Support at the Hospital and Home

Caroline Werner explains the Share the Care program and important aspects of the Affordable Care Act.

The Share the Care program is helpful when someone, especially an LGBTQ senior, needs help with daily household chores or errand running, needs someone to accompany him or her to doctor or physical therapy appointments, is recovering from a hospitalization following a surgery or cancer treatments, or is weakened from surviving a flu or cold. Share the Care works in tandem with any professional nursing support that might be coming in.

When a person calls or e-mails OutReach to request Share the Care, someone will meet with that person to explain the process and help form a group of people he or she already knows to provide the range of support the ill person needs. There are already several Share the Care groups in Wisconsin.

This program is valuable when we don’t all have traditional extended families to rely on, but may have a network of people we know—even if not everyone is especially close to us.

Share the Care should ideally be considered and the group organized before someone is admitted to a hospital, given the emphasis through the Affordable Care Act that hospitals not readmit the patient within 30 days of discharge. Once discharge plans are in place, the group can then prepare for the return home.

It used to be that discharge planning happened as the patient was about to leave the hospital, but not anymore. The best time to start planning for discharge is just after your family member is admitted to the hospital or rehabilitation facility. The hospital wants to make sure that the patient stays at home following discharge, with more emphasis on care at home.

You should not leave the hospital or rehab facility until there is a safe and adequate discharge plan. This means the plan meets your family member’s needs and that you can do what is expected of you.

If you are the caregiver, don’t be afraid to tell the discharge team members (usually doctors, nurses, or social workers) such important details as: A) How much time you can devote to being a family caregiver; B) Whether you can continue to work at your job or must take time off; C) Whether you have any health problems or other limitations, such as not being able to lift; D) Whether you have commitments such as caring for children; and I add E) whether or not you have a Share the Care group in place.

As you get ready for the transition, consider such things as necessary equipment and supplies needed; how much room there is for a hospital bed; safety in the home; and what sort of basic care, food, or medications your loved one needs.

A member of the discharge team should answer every one of your questions before your loved one is sent home.

Whether you provide the care for your loved one, hire a professional agency to do so, organize a Share the Care group, or a combination thereof, make sure you know what to do, what limits or restrictions there may be, and whether the person can be left alone for a short period of time.

The government considers readmissions to be a prime symptom of an overly expensive and uncoordinated health system, in which hospitals have little financial incentive to ensure patients get the care they need once they leave and, in fact, have benefited financially when patients don’t recover and return for more treatment.

The Hospital Readmissions Reduction Act (HRRA), part of the Affordable Care Act, contains a penalty that will be deducted from reimbursements each time a hospital submits a claim, based on the history of readmissions for that particular hospital.

The penalties are part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital quality. Hospitals will also be penalized or rewarded based on how well they adhere to basic standards of care and how patients rate their experiences.

Most of the HRRA will affect elders, primarily because it is related only to Medicare (for now) and most of the people who are readmitted within 30 days are elders with chronic medical conditions. If it is considered to be effective, however, commercial insurers are sure to follow suit.

The HRRA applies only to hospitals that receive reimbursement under Medicare’s Prospective Payment System. Critical-access hospitals, long-term acute-care hospitals, inpatient-rehabilitation facilities, and psychiatric hospitals are exempt.

Causes of avoidable readmissions include hospital-acquired infections and other complications; premature discharge; failure to coordinate and reconcile medications; inadequate communication among hospital personnel, patients, caregivers, and community-based clinicians; and poor planning to provide “patient-centered care” in the home.

Fortunately for Dane County residents, this impact will be negligible for the three Madison hospitals. The three hospitals in Madison will be penalized, according to Kaiser Health News, as follows: Meriter 0.14%, St. Mary’s Hospital Medical Center 0.0%, and University of Wisconsin Hospitals and Clinics 0.01%. HRRA doesn’t consider patients who died with inadequate care while hospitalized.

[HRRA information in this article is taken from an article by Stephen Rudolph (owner of Comfort Keeper of South Central Wisconsin) entitled “Cycle of ER, Discharge, Return Beginning to Change” published in Your Family magazine, Winter 2013. This is not an endorsement of Comfort Keeper.]

Caroline Werner has a Master’s degree in Social Work and was a case manager working with seniors in Dane County before retiring. Now she is the Volunteer Senior Program Coordinator for OutReach.