By Elizabeth Hansen
As a Physical Therapy Practice Leader, I help patients at the rehabilitation level of care — patients who have sustained a significant injury or disease that has life-changing implications.
Caregivers play an important role in the discharge of these patients from the in-patient context back to the home. They take on the burden of learning the techniques and interventions recommended by the clinical team. They may be learning how to use and maintain new equipment, such as power wheelchairs, feeding tubes, and lifts.
During the COVID-19 pandemic, I have noticed increased distress among both health care providers and family caregivers as patients are getting ready to discharge home, due in large part to challenges posed by the pandemic to family health care education.
The problem is two-fold. Health care providers have limited opportunities to provide hands-on, in-person education to caregivers. Accordingly, they have had to adjust their typical practice and expectations for family skill attainment prior to discharge.
Additionally, the volume and complexity of family training has also increased as a result of the pandemic. Families have been reluctant to transfer their loved ones to subacute facilities because of their initial high numbers of COVID cases and more restrictive visitation policies. As a result, patients are going home in need of more assistance than is typical, but caregivers are not able to receive the optimal amount of hands-on training and learning given the pandemic context.
Prior to the pandemic, it was typical to have a family member or caregiver at the bedside several times a week, often for long stretches of the day. This provided a natural opening for rapport between providers, patients, and families. Informal learning that occurred at the bedside established a foundation for the formal education that is an essential element of health care provision.
At the height of the pandemic in 2020, visitors were prohibited from hospitals and skilled nursing facilities. Visitation policies still have strict limitations in place. Though the circumstances are not ideal, health care providers have risen to the occasion by innovating with pre-existing technologies.
Hospitals have acquired additional tablets to facilitate tele-visits with family, and established accounts with various telehealth platforms. Clinicians have developed and adapted their skillsets to these new technologies.
But the physical context of hospital facilities makes virtual access more complicated.
Early on, re-deployed clinicians were employed as technology wranglers, but these clinicians are back in their regular roles now and are no longer available for this kind of support. Often two people are required to help patients with mobility, and adding a third person to manage video calls via tablets and phones is challenging from both a staffing and social distancing perspective. So we’ve acquired mobile poles equipped with tablet holders for use during mobility activities.
And, despite the limitations of new virtual approaches, there are some benefits, too.
Providers have a clear opportunity to improve access via telehealth. Family support and education groups, as well as clinical family meetings, have moved to a virtual meeting format with great success. Families who can’t easily come to in-person training (due to factors like distance, child care, and work schedules) are now able to observe therapy sessions and do initial training prior to hands-on training at discharge. And extended members of a patient’s support system have more of a chance to participate in these activities.
We should build on the momentum gained in this unique instant in time. The format and approach to family training and education should evolve to provide more inclusion and access to a wider audience. Health care facilities should aim to incorporate new technologies that enhance virtual access for families and health care providers. Ongoing staff training, devices, management of software and device updates, and development of procedural guidelines are necessary for these new approaches to family education to succeed.
Elizabeth Hansen, PT, DPT, HEC-C is a physical therapist and supervisor specializing in adult brain injury and the co-chair of the ethics committee at a rehabilitation hospital in Boston, MA.
This post is part of our digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce.
