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   Families often see their responsibility or role in the care process as ended upon admission of their family member to a long term care facility. Family care participation should continue but in different ways under the supervision of the professional medical staff. The new nursing home resident needs the support of their family more than ever and some family members who have been providing care in their home or the resident’s home may want to continue in a care taker role with facility staff.  If they choose, family members can join the care team rather than stand by and observe.


                                                    PAGE CONTENTS

    Importance of family care participation.

    ∆  Family members on the care team.

    ∆  Finding ways to participate.

    ∆  Limits to family participation in the care process.

  ∆  Importance of family care participation.

    The care participation by family members will have a positive effect on the new resident’s mental and emotional well being.  By maintaining strong family connections similar to that which existed before admission, the patient’s dignity, hope, sense of self, and feeling of control over their new situation can be supported and sustained.

    After the significant life change of entering the institutional setting of a nursing home the new resident will most likely move toward depression and withdrawal without the continued feeling of being cared for by family.  The family caregiver can help the resident build relationships with others, participate in group activities, and see the staff not as a threat but concerned medical professionals who will have primary responsibility for their care.

    The structured operation of a nursing home may overwhelm the new resident and give them a feeling of helplessness with no control over their life or activities.  The caregiving family member can help them make and express independent choices such as what foods to eat, what clothing to wear, when to sit up in a chair, or when they want to have visitors.

    Even without actually doing any hands-on care, the family member can provide emotional support that may result in a healthier resident.

  ∆  Family members on the care team.

    Family members can and should act as positive care team members.  There are different levels of participation for them in the care process going from basic visits and participating in care plan meetings to working hands on with the resident.

    Some examples of family care that have been observed:

     * A family member on hand at each meal to deliver the meal tray to a resident who would not eat food delivered by staff.

    * Family members coming at night to bathe a resident who would not allow staff to provide the bathing assistance she required.

    * Family members coming each day to eat lunch and assist in the feeding a resident who was a poor eater.  The facility provided a free lunch to the family member and the process assured one full meal eaten by the resident each day.

   * A husband with a justifiable medical condition but not needing nursing home level of care, admitting himself to the facility to share a room with his wife to provide companionship and direct supervision of her activities of daily living as his wife moved deeper into Alzheimer's.

   * Family members scheduling weekly outings with a resident and periodic overnight or weekend therapeutic leaves from the facility.

    * A husband went through an internship in the care of his quadriplegic wife at the nursing facility.  When the staff was satisfied with his ability to care for her, she was discharge home with a special program paying him as her care provider.

   * Although the facility may provide transportation to outside medical consultation, family members could provide transportation or if special transportation is required, be with the resident at the medical appointment.

   * Families hire a sitter, a qualified medical care provider approved by the facility and paid by the family, to spend the day with the resident providing assistance with the activities of daily living.

  ∆  Finding ways to participate.

    After supporting their emotional health, there are many ways family members can participate that will support the facility’s plan of care for a resident.  Participating in the care plan process and knowing what the assessment has identified as care concerns is the best place to begin.  If you want to maintain your position as a care giver, discuss with the assessment nurse how you can collaborate and support the goals of the care plan through your everyday contact with the resident.

    Your  part in the care of your family member may be as simple as taking him or her for an inside or outside walk or wheelchair ride or eating with them to encourage their food and liquid intake.  Understand and take part in a toileting schedule to treat the resident’s incontinence.  Get advice from the activities department on appropriate one-on-one activities you can carry on with the resident. Join your family member in attendance to entertainment programs or religions services provided by volunteers in the nursing home.

    There is a wide variety of creative approaches to supporting  the nursing home staff through your participation in the care of your family member. Make the nursing and support staff aware of your interest in joining them to fulfill the care plan then follow their guidance in assisting in the resident’s care needs.  Enthusiasm and interest on your part serves to encourage them to provide good care to a loved one.  It also puts you in a position to better judge the quality of care being provided by the facility.

   For more information on the care planning purpose and process, click HERE to go the the website page Care Plans in the Nursing Home.

  ∆  Limits to family participation in the care process.

        Although it is not a common happening, a nursing home resident has the choice of declining family involvement in their care.  Family members have the right to be involved with the care of a relative in a nursing home within a few boundaries.  The resident must approve the participation by anyone in their direct treatment and care, the family member does not have the right to dictate care processes or treatments, and a disruptive person, family member or otherwise, may be refused admission to the facility.

    The facility staff members have primary responsibility for resident care and family members or sitters should be supportive while not attempting or being allowed to assume any professional responsibilities or replace trained staff in the care process.  Participation in the care process should be that of a supportive family member following the lead of the professional medical staff.  Be cautious to avoid overstepping your authority, knowledge, and role as family member.  Do not attempt to act as another health care professional even if you are. When staff professional responsibility is assumed by others, the facility is failing to meet their care and oversight obligations.  Without direct responsibility by trained staff, the family member may deviate from acceptable health care practices or when the family member or sitter is absent, those staff who have not been doing their part may neglect the care usually provided by a family members or a sitter.

   Some overly enthusiastic family members develop detailed care plans of their own expecting the large number of employees working with their family member to be aware of and fulfill the their requirements and schedules precisely.  Often these processes are important only to the family member and do not improve the resident’s care.  Be realistic and work with staff to limit special care demands to those that are really important, not harmful or time wasters, and will enhance the care of the resident. Such requirements should be discussed at care planning meetings and if worthy, incorporated into the master plan.  Some of the ongoing frustrations of family members flow from their detailed but unrealistic expectations of care tasks they determined are necessary for the welfare of their resident.

    As family members become comfortable in their role assisting in the care process, they sometimes start caring for the family member’s roommate or other residents they have come to know.  It is important to restrict your care activities to your family member and then only doing those things approved by the nursing staff.  Certainly in an emergency or when you can prevent immediate harm to another resident, temporary assistance while waiting for staff to intervene would be appropriate.  For everyday assistance and care of other residents, call the nursing staff to do the job.  Even helping another resident walk, eat, or transfer to a wheelchair should not be done.  Call the trained staff and let them be sure the care is done right.

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