From Hospital to Home: Guides Help Families Make Transition
Beal, Eileen, Aging Today
Waiting until the hospital discharge process begins is the worst time for patients and their family caregivers to begin planning for the transition from an acutecare hospital to homecare. Despite the possibility of mistakes and misunderstandings that can adversely affect a patient's recovery-and safety-the discharge planning process is often telescoped into a last-minute consultation with a discharge planner who is juggling paperwork, physician instructions and patient education for patients and caregivers who are overwhelmed. At these times, patients and caregivers "are so anxious and intensely needy that they aren't hearing what's being said," explained Carol Levine, director of the United Hospital Fund of New York (UHFNY) Families and Health Care Project, in New York City. She added that because they do not yet grasp how the system works, "they don't know what their options and rights are."
The desire to improve the transition to homecare and prevent unnecessary crises or readmissions to hospitals prompted Levine and Gail Gibson Hunt, executive director of the National Alliance for Caregiving (NAC), Bethesda, Md., to join forces. They cowrote a pair of straightforward, pocket-size free booklets titled "A Family Caregiver's Guide to Hospital Discharge Planning" and "Hospital Discharge Planning: Helping Family Caregivers Through the Process."
During a workshop at the Third International Conference on Family Care, hosted by NAC in Alexandria, Va., last fall, Levine stressed that although anecdotal evidence indicated a need for the guides, "hard data was the rationale for our project." Levine began with a literature review to examine the discharge planning process. Also, she said, she mined existing research that looked at "key points in the caregiving continuum and at the transitions in care people experience and how they experience them." In addition, Levine analyzed data from a telephone survey her agency had conducted in collaboration with the Visiting Nurse Service of New York and Harvard Health Service. This study found that many of those responsible for post-discharge caregiving felt ill-prepared for caregiving tasks. For example, said Levine, "38% of the people who were changing bandages and 20% of those monitoring feeding tubes said they had not been trained."
After reviewing the data, Levine and Hunt organized two focus groups each, in the New York City and Bethesda areas, one with family caregivers and one with hospital discharge planners. The groups had between eight and 12 participants each and generated reports that helped prioritize many of the talking points eventually used in the guides, including such critical information as stressful aspects of the discharge process, appealing a hospital's discharge order, and finding inhome caregiver services. …