Chinese hospital works with patients, their family, friends, and caregivers to develop a shared care plan that everyone can help with.
Many of our patients are elderly with multiple comorbidities. They need a lot of help to manage their condition at home. The patient’s family and friends could split caregiving activities, but too often it seems like one person is responsible for all of the patient’s care and they quickly burn out.
Chinese Hospital is a non-profit hospital in San Francisco, CA. It has 54 beds and serves a primarily elderly (average age of 76) monolingual population with most patients speaking only Chinese. Their transitions program began in 2008 and is influenced by IHI’s Transforming care at the Bedside and the Care Transitions Program.
What We Tried
When we meet with patients we ask specific questions around whom the main people are in their lives—not just who they call their “caregivers.” So a patient might say his caregiver is his youngest daughter, but he also has a roommate and two other children. These other people are important because they can play a role in his health. It doesn’t have to be one person doing it all.
We try to understand what role everyone plays currently and where there were gaps in care or unhealthy practices that we could prevent. For example, we worked with one patient’s son and roommate to create a care plan. The son would call his father to remind him to take his medication and the roommate would watch to make sure he actually took it. The son would purchase healthy foods for his father and the roommate would help him prepare the meals.
When potential caregivers are reluctant to help, we often call family meetings with everyone together. We highlight the patient’s needs and then talk about how we can work together to split the tasks. Maybe the daughter is the primary caregiver, but the brother or son can stay with the patient one night a week. Or the daughter takes care of the patient, but someone else can help her pick up her kids from school.
We’ve had a lot of success creating care teams for patients after discharge. Often family members don’t know how to help or don’t realize that they can just do a few small things and it will help a lot. Patients are often readmitted when primary caregivers get burned out, so taking some of the burden off of them can be very important.
We have developed strong relationships with the patients’ caregivers. They appreciate that we’re lightening their load and trust us more. This trust makes it easier for us to teach them how to take care of the patients.
The patients’ care teams also get along better now. Before the primary caregiver was always tired and frustrated that no one else was helping. Now they all help a little and everyone feels like they’re spending quality time with their loved ones.
We don’t tell people that it’s their responsibility to help take care of the patient. Instead, we use ourselves as examples. “If it was my mom, I’d want my sister to help me even though we’re both so busy.”