1. Reducing Hospital Readmissions August 2014 Regional Networking Meetings Breakout Session

2. Readmissions & Family Caregivers Rhonda Clark, MSN, RN ~ QI Specialist rclark@tha.com

3. Caring for Those We Love

4. Total Admissions and Readmissions by Patient Point of Origin, HY2 2013 Patient Point of Origin Total Readmissions % of Readmissions Total Admissions % of Admissions Clinic/Phys Office4,68312.58%47,05513.42% Non-healthcare facility (i.e. home)28,39176.28%236,90467.54% Transfer from ambulatory surgery center110.03%490.01% Transfer from another healthcare facility2470.66%2,1140.60% Transfer from different hospital2,6967.24%22,5086.42% Transfer from SNF, ICF or ALF4751.28%2,9320.84% Transfer to another unit in same hospital1960.53%1,5670.45%

5. Discharge Status From Index Admission HY2 2013 Discharge Status # Index Admissions % of Total Admissions To home or self care22,06959.29% To home for home health/skilled care6,47517.40% To skilled nursing facility – Mcare5,29314.22% To short-term general hospital for inpatient care8472.28% To inpatient rehab facility, including hospital rehab units7592.04% Left against medical advice/discontinued care5111.37% To psych hospital or psych unit of a hospital2590.70% To ICF that provides custodial or supportive care2550.69% To hospice-home1740.47% To Mcare approved swing bed within this institution1450.39% T Mcare certified LTCH1440.39% To nursing facility certified under Mcaid but not Mcare400.11% To home or self care with planned acute care hospital IP readmit220.06%

6. Family Caregiving

7. “Family caregivers have become unpaid and untrained lay nurses, routinely providing complex care such as medication management, infusions, injections, wound care, and monitoring of medical equipment.” -- Carol Levine

8. Women (traditional caregivers) have entered the workforce in record numbers since the 1960s Families are smaller Patients have increasingly complicated care – Increased chronic illnesses – Shorter hospital stays – Hospice and palliative care underutilized – Increased technology associated with treatment

9. Increased costs for medical care Long waiting lists for home and community- based services Stringent income and asset eligibility criteria for long term care

11. Higher risk for: – Clinical depression – Stress-related illnesses such as high blood pressure, immune system deficiencies, cardiac problems, headaches, fatigue – Poor self care – Financial strain – Problems at work Impact on Family Caregivers

12. Most readmissions come from home Most home care is provided by family members Family caregivers carry a heavy load for which they may not be adequately prepared or with which they cannot effectively cope Family caregiving will continue to increase as population grows and ages In A Nutshell…

13. What can we do to help prepare and support family caregivers?

14. Three elements documented in record: – Name of family caregiver (upon admission) – Family caregiver notification of patient discharge or transfer – Explanation and live instruction on the medical tasks family caregivers will provide at home Such as wound care, transfers, injections, medication management Caregiver Advise Report Enable (CARE) Act

15. Family engagement in discharge planning http://www.bu.edu/fammed/projectred/Proj ect%20RED%20Revised%20Toolkit%209- 2012/REDTool7FamilyCaregiversUnitedHo spital%20Fund.pdf New Project RED Component: Tool 7

16. Assess needs Provide training or connect with resources to meet needs – Follow up Partner with organizations in community for: – Family caregiver training courses – Family caregiver support groups – Respite services Ways We Can Help

17. Caregiver Action Network

18. Family Caregiver Alliance

19. National Council on Aging

20. AARP

21. Carol Levine Director of United Hospital Fund’s Families and Health Care Project Editor of Always on Call: When Illness Turns Families Into Caregivers Prolific author on family caregiving

22. Blog for AARP: – http://www.aarp.org/home-family/home-family- experts/carol-levine/ Blog for Health Affairs: – http://healthaffairs.org/blog/author/levine/ Blog for United Hospital Fund: – http://www.uhfnyc.org/news/initiatives/family- caregiving?c=char_1&d=uu&e=1

23. Next Step in Care