The management of patient care needs by family members in the home setting continues to increase. Whether the reason care is required is due to postoperative management or post-hospital management, family members are being called upon to care for loved ones in the home. With shorter hospital stays, the family is taking on more responsibility for this care at an earlier stage in recovery. Family members need to manage medications, diet, mobility, monitoring equipment, and follow-up appointments and maybe even wound management, and that is just the start of the list. The problem is that most of these family members have no healthcare experience and are overwhelmed with anxiety and uncertainty about this new role. The term "family member" may refer to others including friends, neighbors, church support groups, and so forth. The family caregiver is a person who will be responsible at the time of hospital discharge. A patient may have more than one family caregiver.
The Caregiver Advise, Record, Enable (CARE) Act is now the law in 36 states plus Washington, DC, Puerto Rico, and the U.S. Virgin Islands. This Act requires that hospitals record who the patient's primary caregiver in the home setting will be; the hospital must make an effort to educate the caregiver about home-going responsibilities and give notice to the family member of the proposed discharge date. You may visit the American Association of Retired People (AARP) website for a map of the states that have this law in place: https://www.aarp.org/politics-society/advocacy/caregiving-advocacy/info-2014/aar.
As the nurse caring for the patient in a state where this law is enacted, you will now need to address how you and your facility will manage this process and ready the patient and the caregiver for discharge.
The AARP has helped lead the charge to help family caregivers. The AARP Family Caregiving website (https://www.aarp.org/caregiving/) provides a tremendous amount of information that will be helpful for nurses, patients, and caregivers.
Wolff, Feder, and Schulz (2016) suggest that to support the important work that family members provide, a National Family Caregiver Strategy should be developed. With the changes in length of stay for hospitalized patients, the need for family caregivers will only increase. This discussion will need to include many different stakeholders including nurses who understand the demands placed on family caregivers. Nurses need to be part of the discussion to ensure that all of our patients' needs and their caregivers' needs are understood and met.
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