Healthcare Provider and Hospital

Healthcare Administration -- New York State Care Act

The New York State Care (Caregiver Advise, Record and Enable) Act was implemented into law in April this year. The development and enactment of this law is geared toward having a positive effect on caregivers who assist patients and family members recover in the aftermath of hospital admission. The legislation ensures patients in healthcare facilities can assign a family caregiver and the facility provides the designated caregiver instruction and illustrations of medical tasks they are likely to offer their loved ones at home. However, the implementation of this initiative across hospitals such as Winthrop Hospital has been characterized by several challenges that could hinder its effectiveness if not addressed.

New York State Care Act and its Importance/Benefit

There are approximately 2.8 million New Yorkers who offer unpaid care to their loved ones at any given time as well as nearly 1.6 million adult New Yorkers who are discharged home from healthcare facilities annually (Kriss, 2015). Given that the value of the unpaid care provided by these caregivers in approximately $31.3 billion per year, New York State has been faced with the need for a suitable legislation that will have positive impacts on caregivers. New York Senate Health Committee Chairperson, Kemp Hannon and Assembly Member, Linda Rosenthal, sponsored the Caregiver Advise, Record and Enable (CARE) Act to help address these problems. Through their tireless work, New York State enacted the bill into law in April this year to help the many family caregivers in the state.

The New York State Care Act is a legislation that was enacted into law to help ensure family caregivers are educated and supported to offer necessary care to their loved ones at home. Through this law, a patient has the liberty to appoint an individual he/she trusts to be involved in his/her discharge process. The appointed individual will be involved in discharge teaching alongside the patient just in case there are any gaps in communication with the patient and the provider. The individual acts as an extra ear during this process since the patient may forget instructions given by the healthcare provider. The law requires every hospital to implement the initiative through filling a form with the nurse and patient during hospital admission. Some of the medical tasks that the caregiver should receive instruction on include administering various medications, operating medical equipment, and dressing wounds (Kriss, 2015).

The effective implementation of this initiative has numerous potential benefits for the patient and hospital. The benefits of this law to the patient include improved patient outcomes or health and decreased hospital readmission through ensuring they are provided needed care at home in an effective manner. For hospitals, this law helps in decreasing unnecessary hospital readmissions and emergency room visits, which in turn saves hospital costs. Moreover, it provides caregivers necessary education and support to be successful in their responsibilities as well as lessens stress and anxiety.

Literature Review

New York is among 14 states that have implemented the Caregiver Advise, Record and Enable (CARE) Act. The legislation has been found to have positive impacts on patients, caregivers, and hospitals when implemented effectively. Dianoski (2014) argues that the CARE Act is important because many people are increasingly required to care for a family member or friend with a major health problem or concern. Based on the current situation, caregivers usually experience tremendous challenges in providing complex medical care, which in turn contributes to unnecessary hospital readmissions. This is primarily because the caregivers miss out on important information in the discharge plan developed by the healthcare team or are not properly educated to effectively handle medical tasks at home. A 2013 survey of hospital readmissions found that 72% of emergency room visits were for conditions that could have been avoided through effective outpatient care at home (Dianoski, 2014). The results of a survey in Kansas indicated that caregivers should be involved in formulation of care plans and require training to handle the various clinical or nursing tasks they encounter (Kansas Department for Aging and Disability Services, 2015). Kriss (2015) concurs by stating that caregiver engagement in discharge plans is necessary because they are likely to be overwhelmed due to lack of necessary information to handle medical tasks. In Kansas, the enactment of CARE Act has helped improve care transitions and lessen readmission through provision of caregiver training and support. The Act provides caregivers necessary information and resources to carry out medical tasks (Kansas Department for Aging and Disability Services, 2015).

Implementation of CARE Act at Winthrop Hospital

Winthrop Hospital is one of New York's healthcare facilities that have implemented this initiative through filling a form with the nurse and patient during admission. After the Act was enacted into law, the hospital implemented it through several measures. The institution educated nurses about the law and the necessary steps required for compliance. Unit managers spoke to the staff during meetings to remind them and sent out emails to nurses to ensure implementation.

Following an audit of 4 random units at Winthrop, it was evident that the hospital experienced challenges after the Act was initiated since nurses were 33% compliant. First, nurses found it difficult to adapt to the change because they were not used to it. Secondly, nurses could not find the form in the admission packet though they heard about them. Third, unit secretaries did not know where to print the forms while managers were not consistently speaking to them about the importance of the document.

After auditing the 4 units and identifying the challenges in implementation, hospital staff and nurses were re-educated on the importance of the form. Some of things that were highlighted when educating staff/nurses included its role in helping patients become more integrated with their care, its role in lessening readmission, and its role in enhancing patient satisfaction and outcomes. Secondly, the registration office was advised to ensure the forms are printed with all admission packets so that units do not do so separately. Third, a permanent place for placing the forms was identified i.e. in front of the patients' charts. These two measures would help ensure consistency in placement of the forms and make it easy for nurses to sign when patients are signing their admission documents. The plan was effective as demonstrated by an evaluation that was carried out after implementation. An audit of the units and charts after implementing the change showed 90% compliance and helped address the challenge.