Reducing Hospital Readmissions
August 2014
Regional Networking Meetings
Breakout Session
Readmissions &
Family Caregivers
Rhonda Clark, MSN, RN ~ QI Specialist
rclark@tha.com
Caring for Those We Love
Total Admissions and Readmissions by Patient Point
of Origin, HY2 2013
Total
Readmissions
% of
Readmissions
Total
Admissions
% of
Admissions
Clinic/Phys Office
4,683
12.58%
47,055
13.42%
Non-healthcare facility (i.e. home)
28,391
76.28%
236,904
67.54%
Transfer from ambulatory surgery center
11
0.03%
49
0.01%
Transfer from another healthcare facility
247
0.66%
2,114
0.60%
Transfer from different hospital
2,696
7.24%
22,508
6.42%
Transfer from SNF, ICF or ALF
475
1.28%
2,932
0.84%
Transfer to another unit in same hospital
196
0.53%
1,567
0.45%
Patient Point of Origin
Discharge Status From Index Admission HY2 2013
Discharge Status
# Index
Admissions
% of Total
Admissions
To home or self care
22,069
59.29%
To home for home health/skilled care
6,475
17.40%
To skilled nursing facility – Mcare
5,293
14.22%
To short-term general hospital for inpatient care
847
2.28%
To inpatient rehab facility, including hospital rehab units
759
2.04%
Left against medical advice/discontinued care
511
1.37%
To psych hospital or psych unit of a hospital
259
0.70%
To ICF that provides custodial or supportive care
255
0.69%
To hospice-home
174
0.47%
To Mcare approved swing bed within this institution
145
0.39%
T Mcare certified LTCH
144
0.39%
To nursing facility certified under Mcaid but not Mcare
40
0.11%
To home or self care with planned acute care hospital IP readmit
22
0.06%
Family Caregiving
Family Members
Family + Paid Care
Paid Care Only
7%
17%
76%
“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
• 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
• Increased costs for medical care
• Long waiting lists for home and communitybased services
• Stringent income and asset eligibility criteria
for long term care
Impact on Family Caregivers
• 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
In A Nutshell…
• 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
What can we do to help prepare and
support family caregivers?
Caregiver Advise Report Enable
(CARE) Act
• 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
New Project RED Component:
Tool 7
• Family engagement in discharge planning
• http://www.bu.edu/fammed/projectred/Proj
ect%20RED%20Revised%20Toolkit%2092012/REDTool7FamilyCaregiversUnitedHo
spital%20Fund.pdf
Ways We Can Help
• 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
Caregiver Action Network
Family Caregiver Alliance
National Council on Aging
AARP
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
• Blog for AARP:
– http://www.aarp.org/home-family/home-familyexperts/carol-levine/
• Blog for Health Affairs:
– http://healthaffairs.org/blog/author/levine/
• Blog for United Hospital Fund:
– http://www.uhfnyc.org/news/initiatives/familycaregiving?c=char_1&d=uu&e=1
Next Step in Care