More on Quality and Safety

Efforts to better integrate family caregivers into healthcare teams can improve quality

Such caregivers can greatly improve quality for patients, yet there are hurdles to true integration with formal care teams.

Jeff Lagasse, Associate Editor

Integrating family caregivers into a patient's healthcare team can help improve care quality and the quality of life for both patients and their families, yet family caregivers face significant barriers coordinating their efforts with the formal healthcare team, according to a new RAND Corporation study.

New policies and approaches may be needed to overcome those hurdles, such as rules to identify and record information on family caregivers, and incentives to encourage providers to engage with them.

Additional efforts may include investing in programs that provide supportive services for family caregivers, as well as expanding access to and funding for care coordinators to support caregivers and connect them to a family member's clinical information.

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Family caregivers, authors said, are often treated as secondary members of a care team, with little direct access to formal providers. Better integration would result in better quality.

Other strategies they recommend include implementing training programs for providers and caregivers to facilitate effective communication, and encouraging leaders to develop technologies that foster caregiver-provider care integration and information sharing.


An estimated 53 million family and friends provide care assistance to loved ones in the U.S., an increase of 9.5 million caregivers from 2015 to 2020. These family members typically provide assistance with everyday activities such as eating, bathing, dressing, driving and taking medications.

Family caregivers have direct and frequent access to loved ones with caregiving needs. More than one-third of care recipients live with their family caregiver, and 55% of caregivers visit the care recipient more than once a week.

These regular interactions allow family caregivers to monitor changes in health and care needs on a more regular basis than would be possible for formal healthcare providers.

To better understand the barriers that face family caregivers and how to mitigate those obstacles, the authors reviewed the research literature and interviewed 13 experts from diverse stakeholder groups. They focused in-depth on integrating family caregivers into the healthcare team by incorporating interviews with payers, providers and caregiver advocates.

They defined family caregiver integration to include communication, collaboration and coordination with providers, broadly defined as individuals or organizations that deliver care or services, or help coordinate care for people with caregiving needs. The healthcare team may include physicians, nurses, social workers, care coordinators and private sector service providers.

The report found that barriers to integration fell under four themes: identifying caregivers, communication and information-sharing, time limitations and competing demands, and trust and cultural barriers.

Researchers say that future work is needed to expand and assess policy approaches through stakeholder-engaged consensus methods, assessing the availability of evidence-based research, assessing each approach on metrics of feasibility and impact, evaluating approaches for their cost effectiveness, and building consensus on how best to implement the most promising choices.


Aging baby boomers, a rise in chronic conditions and the growing belief that the home is the ideal care setting have contributed to home healthcare expenditures climbing faster than those in most other healthcare categories since 2013.

In 2019, the annual growth rate for home health spending was about 6.8%, higher than the national health expenditures growth rate of 4.8%. The spending outpaces that of hospitals, nursing care facilities and continuing care retirement communities.

Twitter: @JELagasse
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