Real World Health Care Blog

Tag Archives: AARP

The Caregiver Act and AARP’s CARE Act Aim to Reduce Readmissions

Hospitals nationwide have gone to great lengths in an effort to reduce readmissions and improve patient quality. However, despite these concerted efforts, hospitals continue to incur fines from Medicare for excessive rates of patient readmissions, which are projected to total more than $428 million. Even worse, readmissions cost patients a collective $17 billion.

Eric Heil, RightCare

Eric Heil, RightCare

However, these numbers and rates are starting to drop thanks to new tools and programs, such as the Delivery System Reform Incentive Payment (DSRIP) Program. We’re also seeing new legislation being introduced in several states aimed at reducing readmissions by ensuring hospitals and their patients communicate better after they are discharged.

The Caregiver Act and AARP’s model state bill, called the Caregiver Advise, Record, Enable (CARE) Act, are examples of legislation currently being discussed in several states. Together, they have the potential to prevent hundreds of thousands of unnecessary hospital readmissions. Oklahoma was the first in the nation to pass legislation back in November 2014 and New Jersey followed suit later the same month.

The new laws would require hospitals to work directly with a patient’s caregiver (usually a family member) to ensure that necessary preparations are in place for the patient to successfully recover at home after being discharged. This process includes providing discharged patients and their caregivers with a clear path to follow for addressing medication, nutrition and living needs in-home.

To achieve this level of customized, high quality care, technology is essential to streamline the care coordination process and support the unique needs of patients. RightCare, a growing medical technology company, has an end-to-end software solution designed to assess patient risk and needs at the time of admission, ensure the most appropriate post-acute care plan is offered, and seamlessly transition patient information to post-acute care providers. RightCare’s software is based on 10 years of academic and clinical research and has helped hospitals nationwide optimize workflow, reduce length of stay times, reduce readmissions and ensure hospitals meet Medicare-mandated standards for preventable readmissions.

We’ve seen time and time again how effective post-care planning with providers, community organizations and technology can significantly decrease readmissions, so it’s encouraging to see these efforts are now supporting caregivers.

Readers: Are you a family caregiver? What are some of the challenges you face, and what tools are you using to help? Let us know in the comments.

Taking Charge at the End of Your Life

Tim Prosch is author of AARP’s The Other Talk: A Guide to Talking with Your Adult Children About the Rest of Your Life, a book that helps parents and their children create a partnership to plan for the years to come, guiding them through important conversations and decisions about finances, medical care, and day-to-day living—before a crisis happens.

Tim Prosch

Tim Prosch

What can happen if you put off your end-of-life health care decisions until “the time is right?”

The Terri Schiavo case, which culminated in 2005, can put the answer to this question in stark relief.

Fifteen years earlier, Terri had collapsed at home, suffered severe brain damage and was put on a feeding tube to keep her alive. For the next decade and a half, she was yanked back and forth in a virulent tug-of-war between her husband and her parents about how she would want to be treated. Ultimately the courts got involved, pulling her off her feeding tube for 3 days in 2001, again for 6 days in 2003, and finally for 13 days in 2005, when she finally expired.

All of this drama and heartache could have been avoided if her wishes had been put in writing and had been thoroughly discussed by all interested parties.

While none of us will ever know what Terri wanted done at the end of her life, it is safe to say that her on-again, off-again existence and her increasingly toxic family dynamic are not what she or anyone else would wish for.

 

How can you avoid Terri’s fate? 

To begin with, it’s important that you understand that health care at your end of life will be a family affair, not just a personal decision. In most cases, it is not about you personally taking charge. It is about you preparing and empowering your family to take charge as you approach that final stage.

The-Other-TalkThe reason for this collaborative approach is that it is highly likely that you won’t be physically, emotionally, or mentally able to direct the final proceedings. Collaboration addresses the challenge for someone acting on your behalf to weigh the options and make decisions and to articulate what should be done in a way that reflects your thoughts about the end of your life.

As a result, it is critical that you start these conversations now while you are mentally sharp. Quite simply, the longer you wait, the less effective these discussions with your family will be, due to the natural deterioration of the aging brain.

In preparing for the end game discussion, you’ll want to take steps in two critical areas: guiding principles and parameters for medical treatment.

 

Step 1. Establish Your Guiding Principles

The first step in making your family confident and empowered in taking charge when the time comes is for you to confront and define what “being alive” means to you as you near the end.

For some people, it is fighting for every last breath. “Even one more day would be important to me. I would do everything I could to hold on to life.”

For others, it is living intensely, yet comfortably, in the time remaining. “I would rather be able to do what I want, to be with my kids, to enjoy life, even if it’s for a shorter time.”

Of course, neither one is the better approach because it is such a personal choice. But if you start now to build a clear understanding of your preferences with your family and your doctors, you can dramatically increase your odds of getting what you want.

 

Step 2. Set Parameters for Your Medical Treatment 

Step 2 in taking charge of your life (versus abdicating it to the medical community) is to put your preferences in writing. Equally important is to distribute and discuss your wishes with your family members and your doctors to ensure that your goals are clearly understood.

An effective and relatively inexpensive way to accomplish this is to consult with your legal advisor, then draw up a health care power of attorney. This document establishes your designated agent who will make health care decisions for you if you are not able to do so.

If you are in the “do not prolong life at any cost” camp, you will also want to explore two health care directives: the living will and the do-not-resuscitate (DNR) order:

  1. The living will establishes that you do not want your death to be artificially postponed. It states that if your attending physician determines that you have an incurable injury, disease or illness, procedures that only prolong the dying process should be withheld and the medical focus should shift to comfort care. This document must be signed by two witnesses who will not benefit from your death.
  2. The do-not-resuscitate (DNR) order is different from the health care power of attorney and the living will in that neither your health care agent nor you can prepare it. Rather, it is a written order signed by your physician that instructs other health care providers not to attempt CPR if your heart has stopped beating and if you have stopped breathing during cardiac or respiratory arrest.

Once you have shared your “what being alive means to me” documents (the health care power of attorney and, if relevant, the living will and the DNR order) and thoroughly discussed them with family and doctors, you all should acknowledge the possibility of revisions. Every time your health status changes in some significant way, you should have another discussion to clarify your views and expectations.

It’s okay for you to move the goalposts on issues pertaining to the end of your life. You just need to make certain that the people in your world know that you moved them.

Do you have a living will or DNR? What did you learn through the process that you’d like for others to know?

Click here to learn more about The Other Talk and here to hear an interview with the author from AARP.

Thanks Project Underscores Why Caregivers Matter to Patient Care

Although many people don’t see themselves as caregivers, more than 65 million Americans provide care on a daily basis for their vulnerable loved ones. This statistic, highlighted by Jeff Foxworthy along with Peter Rosenberger in a video created by AARP, demonstrates the importance of caregivers as advocates work to raise awareness around National Family Caregivers Month.

To say “thanks to as many caregivers as [they] can,” AARP and the Advertising Council are partnering to empower patients and their families to show their appreciation for those who care for them by sharing a personal message, photo or video of gratitude through the Thanks Project. This online tool recognizes family members and friends who are dedicated to taking care of loved ones and makes caregiving resources more accessible so that individuals know they’re not alone and that help is available.

According to a Nov. 5 New York Times story, most people who are caregivers do not identify as such, often feeling overwhelmed by responsibilities that can range from managing bills to providing transportation and preparing meals. To offer emotional support, AARP created a Caregiving site that provides everything from Planning and Resources to information addressing End of Life Care, as well as Grief and Loss. This web portal also enables visitors to chat with experts and ask questions, in addition to learning more about the experiences of those who care for loved ones.

“Since launching the Caregiver Assistance campaign with the Ad Council in August 2012, we have seen more than 10 million visits to AARP’s Caregiving Resource Center,” said Elizabeth Bradley, Strategic Communications Director of the Caregiver campaign. “Through the site, users are connected to valuable local resources and practical information, can find support to handle family dynamics and life-balancing issues, and engage and connect with experts and other caregivers. We hope caregivers feel more appreciated for their hard work and inspired to do the best they can.”

The Caregiver Action Network (CAN), which sponsors National Family Caregivers Month, is also highlighting the difference caregivers make in the lives of those they serve every day. As the leading family caregiver organization working to improve the quality of life for the 65 million+ Americans who care for loves ones, CAN provides online tools to help caregivers handle the responsibilities that come with buying groceries, organizing mail, cleaning homes and so much more.

In a recent Presidential Proclamation spotlighting National Family Caregivers Month, the Obama Administration helped draw national attention to the value of caregivers, who “take up the selfless and unheralded work of delivering care to seniors or people with disabilities or illnesses…With caregivers already balancing their own needs with those of their loved ones, and in many cases caring for both young children and aging parents, our Nation’s caregivers need and deserve our support.”

Paul DeMiglio

Paul DeMiglio

Do you know a caregiver or provide care for a loved one? How do you think individuals, communities and industry stakeholders can collectively mobilize to demonstrate appreciation for caregivers and more effectively strengthen support networks? Share your story and let us know what resources and strategies you think would be most useful.