1. Marrelli, Tina MSN, MA, RN, FAAN

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My husband and I are the primary caregivers for my 95-year-old father in law. A World War II veteran, Otto was on the cover of the June 2012 issue of Home Healthcare Nurse. Otto lives with us and I find myself being the chief nurse and advocate, as well as care coordinator and manager. We are not alone. This role will only increase as more frail elders enter the healthcare system. On August 14,2013, the Journal of the American Medical Association (JAMA) published a "Viewpoint" entitled "The Critical Role of Caregivers in Achieving Patient-Centered Care" (Gillick, 2013). Those of us who have made home visits for many years know how much sense this makes and that it is common sense. What is heartening is that it is being understood by others in the healthcare system.

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We visit a home where there are no caregivers or caregivers without the resources or skills/aptitude for caring for their elderly family member, and we know it changes the equation from a team (the caring or competent) caregiver to one that is not home or otherwise not engaged or interested and sometimes verbalizes this. This is the time for caregivers to be integrated in the care and care planning as had been stated but not actualized in many instances. In fact, the new Patient-Centered Outcomes Research Institute (PCORI) includes families in their agendas for research (PCORI, 2013). This is indeed a new era! For more information, visit their Web site at And I believe this has implications for home care as we can lead the way and model what this role "best caregiver" looks like and is.


In this issue of Home Healthcare Nurse, there are articles that help support caregivers and their family member patients and, sometimes, after "traditional" home care services have left the home. Hadidi and colleagues write about their "A Pilot Study of the Trajectory of Functional Outcomes in Stroke Survivors: Implications for Home Healthcare." This longitudinal study explored patterns of functional recovery at different time point across time. With the growth of the older adult population and the incidence of stroke this topic has implications for care and supports the critical need for home health services. As those practicing and teaching in home care know, function and safe self-care make all the difference if one can remain at home as he or she ages.


This is especially important because of the safety implications of that same aged patient population. Ernest Grant explains this in the first CE article of this issue, entitled "Preventing Burns in the Elderly: A Guide for Home Healthcare Professionals." This in-depth article speaks to the multifaceted and complex factors that make this topic an important one and a fundamental safety review. In "Supporting Home Care Aides: What Employers Can Do to Assist Their Workers," Sandy Butler and Noell Rowan discuss how to retain aides in an environment of high turnover and high demand for this important role. In this article, we listen to the voices of these important aide caregivers.


Many of our patients at home have varying amounts and kinds of disability. In the second CE paper in this issue, Linda Borenstein addresses "Communicating Respectfully with People Who Have Disabilities." Times (thankfully) have changed and so has the glossary of terms and the expectation of patients and their family caregivers that respectful communication be a part of the care equation-as it should be!


We can do much to positively impact the upcoming generations of new nurses. Whether mentoring or teaching or role modeling, we will be the leadership group that is looked up to. In the article entitled "Promoting Nursing Students' Understanding and Reflection on Cultural Awareness With Older Adults in Home Care," Diane Mager and Sheila Grossman articulate strategies that promote students' reflection in cultural awareness using home care-focused case studies and simulations. According to The Joint Commission (TJC), nearly 8.6 mission people receive home care services in the United States (TJC, 2011). Couple this data with the growing population and many cultures-this is a great topic and one that needs continuing and further inquiry and research. Preparing the workforce of the future is always an important priority!


And home care clinicians and managers can always be seen as thinking about "what is best for our patients?" In her Commentary, "Effecting Change: An Occupational Therapist's Pleas for a Coverage Change and Your Thoughts and a Call to Action!" Arlene Goldberg questions the rationale for a system and process that makes electric beds not an easy-to-use or access item. Her examples will sound familiar as you hear her patients and their caregivers' stories. This commentary is a call to action too. How can we best advocate for our patients and their caregivers? This is a great topic and we would love to hear your thoughts about how to effect the change! Feel free to e-mail me and Arlene with your ideas.


We all need to collectively be the voice for caregivers and others who need to be heard and impact care that needs to be provided or processes (bed coverage?!) that needs to be changed. I welcome your thoughts and voices.


And wishing you and yours a happy holiday season!




Gillick M. (2013). The critical role of caregivers in achieving patient-centered care. Journal of the American Medical Association, 310(6), 575-576. [Context Link]


Patient-Centered Outcomes Research Institute. (2013). Mission and vision. Retrieved from[Context Link]


The Joint Commission (TJC). (2011). Home : The best place for health care. Retrieved from[Context Link]