3. Why a family support model is important
For the first time in American history women,
who assume a disproportionate share of the
caregiving responsibility, spend an average of 17
years of their adult lives as the mothers of
dependent children and 18 years as the daughters
of elderly dependent parents [l]. Chronic disease
can strike at any age, although as people get
older and as our population as a whole ages,
chronic illness is becoming more prevalent. Nearly
25% of persons aged 45-64 and more than
half of those aged 65 or older, are limited in their
activities by at least one chronic condition [4].
With families being more dispersed and more
women working, growing challenges face family
care-givers.
The healthcare system must find ways to
support these families without eroding the special
sense of familial commitment and caring that
family caregiving demonstrates and without
transforming personal care into an impersonal
commodity that is merely bought and sold. Providers
must strive to develop a shared approach
to family support, one that responds to the
perceived needs of chronically ill and frail individuals
and their family care-givers, that does
not usurp their sense of control over their lives,
and one that ‘helps them help themselves.’
A new interpretation of health is also evolving.
Being well is no longer synonymous with being
healthy. Being well implies a wholeness and
integrity of self in the face of a variety of
predicaments, including disease. This shift to a
more holistic approach provides opportunities to
find better ways to sustain the family’s commitment
to care.
However health is viewed philosophically,
when a patient or family faces chronic illness or
frailty, the physician is often looked to for help
in where to get community services, in ways to
cope with caregiving issues, and for emotional support [S]. Unfortunately, care-givers are often
frustrated with physicians who fail to refer them
to community resources or other specialty medical
services [6]. The family physician is often the
weak link in the referral chain to other services.
Community service providers also have experienced
a lack of referrals from physicians’
offices. While most physicians regularly refer to
home health and meals-on-wheels, only 10% of
physicians and their staff know about other
family services such as adult day care, mental
health programs, support groups or preventive
health programs [7]. If the physician is functioning
in isolation from the larger community
support system, there is no easy solution when he
or she suspects that emotional factors affect a
patient’s poor self-management of an illness, or
when poor health of a patient is caused by the
everyday stress and fatigue of caring for a chronically
ill friend or family member. Problems
caused by the stress of caregiving cannot be
cured with a prescription or a few days of bed
rest. If the physician doesn’t know what community
resources are available, there is little he
or she can do to help the patient or care-giver in
these situations.
Rather than attempting to be fully knowledgeable
about community services for the chronically
ill or elderly, or financing mechanisms for such
services, most physicians, especially those in
primary care, would prefer to have a place to
refer families with chronic illness [8,9]. A family
support program can be the place where the
medical system and the formal and informal
support systems meet. The Family Support
Model links families, physicians, and community
services into an interconnected system.
3. เหตุใดแบบจำลองสนับสนุนครอบครัวเป็นสำคัญครั้งแรกในประวัติศาสตร์อเมริกันผู้หญิงซึ่งถือว่าร่วมกันนำของcaregiving ความรับผิดชอบ การใช้จ่ายโดยเฉลี่ย 17ปีของชีวิตผู้ใหญ่เป็นมารดาของขึ้นอยู่กับเด็กและ 18 ปีเป็นลูกสาวของผู้สูงอายุขึ้นอยู่กับผู้ปกครอง [l] โรคเรื้อรังสามารถตีทุกวัย แม้ว่าจะเป็นคนได้เก่า และ เป็นประชากรของเราเป็นยุคทั้งหมดเจ็บป่วยเรื้อรังเป็นแพร่หลายมากขึ้น เกือบ25% ของคนอายุ 45-64 และเพิ่มมากขึ้นกว่าครึ่งหนึ่งของผู้ที่อายุ 65 หรือ มากกว่า จะถูกจำกัดในการกิจกรรมตามเงื่อนไขเรื้อรังน้อย [4]ครอบครัวมากกว่ากระจายและอื่น ๆผู้หญิงทำงาน ครอบครัวเผชิญกับความท้าทายมากขึ้นดูแล-giversระบบสุขภาพต้องค้นหาวิธีการสนับสนุนครอบครัวเหล่านี้ โดยไม่มีการกัดเซาะพิเศษภาวะความมุ่งมั่นและการดูแลที่แสดงให้เห็นถึงครอบครัว caregiving และไม่มีเปลี่ยนการดูแลส่วนบุคคลที่ไม้มีสินค้า ที่เป็นห้องซื้อขาย ผู้ให้บริการต้องพยายามพัฒนาวิธีการใช้ร่วมกันการสนับสนุนครอบครัว หนึ่งที่ตอบสนองการต้องการรับรู้ของโรคเรื้อรังคนป่วย และ frailและของครอบครัวดูแล-givers กล่าวไม่แย่งชิงของพวกเขาความรู้สึกของชีวิตซึ่ง 'ช่วยให้พวกเขาช่วยเหลือตัวเอง'นอกจากนี้ยังมีการวิวัฒนาการการตีความใหม่ของสุขภาพกำลังดีอย่างไม่มีมีสุขภาพดี ดีหมายถึงว่าวที่ และความสมบูรณ์ของตัวเองหน้าหลากหลายpredicaments, including disease. This shift to amore holistic approach provides opportunities tofind better ways to sustain the family’s commitmentto care.However health is viewed philosophically,when a patient or family faces chronic illness orfrailty, the physician is often looked to for helpin where to get community services, in ways tocope with caregiving issues, and for emotional support [S]. Unfortunately, care-givers are oftenfrustrated with physicians who fail to refer themto community resources or other specialty medicalservices [6]. The family physician is often theweak link in the referral chain to other services.Community service providers also have experienceda lack of referrals from physicians’offices. While most physicians regularly refer tohome health and meals-on-wheels, only 10% ofphysicians and their staff know about otherfamily services such as adult day care, mentalhealth programs, support groups or preventivehealth programs [7]. If the physician is functioningin isolation from the larger communitysupport system, there is no easy solution when heor she suspects that emotional factors affect apatient’s poor self-management of an illness, orwhen poor health of a patient is caused by theeveryday stress and fatigue of caring for a chronicallyill friend or family member. Problemscaused by the stress of caregiving cannot becured with a prescription or a few days of bedrest. If the physician doesn’t know what communityresources are available, there is little heor she can do to help the patient or care-giver inthese situations.Rather than attempting to be fully knowledgeableabout community services for the chronicallyill or elderly, or financing mechanisms for suchservices, most physicians, especially those inprimary care, would prefer to have a place torefer families with chronic illness [8,9]. A familysupport program can be the place where themedical system and the formal and informalsupport systems meet. The Family SupportModel links families, physicians, and communityservices into an interconnected system.
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