Whether you are working with a family member or another loved one, or in a professional care environment, the support you give makes a real difference. Without the assistance and care you provide, a dignified, fulfilled, normal life may become impossible for those who need care. Without your work, and the work of others just like you, the world would be a much darker place.
This is easy to define in qualitative terms. “Admirable,” “inspirational,” “invaluable” — there are thousands of terms that describe what you do, all of them glowing and worthy of pride. But how do we quantify this inspiration? How do we measure admiration? We can’t — and therein lies the problem. Care services are often seen as invaluable but in two very different ways — in other words, perceived as both vital and lacking a defined value.
We need to think in quantitative terms, not merely qualitative. Care workers like you need to be supported in the proper way, with remuneration and compensation that befits the work you do. And the only way to accomplish this is to document the work you do.
To Demonstrate Value, You First Need to Understand It
Before you can start demonstrating the value of the supports you provide, you first need to recognize this value yourself. At the outset, this should be easy — you are living this experience after all, and you are well-positioned to voice your opinion. The problem is this: it’s easy to become trapped by personal perspective.
Think about things you do every day — like driving a car, perhaps. Maybe you’ve been driving for years and have a clean record, which suggests you are a good driver. But what about if someone asked you to analyze your driving, to describe it in quantifiable terms? This would probably be difficult. This is because the human brain is adept at carrying out frequent tasks essentially on auto-pilot, leaving more space for less familiar cognitive tasks. Imagine if you had to be fully present in the moment in order to activate a turn signal or stop at a red light rather than doing these things semi-automatically. The whole experience of driving would become horribly stressful. It’s the same with the care you provide — it’s difficult to think critically about the value you offer.
Understanding the Psychology of Habitual Care
When care becomes habitual, this is a coping mechanism. Just like in the driving example mentioned above, much of the care you provide will become almost automatic simply because you are so used to doing it. This does not devalue the care you provide — an external assessor can still look at your routine and witness the benefits you deliver to those in need of care — but it does make it difficult for you to truly demonstrate your worth in a quantifiable way.
Essentially, you are losing clarity in terms of the depth of support you give. For instance, you know that you help the recipient of your care to move downstairs and prepare breakfast each morning, and you do
this every day. But you lose sight of the incremental improvements you are providing to their life and their independence. Moving this act from conscious action to unconscious habit means you lose the ability to demonstrate your work to external observers.
Communicating Value: Subjective Experience vs. Objective Observations
To truly communicate your value and demonstrate the difference you are making, you need to step outside of your own subjective experience. You need a set of metrics you can use to prove the value of the supports you are delivering.
These metrics need to be robust and relevant. It’s not enough simply to adhere to the default regulatory guidelines. Different sub-departments within the Department of Health and Welfare have their own goals and expectations that may overlap with one another, or they may conflict with one another. The decision of one department may influence that of another department, while a report delivered by one entity may result in a denial of service from another.
This is what necessitates a whole-care measurement system — a set of metrics that you can use to analyze and prove the entirety of the care you provide over a set time period. Without this system, you risk losing out on the support and compensation you deserve.
Introducing DFI —The Key Metrics for Demonstrating Care Value
DFI stands for Duration, Frequency, and Intensity. With these key metrics, you can begin to report with accuracy and precision on the supports you provide.
Duration is simply how long it takes you to carry out a task — one of the many incremental tasks that make up a day of care. Let’s take teeth cleaning as an example.
- It may only take a couple of seconds to remind someone to clean their teeth, but this is not going to be sufficient for most care environments.
- The actual action of cleaning the teeth may take between three and five minutes.
- Someone who needs more comprehensive care may require a longer process to clean their teeth. For instance, you may need to glove up, prepare the area, encourage the person, and overcome their resistance to the process. This can dramatically increase the amount of time it takes to complete the task. You could be looking at upwards of 15 minutes, to an hour in some cases.
Do you know how long supported activities take to complete in your home or care environment? It can be difficult to keep track without proper measurement.
Frequency refers to how often a task needs to be completed. Some tasks may only need to be carried out each week or every few days, while others may be required multiple times each day.
- Helping to scrub a floor, for example, may only need to be carried out once or twice a week.
- Cleaning teeth will need to take place at least twice a day.
- Mealtimes and other activities related to food will likely take place multiple times each day.
Basically, each and everything you do as part of your care counts toward your frequency of intervention. This includes every time you physically assist someone or complete an action for them, but it also covers every time you need to remind someone, gesture to someone, or handle another lower-level interaction. All of these instances need to be included so that your count is focused on how much support is required during the provision of care.
So far, we’ve looked at duration and frequency — two relatively easy metrics to measure. You can use devices to measure and document how long you are spending on a task, and demonstrate support and intervention frequency. However, there is a third aspect we need to consider. Intensity. Intensity can be a little more difficult to measure objectively.
What does intensity mean exactly? In the care environment, we are talking about the level and type of interaction required to complete a task. In other words, how much effort does the caregiver need to put in to make sure the task is completed properly? Additionally, it’s useful to know if support needs today are more or less than the person’s regular needs. Since this can be hard to measure, we can also derive intensity of support by comparing caregiver support activities to what would happen if they did not intervene and the person was left to complete the task independently.
Let’s go back to the teeth cleaning example and explore this in more detail.
- Reminding someone to clean their teeth in the morning and evening — This might be considered low-intensity. It’s a straightforward task requiring only a basic verbal cue, with relatively little emotional or physical input.
- Encouraging someone to clean their teeth and overcoming verbal resistance — This is a more intense task than the first example, but the problem can still be resolved verbally. How much verbal encouragement is required will influence the intensity of the task. Constantly having to overcome verbal resistance can be emotionally draining.
- Helping someone to prepare the tools, materials, and space they need to clean their teeth — Now we are beginning to add physical activity to the equation and the level of intensity increases, although we still need to be aware of the emotional and psychological aspects.
- Assisting someone with brushing each individual tooth after making preparations for the task — This further increases the level of physical activity and therefore the level of intensity.
- Assisting with brushing teeth while also managing the person’s anxiety and resistance, perhaps having to break the task into smaller increments — Now we are at the high-intensity end of the scale, both in a physical and emotional sense.
- Now you can see the scale of intense support. We can further refine this analysis by noting what support is regularly needed, and how today compares. Additionally, we may discern that not intervening results in teeth no being cleaned, emergency dentist visits, and toothpaste all over the bathroom. All of these factors are important in determining the intensity of supports.
Why is intensity more difficult to assess and manage? Because of what we discussed above — the human brain’s response to familiarity. You may become used to the amount of effort it requires to complete the tooth brushing process, and you may even forget the work you have to do to initiate and complete the process. You essentially “blank out” the work, completing automatic movements and actions that you know will achieve the desired results. This does not diminish the work you put in or the value you provide, but it does make it more difficult to gain the right perspective.
Assessing and Demonstrating DFI: Practical Examples
Let’s take a closer look at how DFI works in practice and how you can adopt these metrics within your own care schedule.
To accurately assess duration, you need to take a scientific approach. This means using timers or similar instruments to examine and record exactly how long a task takes to complete.
In the toothbrushing example, this time would begin when you first start your preparations — perhaps preparing equipment or putting your gloves on. If you had to inform or encourage the person before this point, you will need to start the time here.
You may also want to record the duration in detailed increments. This could involve recording and noting down the verbal cues required, the preparation time ahead of toothbrushing, and the duration of the toothbrushing itself. Doing this provides an accurate picture of how long the complete process takes.
Frequency is relatively easy to get a handle on, probably even more so than duration. However, you need to make sure you are recording frequency accurately and precisely.
By “accurately” we mean avoiding mistakes. If you are doing something seven times a week, make sure you record the full seven instances. Don’t be tempted to guess at a vague number. Again, the proximity to your task can skew your perception, and this could result in you forgetting to record key instances of care. In this context, recording more frequently will result in less memory mistakes.
By “precisely” we mean using the right scale. Let’s say you are carrying out a specific task on a daily basis — recording that you do this “every day” is certainly true, but it might not tell the whole story. Toothbrushing, for example, is carried out at least twice a day, resulting in 14 instances each week. Other everyday care events may run into tens or even hundreds of instances every week. Recording that you have carried out a specific task “25 times a week this week” is far more useful than saying you do something “several times a day on most days.”
Frequency is relatively easy to get a handle on, probably even more so than duration. However, you need to make sure you are recording frequency acIntensity is a little more difficult to track, at least quantitatively. It’s difficult to put a numerical value on the effort — or the intensity of the effort — you expend. This is where you can support your quantitative observations with qualitative inputs while remaining logical and objective.
Even with the best intentions, your capabilities are limited. Yes, you can push yourself to take on more responsibility, you can organize your time methodically, and you can call upon additional resources to help you, but there is still a limit to what you can achieve.
This is important to bear in mind when we approach intensity. When you record the intensity of your tasks, think about the available resources you have to offer. Be sure to record the interventions and work that is required to deliver the proper level of care, but don’t stop here. Physical activities are the ones that are most likely to be noticed — these are the most obvious, the most self-evident — but don’t forget to record your verbal, and gesture cues as well.
When compensation and remuneration are delivered to caregivers, it’s usually these physical tasks that are likely to be recognized first. External observers may find it relatively easy to spot when you have exerted physical effort during your care tasks. Other aspects of intensity — such as the emotional or psychological aspects discussed above — may go unnoticed. This is why you need to make sure you are able to recognize this for yourself, and communicate this when required. Additionally, it’s vital to know what happens if you don’t intervene and communicate that fact to your team and anyone else evaluating supports.
Make DFI Metrics a Core Part of Your Care Reporting
We offer a number of resources to help you record, prove, and demonstrate the value of the care supports you are providing.