Covid-19 has revealed to us what matters most in life when a catastrophe causes life to be stripped down to essentials. Ironically, social distancing has exposed and amplified our drive to express love and commitment to those we love. But in the name of protection from the virus, families have been prevented from attending to their ill or frail loved ones in hospitals and in long-term care homes where health care front lines are under-staffed, under paid and stressed. Designating a family member as an essential partner in care at the patient's bedside can reduce harm to everyone in the circle of care. Now is the time for more, not less, caregiver partnership.Natural care can be described as the drive to ease suffering, to nurture and to soothe another person because they are either ill, in pain or very anxious. Health care providers often cite wanting to care for people as a reason for choosing their profession. Mothers and fathers are compelled to tend carefully to a sick child. Daughters and sons sit vigil at the bedside of ill or dying parents. The drive to give care is natural, strong and undeniable. To be prevented from giving care defies our most basic human instincts. It offends the dignity of our most important relationships.In the news reports of today, we are all witness to heart wrenching stories of patients dying alone and to suffering in the absence of a known, loving touch and a soothing voice. No one, including health care professionals, is immune from the shock and sense of complicit betrayal as these sad scenarios play out in hospitals or long-term care homes across the country. But this forced separation is a necessary sacrifice for the greater good, right?On Twitter, the trending hashtag of #NotJustaVisitor represents a movement of patients, families and clinicians who recognize the unique and indispensable skills, capacities and knowledge that a family caregiver brings to the patient bedside. In 2015, the Canadian Foundation for Healthcare Improvement launched the Better Together campaign, enlisting hospitals and health care delivery organizations to recognize families as allies for quality and safety.Many caregivers of family members with chronic disease regularly perform nursing skills such as managing tube feeds, colostomies and central lines. Research shows that family caregivers prevent medical errors, reduce 30-day readmissions and prevent injury from falls. Family members who have cared for a chronically ill patient at home are expert in maintaining a sterile environment. They are motivated by love to prevent the spread of infection. Currently in Canada, there are nearly 8 million family caregivers who are ready to be mobilized as an army of unpaid personal support workers for someone they love.Across Canada, the hospital visitor zero tolerance policies have eased recently in a few domains. The Children's Hospital of Eastern Ontario (CHEO) allows one parent to be at their child's bedside, properly screened and supported with PPE if required. “Parents are not visitors”, asserts Alex Munter, CEO of CHEO. Most major health care centres now allow one family member to be with non-Covid-infected patients who are at end of life. Fathers are welcome in maternity wards before, during and after birth. Currently, those are the only exceptions to a 'no visitor' policy in all Canadian provinces except Quebec.Starting on May 11, Quebec seniors living in residential care settings will be allowed to have a designated caregiver at the bedside. Globe and Mail health reporter Andre Picard called the policy change “a tacit admission that understaffed seniors' care facilities never have and never will be able to meet residents' needs without the essential contributions of family caregivers. (This applies doubly to caregivers of children with severe disabilities who require institutional care.)”Coronavirus has taught us that systems we thought were unchangeable are actually malleable – we just need the will to change them. So how can our existing health care systems be adapted to include family care partners? In an article for Medium, seasoned caregiver influencers Julie Drury, Claire Snyman and Maggie Keresteci propose the following policy recommendations to safely place family members at the bedside of loved ones:
- Immediate recognition of the difference between 'Visitors' and family caregivers as 'Essential Partners in Care'.
- Collaboration on an immediate reintegration strategy for family caregiver presence that is based on a triage methodology. This includes i) identifying specific high risk and high needs patient and resident groups; ii) allowing for applications for exemptions to any family caregiver and visitor policy and iii) a review committee for these exemptions (of which family & caregivers are a part of; iv) appropriate screening, information and PPE (when available) for one or two identified family caregivers as essential partners in care.
- Assurance that where family caregiver presence is not physically possible, essential partners in care are offered virtual means to connect to either daily rounds with the clinical team and/or a daily update about the status of the patient.
- Assurance that all patients will be supported with access to technology; tablet, cell phone, email, etc., in order to stay connected with family caregivers and that access to this technology will not be restricted unnecessarily and will be supported by the institution.
- Immediate and continual reassessment of visitor policies and emerging reintegration strategies and family presence policies with caregivers, patients and families as the COVID-19 situation changes.