November is National Family Caregiver Month. Family caregivers are the unsung heroes of the health care team. Without their loving care, hard work, and dedication our health care delivery system would crash and burn. They are the ones continuing our plans of care in the home. They are the nurse, physician, physical therapist, nursing assistant, home health aide, counselor, and social worker all rolled into one. They are expected to grasp complex care techniques that years ago were carried out only in the hospital.

Caregiver burnout is a real problem: caregivers dedicate so much time caring for their loved ones they neglect themselves—physically, emotionally, and financially. Many caregivers become socially isolated and often do not reach out for help. There are times the loved one becomes distraught if the caregiver leaves for a time and has someone come in to help—even if it is another family member. I have no doubt many of you, like me, have seen the family caregiver succumb to illness because he or she is worn out from caring for the loved one.

Assessing Caregivers and Their Needs

As part of our assessment we need to evaluate the health and well-being of family caregivers along with our patients. Many people are simply not aware of the services available to them. Our patients need help in understanding that if their family caregivers do not take care of themselves, they will be unable to care for them. I can recall one client I was seeing in home care who started quoting their marriage vows ("in sickness and in health") to his wife as she was trying to set up some relief for her 24/7 caregiving duties. Ultimately, he agreed to give her some respite, but he was not a happy camper.

Family caregivers need to be encouraged to advocate for themselves. All too often well-meaning family members will say "Let me know if I can do anything" and wait for the call that never comes. Some family caregivers are convinced it is their responsibility to be by their loved ones' side 24/7, and asking for assistance means shirking their duties. As health care providers, we need to dig deeper to ensure family caregivers and their loved ones are safe and receiving the assistance they need.

There are a few times I remember seeing clients in ambulatory care centers when their primary family caregivers were not with them. This is obviously a challenge because we need caregivers to be there to see how their loved ones are progressing and what changes may need to be made in the plan of care. What I discovered was not disinterest on the part of the caregivers, but their effort to multitask. While their loved ones are being seen, caregivers may head to the grocery store or complete other errands. In a few cases, the family caregivers were asleep in their cars in the wound clinic's parking lot. It was the only chance they had to take a nap.

Many family caregivers are part of the “Sandwich Generation.” They are caring for their parents as well as raising their own children; typically these caregivers are working full time. They, too, need support and advice on services available to them.

Ways for Wound Care Nurses, Family, and Friends to Help Family Caregivers

I know our time with patients is limited, but taking a little time "up front" can go a long way to improve patients' outcomes and enhance the health and well-being of family caregivers. Social workers are a terrific resource to offer guidance regarding what resources are available to assist them. We often have a very close, established relationship with our clients and their families, so that many feel more comfortable opening up to us first.

Here are a few tips:

• Have someone help the family caregiver make a "wish list" for family or friends with a specific request including day, date, time, and frequency. For example, have someone drive them to their appointments .
• Give the family caregiver scheduled breaks. The caregiver can relax at home or, better yet, get out of the house to go for a walk, visit friends, go out for a meal, get a haircut, do laundry, go grocery shopping etc. If the caregiver is unable to drive, schedule two people, one to remain at home with the client and one to drive the family caregiver.
• If caregivers have a smartphone, share the schedule on an app so everyone is reminded of their commitments.
• Meals can be a big problem. Meals on Wheels is an option for some, but friends and family can prepare meals in advance or have them delivered. Meal delivery and grocery gift cards and paying for an aide, a sitter, or a housecleaning service are good options for family members who do not live locally.
• Groceries can be delivered or pre-ordered for pick up. Some people enjoy grocery shopping; others find it a burden.
• Pet care is another task people can help with to ease the workload on the family caregiver. Vet appointments, litter box duty, dog walking, grooming etc. can be a big help!

The holiday season will be here before we know it. Helpful suggestions for gift giving include gift cards to stores favored by the family caregiver and making arrangements to take the caregiver to the store or help with ordering online. Gift cards are great, but many end up being forgotten or unused. Gift cards for groceries and a favorite pharmacy are especially useful. These suggestions are helpful not only for our client's family caregivers but for the elders in our own families as well.

Please accept my wishes for a Happy, Healthy Holiday Season.

About the Author
Paula Erwin-Toth has over 30 years of experience in wound, ostomy and continence care. She is a well-known author, lecturer and patient advocate who is dedicated to improving the care of people with wounds, ostomies and incontinence in the US and abroad.