Physicians and Family Caregivers

Primary care physicians need a strong and effective model to guide their relationships with family caregivers, key resources for the frail elderly. Caregivers provide a significant proportion of the home care needed by the rapidly growing number of frail elderly living in the community. Caregiving exacts a physical, psychological, social, and emotional toll that no intervention strategies have proven powerful enough to offset. An effective relationship model would acknowledge the key linkage role of the primary care physician, recognize that caregivers and patients form interdependent units, and affirm a care partnership between the physician and caregiver. In this model, the physician conducts periodic assessments of the caregiver as well as the patient; uses a comprehensive home-based approach to care and services; provides training to caregivers, particularly in managing difficult behavior; validates the role of caregiver; and acts as case manager. Educational opportunities and reimbursement structures should be modified to encourage physicians to use the partnership model. (JAMA. 1993;269:1282-1284)