When a boomer-generation group gathers these days, conversation often turns to the care needs of frail parents or ailing spouses or siblings. Stories about bumpy transitions from hospitals to care facilities or hospitals to homes are commonplace.
Take two experiences described by Dianne Pettet of Lakeville, one with her late husband in 2006, the other with her 93-year-old mother last year. When her husband, suffering from emphysema, was released from the hospital to her care, it was with an oxygen apparatus with which she had no experience. She was terrified on the way home that he would die if the breathing tube slipped out of position. Only later, when an oxygen tank was delivered to their home, did she receive training for its use, she said.
Her mother's hospital discharge to the nursing home at which she resided was abruptly announced just hours before she was to be released, Pettet said. She felt unprepared to make a quick decision about how best to transport her mother, who has dementia and was unable to walk after injuries sustained in a fall. Pettit learned only after opting for her transport via a gurney that the $1,000 cost would be her mother's to bear, not Medicare's.
Abrupt announcements that a family member will be discharged from a hospital are typical, said Marilyn Pearson of St. Paul, who has been a family caregiver for the better part of 20 years. Experience taught her to ask for training for tasks like surgical wound care and to advocate for longer hospital stays when warranted, Pearson said. New caregivers often struggle in such situations, she added.
Mary Jo George, associate director for advocacy at Minnesota's chapter of AARP, says she hears reports like these frequently — and not just in Minnesota. A 2012 AARP national survey of people who provide informal care for frail or disabled family members found that almost half of them perform medical services — managing medications, administering intravenous fluids and injections, using monitors and other specialized equipment, and the like. Often they shoulder those responsibilities after a hospitalization. Few reported receiving what they considered adequate training for those duties.
That needs to change, and not just for the sake of vulnerable people and the loved ones who care for them. Helping caregivers play their roles well also helps keep medical costs down for everyone. (See accompanying text.)
The Affordable Care Act gives hospitals particular reason to pay attention to caregivers. It financially penalizes hospitals with high readmission rates for patients with conditions common among the elderly, including heart disease and complications from knee and hip surgeries. This week, 36 Minnesota hospitals were among 2,610 nationwide whose Medicare reimbursement payments were docked because of above-average readmission rates. A smoother, surer handoff of patients from hospital to home care would likely do much to keep readmission rates down.
To its credit, the Minnesota Hospital Association recognizes as much. For several years, it has encouraged its 143 member hospitals to adhere to best-practices protocols for patient discharges, promulgated via a program called Safe Transitions of Care. It involves better communication at the time of discharge not only with family caregivers, but also with primary-care physicians and any specialists whose services are part of a recovery plan. Hospitals adopt the protocols voluntarily, said association spokeswoman Wendy Burt, but the new federal attention to hospital readmission rates gives them strong incentive to do so.
