Family caregivers are essential partners in care. The Planetree organization, an international leader in patient- and client-centred care, states "Care Partners are distinct from casual visitors. Because they know their loved one best, they are uniquely attuned to subtle changes in their behavior or status. This makes the presence of Care Partners an important strategy for reducing the risk of preventable harm."
Having a way to easily identify family caregivers is important. Never has this been more true than now, when hospitals are welcoming back family caregivers in their facilities, with the June 16, 2020 announcement that the government is easing restrictions.
A family caregiver identification card is a simple concept that can have a big impact on caregivers. The Change Foundation led the development of the Caregiver ID (modeled after programs in the UK) along with its Changing CARE teams and caregivers through a co-design process. A made-for-Ontario Caregiver ID program has been in use in some healthcare organizations for the past couple of years. Within those hospitals, the ID has been a pivotal program in the integration of caregivers as essential healthcare partners, and in some cases was used as a key implementation tool for family presence policies. Measurement of the program's impact has shown improvement in the patient, caregiver and provider experience.
The program includes a visual icon, provider training to support culture change and implementation tools. The Caregiver ID is a badge, sticker or card used to facilitate the participation of family care partners in the clinical setting. Healthcare organizations can take the concept further than just a card. Caregiver identification can start with the patient identifying who their caregiver(s) is, documenting the caregiver name and contact information in the patient chart, giving the caregiver an ID card and including the caregiver in care and discharge conversations and planning.
One of the program's biggest strengths: it is adaptable to many environments and situations.
During COVID-19 times, the Caregiver ID is a highly visible tool that helps to differentiate family caregivers from general visitors. It is a visual way to assure other hospital or healthcare facility staff and patients that people they see in the facility have been screened and are permitted to be in the building.
Benefits to the Hospital and its staff and physicians:
- Highly visual way to see that the caregiver in the facility has made arrangements to see their family member.
- More easily recognize caregivers even though they are donning a mask (and/or other PPE), especially through rotating staff, shift changes, and because different family caregivers may come at different times.
- Reassures staff, physicians and patients that the caregiver has been screened, has received training on proper use of personal protective equipment and is permitted in the building.
- Helps distinguish family caregivers from patients, residents or visitors.
- Facilitates the active partnership with family caregivers in healthcare situations and decision making.
- Assists with managing physical distancing.
- Can have added benefits, such as giving caregivers secure access to the patient unit after hours, if the organization's processes allow for caregivers to be issued passes for secured areas.
Benefits to the Caregivers:
Given that family caregivers have been restricted from coming into many hospitals across the province since the declaration of the COVID-19 pandemic, they may feel uneasy about re-engaging and actively partnering in the care of their family members (patients/residents). Providing caregivers with an ID badge at the door may help the caregiver feel more welcome, and may also:
- Re-assure caregivers that staff know they have permission to be in the building.
- Provide formal recognition of the caregiver's role.
- Clearly identify caregivers throughout the building (and facilitate redirecting of caregivers if they get lost).
- Give caregivers confidence to ask questions and be active partners in care.
- Show staff and other patients that the caregiver has received permission, and any appropriate training, to allow them to be in that location.
CASE EXAMPLE: Huron Perth Healthcare Alliance (HPHA)
The Huron Perth Healthcare Alliance (HPHA), who were one of The Change Foundation's Changing CARE partners, began using the ID as soon as the COVID-19 visitor restrictions were put into place.
"The Caregiver ID badge was an important part of our process. It was recognition of the family member as an essential caregiver, and for staff, it was a validation that the caregiver has passed screening and had been trained in using PPE."
This highly visual tool made the process of welcoming essential family caregivers much smoother at a time of such chaos and uncertainty.
"The culture of family caregivers as partners is firmly embedded at HPHA. Since 2015, we have been working with caregivers to co-design the way that HPHA and our partners welcome caregivers as partners in care," explains Anne Campbell, VP, Clinical Services at HPHA. "When COVID-19 hit, you can't revert back. It was a chaotic time, but we knew we had to maintain our commitment to patient-centred care."
As Michelle Jones, Corporate Lead of Patient Experience at HPHA, explains, "We changed our policy to reflect the reality of the pandemic. We defined essential family caregivers, and ensured that patients who were palliative, patients who would be at risk if they were alone, mothers giving birth, or other patients who needed a family member for compassionate reasons, were able to have a family member with them."
Patient partners (people who have been a patient or family member of a patient) were part of the team that helped define the criteria for essential caregivers. Because HPHA had invested in relationships with families over the past five years, they could quickly get input and feedback from patient partners through email. With every change, Michelle could virtually co-design the approach with patient partners and caregivers. This wouldn't have been possible if HPHA's journey to embrace caregivers as healthcare team members hadn't started long before COVID-19.
For Charlene, a family caregiver partner at HPHA, this process of reviewing the changing policies and providing feedback had an added benefit. "We were getting updates from HPHA all the time – it was like they were translating what we were hearing in the news and helping us understand what it meant for us as parents and caregivers. We shared those updates with our networks of caregivers – for example, I could post the information on the Facebook group that I'm on with other parents of children with chronic illness."
More importantly, Charlene said it helped her understand what the exceptions were, and it meant there were "less hoops, less anxiety and less hurdles to go through when going into the hospital with family members."
The Ontario Caregiver Organization and The Change Foundation, in collaboration with family caregivers, have developed the Partners in Care toolkit to support hospitals with this implementation.
The OHA, in collaboration with the OCO and TCF, developed a guidance document to support members in implementation.