TABLE 3.
Individual factors affecting family caregiver training in home health care
| Individual factor | Factor as facilitator | Factor as barrier |
|---|---|---|
| Clinician interpersonal skills: Aptitude for interacting with others, reading and responding to social cues. | “I'm a people person. You have to like to engage people and talk with them, and you have to have patience, to be calm.” (RN, agency D) | “There's some people…maybe they are not really good at talking to people and that kind of dictates…if they are in patient care or not.” (RN, agency A) |
| Clinician home health experience: Tenure working in home health care, familiarity with this unique setting. | “The whole time you are in home care, you just learn something new… It's constant learning, how to properly deal with caregivers.” (PT, agency A) | “When I was a new therapist in the home, I probably just treated the patient more than looked at the entire situation. And as years go by, you think, ‘Wow. This is a bigger scenario.’”(PT, agency B) |
| Caregiver engagement/motivation: Willingness and interest in learning more related to their caregiving role. | “Really the most important thing‐‐ you can teach anyone who is willing.” (RN, agency A) | “The greatest barrier to caregiver training is that the caregiver does not want to be trained.” (PT, agency D) |
| Caregiver expectations of home health care: Expectations regarding scope of care and patient outcomes. | “Caregiver expectations certainly factor in because we need to finesse‐‐ we are not there for our goals. We're there for theirs.” (RN, agency A) | “Things that get in the way are caregiver expectations of what home care is…goals for the patient [that] are very unrealistic.” (PT, agency A) |
| Caregiver experience: Prior caregiving experience and expertise. | “There are a lot of caregivers who have been trained in range of motion… I will say “You probably already know this.” (PT, agency A) | “They say, ‘Well, we have our own way of doing it,’ and, you know, their own way may be very unsafe…But they do not want to change it.” (PT, agency D) |
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Impact of COVID‐19 on Individual Factors: Increased severity of patient clinical needs and decreased caregiver preparation “I think the complexity of our patients have gotten so much more so that it's almost not always realistic for some of these patients to be coming to us in home care as soon as they do, and part of the problem is caregivers not wanting their family members to go to rehabs or skilled nursing facilities…because of fear regarding COVID.” (RN, agency A) “Because of COVID, a lot of our patients are opting not to go to subacute rehab. So, we are sort of seeing this skewed population right now, I think.” (PT, agency A) “COVID has undermined the caregiver and patient preparation in the hospitals horribly… the first time that the family is seeing the patient is when they pick them up at the hospital. The family wasn't included in the review of the discharge instructions…So very ill‐prepared. Unprepared. Blindsided.” (RN, agency A) “Having the caregiver in the hospital before…they maybe had some training in the hospital before they came home, or the rehab center. But now it's all on us. So it is a much harder, more complicated scene, because we are doing more than what we would normally do.” (PT, agency B) | ||