Barriers and facilitators to family caregiver training during home health care: A multisite qualitative analysis

Abstract

Background During Medicare home health care (HHC), family caregiver assistance is often integral to implementing the care plan and avoiding readmission. Family caregiver training delivered by HHC clinicians (nurses and physical therapists [PTs]) helps ensure caregivers' ability to safely assist when HHC staff are not present. Yet, family caregiver training needs often go unmet during HHC, increasing the risk of adverse patient outcomes. There is a critical knowledge gap regarding challenges HHC clinicians face in providing necessary family caregiver training. Methods Multisite qualitative study using semi‐structured, in‐depth key informant interviews with Registered Nurses (n = 11) and PTs (n = 8) employed by four HHC agencies. Participating agencies were diverse in rurality, scale, ownership, and geographic region. Key informant interviews were audio‐recorded, transcribed, and analyzed using directed content analysis to identify existing facilitators and barriers to family caregiver training during HHC. Results Clinicians had an average of 9.3 years (range = 1.5–23 years) experience in HHC, an average age of 45.1 years (range = 28–63 years), and 95% were female. Clinicians identified facilitators and barriers to providing family caregiver training at the individual, interpersonal, and structural levels. The most salient factors included clinician–caregiver communication and rapport, accuracy of hospital discharge information, and access to resources such as additional visits and social work consultation. Clinicians noted the COVID‐19 pandemic introduced additional challenges to providing family caregiver training, including caregivers' reduced access to hospital staff prior to discharge. Conclusions HHC clinicians identified a range of barriers and facilitators to delivering family caregiver training during HHC; particularly highlighting the role of clinician–caregiver communication. To support caregiver training in this setting, there is a need for updated reimbursement structures supporting greater visit flexibility, improved discharge communication between hospital and HHC, and structured communication aids to facilitate caregiver engagement and assessment.

Prevalence and predictors of incident ADRD diagnosis following a Medicare home health episode

“…Abbreviations: aOR, adjusted odds ratio; CI, confidence interval. length33 Study findings echo previous research in demonstrating that community-referred HH patients are more likely to have cognitive impairment and/or be at risk for incident ADRD diagnosis.…”

“…Payment innovations could facilitate these targeted clinical pathways; for example, a reimbursement option akin to Current Procedural Terminology (CPT) code 99483 (which reimburses physicians for dementia care planning 32 ) could support an additional visit by an HH social worker and/or nurse to specifically assess the ongoing care needs of the individual and their caregiver(s) and offer referrals to community‐based supports to meet these needs beyond the HH episode. Current HH reimbursement structures incentivize HH agencies to limit the number of visits provided; as a result, HH staff report difficulty addressing underlying social needs due to agency policies limiting visit frequency and duration 33 . Study findings echo previous research in demonstrating that community‐referred HH patients are more likely to have cognitive impairment and/or be at risk for incident ADRD diagnosis 14,34 .…”

“Second set of eyes:” Family caregivers and post-acute home health care during the COVID-19 pandemic

“…Additionally, a novel theoretical framework for enhancing family caregiver support during HHC was published since we collected these data. This theoretical model may inform important areas of questioning related to how HHC team members solicit information about caregivers’ and patients’ needs, their available supports and resources, and continuity of this information amongst the HHC team [43] , [44] .…”

Preparing caregivers for dehospitalization of technology-dependent patients: perspective of Home Care professionals

“…Nesse contexto, ao mesmo tempo que surge a necessidade de investigar o processo de preparo de cuidadores de pacientes com dependência tecnológica para a desospitalização, a literatura aponta que identificar barreiras e/ou facilitadores a este processo permitem a manutenção ou adaptação das estratégias utilizadas de modo a torná-las mais aplicáveis à prática do cuidado e aos contextos dos diferentes atores envolvidos, ou seja, profissionais e cuidadores (12)(13) . Proporcionam, portanto, melhor assistência e resultados às demandas dos pacientes.…”