Caregiver act brings communication to home care


CMMC Chief Nursing Officer Delilah Duffy displays some of the treatments hospital staff may teach caregivers to administer before discharging a patient.

Photo by Jenny Gessaman

It’s a legislative year in Montana, and the elected officials have been busy: To date, 377 senate bills and 667 house bills have been introduced. While partisan battles can take center stage, the passage of bills seems to hide in the wings. The 2017 session has at least one new law Central Montanan’s may want to study, however: The Caregiver Act.

Known as House Bill 163, the bill outlines how hospitals work with the person responsible for a patient’s care once the patient leaves the hospital. Known in the medical field as the caregiver, this person helps with everyday tasks and medical care not requiring a licensed professional.

Central Montana Medical Center Chief Nursing Officer Delilah Duffy said the idea was not new: Similar measures were recommended, but not legally required.

“We recognize that you can’t send patients home without care,” she said. “The reason this became part of the law is certain hospitals weren’t following it.”

The Caregiver Act states how hospitals interact with caregivers, down to how they earn the title. HB163 says patients name their caregiver, whether it is a neighbor or a relation.

At CMMC, caregiver identification is done during a patient’s check in, according to Duffy. This is an important step because it allows the hospital to disclose medical information.

“You and I don’t want just every Tom, Dick and Harry knowing everything about us,” she said.

Information disclosure starts almost immediately, according to Duffy, and usually focuses on what comes after the hospital.

“Discharge planning starts as soon as you enter the hospital,” she said. “It’s when you start thinking and planning for the patient to go home.”

As a case progresses, Duffy said the hospital can keep a caregiver informed while using that designation to let staff know who needs to be kept in the loop. She added a caregiver could also provide information about the patient’s home to help the hospital tailor treatment. Duffy explained things such as home fall risks are part of a discharge plan.

“It’s all about keeping a patient out of the hospital, keeping a patient out of the ER and keeping them from being readmitted,” she said. “When we work with a caregiver, that’s what it’s all about.”

Practice makes perfect
Avoiding readmission is why part of the Caregiver Act, and part of CMMC’s discharge procedure, requires an explanation of home care. HB163 states hospitals must have a discharge plan describing all necessary home care tasks.

The bill also requires instructions to be in “nontechnical language” and to allow for questions. Duffy said discharge directions could describe a range of duties, from pill regimens to wound care and injections.

“What we would do is make sure it’s demonstrated,” she said. “We certainly do some teaching. The [patient and caregiver] have got to show you that they get it, and then they can go home.”

The idea of requiring clear instructions is why the Area II Agency on Aging supported the bill, according to Director Todd Wood. The nonprofit agency serves the needs and concerns of seniors in 11 counties, including Fergus, and aftercare fits into that description for Wood.

“In years past, we would hear about communication not happening between family members and the medical professionals,” he said. “I haven’t heard as much of that recently, but with a lot of those patients that live in rural Montana, communication is vital because they don’t have [medical] resources at home.”

Problems can also come from patients themselves, according to Wood.

“Because of their health or cognitive conditions, they don’t always remember to pass their information on,” he said.

Wood added some patients valued their independence.

“Montana is filled with rugged individual that often don’t seek care other than independently,” he said. “Sometimes they wait too long, and often they don’t communicate really well with neighbors or friends about their needs.”

The Caregiver Act could change that, according to Wood: Identifying a caregiver now gives the hospital the ability to contact someone and keep that person informed. He labeled the new law as a benefit for everyone.

“I think it’s kind of a win-win for the facility and for the patient in this situation,” Wood said. “This bill improves communication, but it also will help facilities manage that readmission rate a little better, and it will allows patients to stay out of the hospital once they are home.”




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