Background and Purpose: Older adults often need caregivers to help them age in place successfully while maximizing their quality of life. These caregivers have the highest rates of burnout, injury, and turnover. Family-centered care (FCC) involves collaboration between the healthcare practitioner and the patient, family members, and caregivers. There is a paucity of evidence on how FCC is applied to older adults and their caregivers. The purpose of this general qualitative study was to explore how a group of home health physical therapists (HHPTS) deliver FCC to care-dependent older adults.

Methods: This general qualitative study used individual, semi-structured interviews with a purposeful sample of 14 HHPTs working for a variety of home health agencies in San Diego County. The interview responses were hand transcribed, hand coded, thematically analyzed, and conceptualized in the International Classification of Functioning, Disability, and Health model (ICF model). The coding table and interview guide were modified based on reviews by experts in home health physical therapy. A proprietary coding software program called NVivo was used to triangulate the results.

Results and Discussion: The 3 main themes that emerged were: (a) "FCC is Complex"; (b) "FCC Impacts Older Adults' Health Factors"; and (c) FCC is Impacted by Contextual Factors". Eleven subthemes also emerged. The themese and subthemes were conceptualized within the ICF Model. The first theme demonstrated that the HHPTs had a variety of understandings of, training on, and applications with FCC. The HHTP was conceptualized as an environmental factor that could impact the patient's health based on their knowledge and skills with FCC. The second theme demonstrated that FCC was utilized to address every ICF health factor by the HHPTs. This theme was conceptualized around the entire ICF Model. Neurological conditions and motivated families were seen as large factors in performing FCC. The third theme demonstrated that a wide variety of contextual factors impacted the HHPTs ability, time, and resources to perform FCC. This was conceptualized in ICF Model as personal and environmental factors that could facilitate or inhibit ("+/-") FCC approaches by the HHPTs.

Conclusions: This study closed some of the gaps in the literature on how FCC is delivered to older adult clients, their caregivers, and their family members. This knowledge may help to foster changes in FCC approaches and research. Changes like these could lead to improved health outcomes for older adults through reduced hospital readmissions and improved caregiver satisfaction with care as seen in pediatrics.

Key Words: Family-centered care, home health physical therapist, caregiver satisfaction, burnout, and International Classification of Functioning, Disability, and Health model.

Author Bio(s)

Dr. James Mathews, PT, DPT, PhD, is the author, and lead researcher, of the dissertation, “Exploring Family-Centered Care from the Perspectives of Home-Health Physical Therapists”. This dissertation was available for open access in ProQuest as of November 2020. The original Walden University Institutional Review Board (IRB) approval number is IRB# 04-13-0661874. Dr. Mathews is the Associate Program Director of an entry-level Doctor of Physical Therapy Program, a teaching faculty member, and a treating physical therapist in an adult day healthcare center. He is a novel researcher and a Board-Certified Clinical Specialist in Geriatric Physical Therapy. Dr. Mathews has been a licensed California Physical Therapist (PT-24087) since 1999. From 2003 to 2011, Dr. Mathews worked full-time in skilled nursing facilities. Since 2012, Dr. Mathews has worked full-time in academia. His inspiration for this study came from witnessing poor care transitions to home with family members and from the 2017 article by Dr. Alan Jette, PT, PhD, FAPTA, titled, “From Person-Centered to Family-Centered Health Care".


I would like to acknowledge: (a) all of the home health physical therapists involved in this study for their dedication to the long interview and member checking, (b) Dr. Cheryl Anderson, PT, PhD, for mentoring me every step of the way as my dissertation Chair and colleague, and (c) Dr. Christine Childers, PT, EdD, for her ongoing mentorship and reviews.




Submission Location


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