Topic: 11

How to Communicate Effectively with Family, Doctors, and Helpers

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What You Need to Know

As a caregiver, you will often provide the communication “glue” that keeps everyone informed. Information often overlaps between various people on the care team or in the circle of care while some information is unique to each person. Knowing how to communicate effectively with those in the circle of care can save you time and frustration.

How to Communicate Effectively with Family Members

What do we know for certain about families today?

  • Traditional families are changing.
  • Families are often spread out and living apart.
  • Families can include friends and/or blood relations.
  • Families have “norms” or unwritten “rules” by which family members behave.
  • Unresolved family issues and family disagreements will often arise in times of crisis. Even if they don’t, they can still exist under the surface.

Triggers for stress: Facing a family member’s significant illness is extremely stressful and can trigger reactions and emotions that are rooted in long-standing relationships. Families need to talk about their feelings and concerns. It is natural for family members to be anxious and upset. Sometimes families disagree with the person’s care choices and that can cause conflict. One sibling may have been designated as the person’s substitute decision-maker and must manage conflicts with other siblings caused by differences in opinions, values or beliefs. In the case of a second marriage, a spouse who is not a parent of the person’s children may be the substitute decision-maker which can cause conflict with the ill person’s own children.

Supporting the family means being a good listener, being non-judgmental and providing honest reassurance.

  • As the person’s caregiver, make having a good relationship with family members a high priority. This relationship will help reassure family members that their loved one is receiving excellent care.
  • Spend time reviewing how you care for the loved one so people feel included and can offer to help you.
  • Respect each family member and try to understand their issues.
  • Take the time to reminisce, laugh and cry as a family.

How to Communicate Effectively with Doctors

There may be several health care professionals, including doctors, who are involved in the care of the person. It is best if you use your time with the person’s doctor and healthcare professionals wisely. To do that, be prepared!

  1. Write down your most important questions or concerns in advance and take your list with you. Start with the single most important question or concern that you have. For example, any new pain or symptom must be addressed immediately so help can be provided.
  2. Record the answers (on your phone or write them down) or take someone with you to help listen to and record the answers too.
  3. Be honest with the doctor by making sure that you tell the doctor about any other medical or complementary therapies that the person is trying so your doctor has the full picture of how the various medications might interact, what you are observing, if and how symptoms are changing.
  4. Get to the point by telling the doctor clearly and briefly what is of concern.

If you don’t understand the answer, ask another question. Make sure you understand the advice the doctor gives before you leave the office.

Understanding the Personal Support Worker’s Role

You may have Personal Support Workers (PSWs), visiting nurses, therapists and volunteers from a local hospice all coming into your home to help with the caregiving. Be sure to treat these individuals as colleagues or allies in the care of the person.

Personal Support Workers (PSW's) are what are referred to as unregulated health care providers. This simply means that there is no governing body which sets standards for the skills and knowledge needed to practice.   As a result, the skills, accreditation and supervision of PSWs can vary widely in Canada. However, PSWs must always work within the bounds of applicable legislation and regulation and must be accountable to:

  1. The client and or family caregivers;
  2. The employing agency that has hired the PSW; and
  3. Other health care professionals who are caring for the person.

This critical job description includes managing daily tasks for people who are suffering from illness, injury or dealing with the effects of aging.

A professional Personal Support Worker will:

  • Recognize the role of the family and friends in being caregivers;
  • Explain their role as a PSW in providing support;
  • Identify how other caregivers and the PSW will support one another’s role; and
  • Recognize that sometimes conflicts can occur between other caregivers and PSWs and attempt to resolve the issue.

When communicating with a PSW, remember that:

  • The PSW is trained to maintain a distance, a separation, a formal kind of relationship;
  • Your observations and concerns important so share them with the PSW;
  • Working collaboratively with the PSW making the best interests of the person being cared for the top priority.

Home care

  • Home and community services support people of all ages who require care in their home, at school or in the community.
  • Seniors and people with complex medical conditions of all ages can often stay in their own homes if they have some support.
  • If you qualify, the Ontario government pays for a wide range of services in your home and community.
  • If you don’t qualify for funding, you may be eligible for community support services that often have a client co-payment. You can also get help from private companies for a fee.

How to arrange home care and community services: Local Health Integration Networks arrange all government-funded services for people living at home. LHINs are responsible for deciding who receives care, the level of care you need and for how long. To start this process: 1. Call your Local Health Integration Network You will be introduced to a case manager or care coordinator. To contact your local LHIN:

2. Check if you qualify for government-funded services

Your case manager will determine if you qualify. If you don’t qualify, you may be able to receive services through community agencies, which may require a co-payment. You can arrange and pay for services through a private company. Your LHIN can help you find services in your community

3. Tell the case manager about your needs

Your case manager will tell you what services your LHIN can provide and what’s available in your community. Government-funded services are delivered by health professionals and personal support workers who are under contract with your LHIN.

4. Arrange a home visit

Your case manager will need to visit your home to assess your health. If you qualify, your case manager will create a customized home care plan that meets your specific needs. If your needs change, your case manager can reassess your health and adjust your plan of care.

5. Apply for care

If you qualify for government-funded care, your LHIN will coordinate your application and select the provider for you. To arrange private care, you must contact the service provider directly.

If you don’t qualify

If you don’t qualify for government-funded services and believe that you should, you can appeal the LHIN decision through the Ontario Health Services Appeal and Review Board (HSARB). You can also contact the Board if a service you previously received has stopped or been reduced.

Contact HSARB:

416-327-8512 (Toronto area)
1-866-282-2179 (toll-free)

In Home Services

In Ontario, in home services are made up of:

1. Health care professionals

You can arrange to have health professionals visit you in your home. They can assess your needs, provide care or help you to care for yourself by providing:

  • nursing care – including help to take medications, change bandages and clean wounds, recover from an injury or health problem, check your health, create a care plan
  • physiotherapy – including help for back pain, mobility problems, blood circulation, pain relief and relaxation
  • occupational therapy – including help to make day-to-day activities easier and make it easier to move around in your home
  • speech-language therapy – including stroke recovery for seniors who have difficulty speaking or understanding speech
  • social work – including help for caregivers to cope and manage stress, help for families to address conflicts
  • healthy eating – including help to assess eating habits and create a healthy eating plan
  • home healthcare supplies – including dressings, walking aids, braces, cushions

2. Personal care

You can arrange for health care professionals to help you with your daily care or help you safely manage these activities yourself. They can help you with:

  • washing and bathing
  • mouth care
  • hair care
  • preventative skin care
  • routine hand or foot care
  • getting in and out of chairs, vehicles or beds
  • dressing and undressing
  • eating
  • toileting
  • taking you to appointments

3. Homemaking

To help maintain a safe and comfortable home, homemaking services can assist you with routine household activities including:

  • housecleaning
  • doing laundry
  • shopping
  • banking
  • paying bills
  • planning menus
  • preparing menus
  • caring for children

4. End-of-life care at home

If you or a loved one requires end-of-life care at home, there are many programs in Ontario that can help you. You can request:

  • nursing and personal care
  • medical supplies, including low-cost medication for seniors through the Ontario Drug Benefit Plan
  • tests
  • hospital and sickroom equipment
  • transportation to other health services
  • help to manage pain
  • home hospice services – including in-home visits and respite care by trained volunteers

How to make a complaint

To report harm, neglect or other complaints about home care in Ontario, call the Long-term Care ACTION Line:

  • Toll-free: 1-866-434-0144
  • Hours of operation: 8:30 a.m. to 7:00 p.m., 7 days a week

(Retrieved from Ontario’s Home and community care: How to get help for patients and seniors who need support living at home website
https://www.ontario.ca/page/homecare-seniors)

 

1. Read this scenario.

Ashira is a 72 yr. old female who suffers from Type 2 Diabetes. Six weeks ago Ashira had a hip replaced. She is home now being cared for by her husband, Sawarran, and a PSW who comes into their home once a week. This morning, Ashira complained to her husband that she is seeing double in one eye. What should he do?

  • Wait for the PSW to come in a day or two and ask her about the double vision?
  • Call the doctor and make an appointment for as soon as possible?
  • Wait and see if it reoccurs and then call the doctor?
  • Email the doctor now?
 2. What advice would you give Sawarran and why? Think about your advice before checking the suggested response below.

Suggested response:

Sawarran should call the doctor and make an appointment for as soon as possible. Double vision is a serious concern and in all likelihood directly connected to the Diabetes. Uncontrolled Diabetes can be life threatening. In all the other possible answers too much of a delay would be created in getting to see the doctor; therefore, Sawarran is best to choose the option that gets his wife in to see the doctor as soon as possible.

 

Use these additional resources to learn more about the topic of communicating effectively with family, health care professionals and personal support workers.

Ontario College of Physicians Guide to Communicating with Patients
http://www.cpso.on.ca/Policies-Publications/The-Practice-Guide-Medical-Professionalism-and-Col/Principles-of-Practice-and-Duties-of-Physicians/Duties-To-the-Patient/Duties-to-the-Patient-Communicating-with-Patients

Canadian Cancer Society Coping Within a Family
http://www.cancer.ca/en/cancer-information/cancer-journey/if-you-re-a-caregiver/?region=on

Importance of Communication