Transcript Family Caregivers

Patient and Family Engagement Affinity
Group
Engaging the Family Caregiver at the Point of Care
February 24, 2014
Today’s Speakers
• Introduction, Jenifer McCormick, Weber Shandwick
• Caregiver Engagement, Joyce Reid RN MS, Vice President, Community
Health Connections, Georgia Hospital Association
• Organization Spotlight, John Schall, Chief Executive Officer, Caregiver
Action Network
• Hospital Spotlight: Children’s Mercy Hospital, Stacey Koenig, Senior
Director, Patient- and Family- Centered Care/Philanthropic Auxiliaries
• Caregiver Perspective, DeeJo Miller, Family Centered Care Coordinator
Parent on Staff, Children’s Mercy Hospitals
• Hospital Spotlight: Jennifer L. Rutberg, Senior Program Manager, Families
and Health Care Project, United Hospital Fund; Fiona Larkin, LCSW,
Associate Executive Director, HHC Health and Home Care CHHA; and
Richard A . Siegel, LCSW, Senior Associate Director of Social Work,
Metropolitan Hospital Center
• Q & A (please write your questions in the chat box)
• PFE Affinity Group Working Group Updates
2
Introduction
Jenifer McCormick
Project Manager, Patient
& Family Engagement
Contractor
Polling Question
• Regarding the length of the PFE Master
Classes, I think the classes should be:
– 50 minutes
– 60 minutes
– 75 minutes
4
Links to Previous Master Classes
• Master Class 1&2: Patient and Family Advisory
Councils
• Master Class 3: Shift Change Huddles at
Bedside
• Master Class 4: Staff Assigned to Oversee PFE
• Master Class 5: Patients on Governing Boards
• Master Class 6: PFE and Discharge Planning
Checklists
5
Background
Joyce Reid RN MS
Vice President, Community Health
Connections
Georgia Hospital Association
[email protected]
Barriers to Identifying Caregivers
•
•
•
•
•
Language
Multiple visitors
Race/Ethnicity
Leadership engagement
Lack of not listening to cues
7
Steps to Identify Caregivers
• Caregivers are not always who you expect
them to be
• Identification process is important
8
Thank you, and please contact me
with any questions:
Joyce Reid RN MS
Vice President, Community Health Connections
Georgia Hospital Association
[email protected]
Family Caregivers:
Who They Are, Why They Matter,
and How To Engage Them
John Schall
Chief Executive Officer
Caregiver Action Network
February 24, 2014
[email protected]
90 Million Family Caregivers in U.S.

Two out of every 5 adults are family caregivers. 39% of all adult Americans are caregivers – up from
30% in 2010.

Alzheimer’s is driving the numbers up. 15 million family caregivers caring for more than 5 million
with Alzheimer’s.

But it’s not just the elderly who need caregiving. The number of parents caring for children with
special needs is increasing, too, due to the rise in cases of many childhood conditions.

Wounded veterans require family caregivers, too. 1 million Americans caring in their homes for
service members from the Iraq and Afghanistan wars who are suffering from traumatic brain injury,
post-traumatic stress disorder, or other wounds and illnesses.

And it’s not just women doing the caregiving. Men are now almost as likely to say they are family
caregivers as women are (37% of men; 40% of women). And 36% of younger Americans between ages
18 and 29 are family caregivers as well, including 1 million young people who care for loved ones with
Alzheimer’s.

Family caregivers are the backbone of the Nation’s long-term care system. Family caregivers provide
$450 billion worth of unpaid care each year. That’s more than total Medicaid funding, and twice as
much as homecare and nursing home services combined.
What Family Caregivers Do
 Help with 2.6 ADLs and 4.9 IADLs
 Manage medications (70% of time)
 Provide hands-on patient care (46% perform complex medical/nursing
tasks such as providing wound care, and operating specialized medical
equipment)
 Schedule doctor visits, plan travel to and from visits, and go with
them
 Arrange for home visits by therapists and nurses
 Deal with medical emergencies
 Take care of insurance matters
 Navigate health care system for patient
 Provide emotional support to patient
 Continue doing many of patient’s household duties/take over
“breadwinner” role
Family Caregiver Toolbox
During Transitions of Care,
Family Caregivers Need…
…to be better prepared
to:
 Communicate with
healthcare
professionals
 Become a strong
advocate in healthcare
situations
 Prevent medication
mishaps
…and CAN tools can
help:
 Patient File Checklist
 Doctor’s Office
Checklist
 Medication Checklist
 Safe and Sound:
How to Prevent
Medication Mishaps
Ideally, Hospitals Would…
 Designate caregiver in the patient’s medical
record
 Recognize and include caregiver as part of the
health care team
 Meet with caregiver to discuss patient’s plan
of care
 Notify caregiver before transfer to another
facility
 Instruct caregiver at discharge*
 Follow up on after-care tasks after discharge*
How to Connect with CAN
www.CaregiverAction.org
www.facebook.com/CaregiverActionNetwork
@CaregiverAction
Help for Cancer Caregivers
www.HelpForCancerCaregivers.org
Rare Disease Caregivers
www.RareCaregivers.org
Hospital Spotlight: Children’s
Mercy Hospitals
Stacey Koenig
Senior Director
Patient- and Family- Centered
Care/Philanthropic Auxiliaries
DeeJo Miller
Family Centered Care Coordinator
Parent on Staff
Children’s Mercy
Hospitals and Clinics
• 354 beds
• 370,321 outpatient visits
• 147,938 ER/UC visits
* All numbers Fiscal 2012
• 13,397 admissions
• 19,144 surgeries
• 20+ outreach clinics
A Pediatric Hospital: Our Story
20
Children’s Mercy:
A Parent Perspective
Engaging Caregivers in Rounds
Family Centered Rounds
•Facilitate communication
between families and the
medical team
•Improve bedside teaching,
evaluation and overall care
•Improve resident, nursing,
staff communication
•Nurses feel more valued
22
Overcoming Language Barriers to
Communicate with Caregivers
• Over 87,000 non-English speaking
encounters per year
• El Consejo de Familias
Latinas/Hispanas
• Resources for caregivers
• Qualified bi-lingual staff program
23
Family-friendly Medication
Administration Record (MAR)
24
Facilities Updates
•
•
•
•
•
•
25
New in-patient tower
Accessible Family Care
Station
Clinic waiting rooms
Inpatient Parent Rooms
Gift shop redesign
Handicap accessible parking
spaces
Patient/Family Advisors on
Committees
180
160
140
120
100
80
60
40
20
0
1995
2000
2005
2010
2015
Thank you, and please contact me
with any questions:
Stacey Koenig
Senior Director for Patient- and Family- Centered Care and Philanthropic
Auxiliaries
[email protected]
DeeJo Miller
Family Centered Care Coordinator/Parent
[email protected]
Tools to Engage Family
Caregivers
Partnership for Patients Patient and Family Engagement
Master Class
February 24, 2014
Jennifer L. Rutberg, Senior Program Manager
Families and Health Care Project
United Hospital Fund
http://www.nextstepincare.org
© 2014 United Hospital Fund
Family Caregivers: Straight
Answers Regarding Transitions
• Guides for family caregivers in English,
Spanish, Russian, and Chinese
• Toolkit for providers
• No agenda, no pitch
• Developed with experts in the field and a
health literacy consultant
© 2014 United Hospital Fund
Providers: Guides at Your Fingertips
• Topics include:
•
•
•
•
•
•
•
•
Identification of family caregivers
Needs assessment of family caregivers
HIPAA
Medication education
Discharge options
Discharge planning
ED use, urgent care center use
Much more!
© 2014 United Hospital Fund
Next Step in Care: Availability
• All materials available for free on website
• Quality improvement efforts:
• Transitions in Care-Quality Improvement
Collaborative (TC-QuIC)
• Report available at
http://www.uhfnyc.org/publications/880905
• Day of Transition Initiative
• IMPACT
© 2014 United Hospital Fund
Thank you!
Jennifer Rutberg
(212) 494-0751
[email protected]
http://www.nextstepincare.org
© 2014 United Hospital Fund
Metropolitan Hospital Center
and
HHC Health and Home Care
Fiona Larkin, LCSW, Associate Executive Director
HHC Health and Home Care CHHA
Richard A. Siegel, LCSW, Senior Associate Director
Metropolitan Hospital Center
Implementing Caregiver Engagement
• Established a comprehensive, collaborative process between
hospital and home care agency:
– The family caregiver was identified, assessed and engaged by social
worker and care team in the hospital
– This information was given to the home care agency (on-site intake
planners)
– Home nursing visits were arranged to include family caregiver
whenever possible
• Supports to staff:
– Staff given input into the tools used to assess family caregiver needs
– In-services by clinicians (e.g. Chief of Cardiology)
– Weekly meetings of team (hospital and home care agency
combined)
35
Expanding the Care Team
• Family caregivers invited to in-hospital team meetings
with patients.
• Home care visits now included consulting family
caregiver
• “IVR” Interactive Voice Response system:
– Provided care management to patients
– Disease management coaching
– Continuous care coordination with hospital, community
providers, and home visits from a multidisciplinary team
• NYCHHC managed care program (Metro Plus):
– Approved payments for care management, home visits,
and to change formulary to meet patients needs
Breaking through the Barriers to
Caregiver Engagement
• Had to meet the patient and family caregiver where they were
at, and when they could be there
• We focused on strengths not deficits
• “Breakthrough” (LEAN) event:
– Brought care teams together for a week long for program development,
then scheduled weekly case conferences on patients and program
updates
– Scheduled periodic education sessions with members of entire teams
(hospital, out patient, home care, and managed care) including
physicians, field staff, and managed care case managers to bring all
members together and work towards understanding and meeting shared
goals for the patients and the program
Breaking through the Barriers,
continued
• Key intervention:
– Provided medications prior to discharge for patients and
families that had trouble filling prescriptions
• Continually measured our progress and examined successes
and failures
Metrics
Heart Failure 30 Day Re-admissions
Caregiver and
Patient Story
Mr. H:
• 60 year old bilingual
Hispanic man
• Lives with his mother
near Metropolitan
Hospital
• Mother is caregiver – she
cooks for household, so
engaging her is critical
• On Telehealth care
management for Heart
Failure, depression and
slow speech for 3
months.
• Given a prescription for 25 mg. of a
Beta Blocker
• Was only supposed to take 12.5 mg.
twice a day
• He was confused about the dosages of
his medications
• Our Care Manager coordinated with
his pharmacist, his physician, and his
PA to clarify the dose: avoided a "near
miss”
• His caregiver (mother) was supportive
of his lifestyle changes and learned
about appropriate dietary choices. She
cooked food for him that was low in fat
and low in sodium to help him meet
his dietary goals.
Caregiver and Patient Story
He met goal of Project RED HF program by having zero readmissions within 3
months. He was very satisfied customer and to this day, keeps his meds
"straight,” has no shortness of breath. He feels that the changes he has made
have greatly improved his quality of living. He was happy to report feeling well
enough to now take his mother out to eat for seafood at City Island on
Christmas Eve.
By discharge from home care, he met 5 of the 7 American Heart Association
Goals:
Life's Simple 7:
 1. Not smoking cigarettes (never smoked)
2. Keep healthy body weight BIM <25 (his=BMI 26.6)
 3. Getting at least 150 min. moderate intensity exercise/wk. (he walks 1
hr., 5 days per week)
 4. Eating heart healthy diet
 5. Keep cholesterol below 200 (his=147)
 6. Keep blood pressure below 120/80 (his 118/75)
7. Keep fasting glucose less than 100 mg./dL. (his FBS=157)
Thank you, and please contact us with
any questions:
Fiona Larkin, LCSW, Associate Executive Director
HHC Health and Home Care CHHA
[email protected]
Richard A . Siegel, LCSW, Senior Associate Director
Metropolitan Hospital Center
[email protected]
Question & Answers
Please write your questions in the chat box.
Affinity Group Updates
• Success Stories/Emerging Best Practices
Working Group
• Vulnerable Populations Working Group
Thank You
Please contact Weber Shandwick with any
questions:
[email protected]
202-585-2224
45