Implementation of guidelines to integrate the caregiver as a coassistant of health-care personnel during the hospital stay of COVID-19 pediatric patients: adaptation in a Mexican public pediatric hospital / Implementación de guías para integrar al cuidador como coauxiliar del equipo de salud durante la estancia hospitalaria del paciente pediátrico con COVID-19: adaptación en un hospital pediátrico público mexicano

Abstract This paper describes the experience in a public pediatric hospital when implementing the Mexican Health Ministry’s recommendations on the inclusion and importance of a chosen caregiver during the hospitalization of a coronavirus disease 2019 (COVID-19) pediatric patient. The implementation includes the adjustments, observations, and limitations made in real practice and process. In conclusion, the value and benefits of the accompaniment of hospitalized children with COVID-19 by a primary or chosen caregiver are evidenced and supported by family-centered care. Furthermore, the recommendations mentioned result in comprehensive bio-psycho-social care for the benefit of pediatric patients.

Resumen Se describe cómo el Hospital Infantil de México Federico Gómez pone en funcionamiento las recomendaciones publicadas por la Secretaría de Salud sobre la inclusión y la importancia del acompañamiento de un cuidador primario durante la hospitalización del paciente pediátrico con COVID-19. Se incluyen las adecuaciones, las observaciones y las limitaciones del proceso. Se concluye acerca de la importancia de la flexibilidad y el buen uso de los recursos en la implementación de la guía. Además, se examinan la atención biopsicosocial integral en beneficio de los menores y la importancia del acompañamiento, que se sustenta en la atención centrada en la familia y la integración del cuidador como auxiliar en el equipo médico.

Receipt of Posthospitalization Care Training Among Medicare Beneficiaries' Family Caregivers.

Importance: Medicare conditions of participation require hospitals to provide training to family and unpaid caregivers when their support is necessary to enact the postdischarge care plan. However, caregivers often report feeling unprepared for this role. Objective: To describe the characteristics of caregivers who assist with posthospitalization care transitions and assess the prevalence of and factors associated with receipt of adequate transitional care training. Design, Setting, and Participants: This cross-sectional study analyzed data from the 2017 National Health and Aging Trends Study and its linked National Study of Caregiving, surveys of Medicare beneficiaries and their family and unpaid caregivers. The present study included family caregivers for community-living Medicare beneficiaries 65 years or older with disabilities. Data analysis was performed from June to September 2020. Main Outcomes and Measures: Characteristics of family caregivers by whether they assisted during a posthospitalization care transition in the year preceding the survey interview. Unweighted frequencies and weighted percentages, as well as the results of weighted Pearson and Wald tests for differences between groups, are reported. Receipt of the training needed to manage the older adult's posthospitalization care transition (hereafter referred to as adequate transitional care training) as a function of individual caregiver characteristics was modeled using multivariable, weighted logistic regression. Results: Of 1905 family caregivers, 618 (58.9%) were 60 years or older, 1288 (63.8%) were female, and 796 (41.7%) assisted with a posthospitalization care transition. Those who assisted with a posthospitalization care transition were more likely to report experiencing financial (154 [18.3%] vs 123 [10.1%]; P < .001), emotional (344 [41.3%] vs 342 [31.1%]; P < .001), and physical (200 [22.2%] vs 170 [14.6%]; P = .001) difficulty associated with caregiving. Among caregivers who assisted during a posthospitalization care transition, 490 (59.1%) reported receiving adequate transitional care training. Caregivers were less likely to report receiving adequate training if they assisted an older adult who was female (316 [62.3%] vs 227 [73.2%]; P = .02), Black (163 [14.0%] vs 121 [19.8%]; P = .02), or enrolled in Medicaid (127 [21.2%] vs 90 [31.9%]; P = .01). After adjusting for older adult characteristics, caregivers were half as likely to report receiving adequate training if they were Black (adjusted odds ratio [aOR], 0.52; 95% CI, 0.31-0.89) or experienced financial difficulty (aOR, 0.50; 95% CI, 0.31-0.81). Caregivers were more than twice as likely to report receiving adequate training if they were female (aOR, 2.44; 95% CI, 1.65-3.61) or spoke with the older adult's clinician about his or her care in the past year sometimes or often vs never (aOR, 1.93; 95% CI, 1.19-3.12). Conclusions and Relevance: In this cross-sectional study, caregivers were less likely to receive adequate transitional care training if they were Black; experienced financial difficulty; or cared for a Black, female, or Medicaid-enrolled older adult. These findings suggest that changes to the discharge process, such as using standardized caregiver assessments, may be necessary to ensure equitable support of family caregivers.

Implementation of guidelines to integrate the caregiver as a coassistant of health-care personnel during the hospital stay of COVID-19 pediatric patients: adaptation in a Mexican public pediatric hospital.

This paper describes the experience in a public pediatric hospital when implementing the Mexican Health Ministry's recommendations on the inclusion and importance of a chosen caregiver during the hospitalization of a coronavirus disease 2019 (COVID-19) pediatric patient. The implementation includes the adjustments, observations, and limitations made in real practice and process. In conclusion, the value and benefits of the accompaniment of hospitalized children with COVID-19 by a primary or chosen caregiver are evidenced and supported by family-centered care. Furthermore, the recommendations mentioned result in comprehensive bio-psycho-social care for the benefit of pediatric patients.

The Question-prompt list (QPL): Why it is needed in the Indian oncology setting?

BACKGROUND: In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision-makers for the patient. Further, owing to acute resource constraints in the Indian healthcare system, it may be difficult for oncologists to assess and elicit questions from each patient/caregiver. Consequently, there is a need to address these unique aspects of oncology care in India to improve patient outcomes and understanding of their illness and treatment. This can be achieved through a Question Prompt List (QPL), a checklist used by care recipients during medical consultations. RECENT FINDINGS: This narrative review will first introduce research on the development and effectiveness of the QPL, and then it will highlight current gaps in oncology care in India and explore how the QPL may aid in closing these gaps. A literature search of the empirical research focused on the development, feasibility and acceptability of the QPL in oncology settings was conducted. The final review included 40 articles pertaining to QPL research. Additionally, psycho-oncology research in India centered on information needs and experiences was reviewed. Current Indian psycho-oncology research reports patients' want to be actively involved in their cancer care and a need for more illness information. However, a high demand on physicians' resources and the family caregivers' interference can be barriers to meeting patients' information/communication needs. International research demonstrates that a QPL helps structure and decrease consultation time, improves patient satisfaction with care, and improves the quality of communication during medical encounters. CONCLUSION: QPLs for Indian patients and caregivers may focus on the scope of medical consultations to address patient needs while influencing the course and content of the patient-caregiver-physician interactions. Further, it can address the resource constraints in Indian oncology care settings, thus reducing the physician's burden.

Process lessons from evaluating a combined continuity of carer and home birth scheme.

INTRODUCTION: Continuity of midwifery carer improves outcomes, but there is significant variation in how such schemes are implemented and evaluated cross-culturally. The Angus home birth scheme in Scotland incorporates continuity of carer throughout pregnancy, labor, birth, and the postnatal period. METHODS: Manual maternity case note review to evaluate the 80% continuity of carer and 3% planned home birth rate targets. RESULTS: Of 1466 women booking for maternity care, 69 joined the scheme. Forty-four had a planned home birth (3% overall), of whom seven were originally deemed ineligible. Of the 44, eight (18%) also achieved 80% continuity of carer with the primary midwife; by including a home birth team colleague, the continuity rate rose to 73%. Women whose care achieved home birth and continuity targets had lower deprivation scores. Eligibility issues, women's changing circumstances, and data recording lapses were complicating issues. CONCLUSIONS: Targets must be both feasible and meaningful and should be complemented by assessing a broad range of outcomes while viewing the scheme holistically. By expanding eligibility criteria, the home birth rate target was met; including input from a home birth team colleague in the calculation meant the continuity target was nearly met. With dedicated and competent staff, adequate resource and political support, and when considered in the round, the scheme's viability within local services was confirmed. Other generalizable learning points included the need to standardize definitions and data recording methods. Comparability across schemes helps grow the evidence base so that the links between processes and outcomes can be identified.

Cuidadores de adultos mayores durante COVID-19 [infografía]

Consejos para cuidadores de adultos mayores. Cuidar de un adulto mayor puede ser gratificante y al mismo tiempo desafiante, sobre todo en situaciones estresantes como la pandemia por la COVID-19.

Digital Technology, Health and Well-Being and the Covid-19 Pandemic: It's Time to Call Forward Informal Carers from the Back of the Queue.

OBJECTIVE: To describe the current challenges of family caregivers during and beyond the COVID-19 pandemic, the need for future digital innovations including involvement from professional nursing roles. DATA SOURCES: Review of recent literature from PubMed and relevant health and care reports. CONCLUSION: The COVID-19 pandemic has caused monumental disruption to health care delivery and care. Caregivers face unprecedented levels of uncertainty: both for the people they care for and for their own health and well-being. Given that many carers face poor health and well-being, there is a significant risk that health inequalities will be increased by this pandemic, particularly for high-risk groups. Innovations including those supported and delivered by digital health could make a significant difference but careful planning and implementation is a necessity for widespread implementation. IMPLICATIONS FOR NURSING PRACTICE: Carers need to be championed in the years ahead to ensure they do not become left at the "back of the queue" for health and well-being equity. This situation has been exacerbated by the COVID-19 pandemic. Disruptive change to health and social care is now required where digital health solutions hold considerable promise, yet to be fully realized.

Webconferência: cuidado do idoso com ou sem dependência no domicílio - Telessaúde ESWebconferência Cuidado do Idoso com ou sem dependência no domicílio- Telessaúde ES 29/01/2014

Advice for caregivers of people with dementia during COVID-19

Caregivers of people with dementia are facing new challenges during the COVID-19 pandemic. This video provides practical advice to help them reduce their level of stress and to improve their mental health and well-being. The messages are extracted from iSupport, WHO’s knowledge and skills training programme for caregivers of people with dementia.

Co-creating a process of user involvement and shared decision-making in coordinated care planning with users and caregivers in social services.

PURPOSE: Although user participation and shared decision-making in formal statutory coordinated care planning are described as central, they remain to be implemented. The aim of this study is to explore how collaboration and shared decision-making in the social services can be realized in formal care planning activities with people with mental disabilities. METHODS: We conducted eight workshops with 12 users and 17 caregivers to investigate existing barriers to and possible solutions for participation in coordinated care planning. RESULTS: Workshop formats and techniques from participatory design generated rich research materials illustrating challenges currently experienced by users and caregivers in care planning work, as well as a large variety of solutions to these challenges. They also illustrated differences in how participation is understood and the conditions required to realize shared decision-making between users and caregivers. CONCLUSIONS: An improved coordinated individual plan (CIP) process emerged, based on the active participation of users and caregivers. This process is a familiar and transparent process for users and caregivers, reflecting the needs and preferences of users at all stages. It requires careful preparation and collaboration with the users, as well as caregiver flexibility.

Necesidades atendidas por las personas cuidadoras familiares de mayores dependientes en un hospital de media-larga estancia / Basic needs met by caregivers of older relatives in a long-term care hospital

OBJETIVOS: Identificar las características de las personas cuidadoras familiares de mayores dependientes en un hospital de media-larga estancia, conocer la intensidad del cuidado, describir la labor cuidadora que realizan dichas personas en el hospital e identificar su nivel de sobrecarga y ansiedad. MÉTODO: Estudio descriptivo transversal en el Hospital Universitario Dr. Sagaz de Jaén (Andalucía, España). Muestra no probabilística de 270 personas cuidadoras familiares de mayores dependientes. Mediciones principales: necesidades básicas atendidas por las personas cuidadoras familiares durante la estancia en el hospital (según índice de Barthel), sobrecarga subjetiva (índice Esfuerzo del cuidador) y ansiedad (escala de Hamilton). Análisis principales: análisis descriptivo mediante porcentajes, medias, desviaciones típicas e intervalos de confianza al 95%. RESULTADOS: la mayoría de las personas cuidadoras estudiadas eran mujeres (87%), hija o hijo de la persona cuidada (54%), que compartía residencia con esta (68%) y a la que cuidaba en el domicilio antes de ingresar en el hospital (73%). En el hospital atendieron una media de 4,87 actividades básicas de la vida diaria. Las necesidades básicas más atendidas fueron: alimentación (83%), micción (83%), aseo personal (73%), empleo de ducha o baño (69%). El 46,3% de las personas cuidadoras presentó sobrecarga subjetiva y el 60,7%, ansiedad. CONCLUSIONES: La persona cuidadora hospitalaria es mujer, ama de casa, hija de la persona cuidada y comparte domicilio con esta. La intensidad del cuidado es alta. Las necesidades de alimentación, ducha o baño y aseo personal son las más prevalentes. Dichas cuidadoras presentan altos niveles de sobrecarga y ansiedad

OBJECTIVES: To identify the characteristics of family caregivers of elderly dependents in a hospital of medium-long stay, know the intensity of care, describe the care work performed by these caregivers and identify their level of subjective burden and anxiety. METHOD: Cross-sectional study in the Hospital Universitario Dr. Sagaz (Jaén, Andalusia, Spain). Non-probabilistic sample of 270 family caregivers of dependent elderly were recruited. Main measures: basic needs attended by family caregivers in the hospital (according to the Barthel Index), subjective burden (Caregiver Strain Index) and anxiety (Hamilton Anxiety Scale). Main analyses: descriptive analysis using percentages, means, standard deviations and 95% confidence intervals. RESULTS: the majority of the caregivers studied were women (87%), daughter or son of the care recipient (54%) who shared a residence with him or her (68%) and already care for her or him at home before entering the hospital (73%). In the hospital, caregivers attended an average of 4.87 basic activities of daily life. The most frequently attended basic needs were: nutrition (83%), micturition (83%), personal hygiene (73%) and shower or bath use (69%). CONCLUSIONS: The hospital caregiver is a woman, housekeeper, daughter of the care recipient and shares home with him/her. The intensity of care is high. The needs of nutrition shower or bath and personal hygiene are the most prevalent. These caregivers have high levels of burden and anxiety

Informal carers and peer support in pulmonary rehabilitation: an underutilized resource?

PURPOSE OF REVIEW: The aim of this review is to discuss the recent literature relating to the involvement of informal carers and peer support in pulmonary rehabilitation. RECENT FINDINGS: Informal carers and peer support have been identified by both patients and healthcare workers as a crucial component in the care of those with chronic respiratory disease at home. Pulmonary rehabilitation, a cornerstone in the management of patients with breathlessness, is limited in its clinical effectiveness by poor referral, uptake and completion rates. Engagement of informal carers and support from peers may help maximize the utilization of pulmonary rehabilitation. SUMMARY: This review highlights the need for more good-quality randomized controlled trials in identifying suitable interventions that may increase uptake and completion of pulmonary rehabilitation programmes. Qualitative studies have highlighted the potential for informal carers and peer support to play a key role in the design of research programmes, and in the delivery of pulmonary rehabilitation. This needs to be addressed in future research.

La salud de las personas cuidadoras no remuneradas durante la pandemia

La pandemia por la COVID-19 ha puesto nuevamente en agenda el debate central sobre el cuidado de la salud, donde los cuidados que prestan las mujeres en los hogares son esenciales; sin embargo, este trabajo aún es poco visible y reconocido.

Intergenerational Relationships, Family Caregiving Policy, and COVID-19 in the United States.

Families and intergenerational relationships are important sources of risk for COVID-19 infection, especially for older adults who are at high risk of complications from the disease. If one family member is exposed to the virus they could serve as a source of transmission or, if they fall ill, the resources they provide to others could be severed. These risks may be especially heightened for family members who work outside the home and provide care, or for those family members who care for multiple generations. Policies have the potential to help families bear the burden of these decisions. This essay argues that policies that address health, employment, and other social issues have implications for families, and that policies aimed at families and caregivers can affect the health, employment, and the general well-being of the nation.

Safety and placement stability for the Children's Home Network kinship navigator program.

BACKGROUND: With the passage of the Families First Prevention Act, kinship navigator programs have growing support as an intervention to connect kinship families to needed resources. Growing evidence has helped to showcase the outcomes, but no study has shared follow up outcomes past twelve months. OBJECTIVE: This study examined the 12, 24 and 36 month follow up child safety (substantiated abuse record) and placement stability (disruption in placement) outcomes from state administered secondary data for children whose caregivers participated in the Children's Home Network-Kinship Navigator Program (CHN-KN). SETTING: Study participants were 240 (60 in each group) randomly selected kinship caregivers who were enrolled in four treatment groups in CHN-KN (Standard Kinship Navigator, Kinship Navigator with Innovations, Kinship Navigator with Peer-to-Peer only, and Usual Child Welfare). METHODS: Repeated measures anovas were used to show between group differences for each study group. RESULTS: Results show that children living with caregivers who received Kinship Navigator Programs (Kinship Navigator Peer to Peer and Kinship Navigator with Innovations) were the least likely to be involved in a substantiation of child abuse or neglect and most likely to remain in the home of a relative at 12, 24 and 36 month follow up. CONCLUSIONS: Results suggest that the kinship navigator programs could improve child safety and placement stability. This study can help to inform the replication of the CHN-KN model and provide additional supported evidence to inform practice.

Self-Direction of Home and Community-Based Services in the Time of COVID-19.

During the COVID-19 pandemic, nursing homes and assisted living facilities have accounted for over 20% of all infections, adult day care and other congregate sites have closed, and traditional home care agencies are facing staff shortages. In this environment, self-direction of home and community-based services, where the participant can hire their own staff and manage a budget that can be used for a broad range of goods and services including home modifications and assistive devices, is seen as a promising intervention. Using self-direction participants can minimize the number of people who enter their homes and pay close family and friends who were already providing many hours of informal care, and now may be unemployed. The Center for Medicare and Medicaid Services is encouraging this approach. This commentary presents information on how states have responded using the new CMS Toolkit by expanding who can be a paid caregiver, increasing budgets and broadening the kinds of items that can be purchased with budgets to include items like personal protective equipment and supports for telehealth. This Commentary concludes with policy and research questions regarding how the delivery of long-term services and supports (LTSS) may change as the world returns to"normal".