Address caregiver stress to achieve better patient outcomes, HHCAHPS scores

Conduct a brief test to determine caregiver stress/strain.

 

Agencies often focus all their attention on the patient, not realizing the caregiver’s health is vital to the patient’s long-term success. But reversing this trend will help agencies significantly with patient outcomes and HHCAHPS results.

 

Caregivers assisting home health patients are often the ones left neglected. Family/caregivers burdened by the demands of daily caregiving may be depressed, anxious, fatigued and struggling with social and financial burdens. As a result they may not be able to effectively learn new things to care for their loved one.

 

Added stress of being a caregiver may aggravate and intensify the caregiver’s own health problems. Caregivers often neglect their own health and well-being due to their daily demands.

 

Plus, with HHCAHPS an integral part of an agencies’ star ratings, it is even more vital that caregiver issues are addressed. Let’s not forget that caregivers often fill out the HHCAHPS.

 

Note that conducting a test to determine caregiver stress/strain only would take an agency about 5 to 10 minutes — and the test could even even be left for caregivers to fill out on their own.

 

 

Within the final Home Health Conditions of Participation (CoPs) released Jan. 13, a commenter explained caregivers play a significant role in the care delivery and ultimate outcome of the patient.

 

The commenter suggested patient assessments include several additional elements: Caregiver willingness and ability to provide care; caregiver availability and schedules; the caregiver’s current level of comfort in carrying out medical/nursing tasks or assisting with activities of daily living; and a brief screen for caregiver strain or depression.

 

CMS agreed such screenings “are certainly a best practice” that agencies should incorporate on their own. But the federal Medicare agency said it didn’t have the authority to require them.

 

Indeed, to provide appropriate, effective caregiver education and training, an agency’s best practices should include assessing caregivers with an evidence-based tool.

 

Utilizing a screening tool to evaluate caregivers’ level of stress/strain, communicating to caregivers how stress can affect them and giving recommendations to lessen their caregiving burden can all improve patient outcomes.

 

• Educate staff on how to speak with caregivers about strain/burden. Clinicians should explain to caregivers that a loved one’s health issues might be difficult for the caregivers. Clinicians should say something like, “With everything that you are dealing with in your daily caregiving, I wouldn’t be surprised if you didn’t feel overwhelmed, stressed, down or blue. I’d like to ask you some questions so that we may help you alleviate your strain.” This is called normalizing, and will often make it easier for caregivers to respond.

• Teach clinicians to identify signs of a stressed caregiver. Examples of caregiver stress/strain might be exhibited as irritability, tearfulness, anger, anxiety or appearing depressed. Caregivers also could say that the strain of caregiving is affecting their work, financial and social well-being. The physical condition of the caregiver also may be result of stress/strain. For example, the caregiver may appear tired, unkempt, lethargic, unmotivated and/or unorganized during a visit.

• Incorporate into practice a screening tool that can be used to assess caregiver level of strain. Stress and burden are key components of the profile psychological distress experience by caregivers, although they are not diagnostic labels in and of themselves. There are a few scales available and they are the following; Modified Caregiver Strain Index — can be clinician administered or self-administered by caregiver. It looks at financial, physical, psychological and social health. Caregiver Burden Scale (Zarit). This is a 22-item Likert scale. It could be administered by the clinician or given to the caregiver to complete. It is commonly used with caregivers managing a loved one with dementia. View the Modified Caregiver Strain Index at http://bit.ly/2jzy2Nc and the Caregiver Burden Scale at http://bit.ly/2jxiV7k.

• Teach clinicians how to interpret results and discuss the results with the caregiver. “How have you been doing lately? Your overall score was a 23 out of 26. This shows that you are experiencing a high level of strain. Let’s discuss.”

• Identify interventions that might be helpful for the caregiver. Among those interventions available: Bring in a social worker from the agency, referral to counseling, support group, financial planner, geriatric care manager, planning or long-term care agency.