Overview of Manual

The purpose of this manual, prepared for Veterans Affairs Canada, is to provide a complete guide for implementing workshops offering education and support to family/friend caregivers. The term "family/friend caregiver" refers to an individual who voluntarily assists a spouse, relative or friend with the activities of daily living, often enabling that person to remain at home. The term "informal caregivers" is also used to describe this group. The use of the word "informal" refers to the nature of the relationship based on a personal history, making a distinction between paid (formal) and unpaid (informal) caregivers. It does not refer to the tasks involved in the care. Clearly, family caregivers offer a complex range of caregiving tasks that cannot be underestimated in any way.

An extensive body of knowledge has emerged over the past two decades which has helped to raise the profile of the significant role played by unpaid caregivers as well as some of the consequences - both positive and negative that can be present in caregiving relationships. It is recognized that caregivers need both education and support to sustain them in their role. A program of educational sessions in a supportive environment offers an opportunity for caregivers to share experiences, develop new skills, consider different approaches, and deal more effectively with their relationships and feelings.

The contents of this manual are targeted primarily to those caring for older adults at home, although the information contained in some of the sections has relevance for adults in younger age groups with different types of disabilities (specifically the sections on stress management and communication skills).

The majority of adults requiring assistance with daily living are seniors. Of 2.8 million caregivers in Canada, over two thirds (2.1 million) provide care to an older adult at home. In the last decade, significant changes in the delivery of health care, in the complexity of care being provided in home settings, and increased reliance on informal support mechanisms for care of seniors have made the need for this manual even more pressing.

This manual was originally prepared (1993) for Veterans Affairs Canada to enable its field staff to provide education and support workshops primarily to those providing informal care to veterans or for veterans providing care for other family members. However, as part of their broader caregiver strategy, Veterans Affairs began responding to requests from community sectors. They made the manual available to community groups to enable them to develop education and support groups in other settings. Accordingly, this manual (second edition) has been revised to reflect the wider use of this material.

The target audience of the workshops - unpaid caregivers - remains the same. The facilitators may include social workers, community mental health workers, nurses in a variety of settings, caregivers and others with experience in providing or arranging care for individuals needing assistance to remain at home in the community. The delivery agency or sponsoring group may also be from a wide range of service or interest groups such as self-help groups; the Alzheimer Society; municipal, provincial or federal government departments (for example in the health, housing, or social service fields); home care/home support agencies; seniors organizations, as well as others. Community Health Boards, District Health Authorities, provincial home care programs, home support agencies, seniors organizations, church groups, and others with an interest in the well-being of older adults and their families may wish to consider offering this workshop series to family caregivers in their communities. For those agencies considering delivering such a program, it is suggested that some thought be given to:

• A process for selection of facilitators
• A plan for training facilitators
• A plan to support facilitators
• A strategy for ongoing involvement, if required

A process for selection of facilitators.

The success of the workshop series is highly dependent upon the skills of the facilitator. A good facilitator will have knowledge of group dynamics, experience in working with groups, presentation skills, and a comfort level with the role of a facilitator and with the material. S/he must also be comfortable with diversity, be prepared to field difficult questions, and appreciate the sensitivity of the subject matter. S/he must be prepared for expression of a range of emotional responses from the audience and how to best address issues as they arise. Usually, potential facilitators will have some preparedness for this task by way of their professional background. Selecting a skilled facilitator is critical and requires a carefully thought out set of criteria that reflect the profile of the sponsoring organization.

A plan for training facilitators.

Training facilitators - be they professionals or lay persons with an interest - increases their preparedness, their comfort level with the material, and their ability to offer the workshop in a consistent way. This is important particularly if a sponsoring group is planning to offer the workshops on an ongoing basis and/or if the potential facilitators come from a variety of environments, professional disciplines, or possess varying skill or confidence levels. Training and development is an ongoing process.

A plan to support facilitators.

Related to this is the degree of support a sponsor is prepared to offer its facilitator(s). If the agency anticipates offering these workshops on an ongoing basis using the same cadre of volunteer facilitators, it is important to address how the facilitators will be supported in their role. Over time, facilitators, like any volunteers, are likely to experience burnout, lack of motivation, and reduced enthusiasm for delivering the course if not supported, recognized, and encouraged in their role.

Opportunities to discuss the workshops with other facilitators or to identify potential changes/enhancement to the material over time may be helpful. An organization may need to consider offering a variety of incentives, for example, which do not have to be monetary in nature. There may be advantages in choosing a facilitator who is linked with the sponsoring agency for both accountability purposes and to ensure a support structure is in place for that person. This does not preclude joint sponsorship by several agencies, particularly in an effort to pool resources.

A strategy for ongoing involvement, if required.

The role of the facilitator is to conduct the six Care for the Caregiver workshops and create a safe and supportive environment for participants. After the workshops conclude, some participants may express an interest in continuing to meet together to form an ongoing support group. At this stage, it becomes necessary for the sponsoring organization and facilitator to renegotiate the facilitator's role. The facilitator may not wish to continue in any capacity, may only be willing to coordinate provision of the facility for meetings, or may be prepared to continue to facilitate/lead group discussion but without a formal manual or course of instruction. The nature and extent of commitment expected of the facilitator by the sponsoring organization should be made clear at the outset, as should the commitment the facilitator is prepared to make. Commitment beyond the initial six weeks of instruction should not be an expectation of the facilitator. This should be discussed again as the sessions approach conclusion so the facilitator and sponsoring agency are prepared for this discussion with the group.