TABLE 2.
Structural factors affecting family caregiver training in home health care
| Structural factor | Factor as facilitator | Factor as barrier |
|---|---|---|
| Formal team communication: Structures and policies guiding formal care team interactions. | “We do regular interdisciplinary phone calls… I think those help a lot.” (RN, agency D) | “In home care it's hard because you work independently a lot. You're alone a lot.” (RN, agency A) |
| Informal team communication: Organizational norms for informal care team interactions. | “We collaborate with other colleagues that go in…we do a lot of talking to each other about further teaching.” (RN, agency C) | “Some nurses are willing to help you and some nurses would just be like, ‘That's not my patient.’” (PT, agency D) |
| Training materials: Availability, quality, and scope of agency‐provided training materials. | “We have a bunch of different tools that help us help [caregivers].” (RN, agency A) | “The educational materials that we have…are definitely not very user friendly.” (PT, agency C) |
| Resources to address social vulnerabilities: Ability to connect caregivers with supports related to social needs. | “It does help to have my social work department, who we can always call and get support from.” (RN, agency B) | “It's now dealing with social work issues… something that should've been simple from a skills perspective is now so much more complicated” (RN, agency A) |
| Visit flexibility: Ability to change the number/timing of visits as needed. | “If I say, ‘They're going to take two hours for the patient and the caregiver…lighten my load a little bit’ [managers] understand.” (RN, agency B) | “Some [insurers] are really stingy with visits. And I just cannot get it done in the number of visits.” (PT, agency C) |
| Discharge information: Accuracy of information regarding prior care and ongoing needs. | “Knowing that there would be [a caregiver] there…we would hope that would be included in their referral.” (PT, agency A) | “They give us a brief background of the patient…but that's not always accurate. You kind of go in blindly…in the house can be something completely different.” (RN, agency D) |
| Caregiver preparation: Education–communication regarding their role postdischarge and the role of home health care. | “We try to do a lot of just kind of intercepting at the hospital and kind of getting them a little bit more comfortable with the idea of being on home health…they have done really well with that.” (RN, agency B) | “They did not realize until the patient was in the home… they are realizing that they are drowning and have no clue what they are doing” (RN, agency A) |
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Impact of COVID‐19 on Structural Factors: Personal protective equipment (PPE) as an obstacle to effective communication “It does create some challenges especially with just masking in general if you have an older patient and older caregiver, sometimes they cannot hear you that well and then they cannot read your lips, so that can create a challenge as well.” (RN, agency B) “They'll say, ‘I cannot see your face. I want to see what you look like,’…we are supposed to look at each other and talk.” (RN, agency C) “People aren't willing to wear their mask, so they'll leave the room and I cannot get all of my questions answered or that super in‐depth education that's necessary.” (RN, agency B) | ||