New York State CARE Act: Implementation in Hospitals
This paper examines the New York State Caregiver Advise, Record and Enable (CARE) Act, enacted in April 2015, which requires hospitals to identify and educate designated family caregivers during patient discharge. The paper reviews the law's benefits—including reduced hospital readmissions and improved patient outcomes—and surveys evidence from other states such as Kansas. It then analyzes the implementation experience at Winthrop Hospital, where initial nurse compliance stood at only 33% due to form availability and staff communication failures. The paper describes the corrective measures taken, including staff re-education and standardized form placement, which raised compliance to 90%, and frames this improvement through Lippitt's Theory of Change in nursing practice.
- Overview of the New York State CARE Act: Background, scope, and requirements of the CARE Act
- Benefits of the CARE Act for Patients, Caregivers, and Hospitals: Improved outcomes, reduced readmissions, caregiver support
- Literature Review: Evidence and Context: Multi-state evidence supporting caregiver engagement policies
- Implementation of the CARE Act at Winthrop Hospital: Initial rollout steps and compliance audit findings
- Challenges, Corrective Measures, and Outcomes: Re-education, form standardization, and 90% compliance achieved
- Conclusion: Lippitt's Change Theory applied to policy compliance
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What makes this paper effective
- Grounds the legislation in concrete statistics—2.8 million unpaid caregivers and $31.3 billion in annual unpaid care value—giving the policy argument immediate real-world weight.
- Moves logically from broad policy context to an institutional case study, allowing abstract legislative goals to be tested against measurable compliance data (33% rising to 90%).
- Applies a named theoretical framework (Lippitt's Theory of Change) to explain the corrective process, demonstrating awareness of nursing management literature beyond the immediate policy sources.
Key academic technique demonstrated
The paper uses a before-and-after audit structure as its central evidence strategy. By reporting a compliance rate of 33% before intervention and 90% after, it creates a quasi-evaluative design that links specific administrative actions (re-education, standardized form placement) to measurable outcomes. This approach mirrors small-scale quality improvement methodology commonly used in healthcare administration writing.
Structure breakdown
The paper opens with a policy overview and benefit analysis, moves into a brief literature review drawing on multi-state evidence, and then narrows to a detailed case study of Winthrop Hospital. The case study itself is divided into problem identification, corrective action, and evaluation, before a short conclusion synthesizes the broader lesson. This funnel structure—from state policy to unit-level compliance—is well suited to healthcare administration topics.
Overview of the New York State CARE Act
The New York State Caregiver Advise, Record and Enable (CARE) Act was enacted into law in April 2015. The development and passage of this legislation is geared toward having a positive effect on caregivers who assist patients and family members in recovering after a hospital admission. The law ensures that patients in healthcare facilities can designate a family caregiver, and that the facility provides that designated caregiver with instruction and demonstrations of medical tasks they are likely to perform for their loved ones at home.
There are approximately 2.8 million New Yorkers who provide unpaid care to their loved ones at any given time, and nearly 1.6 million adult New Yorkers are discharged home from healthcare facilities annually (Kriss, 2015). Given that the value of unpaid care provided by these caregivers amounts to approximately $31.3 billion per year, New York State faced a clear need for legislation with positive impacts on family caregivers. New York Senate Health Committee Chairperson Kemp Hannon and Assembly Member Linda Rosenthal sponsored the CARE Act to help address these needs. Through their efforts, New York State enacted the bill into law to help the many family caregivers across the state.
Through this law, a patient has the liberty to appoint an individual he or she trusts to be involved in the discharge process. The appointed individual participates in discharge teaching alongside the patient, helping to bridge any gaps in communication between 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 by completing a form with the nurse and patient during hospital admission. Medical tasks on which the caregiver should receive instruction include administering various medications, operating medical equipment, and dressing wounds (Kriss, 2015).
References
Dianoski, T. (2014, November 18). How the new Caregiver Advise, Record, Enable (CARE) Act affects hospitals and health plans. Retrieved August 11, 2016, from https://gomohealth.com/2014/care-act-hospitals-health-plans/
Kansas Department for Aging and Disability Services. (2015). The Kansas Caregiver Advise, Record, Enable (CARE) Act (HB 2058 and SB 265). Retrieved from Kansas Government website: https://www.kdads.ks.gov/docs/default-source/CSP/HCBS/HCBS-2015-Spring-Summit/Presentations/the-kansas-caregiver-advise-record-enable-(care)-act-presentation.pdf
Kriss, E. (2015, June 1). AARP: Millions of NY family caregivers in line for help as lawmakers pass CARE Act. Retrieved August 11, 2016, from http://states.aarp.org/aarp-millions-of-ny-family-caregivers-in-line-for-help-as-lawmakers-pass-care-act/
Mitchell, G. (2013, April). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32–37.
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