Family members play a major role as caregivers, in chronic conditions. Family members, friends, or neighbors provide unpaid care in several domains including hands-on care, assistance with daily activities, financial management, and care coordination. Deteriorating conditions may pose additional demands on caregivers as care needs of patients become complex. As a result, caregivers are often at risk of physical and mental conditions, financial instability, and adverse impact on social life. Therefore, policies and programs are required to sustain caregiving for optimal care in the home.
Geography: United States; Focus Area: Family-centered care
The Need for a Family Centered Care Model
Supporting caregivers may be in the form of a shift from long term care to home care, supported by a population-based funding model that offers social and health services to patients and caregivers. A family-centered care model addresses the needs of family members, beyond the patient. According to a definition by the Institute of Patient and Family Centered Care (IPFCC), family centered care refers to “beneficial partnerships between healthcare providers, patients, and families - in healthcare planning, delivery, and evaluation”. Family centered healthcare models have been successful in pediatrics, stroke rehabilitation, and supporting an aging population. This scenario was comprehensively evaluated by Kokorelias and colleagues (2019), who performed a scoping review to determine the key aspects of a family centered model for validity across care contexts and patient populations, and provided important recommendations for the future.
Implementing Family Centered Care (FCC) Models
The family centered models studied for the purpose considered interactions between care providers, families, and patients, and were applicable to diverse patient populations and care settings (community, rehabilitation, acute care, long-term care). Models evaluated were related to a specific healthcare or clinical context. On analyzing different family centered care (FCC) models, researchers identified the universal goal of implementing patient care plans within family contexts. Implementing such models required detailed policies and procedures, collaboration between caregivers and family members, and education for family members, patients, and caregivers.
- Care plans were intended to cover important aspects of daily home routines, patient-identified functional outcomes (such as motor skills), improved family satisfaction, reduced discharge complications, and improved caregiver support.
- For a successful implementation, it was important to understand family priority and needs, enhance family abilities to support the care plan, enhance caregiver support, define realistic outcomes, and optimize patient outcomes.
- FCC models may identify unique family strengths such as coping, resilience, motivation, and competence in providing care. Caregivers may be encouraged to identify these strengths and areas of weakness may be identified.
- Family members may devise a culturally sensitive care plan by conveying cultural priorities, values, preferences, and ideas.
- FCC models may contain detailed definitions of the nature of collaboration between family caregivers and healthcare providers across the illness trajectory, define family ability to maintain control over patient care delivery when care becomes complex, define greater decision-making authority on families and the degree of healthcare provider involvement in development of care plans.
- Communication was important for information exchange, advocacy for patient preferences and family values, promoting interdisciplinary care, and undertaking informed disease-related decisions.
- Education on disease and care planning increased control of patients and family members and reduced anxiety. Education could be provided in a written form, but may be presented in a language level that is understandable by the patient and family, with minimal medical jargon. Education is an ongoing process, beyond inpatient care, to improve trusting relationships between care providers and patients and families, empower family caregivers with knowledge, and facilitate independent treatment decisions. Peer sharing of resources is encouraged and also enhances emotional support. In addition, support groups, retreats, and workshops may be encouraged.
- Agreement of all stakeholders is important for commencement of care delivery.
- Family members communicate issues and priorities to care providers and are involved in discharge planning (for inpatient care).
- Care plans may be monitored to achieve additional goals such as minimizing duplication of resources, bridging service gaps, and optimizing service utilization.
- FCC models are designed to support caregivers through mental health services, financing, homecare, transportation, vocational services, public health, housing, social services, and education.
Therefore, patient-centered care is a key component of FCC models. Partnerships among stakeholders in the care delivery plan is integral to the implementation of illness-specific models. In future, models may be developed with due consideration to patient preferences for permission to access medical records, evaluating cognitive capacity for decision making, and improvement in caregiver burnout and efficient use of services. Finally the models need to be evaluated for outcome measures such as improvement in family and patient satisfaction, overall health outcomes, health services utilization, increase in efficiency, cost effectiveness, and community reintegration.
Promotion: Person and Family Centered Care Paperback – Import, 29 May 2014 by R.N. Barnsteiner, Jane H., P.D. (Author), R. N. Disch, Joanne, Ph. D. (Author), R.N. Walton, Mary K. (Author)
Keywords
health education, health systems, health policy, care plans, patient-centered care, care model, healthcare delivery, healthcare communication, family-centered care, FCC models, culture-sensitive care
References
Kokorelias, K. M., Gignac, M. A. M., Naglie, G., & Cameron, J. I. (2019). Towards a Universal Model of Family Centered care: a Scoping Review. BMC Health Services Research, 19(1), 1–11. https://doi.org/10.1186/s12913-019-4394-5
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