10 Actions to Improve Care Transitions Through Caregiver Involvement

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The United Hospital Fund recommends 10 actions to improve transitions of care for chronically ill patients by engaging their family caregivers in a new report, "Transitions in Care 2.0: An Action Agenda."

"Integrating family caregivers into existing and future transitional care programs and practice is an essential step toward a redesigned healthcare system," the report states. Here are the 10 recommendations, which are grouped into three categories:


Laying the foundation for healthcare professionals and administrators to work effectively with family caregivers
1. As a component of quality improvement activities, providers should map current transition processes, including staff attitudes and behaviors toward family caregivers.
2. HHS' Office of Civil Rights should lead the retraining of healthcare organizations and professionals about HIPAA to ensure effective communication with family caregivers.

Making family caregivers part of the care team
3. Healthcare providers should develop systematic protocols to identify family caregivers and include this information in the patient record.
4. Healthcare providers should guide family caregivers in assessing their capabilities, limits and needs.
5. Train family caregivers and provide follow-up support and reinforcement.
6. Measure the family caregivers' experience, apart from the patient experience, especially in the transition process.
7. Healthcare providers should connect family caregivers with medical services and community support services post-transition and coordinate post-transition care.

Aligning financing and accreditation policies
8. Payors should financially incentivize healthcare providers to support family caregivers' involvement.
9. Enforce accreditation standards by CMS and The Joint Commission related to the need to involve family caregivers.
10. CMS and its Center for Medicare and Medicaid Innovation should include a family caregiver impact assessment when predicting the effects of a proposed innovation.

More Articles on Care Transitions:

9 Actions to Take During Post-Discharge Follow-Up Calls
Medication Reconciliation Program Cuts Hospital Readmissions 50%

3 Questions to Ask When Developing Post-Discharge Follow-Up Call Program

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