A few years ago, Gwen’s mother, Emily, was discharged from the hospital after a short stay. When Emily was ready to go home, Gwen arrived to find her mother dressed and sitting in a wheelchair with a list of medications on her lap. Gwen was never given instructions on her mother’s new prescriptions, and assumed she knew what to do. Unfortunately, she somehow missed out on a key piece of information, that one of the medications was only meant to be given for a very short time. This was discovered months later, but it was too late. Emily’s kidneys had been damaged irreversibly by the medication. Gwen was given the choice to start her mother on dialysis or begin hospice care.
Sadly, the situation in our example happens all too often. In fact, nearly half of all family caregivers perform complex medical and nursing tasks, including managing medication, giving injections, or cleaning wounds. And, most do so with little or no training. To Gwen in our example, receiving instruction about her mother’s medications could have been life changing.
A “common sense” solution (as AARP calls it), the Caregiver Advise, Record, Enable (CARE) Act, supports family caregivers from hospital to home and could have helped Gwen and Emily. The CARE Act ensures that:
•The name of the family caregiver is recorded when a loved one enters the hospital;
•The family caregiver is notified prior to the loved one’s discharge;
•The family caregiver receives a simple instruction of the medical tasks they will be performing when their loved one returns home — such as managing medications.
Under the CARE Act, hospitals must consider the availability of family caregivers, their capacity to provide care, and community supports available to the patient. It is coined a “common sense” solution because ensuring that a family caregiver is well-informed and trained to provide appropriate post-discharge care can help avoid re-hospitalizations as well as prevent a decline in the health and functional status of the patient. Early caregiver research also indicates that incorporating family caregivers into discharge planning could improve the psychological and physical health outcomes of patients while reducing readmissions and total health expenditures.
Participating States
The CARE Act is known by different names in some states, but what remains consistent is that it helps family caregivers from the moment their loved ones go into the hospital to the moment they return home. Yesterday, Ohio became the 34th state to pass the CARE Act. Virginia, Maryland, and DC are also among the states to pass the CARE Act. Please see the map below for participating states (new states may have been added since this map was created, but this is the latest one available). Follow the status of the CARE Act on aarp.org, using the search term, “CARE Act.”
Download your free CARE Act wallet card.
On the AARP website, you can now download your free CARE Act Wallet Card. They are not available for Virginia or DC yet, but the notation on the page says they will be soon, and the information is the same on all of the cards, including the Maryland one. AARP suggests that you print one for you and one for your loved one. You can fold the cards, wrap around each of your insurance cards, and place them in your wallets. That way, you’ll both have the important information about this new law available when you need it most.
Additional Tips for Caregiving for Discharged Patients
Nearly 20% of patients experience an adverse event within 30 days of discharge. Common post-discharge complications can include adverse drug-related events, hospital-acquired infections, and procedural complications. Many of these complications can be attributed to poor discharge planning, and research shows that three-quarters of these could have been prevented.
To improve quality and reduce preventable readmissions, the Agency for Healthcare Research and Quality’s Care Transitions from Hospital to Home: IDEAL Discharge Planning tools engage patients and families in preparing for discharge to home.
These are the key elements of IDEAL discharge Planning
I
Include the patient, yourself, and medical professionals as a full partners in the discharge planning process.
D
Discuss with medical professionals these key areas to prevent problems at home:
1. Discuss the patient’s and family’s goals, preferences, observations, and concerns.
2. Describe what life at home will be like
3. Review medications
4. Ask about warning signs and problems
5. Ask for any clarification about test results
6. Make any necessary follow-up appointments
E
Educate yourself by asking medical professionals about the patient’s condition, the discharge process, and next steps throughout the hospital stay
A
Assess how well doctors and nurses explain the diagnosis, condition, and next steps in the patient’s care. Ask questions, if something isn’t clear.
L
Listen to and follow suggestions and recommendations from medical professionals.
Research has shown that good planning and follow-up can improve patients’ health, reduce readmissions and decrease healthcare costs. Hopefully, the CARE Act and the tips provided in this article will prove to be helpful whether your loved one is returning home, going to a rehabilitation facility, or transitioning to a nursing home.
What if You End Up in
Serious car accidents, strokes, or other instances that require medical care are never planned for. This is why thought needs to be given (in advance) to what your preferences are for how care will be delivered. Will it be at home, an assisted living facility, or a nursing home? Of course, you cannot predict the exact outcome of your long-term care needs, but before anything happens, it is a wise idea to start a discussion now with the people who might be involved in helping to coordinate your care needs in the future, and include your preferences in your planning documents.
Planning for Long-Term Care
Medicaid planning can be started while a person is still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if a person is already in a nursing home or receiving other long-term care. Please visit our Website for more details on Lifecare Planning and Medicaid Asset Protection Planning. If you or your loved ones have not done Long-Term Care Planning, Incapacity Planning, or Estate Planning, please call us as soon as possible to make an appointment for a consultation:
Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797
About Evan H Farr, CELA, CAP
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