At the time of this writing, 36 states have signed the Caregiver Advise, Record, Enable (CARE) Act into law. As home care clinicians, we are very familiar with the essential role family and other informal caregivers play in caring for loved ones in their homes, allowing them to age in place. As home care clinicians, you are there to provide expert care, education, therapy, and support. What you may not know is that 69% of people discharged from hospitals do not receive visits from a healthcare professional (Reinhard et al., 2012). Family caregivers are left on their own, expected to provide care formerly performed only by highly educated healthcare professionals. Family caregivers are now tasked with organizing complex medication regimens, providing infusion therapy through central vascular access devices, performing complex wound care and communicating with, and coordinating care by, multiple providers. Unfortunately, most family caregivers report inadequate or no training.
So what does the CARE Act require? There are three important components:
* When a person is admitted to a hospital or rehabilitation facility, they are asked to identify their caregiver, which is then recorded in their health record.
* The caregiver must be notified of plans to discharge the person home or to another facility.
* The facility is responsible for providing education on, and demonstration of, any procedures the caregiver will be expected to perform at home.
What outcomes will be achieved by the CARE Act? A recent integrative review and metaanalysis by Rodakowski et al. (2017) examined 15 randomized controlled trials. In all, the metaanalysis looked at 4,361 participants. Interventions included medication reconciliation, in-person demonstration, teach-back, caregiver assessment, written instruction, and referrals to community resources. Follow-up with phone calls and home visits continued for 1 week to 3 months. The researchers found that including family caregivers in the discharge process led to a 25% decrease in 90-day readmission rates, and 24% less risk of 180-day readmissions. With estimates of the cost of readmissions at approximately $12 billion dollars per year in the United States, this research suggests a considerable potential for significant cost savings. The quality of life of caregivers and patients is also likely to improve.
The AARP Public Policy Institute and the United Hospital Fund conducted a survey of 1,677 family caregivers to learn what they are tasked with doing for their family member (Reinhard et al., 2012). Almost half (46%) performed tasks such as helping with medications, assisting with mobility, providing wound care, and operating specialized equipment. Despite many encounters with healthcare providers, few of the family caregivers reported receiving training. More than a third of those who performed wound care desired more training that they had received.
The report by Reinhard et al. concluded with the following recommendations:
* Measures of activities of daily living are outdated and need to be revised.
* Every healthcare provider needs to ensure caregivers are educated and trained to perform care safely and effectively.
* Payment structures need to support training of caregivers.
* Institutions who educate healthcare providers should examine curricula and ensure students receive education in acknowledging, supporting, and training caregivers.
* Accrediting organizations should evaluate how well institutions meet the learning needs of caregivers.
* Federal and state policy makers should encourage new models of care.
* Advocacy and support groups should address the needs of family caregivers.
Check the AARP website to see if your state has enacted the CARE Act. If not, advocate for this important step in acknowledging the vital contributions of caregivers.
REFERENCES