**4. Home care interventions delegated to the family caregivers**

### **4.1 Physical domain**

The physical domains of home care such as hygiene of the recipient, proper mobilization of the patient in bed, daily chest massage and oral cavity cleaning are daily medical manoeuvres which are delegated to the family caregiver by the GP. Family caregivers' education about the treatment is mandatory and implies the administration schedule, onset of action, routes of administration and possible side effects. The fulfilment of the treatment plan involves the following interventions: (a) medication administration by different routes (oral, rectal, percutaneous, enteral or using a nasogastric tube) and (b) monitoring of symptom control by

the family caregivers. Warnings regarding late-release medications, which require administration at fixed times, and fast-release medications, which are administered when needed, are important. The family caregiver should record in a diary the problems they are experiencing, the side effects of the drugs and the presence of intestinal transit. Some medical interventions can be assigned to a certain family member as long as he/she is well trained and if a safe device is used (e.g. administration of the medication subcutaneously by a microperfuser) and will be supervised by the GP and community nurse.

## **4.2 Psycho-emotional domain**

The psycho-emotional aspect of the home care is burdensome for both the recipient and the family caregiver, affecting the formal home care team as well. Interventions delegated to the family caregiver imply discussions on pleasant topics, keeping in touch with the patient's friends and creating an enjoyable environment. Keeping honesty about the diagnosis, treatment and evolution is a desideratum of communication. Solving family conflicts, establishing good relations between its members and paying attention to people at risk especially for children will complete the care, keeping family members involved in the home care process. Cultural values and spiritual beliefs should be respected.

### **4.3 Social domain**

The social support includes financial assistance, emotional support, information, companionship and self-esteem support. Inadequate social support and social isolation are associated with increased depression [25], cognitive decline, increased pain intensity and increased mortality [26]. The social needs are addressed by the social assistance specialist, and some can be delegated to the patient's family. The family caregiver will create a socially appropriate environment by avoiding isolation and participating in social or religious events and walks, depending on the degree of patient dependence.
