The ACA and the Care Partner’s Role in Preventing Readmission

The transition from hospital to home and the prevention of readmission to a hospital is a hot topic. So much so, in fact, that according to a recent study, the mention of readmissions in publications increased by 94% in 2013 compared to the year before.

Much of this is due to the Affordable Care Act (ACA) which established a hospital readmission reduction program, effective for discharges beginning in October 2012. The program defines a readmission as “an admission to a hospital within 30 days of a discharge.” In addition to measuring the rate of such occurrences, it introduces a change in the payment structure and/or penalties as incentives to hospitals to do a better job in keeping these numbers down.

It appears to be working. According to government data, hospital readmissions dropped by nearly 70,000 in 2012, a trend that is expected to accelerate through this year.

Care Partners and Prevention of Readmissions

Care Partners, a concept discussed in last month’s Healthassist Newsletter, are instrumental in the successful transition from hospital to home and, therefore, in keeping readmissions to a minimum. The vulnerability experienced when ill often prevents us from managing this transition on our own and so we depend on our Care Partners to do what we are not able to do for ourselves.

In my work with clients, I am frequently astonished by how sick individuals remain upon discharge and, as a result, how much responsibility we are placing on Care Partners to do such things as:

  • Recognizing when recovery is stalled and/or headed in the wrong direction
  • Noticing and gathering data about a change in clinical status
  • Reporting clinical symptoms to an appropriate party
  • Wading through the administrative barriers that are often placed in front of them

For example, the Care Partner of a client of mine was asked recently to do the following for her loved one:

  • Take a temperature and blood pressure every day
  • Set up and manage feeding through a tube twice per day
  • Change two dressings every day
  • Encourage swallowing strategies to prevent aspiration/choking from drinking fluids

Would you know how to do all of that?

Although she was successful and had support from the local Home Care Services Company, she was with her loved one 24/7 and clinical personnel were only present for approximately 45 minutes every other day. Needless to say, the bulk of the responsibility fell to her.

Advice for Care Partners

It’s in everyone’s best interest to reduce hospital readmissions. As a Care Partner, therefore, you’ll want to put the professional/clinical staff in the position of educators. As you meet them and identify their respective roles on the team, here are some suggestions on what to say:

Regarding illness and expected recovery:

  • I’m my husband’s Care Partner. I know discharge will be coming quickly and, because I’ve never been through this before, I’d like to tap into your knowledge and experience. Please educate me about his condition and the care he’ll need at home.
  • What can I expect in the first few days and then after a week at home?

Regarding monitoring and what to report:

  • Do I need to monitor anything at home, such as temperature or blood pressure?
  • What should concern me?
  • Who should I call if I have concerns?

Regarding resources at home:

  • Will a nurse or any other professional be visiting my husband at home?
  • If so, when and how often?
  • What can I expect from them?

Regarding medications:

  • On which medications will my husband be discharged?
  • Can we compare the new list to those he was on before admission? They may be different and I don’t want to be confused.

Regarding follow-up:

  • When and with whom should I follow up?
  • How much does my husband’s primary care physician know about this admission and the current treatment plan?

You get the idea. In my experience, the first 24 hours at home with a recently hospitalized person is critical to preventing a re-admission. It can also be a scary time for the Care Partner.

In my fantasy world, a clinical person would visit on the day of discharge to be sure that all the best laid plans have been carried out at home. Among other things, this would reduce issues with obtaining and understanding the medication regimen, as well as in the delivery and use of any necessary equipment, two things which are often problematic, and which can lead to a subsequent trip to the ER.

Remember, we all want the discharge and transition from hospital to home to be as successful as possible; the ACA underscores this emphasis. As a Care Partner, don’t hesitate to be assertive, to ensure you receive whatever education you need to care adequately for your loved one at home.