Family caregiving during healthy aging and illness.

mediciNe & HealtH/RHode islaNd family Caregivers are inextriCably nested in health care. Upon return home after an important physician visit, a patient may encounter questions from a spouse or other loved one. For many patients, family members provide direct accompaniment to the physician and actively participate in informed consent and other clinical decisions; for some, the caregiver is a designated legal proxy decision-maker. There is variety in how these patient-caregiver relationships form and develop over time; some individuals clearly identify who will help long before the help is needed whereas others are forced to recruit family caregivers amidst an unexpected and urgent crisis. Be it routine, a crisis or advanced care planning, there are always opportunities to enhance the process of patient, caregiver and clinician working together. The Institute for Healthcare Improvement (IHI) proposes that all initiatives to enhance quality should concurrently address three facets of a “Triple Aim,” including: “better care for individuals, better health for populations, and lower per capita costs.” In Rhode Island, estimates suggest that there are over 100,000 individuals providing substantive unpaid family caregiving, translating into millions of dollars of free health care to the seriously ill. Any quality initiative targeting an illness, such as post-stroke rehabilitation, or an environment, such as hospital service use, must attend to the role of the family caregiver as an essential component of improving health care quality. The question is: what opportunities currently exist for better integration of family caregivers into routine health maintenance and acute patient care settings? Enhancing patient care by incorporating family caregivers must address the public health context of caregiving, including health risks for family caregivers, and caregivers’ instrumental needs. There is growing concern that the chronic stressors associated with protracted family caregiving pose health risks. Specifically, Family caregivers report worse health than non-caregivers, engage in fewer healthFamily caregiving during Healthy aging and illness