Project Update - July 2003

A partnership is a "mutually beneficial relationship" (Frank and Smith, 2000). VON Canada, over the last 3 years, has been exploring new ways to care for caregivers in our everyday practice as 'partners in care.' The question we have been exploring is: "How do we as providers develop therapeutic partnerships with caregivers to ensure positive outcomes for caregivers?"

The Partnership Model - Making it Work for VON

Working together on mutual goals and shared responsibility is a cornerstone of our practice with clients in home and community care. The VON Canada Learning to Listen - Listening to Learn Project is developing, implementing, and evaluating a national best practice and educational strategy to be more responsive to the needs of caregivers as partners. This strategy supports the role of the provider to build strong working relationships and partnerships to achieve positive outcomes for both the caregiver and care receiver. Partnerships take many forms, interpersonal partnerships between caregivers and providers; and partnerships in the Branch programs, or the wider community to support caregivers.

The role of caregivers suggest an ambiguous relationship between the formal system and the caregiver, however, it was clear the relationship is complex and dynamic - each relied on the other for support. According to Twigg (1989), caregivers are seen as either

• 'Resources' responsible for providing hands-on care
• 'Co-clients' with their own needs
• 'Partners' contributing to the relationship bringing knowledge, skills, and experience to the situation
  

Therefore, as an organization, we are examining our practice with caregivers. We have concluded that we approach caregivers more as 'co-client' with their own needs with many programs and services that target caregivers as clients. We are exploring ways to move towards a 'partnership' model and are piloting several interventions including staff education, program changes and a community awareness campaign.

Understanding our Values

A partnership model of care has values that affect the way we approach caregivers. These values include: assumptions about family care, the reality of caregiving and choices in care, listening to the voices of caregivers, and respite as outcome.

Assumptions of Family Care

In the past decade, the Canadian health care system has undergone drastic changes with community-based care often seen as a cost effective alternative to the institutional sector. The result has been a shift away from the publicly funded home care system to families, not-for-profit groups and the private sector. This shift has been marked with an assumption about family care that the home is the 'best' and only place to provide care. However, this assumption set up a false dichotomy between home and institutional care that is not helpful for family members who are unable or unwilling to provide the required care in the home and community. Where is the "choice" of caregivers?

Reality of Caregiving Situations

While providing care to a family member can be a rewarding experience, for others, when the demands of caregiving exceed their capacity to cope, the result is stress, declining health, financial loss, mental anguish and long-term effects on family, work and social lives. In addition, it is becoming more the rule than the exception that family caregivers are delegated tasks that were once the domain of health care professionals. Not only has the nature of the task changed drastically, in many cases so has the duration and intensity. How do caregivers balance their own needs with those of their family members who need support? How do we engage caregivers as "partners in care"?

Listening to the Voices of Caregivers

For families, the shift to home and community care has occurred without public debate. The voices of caregivers are important in planning care for a family member who requires care. How do we assess and incorporate their needs into the care planning? Are they seen as 'resources' or as 'partners'? Do they have access to support and services that address their identified needs?

Respite as Outcome- Plan It!, Do It!, Feel it!

Respite as an outcome" (CACC, 1997) means different things to different people. Respite is "anything that contributes to a caregiver's emotional, spiritual, physical and/or social rejuvenation enabling them to have the reserves and resources they need to care for their family member or friend" (J.W. McConnell Family Foundation Respite Projects, 2001).

For VON Canada, a new definition of respite shared by a participant emerged in the Focus Groups held with caregivers in late 2001:

"Respite is the period of time when the stress and responsibility of caregiving is temporarily transferred to trained providers so that one may enjoy that time with peace of mind."

Therefore, respite is more than just a service; it actually provides a positive experience to have a break away from the caregiving responsibilities. How do we engage caregivers to ensure positive outcomes including respite? How do we support caregivers plan for respite? How do we support caregivers to do respite? How do we support caregivers to feel respite?

Conclusion

To sustain a partnership, a relationship should be based on communication, compromise, and sensitivity to the context of care and the realities of caregivers. This partnership with caregivers supports a VON vision of care that deserves a collective response, not as a 'family problem', but as a societal issue. This vision of care supports choice for caregivers within the relationship - the choice to care with adequate supports across the continuum of care (acute, chronic, and long-term) and across care settings (home, community, institution). This vision of care supports making changes to our practice to engage caregivers as genuine 'partners in care' and to ensure the right level of support and positive outcomes for caregivers including respite.

References

Frank, Flo and Ann Smith. (2000). The Partnership Handbook. HRDC: Ottawa.
[On-line]: www.hrdc-drhc.gc.ca/common/partnr.shtml

Canadian Association for Community Care. (1997). National Respite Care Project: Final Report. CACC: Ottawa.

Cranswick, K. (1997). Canada's Caregivers. [On-line]: http://www.hc-sc.gc.ca/seniors-aines/pubs/unsorted/survey.htm. Statistics Canada: Ottawa.

Twigg J. (1989). "Models of Carers: How Do Social Care Agencies Conceptualise their Relationship with Informal Carers?," Journal of Social Policy, Volume 18, 53-66.

Websites

Canadian Caregiver Coalition - La coalition canadienne des aidantes et aidants naturels.
[On-line]: www.ccc-ccan.ca

VON Canada. [On-line]: www.von.ca

J.W. McConnell Family Foundation. [On-line]: www.mcconnellfoundation.ca