Care team coordination is a strategic way to care for an aging parent or loved one, as this approach focuses on distributing tasks among a group of individuals, rather than placing the burden of caregiving tasks on a primary caregiver.
Using this approach members of the caregiving team coordinate with one another to stay abreast of care transitions and unmet needs of a loved one. This means team members openly share information, arrange care support services, and report changes in a loved one’s medical condition to other team members.
There are several benefits to this approach as having a team of professionals and family members work together to care for your loved one can result in positive outcomes of a shared workload, thereby decreasing caregiver distress and burnout.
This article will provide tips to help you coordinate care with others that are willing to help.
Despite being close to your aging parent or loved one, you may feel overwhelmed by the amount of care coordination involved in providing proper care.
In fact, when you work as a team with others, misunderstandings or miscommunication may lead to conflicts. If you seek to save time and energy, it is vital to have a solid plan.
Make a care plan of how the team will work and decide the duties of everyone. If the patient is in the hospital and is about to discharge, plan the aspects of caregiving before they get discharged.
It may involve considering the current health status, action plan to improve the health, and arrangement of the community resources if needed, etc. In case the team is based on family members, evaluate if the team is experienced in taking care of the patient or if there is a need for skilled and experienced professionals.
Delegating tasks is necessary to clearly state the responsibilities of everyone on the care team and avoid potential conflict. Be sure team members have a mutual understanding of who will be responsible for each task to ensure there is a smooth transition of care.
For example, one care team member might be held responsible for filling prescriptions, another ensures a loved one is accompanied to routine checkups, and a third might oversee physical therapy instructions and ensure they are followed.
Effective delegation of the tasks helps every caregiver coordinator remain involved and play their part in taking care of their aging loved one without feeling burnt out or frustrated.
When family caregivers and the health care team decide to work together, it is likely that there will be conflicts and disputes. It is not realistic to expect everyone to be on the same page all the time.
Rather than ignoring the potential for disputes, it is best to acknowledge your differences and refocus the conversation to meet the needs of your loved one. For example, the care team may disagree about a particular intervention, resulting in a conflict.
It is important to remember that the purpose of coordinated care is to ensure your loved one gets the best care. Try to avoid making the conflict about you as this is counterproductive.
Rather, work to prioritize your loved one’s wellness. If you still fail to settle the dispute, consider involving a neutral third party, such as a geriatric care manager, professional counselor, respected elder, clinical social worker, a mediator, or other healthcare professionals.
Conflicts are normal and demonstrate care and concern. However, conflicts are only positive if everyone is advocating for the best interest of your loved one. If anyone is putting their needs above the needs of your loved one, you might want to weigh removing them from the care team.
One of the main goals of setting up a care coordination team for a loved one is to design a formal structure to ensure each member of the care team is responsive and updated about the evolving needs of your loved one.
During a care team meeting, caregivers can review the clinical and nonclinical status of a loved one and evaluate the care plan accordingly. If follow-up is needed, team members make the appropriate changes and inform other members.
Care team meetings are usually more effective if the attendees are present. However, if members of the health care organization or the caregiver find that attending every meeting in person is too difficult, members can attend the meeting via phone or online conferencing.
Establishing regular communication methods and creating an alternative plan B in case any conflicts arise is important. Not ironing out a clear plan and efficiently exchanging information in a timely manner may create unwanted challenges.
There are three categories of care team meetings to consider, which are mentioned below:
This meeting is organized for the team members to gather relevant information to provide advocacy for their loved ones in a collaborative manner.
The primary caregiver exchanges essential information to formulate caregiving strategies.
The shared information might include the required social services, behavioral health details, clinical status of the patient, and medications. All members of the caregiving team need to be present at the meeting. This type of meeting is held only when a loved one is going from the hospital to home or long-term care.
This meeting can be scheduled at regular intervals. During formal meetings, any changes that occurred since the last meeting are discussed.
Care team members can review the initial plan and make changes if required. New strategies can be integrated into the care plan to address your loved one’s unmet needs.
A formal caregiving meeting should be attended by the primary care providers. If a team member is not present, make sure to share all necessary points discussed in the meeting. Moreover, additional staff can be included if the patient needs them.
For example, you may want to call a medical specialist, social worker, or mental health caregiver, depending on the needs of your loved one.
An informal meeting can be helpful for care team members to stay in touch between formal meetings.
For example, if you or your loved one feels overwhelmed and needs emotional support, an informal caregiving meeting can be arranged.
An informal caregiving meeting might be scheduled to briefly review new information about your loved one to address potential challenges or to communicate new information. An informal care team meeting should be brief, so they can even be held daily. Alternatively, they can be arranged as per the request of a team member.
The role of a caregiving team is not limited to accomplishing tasks and attending meetings.
Team members should care for and support one another as well. It is not uncommon for members of the care team to experience feelings of sadness, hopelessness, frustration, and physical exhaustion.
In fact, caring for someone you love can feel like a series of never-ending tasks. It is vital to demonstrate kindness, compassion, and understanding to care for team members when they are feeling overwhelmed.
Your loved one may require skilled services to improve their condition.
Skilled services are generally provided by a licensed professional like a registered nurse or physical therapist to improve their condition.
You might consider working with a professional care coordinator who would be responsible for making a list of the service providers so the best one can be chosen according to your loved one’s care needs and budget.
In case your loved one is eligible for skilled nursing placement; a professional care coordinator helps you determine the best option.
Long-term caregiving will require your loved one’s care team to work together to meet the needs of the loved one they’re providing care for. This means that whether your loved one requires a hospital stay, routine checkups, scheduling of medical procedures, or medical tests - care team members must work together.
All these responsibilities will likely be overwhelming for just one individual caregiver.
You might consider expanding the team to involve agencies or health service providers once your loved one returns home. Communication is the key when it comes to providing ongoing support and guidance.
Unfortunately, family caregivers typically have to make complex decisions under challenging circumstances.
However, with the right care team in place, caregivers increase the likelihood of successful caregiving. Your caregiving situation can be greatly enhanced when you have a trustworthy care team consisting of primary care physicians, family members, and accountable care organizations supporting you.
Having a clear understanding of what constitutes a care team and how you can make the process work best for your family can make a big difference in the care you provide and how you cope long-term.
Dr. Eboni Green is a Registered Nurse and family caregiver expert. She holds a Ph.D. in human services, with a specialization in health care administration. She has extensive experience focusing on caregivers' health and wellness, with an emphasis on caregiver stress, burnout, and related family conflicts. She has contributed to several publications and given presentations that focus on training, assessing, and supporting caregivers throughout their caregiving journeys. Green is also a published author and has written three books focusing on family caregiving: At the Heart of the Matter, Caregiving in the New Millennium, and Reflections from the Soul.
Ready Set Care is creating a community to provide guidance for anyone caring for an aging loved one.
If you know someone that could benefit from our website, click the share icons below
or copy link below