Physical therapists spend a lot of time teaching patients how to do things. We teach home programs. We teach precautions. We teach safety. We teach how to use devices. The list of things we teach is almost endless. And right after we teach it, we document it. That documentation always includes some form of the phrase, "return demonstration."
A lot of thought is given to teaching patients and making sure they understand what is being taught. Not all therapists teach patients. Frequently I find myself teaching family members and caregivers because my patients aren't cognitively intact. Although there is much discussion concerning whether patients understand the directions, very little concerns the family.
The problem is we assume the family is capable of learning because they aren't the one in the hospital. That isn't always true. Sometimes there is a language barrier. Illiteracy is another problem, particularly with older family members for whom English is a second language. Older caregivers may have memory problems. Visual impairments can make reading directions a challenge, especially with small print.
Sometimes family members themselves have cognition impairments. They don't have the ability to understand simple instructions, much less complex medication regimens. Someone who lacks safety awareness for himself probably isn't going to remember to lock a wheelchair for someone else. Yet these are the people we send our patients home with.
Younger caregivers have problems as well. Children who abuse drugs and alcohol aren't going to be reliable caregivers for their parents. Thrusting the care of a parent on a teenager is another problem. Teenagers can barely care for themselves. Yet I've had situations where the teenager was the only one available. One woman volunteered her 12-year-old daughter because she was mature for her age.
As a result, I've started looking more carefully at family members. I always include them in education. I encourage them to be present during therapy. All the time, I watch them to see how much is processing. If a family member is going to take a patient home, that family member must be capable of providing the required care. If not, a SNF or nursing home may be more appropriate. That decision is better made sooner rather than later.
Patient return demonstration is good. Family return demonstration is better. Both must be documented. Ideally both should understand, but that isn't always possible.