A free toolkit developed by United Hospital Fund (UHF) and released today supports hospital staff as they engage family caregivers in planning for increasingly complex post-discharge care. The toolkit was designed to help hospitals smooth the transition from hospital to home for patients and meet the requirements of New York State's Caregiver Advise, Record, and Enable (CARE) Act, which went into effect in April 2016 and provides guidance on common questions about discharge planning.
“Almost two million adults are released from the hospital each year in New York State,” said UHF President James Tallon. “The toolkit is an important and necessary support for health care professionals as they prepare patients, and their families, for the often difficult realities of care when they return to the community.”
UHF also created a companion guide on the CARE Act for caregivers and patients, available in four languages on its Next Step in Care website. Development of the CARE Act materials was funded by The Fan Fox and Leslie R. Samuels Foundation, Inc.
The CARE Act's language was developed by AARP to help support the more than 42 million unpaid caregivers in the United States, including 2.6 million New Yorkers, who tend to family members or friends in the home, often with little or no training. To date 31 states, plus the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, have enacted the law.
Family caregiver roles have dramatically expanded over the last several years, with responsibilities extending far beyond helping with eating, bathing, or getting dressed. A 2012 UHF/AARP survey found that 46 percent of family caregivers perform medical and nursing tasks, and three out of four administer medicine, including IVs and injections. Many patients have multiple complex medical conditions, including dementia, which make caregiving particularly challenging and stressful.
“Coming home from the hospital can be as scary as being admitted. Family caregivers who are part of the discharge planning process will be better prepared and more confident about providing the kinds of care that used to be provided only in hospitals,” said Carol Levine, director of UHF's Families and Health Care Project. “The CARE Act toolkit takes the discharge planning process step by step and answers many common questions.”
The toolkit is organized around four key requirements of the CARE Act:
As soon as possible after admission, offer a patient an opportunity to identify a caregiver who will be able to help with care at home, and document the caregiver's name and contact information (or the patient's unwillingness to name a caregiver) in the medical record;
Obtain written consent to share medical information with the designated caregiver or document refusal of consent;
Consult with the patient and designated caregiver about discharge options and post-acute care needs and inform the caregiver about the anticipated discharge date;
Provide any needed instructions to the caregiver as soon as possible, but no later than 24 hours before discharge.
A fifth section addresses follow-up care after discharge, which is not mentioned in the law but is a critical part of a patient's transition loop.
The toolkit is designed to help hospital staff as they integrate the law into their daily routine. Each section includes a description of the CARE Act requirement, frequently asked questions, and links to additional resources about that topic. The Appendices contain additional documents related to the overall implementation effort, including a timeline of critical CARE Act activities prepared by the Greater New York Hospital Association and used with permission.
Implementing New York State's CARE Act: A Toolkit for Hospital Staff can be downloaded for free, and can also be distributed to patients and caregivers to supplement staff explanations. UHF is distributing the online link via e-mail to a broad range of personnel involved in patient transitions.
Both the toolkit and the patient and caregiver guides draw on UHF's Next Step in Care portfolio of web-based tools, which in turn grew out of 20 years' experience working to improve partnerships between family caregivers and health care professionals. It includes information drawn from UHF's three-year Transitions in Care–Quality Improvement Collaborative, as well as material from other transitional care initiatives.
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About United Hospital Fund: United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care.