It’s Not Just About the Patient
Jody Fountain, RN, Director of Clinical Services, First Texas Home Health, Texoma SENIOR Magazine
Being an administrator at First Texas Home Health, I have witnessed many caregiver/patient relationships and the daily hardships that they endure. The term and definition “Burden of Care” is a multi-dimensional response to the physical, psychological, emotional and financial stressors associated with the care giving experience. Examples of care giver burden include daily on-going patient assistance i.e. lifting, transferring, hygiene, cleaning, meals, isolation from social settings, loneliness, limited time for one self, financial stressors, etc.
Because of the daily impact associated with B.O.C., our agency now notes in the home health setting an Outcome Assessment Form on each new patient being admitted into home health care. Objective assessments are performed by the admitting skilled disciplines with answers designated by Centers of Medicare and Medicaid Services. It is the most underutilized assessment in the home health business today and unfortunately not being used throughout most of the country.
Such underutilization prompted our own company to take more of a “holistic” approach to assess the burden of care involving those individuals providing environmental, financial, psychosocial and physical care for our home health patients. Our agency realized that the health and welfare of a patient’s caregiver has a direct impact on favorable health outcomes for both parties involved.
Burden of care crosses all professional boundaries because it relates to developing a relationship with both the patient and caregiver that involves trust, understanding the burdens and a non-judgmental perspective in patient care. Home health is the final opportunity to assess the needs of the caregiver in their own environment.
Developed from our agency’s own F.I.R.S.T. program and a clinical “tool” called the Burden Scale for Family Caregivers, (BSFC is a scientifically developed instrument that originated in Canada and is designed to measure the perceived burden of family caregivers resulting from home care. It has 28 items and can be used as a research or clinical tool) we utilize a very comprehensive questionnaire for the caregiver involved in direct patient care. This unique F.I.R.S.T. program tool provides a realistic approach to patient care and health outcomes. Whether the caregiver is living with the patient or resides outside the home, this questionnaire can be completed and evaluated by our agency’s team members. A plan of care is then formulated to include the caregiver.
The caregiver is also able to answer the questionnaire at their own pace and leisure. Any member of the team can encourage or assist the person filling out the form. The questionnaire is assessed and evaluated by the homecare team during the patient’s time on service with us. Appropriate intervention should be focused on reducing the area of caregiver burden with high indicators that require immediate and long term planning. Such interventions can include: caregiver training and education to provide practical skills needed for maximizing care, simplifying care regimes, utilizing community resources, respite time away using supplemental care givers and optimizing the home environment and equipment needed.
Communication remains the pivotal means to success in lessoning the caregiver’s issues. As healthcare professionals, we must continue to strive to care for patients with superior standards. It is only when we look at all avenues in patient care that home health can change the standards we all work toward.
Jody Fountain is an RN and Director of Clinical Services at First Texas Home Health. Jody has 23 years experience in the home health industry and may be reached at jfountain@first-texas.com.
