Caregivers

Caregiver ID: A program to help re-integrate caregivers during COVID-19

By Christa Haanstra, Executive Lead, Strategic Communications

Over the course of our 2015-2020 strategic plan, Out of the Shadows and Into the Circle, we focused on improving the caregiver experience in Ontario’s healthcare system. We, along with many partners, worked hard over that time to ensure that caregivers are treated as a respected partner in care. We saw a lot of progress.

However, once COVID-19 hit, we saw, by necessity and due to the rapidly evolving pandemic, a step taken backwards in the inclusion of caregivers as part of the care team.

In June, the government announced that it was easing restrictions. As a result, attention is now being put on reintegration. Part and parcel of this work is finding a way to easily identify family caregivers and treating them as distinct from visitors.

One of the innovations that came out of The Change Foundations’ work with the Changing CARE teams was the caregiver identification program (Caregiver ID) – a simple concept that can have a big impact on caregivers and is now more timely than ever.

The program has already been implemented in various healthcare organizations over the past couple of years, and has proven pivotal in the integration of caregivers as essential healthcare partners. In some cases it was also used as a key implementation tool for family presence policies.

One of the program’s biggest strengths: it is adaptable to many environments and situations.

The Caregiver ID is being used to welcome caregivers back, as a visual way to assure staff and patients that people they see in the facility have been screened and are permitted to be there.

Caregiver ID includes a visual icon, provider training to support culture change and implementation tools. The Caregiver ID is a badge, sticker or card used to facilitate the participation of family care partners in the clinical setting. But the card is just the tip of the iceberg.  Healthcare organizations can extend the identification program by asking the patient identifying who their caregiver(s) is, documenting the caregiver name and contact information in the patient chart, giving the caregiver an ID card and including the caregiver in care and discharge conversations and planning.

At the Huron Perth Healthcare Alliance (HPHA), one of our Changing CARE partners, Caregiver ID was put in place as soon as the COVID-19 visitor restrictions were put into place.

The highly visual tool made the process of welcoming essential family caregivers much smoother at a time of such chaos and uncertainty.

“The culture of family caregivers as partners is firmly embedded at HPHA. Since 2015, we have been working with caregivers to co-design the way that HPHA and our partners welcome caregivers as partners in care,” explains Anne Campbell, VP, Clinical Services at HPHA. “When COVID-19 hit, you can’t revert back. It was a chaotic time, but we knew we had to maintain our commitment to patient-centred care.”

And as Michelle Jones, Corporate Lead of Patient Experience at HPHA, explains, “We changed our policy to reflect the reality of the pandemic. We defined essential family caregivers, and ensured that patients who were palliative, patients who would be at risk if they were alone, mothers giving birth, or other patients who needed a family member for compassionate reasons, were able to have a family member with them.”

This type of nimbleness and commitment to caregiver engagement is what helped HPHA keep caregiver involved when COVID-19 hit, and it’s what will help caregivers be reintegrated into healthcare organizations as things open-up.

The Change Foundation has been working with the Ontario Caregiver Organization and the Ontario Hospital Association to develop tools, resources and supports to make it easier to reintroduce family caregivers into healthcare organizations.

This collaboration with the Ontario Caregiver Organization is timely, as the Foundation wraps up our incubation work.

Related resources

External resources

Benefits to the healthcare organizations:

  • Highly visual way to see that the caregiver has made arrangements to see their family member.
  • More easily recognize caregivers even though they are wearing a mask (and/or other PPE), especially through rotating staff, shift changes, and because different family caregivers may come at different times.
  • Reassures staff, physicians and patients that the caregiver has been screened, has received training on proper use of personal protective equipment and is permitted in the building.
  • Helps distinguish family caregivers from patients, residents or visitors.
  • Facilitates the active partnership with family caregivers in healthcare situations and decision making.
  • Assists with managing physical distancing.
  • Can have added benefits, such as giving caregivers secure access to the patient unit after hours, if the organization’s processes allow for caregivers to be issued passes for secured areas.

Benefits to the Caregivers:

Providing caregivers with an ID badge at the door may help the caregiver feel more welcome and mitigate feelings of unease about re-engaging and actively partnering in the care of their family members (patients/residents).

  • Re-assure caregivers that staff know they have permission to be in the building.
  • Provide formal recognition of the caregiver’s role.
  • Clearly identify caregivers throughout the building (and facilitate redirecting of caregivers if they get lost).
  • Give caregivers confidence to ask questions and be active partners in care.
  • Show staff and other patients that the caregiver has received permission, and any appropriate training, to allow them to be in that location.

Huron Perth Healthcare Alliance: Caregivers As Partners

In 2015, the Huron Perth Healthcare Alliance (HPHA) made an organizational commitment to partner with family caregivers as essential members of the healthcare team. Little did they know that their work to put their commitment into action would be so important five years later when the COVID-19 pandemic hit.

To prevent spread of the virus and protect patient and providers, the Ontario government immediately put out a directive to the hospital sector that visitors weren’t allowed to come into hospitals.

For many hospitals, the response was quick. A blanket “No Visitor” policy was put in place – meaning family caregivers could not come in to support their family member, sometimes at very vulnerable and scary times in their lives, with very few exceptions.

HPHA had to revise their family presence guidelines, but, by definition family caregivers were not visitors. The process for coming into the hospital had to be different, including screening and PPE requirements, to ensure that everyone involved was safe, but essential caregivers were still allowed to accompany and support their family members.

“The culture of family caregivers as partners is firmly embedded at HPHA. Since 2015, we have been working with caregivers to co-design the way that HPHA and our partners welcome caregivers as partners in care,” explains Anne Campbell, Vice-President, Partnerships and Chief Nursing Executive. “When COVID-19 hit, we couldn’t revert back. It was a chaotic time, but we knew we had to maintain our commitment to patient-centred care.”

As Michelle Jones, Corporate Lead of Patient Experience at HPHA, explains, “We changed our policy to reflect the reality of the pandemic. We defined essential family caregivers, and ensured that patients who were palliative, patients who would be at risk if they were alone, mothers giving birth, or other patients who needed a family member for compassionate reasons, were able to have a family member with them.”

Patient partners (people who have been a patient or family member of a patient) were part of the team that helped define the criteria for essential caregivers. Because HPHA had invested in relationships with families over the past five years, they could quickly get input and feedback from patient partners through email. With every change, Michelle could virtually co-design the approach with patient partners and caregivers. This wouldn’t have been possible if HPHA’s journey to embrace caregivers as healthcare team members hadn’t started long before COVID-19.

For Charlene, a family caregiver partner at HPHA, this process of reviewing the changing policies and providing feedback had an added benefit. “We were getting updates from HPHA all the time – it was like they were translating what we were hearing in the news and helping us understand what it meant for us as parents and caregivers. We shared those updates with our networks of caregivers – for example, I could post the information on the Facebook group that I’m on with other parents of children with chronic illness.”

More importantly, Charlene said it helped her understand what the exceptions were, and it meant there were “less hoops, less anxiety and less hurdles to go through when going into the hospital with family members.”

To make it clear that essential caregivers were allowed to be in the hospital, HPHA used a Caregiver ID badge.

“The Caregiver ID badge was an important part of our process.  It was recognition of the family member as an essential caregiver, and for staff, it was a validation that the caregiver has passed screening and had been trained in using PPE.”

This highly visual tool made the process of welcoming essential family caregivers much smoother at a time of such chaos and uncertainty.

Shortly after the revised family presence policy was introduced to reflect the realities of COVID-19, HPHA heard from cancer patients and their family members. They were anxious, especially those who were coming for their first chemo treatment and would be in the hospital for up to 8 hours on their own.

HPHA responded quickly to these inquiries from family members and set up a process to allow them to come to the hospital and provide support to their family members at this incredibly scary time.

The Manager of the Unit had conversations with the caregivers, and provided the screeners at the front doors of the hospital with the names of the caregivers who were allowed to come in.

“As part of our journey, staff and provider education was imperative,” says Anne. “In the past two years, we made the Caregivers as Partners training modules mandatory for all staff. In the end, more than 1000 people completed that training session. For many, the training was a turning point when staff realized that caregivers were so essential. The modules really showed that if the caregiver isn’t doing well and isn’t prepared at discharge, the patient will flounder and end up back in hospital.”

Barbara, an HPHA family caregiver partner reinforces this point. “When you have the correct information when you are caring for someone, it makes a world of difference.  We’re all in this healthcare journey together.”

Never has that been more true, than during a pandemic.

Related resources

External resources

The Caregiver Resilience Pilot

The Caregiver Resilience Pilot tests a model of care that aims to provide caregivers with temporary relief by offering a suite of services they can choose from, depending on their needs.

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Services include:

  1.  In-Hospital bed for up to 13 days,
  2. Adult Day Programs,
  3.  In-Home Personal Support Worker assistance, and
  4. Individual and group-based caregiver support.

 

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The pilot is an integrated project delivered by WoodGreen Community Services and Sinai Health.

Self-care for Parent Caregivers

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To support self-care for parent caregivers, WoodGreen Community Services has integrated a parent self-care module into the existing Parent Outreach Program Curriculum. The module follows a co-designed

model that promotes incremental shifts in awareness and practice around self-care. The model is supported by workbooks that share strategies and prompts for each phase, for both staff and caregivers.

 

The Care Partnership Office: A Patient & Family Partners Structure

St. Joseph’s values partnerships with both patients/residents and caregivers in program/organizational planning and development.

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In alignment with the St. Joseph’s Healthcare London corporate Care Partnership framework and strategic priorities, a Patient and Family Partners structure is being developed to facilitate patient/resident and caregiver engagement across the organization. The corporate Care Partnership Office will:

  • support patients/residents and family caregivers who wish to be active partners in quality improvement or research initiatives and/or participate on committees/councils throughout the organization
  • provide support to sustain the work of the Improving CARE Together project which has focused on caregiver inclusion, education, and on improving the caregiver experience during care transitions.

Partner recruitment tools, on-boarding materials and staff training resources have been developed to support the meaningful engagement of patients/residents and caregivers across the organization.

Supporting Care Transitions: Moving into Long Term Care

Moving can be an emotional and anxiety-inducing experience. In response to learning that the process of transitioning from the community to the Mount Hope Centre for Long Term Care (London, ON) is overwhelming, new supports were created to better inform and educate new residents and their families/caregivers to ensure they felt prepared for their move-in day.

Welcome & Orientation Email

An email or hard copy letter outlining detailed information about what the moving day involves, what to bring  (e.g., clothing, forms, furniture), and where to park is sent to families/caregivers prior to the move-in day. The email or letter also includes information about community support groups for families.

Download a copy of the email the Mount Hope Centre for Long Term Care team uses.

What to Expect on Moving Day Video

To help ease the transition from the community to Mount Hope Centre for Long Term Care, a video outlining key information about what to expect on the first day was developed as part of a collaborative process with family caregivers, residents and staff. The video aims to demystify the move-in process to help decrease anxiety and fears about the transition.  A link to the video is included in the email.  The video is featured on the St. Joseph’s Health Care London website (see the Mount Hope page), and can be viewed below.

E-Talks

Each parent’s journey in the Neonatal Intensive Unit (NICU) is different and unique. To provide hope and support to parents currently living that journey, a series of videos featuring veteran NICU parents has been developed. In these videos, parents share stories of their NICU journey, talk about what life looks like for their families afterwards, and offer advice to parents currently in the NICU.

Two videos in the series have been published:

  • Stories of Encouragement

  • From One Caregiver to Another

The Mount Sinai NICU has implemented E-Talks as a new resource. The NICU healthcare team encourages parents to take a few minutes to find comfort and support in the stories shared by veteran parents. A component in scale and spread efforts, E-Talks is part of a research study, Family Integrated Care (FICare) Plus with Mount Sinai Hospital, Sunnybrook Health Sciences Centre and SickKids.

Caregiver Training and Education Program

caregiver-thoughtsOffered at Bridgepoint Active Healthcare (Bridgepoint) in their Stroke Inpatient Rehabilitative Program, the Caregiver Training and Education Program proactively provides caregivers with equitable access to training and education, empowering them in their roles.

Program activities include:

  1. aligning the six existing stroke education modules with the stroke networks binder – as well as providing practical caregiver tips and a co-designed knowledge checklist for patients and caregivers,
  2. developing a process to ensure patients and caregivers receive the binder,
  3. offering an additional education session on Saturdays as requested by caregivers and
  4. creating six co-designed animated videos based on stroke education sessions and caregiver feedback.

These videos are available in the following seven languages: English, French, Arabic, Italian, Portuguese, Cantonese and Mandarin.

Access the English videos on Bridgepoint’s website in their Stroke Programs section.

Family Caregiver Centre

caregiver-centre-outside The first support service of its kind in the Eastern Champlain region of Ontario, the Family Caregiver Centre is dedicated to helping caregivers on their caregiving journey. Located in the Cornwall Community Hospital, the Centre gives caregivers access to a physical space where they can take a break, find information, or talk to someone who understands their experience. The Centre features a lounge, kitchenette and a family meeting room. Additionally, caregivers can pick up printed information, request an educational book on loan, and access www.embracecaregivers.com.

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The Centre is open daily, and it’s staffed with trained volunteers (all of which have lived experience as family caregivers) who can provide one-on one support to visitors.

Learn more about the Caregiver Centre on the Cornwall Community Hospital’s website.

The Care Team Description Wall

The Care Team Description Wall

Often, a circle of care involves several different healthcare providers and it can be challenging for patients and their caregivers to remember the role of each provider on the care team.  To support patients and family caregivers in being able to identify and understand the different roles on the team, Bridgepoint Active Healthcare has implemented Care Team Description Walls in each of the inpatient stroke units and in ambulatory care.

The Care Team Description Wall visual includes a description of the different types of providers on the unit. Accompanying each description, is an icon that represents their profession.

To help caregivers and patients easily identify them, providers wear a button with the icon that represents their profession. For example, in ambulatory care, physiotherapists will wear a button with the following icon:

physiotherapist-icon

Patients, caregivers and healthcare providers have found the Care Team Description Wall to be a very useful tool in educating patients and informing caregivers about the different types of providers that may be a part of the patient’s care team in the unit they are visiting. With positive reviews, the Care Team Description Wall initiative is being scaled across other units at Bridgepoint. Currently the initiative is being adapted for implementation in the palliative care unit.

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