Caregiver Unburdened

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Renee Kinder
Renee Kinder

The ocean is big, the ocean is wide and in South Carolina, it can also be murky with a strong undertow and large crashing waves that come daily at high tide.

The combination of these factors sent our eldest child, Lawson, into a bit of caregiver overload last week during a family vacation.

Being the oldest of five children is a big job.

Lawson always stays fully aware of who is in the ocean, who is missing their puddle jumper floaty, what flags the lifeguards are using to signify the strength of the waves, what may be under the ocean, and, “Mommy do you think Daddy is going too far in the ocean? Can he even touch out there?”

The extra caregiving with siblings is sweet, welcomed, and helpful. However as I had to remind Lawson, “Bubby you don't need to worry about Daddy. Don't let that burden you.”

Similar themes present themselves for caregivers of persons in long-term care facilities.

Being a CNA, nurse, or therapist is also a big job requiring us to make decisions daily on when to care and when to allow those we serve to demonstrate their independence with tasks.

“Is Ms. Smith safe for walking across uneven surfaces or should we simply avoid walks in the courtyard?”

“Don't give Mr. Jones a straw when he drinks. I know he wants one, but sometimes he coughs when doing so.”

“Mrs. Brown, no worries that you are having trouble dressing yourself this morning, I will just do this for you.”

“I know that you transfer on your own with your physical therapist, but they are not here so I am going to help.”

Where do we, as caregivers, draw the line between helping and letting go?

Furthermore, you should ask yourself, “Who is involved in making these decisions within my facility?”

Rehab professionals can often assist in educating and guiding the interdisciplinary team (IDT) in making these decisions for which areas require caregiver assist and which areas we can unburden ourselves.

Additionally, rehab teams should include the necessary education to the IDT as part of discharge planning to promote highest level of independence and avoid cultures of excessive disability and unnecessary caregiver burden.

CMS's expectations for training in these areas is outlined in the critical element pathway for specialized rehab/restorative services (Form CMS 20080) including:

How was the resident/representative involved in decisions regarding their goals, interventions and treatments?

How and by whom were you trained on the resident's therapy or restorative program needs?

How and by whom are therapy and nursing staff supervised and monitored to ensure they are implementing care planned interventions?

How much assistance from staff does the resident need with their therapy or restorative services?

How do you promote and encourage the resident's participation in these services?

Consider reviewing these questions with your teams. Generate conversations on abilities versus need for assist. And see which opportunities are present for caregiver unburdening in your facilities.

Renee Kinder, MS, CCC-SLP, RAC-CT, is Director of Clinical Education for Encore Rehabilitation and is the Silver Award winner in the 2018 American Society of Business Publishing Editors competition for the Upper Midwest Region in the Service/How To Blogs category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association's (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association's Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).

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Rehab Realities is written by Renee Kinder, MS, CCC-SLP, RAC-CT.  She currently serves as Director of Clinical Education for Encore Rehabilitation and acts as editor of Perspectives on Gerontology, a publication of the American Speech Language Hearing Association.

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