Patient and Family Engagement Affinity Group Engaging the Family Caregiver at the Point of Care February 24, 2014.

Patient and Family Engagement Affinity Group

Patient and Family Engagement Affinity Group

Engaging the Family Caregiver at the Point of CareFebruary 24, 2014

• 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

Today’s SpeakersToday’s Speakers

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IntroductionIntroduction

Jenifer McCormickProject Manager, Patient & Family Engagement Contractor

• Regarding the length of the PFE Master Classes, I think the classes should be:– 50 minutes– 60 minutes– 75 minutes

Polling QuestionPolling Question

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• 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

Links to Previous Master ClassesLinks to Previous Master Classes

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BackgroundBackground

Joyce Reid RN MSVice President, Community Health ConnectionsGeorgia Hospital Associationjreid@gha.org

Barriers to Identifying CaregiversBarriers to Identifying Caregivers

• Language• Multiple visitors• Race/Ethnicity• Leadership engagement• Lack of not listening to cues

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Steps to Identify CaregiversSteps to Identify Caregivers

• Caregivers are not always who you expect them to be

• Identification process is important

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Joyce Reid RN MSVice President, Community Health ConnectionsGeorgia Hospital Associationjreid@gha.org

Thank you, and please contact me with any questions:

Thank you, and please contact me with any questions:

Family Caregivers:Who They Are, Why They Matter,

and How To Engage Them

John SchallChief Executive Officer

Caregiver Action NetworkFebruary 24, 2014

JSchall@CaregiverAction.org

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 ChecklistDoctor’s Office

ChecklistMedication ChecklistSafe and Sound: How

to Prevent Medication Mishaps

Ideally, Hospitals Would…Designate caregiver in the patient’s medical

recordRecognize and include caregiver as part of the

health care teamMeet with caregiver to discuss patient’s plan of

careNotify 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 Caregiverswww.HelpForCancerCaregivers.org

Rare Disease Caregiverswww.RareCaregivers.org

Stacey Koenig Senior Director

Patient- and Family- Centered Care/Philanthropic Auxiliaries

DeeJo Miller Family Centered Care Coordinator Parent on

Staff

Hospital Spotlight: Children’s Mercy Hospitals

Hospital Spotlight: Children’s Mercy Hospitals

• 354 beds• 370,321 outpatient visits• 147,938 ER/UC visits

* All numbers Fiscal 2012

Children’s MercyHospitals and Clinics

Children’s MercyHospitals and Clinics

• 13,397 admissions• 19,144 surgeries• 20+ outreach clinics

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A Pediatric Hospital: Our StoryA Pediatric Hospital: Our Story

Children’s Mercy: A Parent Perspective

Children’s Mercy: A Parent Perspective

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Engaging Caregivers in RoundsEngaging 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

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Overcoming Language Barriers to Communicate with Caregivers

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

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Family-friendly Medication Administration Record (MAR)

Family-friendly Medication Administration Record (MAR)

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Facilities UpdatesFacilities Updates

• 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

Patient/Family Advisors on Committees

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Thank you, and please contact me with any questions:

Thank you, and please contact me with any questions:

Stacey Koenig Senior Director for Patient- and Family- Centered Care and Philanthropic

Auxiliariesskoenig@cmh.edu

DeeJo Miller Family Centered Care Coordinator/Parentdkmiller@cmh.edu

Tools to Engage Family Caregivers

Partnership for Patients Patient and Family Engagement Master Class

February 24, 2014

Jennifer L. Rutberg, Senior Program ManagerFamilies 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

jrutberg@uhfnyc.org

http://www.nextstepincare.org

© 2014 United Hospital Fund

Metropolitan Hospital Centerand

HHC Health and Home CareFiona Larkin, LCSW, Associate Executive Director

HHC Health and Home Care CHHA

Richard A. Siegel, LCSW, Senior Associate DirectorMetropolitan 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)

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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

MetricsHeart Failure 30 Day Re-admissions

Caregiver and Patient Story

• 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.

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.

Caregiver and Patient StoryHe 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 DirectorHHC Health and Home Care CHHA

Fiona.larkin@nychhc.org

Richard A . Siegel, LCSW, Senior Associate DirectorMetropolitan Hospital Center

Richard.siegel@nychhc.org

Please write your questions in the chat box.

Question & AnswersQuestion & Answers

• Success Stories/Emerging Best Practices Working Group

• Vulnerable Populations Working Group

Affinity Group UpdatesAffinity Group Updates

Please contact Weber Shandwick with any questions:

Amarcus@webershandwick.com202-585-2224

Thank YouThank You

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