Family and informal caregivers play a significant role in the lives of their loved ones. They also play an important role in how the healthcare system functions.
By communicating effectively with all the individuals involved in your patient's care, you can both help the patient and make more efficient use of your time and resources.
Informal caregivers are able, for example, to be knowledgeable "informants." They can also help to reinforce the information you give or the treatment you prescribe.
Ask about the Caregiver's Role
To protect and honor patient privacy, be sure to ask the patient how he or she sees the companion's role. In many cases, that person can be a facilitator, helping the patient express concerns and reinforcing what you say. But it is best not to assume that a companion should be included in the medical encounter. First, check with the patient.
You might ask the companion to step out of the exam room during part of the visit so you can raise sensitive issues while protecting the patient's privacy. For instance, the best time to conduct a "mini-mental" test is when the companion is not present, so that he or she cannot answer questions or cover for the patient's cognitive lapses.
Keep the Patient Involved
When a companion is present, be aware of communication issues that arise in three-party interactions. Whenever possible, try to sit so that you form a triangle and can address both the patient and companion face-to-face. Be careful not to direct your remarks to the companion. This will help you prevent the encounter from feeling like a "two against one" match.
Families may want to make decisions for a loved one. Adult children especially may want to step in for a parent who has cognitive impairment . If a family member has been named the healthcare agent or proxy, under some circumstances, he or she has the legal authority to make care decisions. However, without this authority, the patient is responsible for making his or her own choices. When necessary, set clear boundaries with family members, and encourage others to respect them.
Some patients may ask that you contact their long-distance caregivers  to discuss conditions or treatment plans. Make sure these patients fill out any necessary paperwork giving permission for you to speak with specific family or friends.
Consider Caregivers to Be "Hidden Patients"
Family caregivers face many emotional, financial, and physical challenges. They often provide help with household chores, transportation, and personal care, in addition to juggling their own jobs and families. Many also give medications, injections, and medical treatments to the person for whom they care (and may need advice or guidance on how to provide such medical care).
Caregivers often have their own health issues to manage. Sometimes, the patient will outlive his or her caregiver. It makes sense to view informal caregivers as "hidden patients" and be alert for signs of illness and stress. Caregiver burnout can lead to negative health events. It can also sometimes give way to elder abuse .
Caregivers may find it hard to make time for themselves. Encourage them to seek respite care so they can recharge and take a break. And remember, your encouragement and praise can help to sustain a caregiver.
"What would you like your family to know?"
Mr. Patrick admitted to Dr. Hwang that he has trouble remembering much of what she said about managing his condition. Dr. Hwang wonders if it might be helpful for someone to accompany Mr. Patrick to his next appointment. Mr. Patrick isn't sure. He is concerned his daughter, who often assists with his care, won't let him speak for himself. He also doesn't want his daughter to know about some personal issues. Dr. Hwang assures him that she will keep Mr. Patrick involved in the conversation and that they will have some private time to discuss any personal matters.
For more information on working with families and caregivers, contact:
The Administration on Aging, part of ACL, provides funding and community-based services for programs that serve older adults.
The organization has programs in patient care, research, professional and public education, and public policy. Among its resources is a free Caregiver Health Self-Assessment Questionnaire, available in English and Spanish.
This Network supports family caregivers and offers education, information, and referrals.
The Eldercare Locator offers referrals to and information on services for seniors by geographic location.
The Alliance offers programs to provide information to and support for caregivers.
The National Alliance offers support and resources for the public and professionals.