The Interdisciplinary Team is key to the health care provided directly or subsidized by Alberta Health Services (AHS). This includes Alberta Home Care and “Designated” AHS-subsidized Supportive Living and Long-term Care facilities. The caregiver that acts as the legal representative for the person with dementia is an important member of this team and can therefore have significant input into the health care.
Role of the Interdisciplinary Team and Caregiver
In addition to regulations related to their operation, DSL and LTC facilities must follow the Continuing Care Health Service Standards (CCHSS). These standards, which also govern Home Care, were updated in July 2018. They are extremely well-written, organized and easy to follow. From a Client’s point of view, they offer important information concerning not only the required health care services but also the Client’s rights. The clauses related to the Interdisciplinary Team are of particular interest. The Definitions section of the CCHSS standards define the Interdisciplinary Team as follows:
“A group comprised of Health Care Providers, the Client or the Client’s legal representative, if applicable, and other individuals of the Client’s choosing, who meet for the purposes of planning, coordinating and delivering Health Care services to the Client. The Health Care Providers on the Interdisciplinary Team are determined by the Client’s assessed Health Care needs.”
The Client plays a vital role on the team and, according to the standards, is involved in key areas and decisions. These include those related to the
- Care plan
- Client’s access to information
- Risk management
- Medication review and management
- Nutrition and hydration
- Restraint management, including the use of antipsychotics
For Clients with dementia, the above participation in the Interdisciplinary Team is usually done through the caregiver acting as the Personal Directive Agent. This participation is particularly important for medications, including antipsychotics, and in the formulation of the Care Plan that is prepared by the Home Care Case Manager for DSL facilities and by the facility nursing staff for Long-term Care. The emphasis on involving the Client is consistent with the intent by Alberta Health and AHS to have a Client-centered health care system. Unfortunately, Clients and their caregivers are usually not aware of these regulations or the scope of their rights to actively participate in the care process. This is to a great extent due to the fact that facilities and AHS Home Care often do not make the required effort to inform their Clients of either the CCHSS standards, the existence of the Interdisciplinary Team, or the Client’s role on that team. As a result, key decisions are often made and care plans developed with insufficient input and review on the part of the Client or caregiver. This issue could be addressed if facilities developed Policies and Procedures specifically dedicated to the Interdisciplinary Team, emphasizing its importance and outlining procedures to ensure that the CCHSS standards concerning this team are followed.
Clients should be made aware by DSL and LTC facilities and by Home Care of the CCHSS standards and the important role that the Client and caregiver can play in the Interdisciplinary Team. This could be done by providing a copy of the CCHSS regulations to the Client or caregiver along with a separate Policy and Procedure document that clearly outlines their role on the Interdisciplinary Team. This should occur when the Client is admitted into a facility or registers with Home Care. Similarly, caregivers should be encouraged to make themselves aware of the CCHSS regulations and to inform DSL and LTC facilities and Home Care when these regulations are not being followed.
The underlying premise in the above recommendation is that Alberta Health, AHS and its Clients wish to have a truly Client-centered system. DSL and LTC facilities, Home Care, along with their Clients and caregivers, share a responsibility in ensuring that this is indeed the case. This requires not only a commitment to understand and follow the regulations but, in some cases, a shift in perspective to a Client-centered mindset and culture by all those concerned.