CAREGIVER-FRIENDLY PHARMACY TRAINING PROGRAM

© 2021 Pear Healthcare Solutions Inc. www.healthelearning.ca

CAREGIVER-FRIENDLY PHARMACY TRAINING PROGRAM

Module 1: Life as a Caregiver: Understanding the Realities of Caregiving

Subject Matter Expert

Mark Stolow, CEO, Huddol

Reviewer

Rosemarie Patodia, BScPhm, BCGP

Disclosures

The subject matter expert wishes to disclose that he has received funds from the

sponsoring company. The reviewer wishes to disclose that she is the Editorial Director at

Pear Healthcare Solutions.

An educational service for Canadian pharmacists and pharmacy technicians

brought to you by Teva Canada.

CCCEP Information

File no. 1057-2019-2659-I-P

Expiry: April 30, 2022

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Program Introduction This course includes three modules for pharmacists and pharmacy technicians on the

subject of caregivers* and caregiving. This training is part of a broader initiative to

support the creation of a caregiver-friendly pharmacy environment. A caregiver-friendly

pharmacy helps the pharmacy team nurture an optimal partnership between the

pharmacy team and caregivers.

The development of these modules was informed by existing literature and research,

market research, and contributions from an advisory board consisting of pharmacists

and pharmacy technicians. Key takeaways from this comprehensive research included:

• Caregivers place a high value on their relationship with pharmacists

• Caregivers are critical in ensuring better patient** outcomes

• Pharmacists recognize the importance of caregivers in their practice but require

more insight into how to support their experience of care

• Optimizing the relationship between the two parties can also support better

health outcomes for caregivers, can help to streamline pharmacy care delivery for

the patient, and may be the starting point for a new client-pharmacist

relationship (the caregiver is also a pharmacy customer)

Content

This training program includes three modules:

• Module 1: Life as a Caregiver provides insight into the caregiving experience.

• Module 2: Caregivers and Pharmacists provides tools and strategies to improve the

caregiver/pharmacist relationship with the goal of better supporting the patient.

• Module 3: Supporting Caregivers provides resources and information to help

pharmacists support caregiver health and well-being.

Downloadable checklists, tools and resources are available to pharmacies across Canada

to complement this training program at TevaCanada.com/Caregivers. After successfully

completing all three modules, pharmacists will have the opportunity to be added to a

map of caregiver-friendly pharmacies across Canada by simply filling in an online form

that captures the pharmacy’s address, website and contact information. View the map

at: TevaCanada.com/CaregiverPharmacies. Once added to the map, bag stuffers

featuring this dedicated website can be used during the dialogue between the

pharmacist and caregiver.

http://www.tevacaregivers.com/

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*We use the term caregiver throughout the training modules to refer to family or friends who are unpaid and who care for a person who has a physical, cognitive or mental health condition.

**Throughout the training modules we refer to the person in the caregiver’s care as the “patient.” This is to simplify the language used. It should be noted that most caregivers will not see the patient in that light. Pharmacists may want to use language like “the person in your care” or reference the filial relationship (e.g., mother, daughter, father) rather than referring to him/her as a “patient.”

Learning objectives

After successful completion of this module, you will be better able to:

• Discuss the Canadian caregiving context

• Describe who caregivers are

• Outline the types of tasks caregivers undertake to support those in their care

• Review the impact of providing care on caregivers

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Canada Is a Caring Society • In 2018, 25% of Canadians aged 15 years and older cared for or helped

someone who had a long-term health condition, a physical or mental

disability, or problems related to aging.1

• Caregiving is an issue that affects people across the lifespan, including parents

of children with an illness or disability as well as adults caring for parents. In

2006, 3.7% of Canadian children under the age of 15 were reported as having

one or more disabilities.1

• It is estimated that there are 7.8 million active caregivers in Canada. This

represents roughly one in four Canadians.1

• Almost half (45%) of caregivers received help from a spouse or partner who

modified their life or work arrangements to help provide care, 43% received

help from their children, and 39% received help from extended family

members.1

• Caregiving is not limited to helping family members. Although most

caregivers (84%) care for relatives, 16% care for friends and neighbours.1

• Caregiving crosses over many therapeutic areas, from acute to chronic care.

Age-related needs and children with disabilities most commonly call on the

involvement of caregivers.

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Distribution of Care across Health Areas Figure 1 provides insight into the care provided by caregivers across different health

issues and shows that over a quarter of caregivers provided care for aging-related

needs.

Figure 1: Caregiving and Health Problems Source: Statistics Canada, Caregiving and Health Problems, 2012. Reproduced and distributed on an “as is” basis

with the permission of Statistics Canada.

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Caregiver Demographics1 • Proportionally, 54% of caregivers are women and 46% are men.

• Reflecting the fact that the most common care recipients are parents, caregivers

are most often between the ages of 45 to 54 years (24%) and 55 to 64 years

(20%).

• The next most common group is comprised of young Canadians aged 15 to 24

years, accounting for 15% of all caregivers. This group was most likely providing

care to grandparents (48%) and parents (25%).

• Caregivers have multiple responsibilities beyond caring for their chronically ill,

disabled, or aging family member or friend. In 2012, 28% of caregivers were

“sandwiched” between caregiving and childrearing, having at least one child

under 18 years of age living at home.

Looking into the Future

The elder care landscape in the coming decades2,3

Figure 2 describes the dramatic increases in the population of people 65 years of age

and older over the coming decades. These demographic changes will have a major

impact on the responsibilities associated with family care. These changes will also shape

the profile of clients moving through pharmacy practice, notably with increases in family

caregiver presence.

Figure 2: Elder Care on the Rise

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Adapted with permission from references 9 and 10.

Common Caregiving Responsibilities • The intensity and nature of tasks assumed by caregivers is closely correlated to

the type of illness or disability and the degree of patient autonomy; as the

patient’s independence declines, the caregiver’s commitments will increase.

• Caregiving can include a wide array of helping activities, varying in levels of

intensity and degree of physical and emotional demands on the caregiver.

• The majority of caregivers report providing transportation to their primary care

receiver, making it the most frequent type of care provided.1

• Half of caregivers report being engaged in tasks of daily living inside the patient’s

home, such as cleaning, cooking, bathing, etc.1

• Caregivers are commonly called upon to assist with medical treatments, including

supporting medication management (63%).1

• By virtue of its longevity and intensity, chronic care often calls upon the

engagement of families the most. For example, in the care of older adults at

home, it is estimated that families assume 70% to 75% of the care load.4 In the

case of caring for a family member with a developmental disability, more than

50% of caregivers spend 10 hours or more per week providing care.1

The Continuum of Care Figure 3 describes how the intensity and nature of caregiving impacts the ability to plan

and manage. It is particularly relevant in describing how varied care experiences are and

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the necessity for caregivers to be highly adaptable.

Figure 3: Continuum of Care: Intensity, Predictability and Controllability5 Source: This figure was duplicated with the permission of the Vanier Institute for the Family.

The Impact of Caregiving on Caregivers The negative impact of caregiving on caregivers is well researched and documented.6

The common health and social implications for caregivers are:

• Physical

• Psychological

• Social

• Financial

Physical

The physical demands of caregiving can have a long-term impact on caregiver health.

Tasks of daily living, hands-on medical care, transportation to and from appointments,

or reduction in sleep hours, coupled with the stress and strain of caregiving, can worsen

the physical health of the caregiver, or exacerbate an existing medical condition.6

Psychological

Caregivers can experience a wide range of emotions: from shock, fear, sadness, guilt and

hopelessness, to exhilaration from a positive treatment outcome. The spectrum of

feelings can be quite broad but often very intense.

Caregiving can significantly alter caregivers’ expectations, hopes, and dreams as they

figure out how to adjust to a new normal. The tension between what they hoped and

planned for versus their reality is difficult to reconcile.

Depression and anxiety are common among caregivers. Over half (55%) of caregivers

feel worried or anxious as a result of their caregiving responsibilities. Other common

symptoms associated with providing care include feeling short-tempered or irritable

(36%) and feeling overwhelmed (35%).1

Social

Social disconnection and isolation can have a significant impact on a caregiver’s health

and experience of care. Caregiving can take a lot of time, forcing caregivers to choose

between their care commitments and time with friends and family. Also, the stigma

associated with certain health conditions that either cause the caregiver to feel ashamed

or cause the caregiver’s social networks to withdraw when they are faced with the

unknown; e.g., a caregiver is assisting a family member with Alzheimer’s disease.

Alzheimer’s disease and other dementias can cause behaviours, such as physical or

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verbal aggression, that are considered socially inappropriate. Caregivers may withdraw

from friends, fearing that their loved one’s behaviour will embarrass them. This isolation

means that they may have limited access to peer support networks, leaving them feeling

under-supported, invisible, and unrecognized. Social isolation and loneliness have been

associated with negative psychological effects such as depressed mood, and decreased

quality of life and life satisfaction.7

Financial

Increasing medical and out-of-pocket expenses, coupled with reduction in work hours

due to competing care commitments, can create significant financial strain on

caregivers. Immediate and longer-term financial outcomes for caregivers include

reduced or foregone income, lost employment benefits, reduced pension benefits,

reduced savings and investments, and reduced overall financial security.1

Caregivers make up 30% of the paid labour force in Canada, and annually, more than

550,000 leave work to provide care.8

Pharmacy practice tip

Caregivers are usually the last ones to acknowledge that their health is suffering – most of their caring is projected towards the patient. Regular check-ins, which might be as simple as asking the caregiver how he/she is doing, can go a long way towards helping caregivers become aware of the importance of their own wellness. It may also increase the likelihood that they will share their health concerns with you in future interactions.

Asking caregivers how they are doing can be a powerful way to start to build the trust that is so critical to a therapeutic relationship.

My Life as a Caregiver – Video Testimonial This testimonial highlights one caregiver’s journey and the challenges she faced.

To view the video, return to the course page on HealtheLearning.ca and open the interactive Module 1 lesson.

Critical Factors Influencing the Care Experience The challenge of developing a global response to the experience of care is that each

situation is unique. So many factors will predict how caregivers see themselves and

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evolve through the care journey. Some of the more common factors that will influence

the experience of care for both the caregiver and patient are described here.

Financial means

Caregivers with the means to access private care may experience less strain or

commitment conflicts as they may be willing to pay for additional assistance through

private channels.

Those without financial means will rely on public services that are often limited in

availability or inaccessible in the short term due to wait times. Lower or mid-level

income individuals may also have fewer options when deciding if they can leave work to

provide care.

Ethno-cultural and religious values shaping perceptions and attitudes towards care

Religious and cultural norms influence how families provide and divide care and

perceive the overall experience. For example, in certain cultures, women are assumed to

be the best source of care and the greatest responsibility falls on their shoulders.


Attitudes towards care are often shaped by filial, cultural, and religious values. Professionals can inadvertently project expectations or value systems onto a caregiver about how he/she should be involved in care. Meeting caregivers where they are in a spirit of non-judgment helps to build a trusting relationship. It can be helpful to take a minute to understand how your own value systems influence your understanding of caregiving or filial expectations. This reflection can help mitigate a potential bias when dealing with caregivers.

Current and past family dynamics

A history of family conflict can affect how a caregiver and patient relate to one another;

pre-existing tensions may become more pronounced under stressful circumstances.

Abuse of the patient perpetrated by the caregiver is more common in situations of

relational conflict.

Availability and involvement of extended family

The experience of a single child versus a caregiver with a large extended family will have

a significant impact on the burden of care. The reliance on a network of support can

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help curb caregiver strain by allocating a range of responsibilities across different family

members.

Inversely, the involvement of many family members can also create disagreements

around care management or end-of-life planning.

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Passive or active disposition of the caregiver

Caregiving is an experience of adversity for many. The resilience of the caregiver will

influence his/her capacity to manage.

When faced with a major life challenge, some caregivers will shut down, as they are

unable to cope with the scale of the problem. Others will become proactive advocates.

The disposition of the caregiver will influence his/her sense of mastery over the situation

and affect how and if he/she seeks help.

Understanding Caregiver Needs Caregiver needs can be very eclectic and change with time. The following describes

common needs expressed by caregivers that relate to pharmacy practice:

• Managing symptoms

• Knowing when to report a problem with treatment

• Transitioning from hospital to home

• Equipment in the home to support the patient

• Understanding the medical condition, treatments, and prognosis

• Communicating information about the condition to the patient

• Supporting adherence and dealing with resistance

• Validation and reassurance that they are managing the medications correctly

• Disposing of medications safely

What We Learned from Caregivers – Video This video examines the relationship between caregivers and pharmacists.

To view the video, return to the course page on HealtheLearning.ca and open the interactive Module 1 lesson.

Caregiver Self-Identification Caregivers often have difficulty seeing themselves as “caregivers.” Many simply identify

with the filial role, i.e., “He is my son” or “I am his wife.” What contributes to this?

1. Societal expectation

As a society, we assume that families should provide care, thus we provide them

no distinct designation that recognizes the extraordinary nature of their work.

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2. Filial duty

Despite how difficult and complex care can be, we assume that being good to a

loved one is an extension of an inherent commitment. Even when the role

exceeds typical family roles, many individuals simply resist the label of “caregiver”

– it can feel uncomfortable.

3. Lack of recognition

Everyone knows the “patients.” They have health files that track their status and

so many stakeholders looking after their interests. Caregivers are often treated as

invisible; their work is under-recognized. Societal attitudes are shifting, but many

still move through the healthcare system unnoticed.


As healthcare providers, you can support caregivers in the self-identification process. Recognition and validation of their unpaid work can be deeply reaffirming and can be an important catalyst for a conversation about their status, health, and wellness.

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Key Learning Points 1. Caregiving is an issue that crosses the lifespan.

2. Caregiving is both a social and health issue affecting millions of Canadians.

3. While there are common experiences that affect all caregivers, the experience of

care can be quite unique.

4. One of the challenges in supporting caregivers is that they often do not self-

identify as caregivers.

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References 1. Hango D. Support received by caregivers in Canada. Statistics Canada.

https://www150.statcan.gc.ca/n1/pub/75-006-x/2020001/article/00001-eng.htm.

Accessed February 24, 2021.

2. Statistics Canada. Seniors. 2011. https://www.statcan.gc.ca/pub/11-402-

x/2011000/chap/seniors-aines/seniors-aines-eng.htm. Accessed February 24,

2021.

3. Stonebridge C, Hermus G, Edenhoffer K. Future Care for Canadian Seniors: A

status quo forecast. The Conference Board of Canada. November 3, 2015; 102

pages. https://www.conferenceboard.ca/e-library/abstract.aspx?did=7374.


4. Canadian Caregiver Coalition and Centre de sante et de services sociaux

Cavendish. Beyond Recognition – Caregiving and Human Rights in Canada: A

Policy Brief. March 2015. http://www.carerscanada.ca/wp-

content/uploads/2021/03/CCC_Policy_brief_Human_rights_EN.pdf. Accessed

February 24, 2021.

5. Battams N. Family Caregiving in Canada: A Fact of Life and a Human Right. The

Vanier Institute of the Family. 2016. http://vanierinstitute.ca/family-caregiving-in-

canada/. Accessed February 24, 2021.

6. Turcotte M. Statistics Canada. Family Caregiving: What are the consequences?

2015. https://www.statcan.gc.ca/pub/75-006-x/2013001/article/11858-eng.htm.


7. Bowling A. Social networks and social support among older people and

implications for emotional well-being and psychiatric morbidity. Int Rev

Psychiatry 1994; 6(1): 41-58.

8. University of Alberta. Research on Aging Policies and Practices. Combining care

work and paid work: Is it sustainable? September 2014; 1-6.

9. Statistics Canada. An aging population. October 2016.

https://www150.statcan.gc.ca/n1/pub/11-402-x/2010000/chap/pop/pop02-

eng.htm. Accessed February 24, 2021.

10. Sanmartin C. Research highlights on health and aging. Statistics Canada. Released

July 28, 2016. https://www150.statcan.gc.ca/n1/pub/11-631-x/11-631-x2016001-

eng.htm. Accessed February 24, 2021.

https://www150.statcan.gc.ca/n1/pub/75-006-x/2020001/article/00001-eng.htm

https://www.statcan.gc.ca/pub/11-402-x/2011000/chap/seniors-aines/seniors-aines-eng.htm

https://www.statcan.gc.ca/pub/11-402-x/2011000/chap/seniors-aines/seniors-aines-eng.htm

https://www.conferenceboard.ca/e-library/abstract.aspx?did=7374

http://www.carerscanada.ca/wp-content/uploads/2021/03/CCC_Policy_brief_Human_rights_EN.pdf

http://www.carerscanada.ca/wp-content/uploads/2021/03/CCC_Policy_brief_Human_rights_EN.pdf

http://vanierinstitute.ca/family-caregiving-in-canada/

http://vanierinstitute.ca/family-caregiving-in-canada/

https://www.statcan.gc.ca/pub/75-006-x/2013001/article/11858-eng.htm

https://www150.statcan.gc.ca/n1/pub/11-402-x/2010000/chap/pop/pop02-eng.htm

https://www150.statcan.gc.ca/n1/pub/11-402-x/2010000/chap/pop/pop02-eng.htm

https://www150.statcan.gc.ca/n1/pub/11-631-x/11-631-x2016001-eng.htm

https://www150.statcan.gc.ca/n1/pub/11-631-x/11-631-x2016001-eng.htm

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CE Test In order to receive CE credits for this course, you must complete the CE test online at

www.HealtheLearning.ca.

Documents

CAREGIVER-FRIENDLY PHARMACY TRAINING PROGRAM