As healthcare providers, we must work as a team with other physicians, therapists, and nurses. The cooperation of all members is advantageous to the rehabilitation process. However, with each of these roles, there seems to be a field that receives less attention than deserved. They are the unpaid supports, such as family members or friends, and the paid supports, such as CNAs, DSPs, and Home Health Aides. These individuals are our patients' caregivers.
Caregivers come in a variety of forms, but they all serve the same important purpose. Caregivers are the advocates for our patients and they are fundamental to patient outcomes. As physical therapists, we must recognize that caregivers are critical members of the healthcare team.
Communication with our patients is imperative to every aspect of examination, evaluation, and intervention. The subjective information provided by our patients gives us the pieces to the puzzle, deciphering which edges fit together to unify a section of the whole picture.
For individuals with cognitive dysfunction or for those who are unable to communicate independently, caregivers provide us with vital insights. Physical therapists have the advantage of spending more time with our patients than most other medical professions, where brief office visits are the norm. However, caregivers are often with their clients all day, every day. Caregivers are the individuals who truly know our patients. They know the meaning of our patients’ reported symptoms, what they do during the day, and which medications they take.
At times, our patients' bad habits, such as lack of exercise or poor posture, can have an enormous impact on the return to highest function. We prescribe exercises for our patients to perform outside of our supervision. Even if these exercises leave our patients feeling sore, we expect them to participate in physical therapy. What our patients do after they leave their sessions and their dedication to show up to physical therapy are outside of our control.
Individuals who lack the independence to stand up on their own, or need another set of hands to help lengthen a contracture, are unable to take the greatest strides towards increasing function without a caregiver. Caregivers are the people who drive our patients to appointments, who get them up to walk, and who remind them to reach back for their wheelchair before they sit down.
The greatest supporters of our patients will be the caregivers behind them. Utilize this asset and ensure the caregivers are on board with the rehabilitation process.
Our profession is very familiar with productivity and efficiency, but what does it truly mean to be effective? One could argue that productivity, efficiency and effectiveness are synonymous terms. However, there is one key element that must not be forgotten here: quality. As we get to know our patients, there are factors that help us decide if one form of treatment is more effective than another, even though it may not be the most efficient or productive option.
Caregivers are often well versed in a patient's previous medical history and prior treatments. For example, performing a treatment with our patient in supine may allow us to implement tests or interventions efficiently. However, if a history of spinal fusion does not allow the patient to be in that position without discomfort, then effectiveness is lost. A caregiver will key us in to this important piece of information.
While we often think of support as physical in our field, it is the emotional support that often makes a tremendous difference in the rehabilitation process. Any dysfunction, small scale or large, can place a psychological toll on our patients. As healthcare providers who see our patients on a daily, weekly, or biweekly basis, it is our responsibility to recognize and be aware of any psychological alteration while they are under our care.
The caregiver is the person our patients trust. The caregiver is who can make them feel comfortable in a vulnerable situation. We must make sure to include caregivers in the rehabilitation process when appropriate. It is our responsibility to be proactive in establishing a balanced support system in order to prevent the reduction in functional improvement.
As healthcare providers, we must go above and beyond what is expected of us. There are things we must incorporate in our services that we do not get paid for. We put our patients' needs before our own and we don’t question why. This characteristic also holds true for the caregiver, either paid or unpaid.
One of the most valuable things for the improvement of patient outcomes is reciprocal education between the caregiver and the physical therapist. The pertinent information shared may play a substantial role in the progress made outside of the clinic, hospital, or skilled nursing facility.
We must provide the skills necessary for the success of our patients. Taking the time to educate and be educated by the caregiver requires altruism, but will lead us on a path to improved patient outcomes and a more rewarding career.