ISQUA16-2418FAMILY AND CAREGIVERS ARE AN INTEGRAL PART OF HOME CARE SAFETY

Abstract

Objectives: This presentation will feature national evidence collected over the past 10 years from seniors receiving homecare services in 7 Canadian provinces. This program of research showcases the multiple meanings and influences on the broadened conceptualization of homecare safety including emotional, social, and functional safety from the perspectives of clients, family/caregivers, and providers. Method(s): Caregivers are family members and friends who enable and support homecare clients to receive care at home. In 2012, 28% of Canadians 15 years of age or older, spent a median of 4 hours a week providing help or care to a relative or friend with a chronic health problem. Caregivers are increasingly relied upon by the health system to provide 70-75% of the care required at home, with little or no attention paid to the caregivers' health, safety, concerns, or preoccupations. This research represents the product of multiple complementary and interconnected studies led by an interdisciplinary pan-Canadian team of knowledge users and researchers. Using a mixed method design, client and caregiver interviews were followed by photo "walkabouts" where participants visually guided the interviewer through their daily experience of managing at home. The concerns or strategies that were pointed out were captured on digital camera. Focus groups were conducted with regulated professionals and non-regulated home support workers about safety in home care. Result(s): The most compelling and consistent finding across this pan-Canadian program of research is that the safety of the client is inextricably linked to the safety of their family and caregivers, regardless of the focus of each homecare safety study (i.e., palliative, medication management, multiple chronic illness). Some key safety risks specifically associated with caregivers include how the physical and emotional toll is a source of distress for caregivers. Caregivers, regardless of their age, personal health, work obligations, or family situation often feel pressured to assume care of a family member/friend because there are few options available. In institutions, 24-hour care is primarily provided by experienced and regulated care providers; at home, caregivers are often unprepared for the extent of the care they have to give. Caregivers find themselves responsible for complex, around-the-clock care such as helping with mobility, toileting and pain control and possibly dealing with confusion and wandering. Caregivers' inevitable fatigue is a potential safety risk to clients because it affects decisions about medication or care. Fatigue and the psychological and physical impact of stress on caregivers also lead to depression or substance abuse, endangering both caregivers and clients with the potential to lead to physical and psychological abuse. These factors add up to a significant risk that caregivers may become patients themselves, ultimately increasing, rather than easing, system demand for healthcare. Conclusion(s): This cumulating body of evidence is highly relevant for practice and decision-making given the shift both in Canada, and internationally, of healthcare services from institutions to the home and community. The national results collected over 10 years clearly indicate that the safety of caregivers and clients are intertwined and threats to the safety of family and caregivers must not be severed from client safety. Focusing on the client and caregivers as the "unit of care" will mitigate risk, help to ensure seamless quality care, and better support for caregivers and clients. Recommendations for actions, relative to the identified risks, at different levels of the system will be discussed.