiver, the assessor should clarify the goals of the assessment 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 for their family member.
Once the assessment is complete, the assessor should note any issues that have been raised, and suggest a process for following up. The family caregiver can also be given a copy of the AMA Caregiver Self-Assessment tool for future use.
In addition to providing information in a thorough and systematic way, caregiver assessments recognize the importance of family caregivers as direct care providers and managers. Assessments also help caregivers take stock of their situation and recognize where they may require additional support, training or assistance. To be effective, however, caregiver assessments must be undertaken by professionals with good communication and relationship-building skills.
Additional Resources for Family Caregivers
Once the assessment is complete, be sure to provide guidance and additional resources to the family caregiver, both for areas of weakness and for areas of strength. CaregiverStress.comSM contains many such resources, including:
- Caring for yourself while caring for others
- Financial issues
- Senior safety
- Family educational webinars
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