Identify Effective Dissemination Approaches and Evaluate Outcomes
Additional research is needed to evaluate approaches to disseminating AT/HM among family caregivers and to measure impacts on caregiver physical strain, as well as impacts on community living/nursing facility utilization and costs.
While our literature search found many studies documenting the effectiveness of assistive equipment in nursing homes and institutions, research evaluating the use of AT/HM to reduce physical strain among family and paid caregivers in the home was much more limited. In the TEP meeting, participants suggested that a reason for this research gap may be that conducting controlled research in peoples' homes is extremely difficult, due to the logistics of arranging home visits and the challenge of controlling for the variance across home care work settings.
Although a growing number of studies have evaluated outcomes of providing family caregivers with AT/HM services, these studies have not measured caregiver physical strain as a specific outcome. In the TEP discussion, the experts agreed that the majority of caregiver intervention research has focused on reducing caregiver emotional stress or improving care recipient independence, rather than reducing caregiver physical strain.
Other important outcomes to measure include reducing nursing home entry and independence and quality of life for older adults. Any device that increases the level of independence for the care recipient is likely to simultaneously decrease the amount of assistance needed and thereby indirectly relieve burden for care providers (Mann, 2001). The TEP discussion, however, suggested the association between AT and caregiver strain may be more complicated. Traci Galinsky noted that, anecdotally, some caregivers often left care recipients in bed rather than manually lift them, which wasdifficult and put them at risk of injury. Some of these caregivers assisted care recipients in getting out of bed more often after receiving hoists or other devices. Although the effect was an increase in physical exertion among caregivers, this was seen as a positive effect because getting help with transferring improved quality of life for care recipients and the caregivers were using assistive devices to minimize physical strain.
Jon Sanford noted that research is almost always focused on the care recipient and impacts on increasing their independence. This is assumed to correlate with decreased need for assistance, but more outcomes data are needed to show the extent to which AT/HM helps family caregivers and paid home care aides. Outcomes to examine include reducing family caregiver physical strain, increasing function of older people, cost savings, decreased falls, and other benefits to caregivers.
For study design, panel participants suggested case studies paired with quantitative research. A suggestion was to take two comparable communities and use existing resources in one community and compare it to the intervention community, which would receive information dissemination. Case studies with cluster interviews can provide rich and detailed information, while randomized trials can provide evidence of outcomes.
Participants suggested aligning the demonstration with an existing project, such as VA Independence at Home or Medicare Care Transitions. They noted that both outcomes and the process by which information is delivered are important to study.
Develop AT Designed for Family Caregivers
A problem, noted in the TEP discussion, is that many of the available assistive devices are institutional and need to be redesigned so that they can fit into a home. Also, many homes need to be designed to allow the technology to work effectively. While the majority of older people with chronic disabilities strongly prefer to live at home, many homes are not designed or arranged to support safety and independence for people with physical or cognitive impairment, or to support caregiving in the home. A simple solution is to make the AT more adaptable to home environments. TEP members stated that AT needs to be redesigned to become more adaptable to the home and more accommodating to home environments, in addition to training family caregivers on the use and benefits of AT/HM.