Have you heard of the CARE Act? An acronym for Caregiver Advise, Record, and Enable, the CARE Act is a sweeping effort finding its way into many state legislatures in hopes of better equipping caregivers and patients for maintaining health and wellness at home, especially after leaving the hospital.
So far 18 states have signed the CARE Act into law including Minnesota, New Jersey, California, and Oklahoma. Championed in large part by AARP, the CARE Act requires hospitals to:
• Require the name and contact information of the family caregiver who will be responsible for a patient and record it on the patient’s medical record
• Inform the family caregiver when the patient is going to be discharged
• Provide the family caregiver with the resources and education they need to be able to administer care successfully at home, including instruction of skilled medical tasks like dressing a pressure ulcer or dosing medicine to stop a seizure
According to the Caregiving Alliance, over 40 million family caregivers currently reside in the U.S. providing everything from transportation to appointments to full-time medical care, including giving medicine and injections, for spouses, relatives, and children with special needs. Unfortunately, for many caregivers, the most important lessons are learned on the job. Often after the chaos of a medical emergency, communication with caregivers regarding at-home care, warning signs, risk factors, and guided instruction is very much needed from hospital staff, but not well relayed or understood.
Even with assistance from a home health nurse who may visit once or twice a week, family caregivers can lack the medical expertise and know-how during those in-between windows of time which can help keep their loved ones from returning to the hospital. For example, knowing the warning signs of respiratory depression while a loved one is being treated with opioids or benzodiazepines could prevent hypoxia and ultimately a tragic death. Or being taught that incontinence and immobility put a loved one at a high risk for a urinary tract infection which could lead to septicemia can equip caregivers with steps to prevent infection or at the very least recognize symptoms and seek proactive treatment.
Even seemingly simple caregiving resources that foster a collaboration between the medical community and family caregivers can make a huge difference with the CARE Act. Imagine if the caregiver of an older adult who received a hip replacement after a bad fall was given helpful guidance and resources for fall prevention in the home? A patient advocate may share ideas with a caregiver for employing ease of use tools like a long handled shoe horn for getting dressed or grab bars in the shower for bathing to prevent future falls and re-hospitalization.
Do hospitals make more money for involving family caregivers during discharge and for in-person training on providing care in the home? No. And largely, even with the states who have some sort of legislation passed, it is still left up to the hospitals how they will handle the task of educating caregivers. Medicare does, however, penalize medical centers for patients who bounce back and forth from the hospital as part of the Hospital Readmissions Reduction Program. A 2009 study actually revealed that almost 20% of Medicare beneficiaries who were discharged from the hospital were readmitted within a month, with that number jumping to 34% within 90 days. The Hospital Readmissions Reduction Program was enacted as part of the Affordable Care Act in 2012, which is currently undergoing its own repeal in the Senate and only time will tell what its future looks like.
Innovative hospital caregiver programs, like the 7 grant-funded NYC-area ones featured in a 2003 report from United Hospital Fund, found that “Caregivers report a lack of training on equipment and procedures, and say that health care professionals often dismiss their fears and discomfort about having to take on professional tasks.” With key tactics in both involving family caregivers as advisors, as well as training hospital staff on working with caregivers, and receiving high-level institutional support from the hospitals themselves, the report revealed significant success in hospital-caregiver relations as well as improved patient care. The report does acknowledge that many hospitals will not see immediate revenue from integrating these types of programs into their cycle, and that many institutions may lack the funds to carry off interdisciplinary caregiver programs without ongoing grants.
When it comes to patient health and safety, the care provided at home which keeps a loved one out of the hospital is oftentimes the most important. Knowledge, instruction, and guidance from the medical community and hospitals on providing the best care possible at home plays a critical role in helping patients heal or live with chronic disease as successfully as possible. The CARE Act and similar legislation is aiming to do just that.
Nathan Bradshaw is an expert marketer who specializes in promoting and growing physician practices. He currently works with an urgent care center in Brooklyn to help improve their online footprint and garner interest in their Urgent Care, Occupational Health and Health Services.
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