Healthcare Workforce Training in
Supporting Family Caregivers of Seniors-in-CareDR. JASNEET PARMAR, MBBS, MCFP(CAC)
[email protected] Professor, Department of Family Medicine, University of Alberta
Medical Director, Network of Excellence in Seniors’ Health and Wellness, Covenant Health
Medical Lead, Alberta Health Services – Edmonton Zone - Home Living and Transitions
Faculty/Presenter Disclosure
Faculty/Presenter: Jasneet Parmar
Relationships with financial interests:– Grants/Research Support: ($3000) Campus Alberta Health Outcomes and
Public Health Meeting Grant, with contribution from Covenant’s Network of
Excellence in Seniors' Health and Wellness.
– Speakers Bureau/Honoraria: not applicable
– Consulting Fees: not applicable
– Patents: not applicable
– Other: Employee University of Alberta
Healthcare Workforce Training in Supporting FCGs
of Seniors-in-Care
• Collaborative one-day event (February 22, 2018)
• 40 stakeholders from across Alberta: HCPs; FCGs;
senior’s service organizations; academics; policy makers
• Shared experiences and knowledge about what optimal
training for HCPs might look like and how it could be
implemented and sustained
Outline
• Present the results of the pre-meeting work;
• Highlight the findings in the meeting;
• Outline the products and strategies arising from
the meeting.
Healthcare providers need to include family caregivers to fullest
extent possible, and communication between seniors, family
caregivers and healthcare providers needs to improve vastly. We
must find a way for everyone involved to work together. - Response from Covenant’s ‘Shape Seniors Care’ Campaign (2015)
Healthcare Workforce Training in
Supporting Family Caregivers of Seniors-in-Care
PRINCIPAL INVESTIGATORS
Jasneet Parmar, MBBS, MCFP(CAC)
University of Alberta; Alberta Health Services; Covenant Health
Suzette Brémault-Phillips, PhD
University of Alberta
Wendy Duggleby, PhD
University of Alberta
Debbie Cameron-LaningaCaregivers Alberta
Lesley Charles, MBChBUniversity of Alberta; Covenant Health
Kathy ClassenCovenant Health
Vivian Ewa, MBBSUniversity of Calgary; AHS
Carmen GrabusicAlberta Health
Jennifer Mah, RN, MN NorQuest College
Grace Maier Glenrose Rehabilitation Hospital
James Silvius, MD Alberta Health Services
Valerie Smith, MD Alberta Health Services
Peter Tian, MD, MPH University of Alberta
CO-INVESTIGATORS
This meeting is funded by a Campus Alberta Health Outcomes and Public Health Meeting Grant,
with contribution from Covenant’s Network of Excellence in Seniors' Health and Wellness.
Objectives
1. Create and foster a cross-sectoral dialogue;
2. Analyze and overcome barriers to empowering,
engaging, and supporting FCGs;
3. Devise concrete next steps to implement
recommendations for training HCPs to support
FCGs.
This meeting is funded by a Campus Alberta Health Outcomes and Public Health Meeting Grant,
with contribution from Covenant’s Network of Excellence in Seniors' Health and Wellness.
Pre-Meeting
This meeting is funded by a Campus Alberta Health Outcomes and Public Health Meeting Grant,
with contribution from Covenant’s Network of Excellence in Seniors' Health and Wellness.
Determine key areas of focus:
• Previous symposia reports (2016 & 2017);
• Literature Review & Environmental Scan;
• Survey of meeting participants.
Background
FCGs are the backbone, ‘the shadow workforce” of our
society and healthcare system.
• There is increasing evidence that caregiving is being
provided at significant physical, emotional and financial
costs to FCGs.
• HCPs receive little or no education/ training on how to
support FCGs.
It is time for healthcare providers to learn how to connect with
family caregivers and how to treat them as an integral part of the care team.
-Attendee, Supporting Family Caregivers of Seniors within Acute and Continuing Care Systems Symposium (2016)
Background Information
• FCGs provide the majority of care to seniors with
complexities and frailty [1-4]
– Educating and empowering FCGs linked to better outcomes for
care recipients and reduction of harm to FCGs [5-8]
• High burden associated with providing care [9-13]
• Significant lack of awareness and support for FCGs within
the healthcare system [14]
– How do we increase awareness among HCPs of the crucial role
FCGs play?
• HCPs have found that involving FCGs in care plans make
their work easier [15,16]
Findings from the Literature
• Lack of research examining the best way to train HCPs to
better support FCGs
• HCPs play a critical role in providing information and
referring FCGs to necessary services or supports [17-19]
• Communicating appreciation and gratitude for FCGs can
significantly reduce burden [16,20]
Literature Review (con’t)
• A variety of assessment tools for quality of life,
depression, and caregiver burden [9,18,21]
– Very little evidence on what to do after the assessment has taken
place
• There is value in having nurses and other frontline
practitioners liaise to the rest of the care team on behalf of
FCGs and the care recipient [14,22]
• Less jargon, more cultural awareness, open
communication, and engagement of FCGs on the care
team [18, 23-26]
This meeting is funded by a Campus Alberta Health Outcomes and Public Health Meeting Grant,
with contribution from Covenant’s Network of Excellence in Seniors' Health and Wellness.
Supporting FCGs of Seniors in Acute and
Continuing Care Settings, 2016
• Symposium hosted by the Network in August, 2016
• Goals identify how to best involve and support FCGs in
the healthcare setting
• Six “conversation circles” used to identify current issues
and provide recommendations
• Attendees included FCGs, frontline HCPs, healthcare
managers, seniors’ service organizations, academics
It is time for healthcare providers to learn how to connect with
family caregivers and how to treat them as an integral part of the
care team.-Attendee of Supporting Family Caregivers of Seniors within Acute and Continuing Care Systems (2016)
Findings from 2016 Symposium
• Conversation Circles identified a need for education for
HCPs to:
– Better understand the value of FCGs in patient outcomes
– Assess caregiver burdens and needs
– Understand the supports and services available for FCGs
– Know the points of contact in other supports
• Work to change culture in the healthcare system to
respect and acknowledge the crucial role of FCGs.
Fostering Resilience of FCGs of Seniors
in Care, 2017
• Expanded on the findings of the 2016 symposium by
engaging FCGs
• FCGs provided specific examples or interventions that
could improve supports
Family caregivers need more than just information – they need
resources and supports to help them successfully navigate the
complexities of the healthcare system. -Attendee of Fostering Resilience of Family Caregivers of Seniors in Care (2017)
What FCGs Told Us
• Educate HCPs to better support FCGs
• Improve communication between HCPs and FCGs.
• Assist FCGs in navigating the healthcare system.
• Reframe the perception of FCGs and how they interface with
HCPs.
• Need for comprehensive policies to ease FCG burden.
If families and family caregivers truly feel that their loved ones are cared
for and cared about, their stress and guilt will be greatly reduced. -Attendee of Fostering Resilience of Family Caregivers of Seniors in Care (2017)
This meeting is funded by a Campus Alberta Health Outcomes and Public Health Meeting Grant,
with contribution from Covenant’s Network of Excellence in Seniors' Health and Wellness.
Reports from 2016 and 2017 symposia
included in attendee packages
Pre-meeting Survey
• A survey was sent out to all attendees in early February
– What do FCGS need from HCPs?
– What do HCPs need to support FCGs?
– What resources or education tools exist for HCPs?
– What outcomes are expected from the day?
• 29 attendees responded:
– Average age: 55 ± 10.1 years
– Female: 93%
This meeting is funded by a Campus Alberta Health Outcomes and Public Health Meeting Grant,
with contribution from Covenant’s Network of Excellence in Seniors' Health and Wellness.
1. What do FCGs
need from HCPs?
This meeting is funded by a Campus Alberta Health Outcomes and Public Health Meeting Grant,
with contribution from Covenant’s Network of Excellence in Seniors' Health and Wellness.
Response %
Understanding 79%
Referrals/Resources 59%
Education 52%
Respect 41%
Inclusion with Care Team 34%
Communication 28%
Recognition 24%
2. What do HCPs need
to support FCGs?
Response %
More knowledge and
training59%
Understanding 34%
Communication 34%
Time 34%
Resources 28%
3. What resources or
education tools
exist for HCPs?
This meeting is funded by a Campus Alberta Health Outcomes and Public Health Meeting Grant,
with contribution from Covenant’s Network of Excellence in Seniors' Health and Wellness.
Response %
Caregivers Alberta 31%
Did not know any
resources28%
Alzheimer's
Association 14%
Case management
education10%
Seniors’ Alliance of
Greater Edmonton 7%
Response %
Create Action Steps and
Commit to them76%
Share Knowledge 34%
Clarify Needs/Deepen
Understanding31%
Increase awareness of the
need for HCP training28%
Share Resources 24%
Be listened to/acknowledged 24%
4. What outcomes are
you expecting from
today?
Environmental Scan
• Searched the internet, academic, and grey literature from
community organizations and health agencies
• Growing awareness about the importance of FCGs and a
palliative care approach
• Majority of information targeted to FCGs
– Onus placed on FCGs to navigate the system
• Only a select amount of resources designed to train HCPs
to support FCGs
– Little done to evaluate interventions
CHANGE Foundation (ON)
• A think tank in Ontario - improving the experiences of
FCGs as they move across Ontario’s healthcare system
• 2015 – 2020 Strategic Plan: Out of the Shadows and Into
the Circle
• Incorporates both FCG and HCP perspectives through
various research and engagement activities
- FCGs wishing for collaboration, to be included in decision-making,
and to have access to information
- In contrast, HCPs were concerned about privacy rules and their
ability to share information with caregivers
• May develop tools in the future for training HCPs, but no
commitments yet
– Currently in the Listen and Learn phases
Caring for the Caregiver
Program
• Developed at the University of Texas at San Antonio after
a community-academic forum
– Free workshops to improve caregiver capacity
• FCGs involved in planning programs and conducting
research to inform best practices
• Evidence-based skills and training offered from an
academic institution
– Gives HCPs, nursing and medical students opportunities to work
directly with FCGs through peer-support groups and connecting
them to resources
Caregivers Alberta
(Navigator Workshop)
• A one-day workshop with the aim of helping HCPs to:
1. Identify caregivers
2. Support caregivers and assess their needs
3. Increase knowledge of available resources
• Have had attendees from all areas of healthcare (HPs,
LPNs, RNs, social workers, chaplains, etc.)
• Lack of support from upper management routinely
prevents HCPs from participating
Before the workshop, one healthcare professional had categorized
caregivers as mad, bad, or sad- Caregivers Alberta Staff
Palliative Care Matters
• Palliative care focuses on addressing symptoms and
enhancing quality of life for both patient and caregiver
after a terminal diagnosis
• Engaging and empowering FCGs is an essential
component of the palliative care approach
• PCM’s goal is to advance a palliative care national
strategy in Canada by bringing forth the collective wisdom
of patients, FCGs, and HCPs
• Consensus Development Conference
– Engaged healthcare practitioners, patients, FCGs, academics,
and policymakers to discuss how to further a palliative care
framework
Pallium Canada
• Offers Learning Essential Approaches for Palliative Care
(LEAP)
– Evidence-based, peer-reviewed learning targeted to HCPs, FCGs,
and educators
– One-day, two-day formats
• Online learning module Taking Ownership of Palliative
Care
• Possible to become a LEAP Facilitator and deliver training
in your area
Five Working Groups; 3 Discussion
Sessions
Key Areas of Focus:
• Culture change in the healthcare system
• Communication between HCPs and FCGs
• Assessment of FCG needs: individualized
• Navigating the healthcare system and access
to resources: timely and flexible
• Organizational support: for HCP training;
creation/ examination of policies
This meeting is funded by a Campus Alberta Health Outcomes and Public Health Meeting Grant,
with contribution from Covenant’s Network of Excellence in Seniors' Health and Wellness.
Thematic Analysis
Thematic Analysis
• Orientation to the caregiver role
• Implementing caregiver-centered care
• Engaging with caregivers
• Coaching caregivers
• Challenging the status quo in healthcare settings
• Fostering caregiver resilience
Orientation to the caregiver role
• Vital role in the care of older adults.
• Remains largely unrecognized by HCPs.
• Physical, emotional and social costs of caregiving +
potential impacts on quality of life for both the caregiver
and care recipient.
• Enabling HCPs to identify needs & understand how they
can best support caregivers in their daily responsibilities.
• Initiate policy change and allocation of resources to
support FCGs through awareness at systems level.
Implementing caregiver-centered care
• Connecting HC providers with FCGs on a more personal and
human level.
• Tension exists between the healthcare system and the desire
to provide person-centered care.
• Saving future time and resources HC providers identify
individual values, strengths and limitations of FCGs.
• Inviting caregivers into the care environment and acknowledge
them as integral members of the care team facilitate
transparency and open communication.
Engaging with caregivers
• Not always experienced by caregivers as being supportive nor
optimal.
• Reports of: disrespect, unheard and invalidated during
interactions with HCPs.
• The lack of empathy and compassion feeling frustrated with
and distrusting of the overall system.
• Teaching empathy and compassionate interactions initially and
continuously.
• Training of HCPs in communication and interpersonal skills.
Coaching caregivers
• Navigation through the healthcare system and community
resources is challenging, frustrating and time-consuming for
both healthcare professionals and caregivers.
• Existing services are disconnected, scattered and often under-
resourced. Need for integration & centralization.
• Overwhelmed FCGs: complexity of the healthcare system and
community resources. FCGs are unaware of available
resources and how to gain access to them.
• Access to navigation or “coaching” services that can empower
caregivers to make decisions, advocate for their needs and
gain access to beneficial resources.
Challenging the status quo in healthcare
settings
• HCPs may subscribe to prevailing norms within healthcare
environments that overlook caregiver needs and cultivate negative
attitudes towards them.
• Healthcare workforce training to address culture change within
healthcare environments. Encouraging healthcare workers to engage
in self-reflection, and model positive behavior in the workplace
• Policies, standards, guidelines for working with caregivers may
facilitate greater consistency regarding quality of care across service
settings.
• FOI: HCPs would benefit from having a better understanding of what
they can and cannot share and how to communicate privacy
obligations.
Fostering caregiver resilience
• Autonomy and prefer making decision for themselves.
• Need for HCPs to work alongside caregivers to increase their ability
to cope with adversity and thrive while caregiving.
• Fostering resilience is important for preventing physical and
emotional burnout and for maintaining caregiver contributions.
• HCPs - enhance caregiver resilience by using a caregiver-centered
approach, providing a listening and supportive ear during times of
difficulty, and making available applicable educational or therapeutic
resources.
• HCPs can facilitate personal growth by teaching caregivers to
recognize and manage their own physical and psychological
stressors.
Next steps:
Pre-Meeting
Oct-Mar 2019
• Refresh literature &
environmental scan
• Complete thematic
analysis and concept
mapping symposia
• Develop core
competencies, education
& training content
Meeting
Mar 14-15, 2019
• Validate content
• Identify education & training
materials/format
• Map strategies for
implementation &
dissemination
• Generate evaluation research
plans
• Obtain stakeholder
commitments
Family Caregiver & Stakeholder Engagement
Post-Meeting
Mar-Aug 2019
• Create and disseminate
resources for education &
training
• Develop a central online
repository of resources
• Implement training
• Evaluate training
https://www.youtube.com/watch?v=c99O2EChQAA&feature=youtu.be
Need more information?
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