You are caring for a parent or spouse who is in the hospital. At 9:00 AM, your loved is told she’s being discharged by Noon. You had no idea this was coming. Worse, she’s going to have complex care needs—maybe wound care after surgery, or lots of medications to take on a complicated schedule. You have no idea what to do next.
It is a familiar story that often ends with needless infections, emotional distress, and costly and dangerous rehospitalizations.
Help may finally be on the way. In the past month, two very different models have surfaced that will begin engaging family caregivers in hospital discharges, and give them the information and training they need to care for their loved ones once they return home. One expands a powerful voluntary program that helps hospitals improve the way they discharge patients. The other is new model state law that would require hospitals to better inform and educate family caregivers.
The need is enormous. Under pressure from Medicare and other payers, hospitals are discharging patients faster than ever. They often go home, where with little or no professional assistance family members must provide complex and difficult care. Not only must spouses and adult children help with activities such as bathing, feeding, and lifting their loved ones, they often must take on complicated medical care that would otherwise by handled by highly-trained Registered Nurses.
A 2011 survey by AARP and the United Hospital Fund found that half of family caregivers perform medical tasks. Nearly 80 percent manage medications, more than one-third change dressings and do other wound care, and more than one-quarter use incontinence equipment or give enemas.
And they often do it with little or no training.
That may be about to change. One solution builds on a highly successful discharge planning tool called Project RED (Re-engineered discharge) that has been used by at least 500 hospitals and some nursing facilities. RED, developed by Dr. Brian Jack and his team at the Boston University Medical Center, is a carefully designed toolkit that takes facilities step-by-step through a successful discharge.
Now, RED has added a template for engaging family caregivers in this process. The model was created by Carole Levine and Jennifer Rutberg at the United Hospital Fund and Dr. Jack and Dr. Ramon Cancino at BU. The RED toolkit is here. The caregiver section is here.
It guides participating hospitals through several steps: Identify the primary family caregiver, assess her needs (as well as the patient’s), document the information, and train her in the skills she’ll need to help her loved one after discharge. Ideally, this process begins at admission.
There may seem to be something of a ..duh…factor here. But you’d be amazed at how rarely hospitals know who the family caregiver really is, much less make them full participants in any discharge plan.
While RED provides the technical assistance hospitals need to help family members, a growing number of advocacy groups, led by AARP, is turning up the heat on those that don’t.
AARP has developed model state legislation, called the CARE Act (Caregiver Advise, Record, Enable Act) that would require hospitals to identify and record the name of the main family caregiver and notify that family member when the patient is discharged. Finally, the hospital would explain to the caregiver what she’ll need to do to help the patient after discharge and teach her the skills she’ll need.
Oklahoma passed its version in May. Similar measures have been introduced in New Jersey, Hawaii, and Illinois.
These bills give hospitals plenty of flexibility and include no specific penalties for failing to comply. Still, they send a strong signal to facilities: Prepare families for life after discharge.
It would be great if hospitals accept this role voluntarily. Medicare penalties for excessive readmissions and new risk-based reimbursement systems all provide plenty of financial incentives to do so. But if they don’t, there is growing interest in states, including red states such as Oklahoma, to make them. It is about time.
After several personal experiences with hospital discharges for family members, there is no “duh”
factor for me. Inconceivably to me, standard hospital culture seems to be get the patient to the minimum qualifications for discharge, get them out the door, case closed. If they come back that’s their problem.
Finally something that makes sense instead of kicking people out the door. Understanding the person’s situation should be part of discharge and some assistance offered- could be follow-up nurse visits, home assessments, caregiver education, and suggestions on what services/products should be considered to keep a person safe. Our “Friendly Beds” will hopefully be remembered as an innovative product to help those struggling with bed mobility (transfers and repositioning).
[…] health centers, or other services, could reduce many of those preventable hospitalizations. Better training and more support for family caregivers could help as […]