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

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Presentation on theme: "Patient and Family Engagement Affinity Group Engaging the Family Caregiver at the Point of Care February 24, 2014."— Presentation transcript:

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

2 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: Childrens Mercy Hospital, Stacey Koenig, Senior Director, Patient- and Family- Centered Care/Philanthropic Auxiliaries Caregiver Perspective, DeeJo Miller, Family Centered Care Coordinator Parent on Staff, Childrens 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 Todays Speakers 2

3 Introduction Jenifer McCormick Project Manager, Patient & Family Engagement Contractor

4 Regarding the length of the PFE Master Classes, I think the classes should be: – 50 minutes – 60 minutes – 75 minutes Polling Question 4

5 Master Class 1&2: Patient and Family Advisory Councils Master Class 1&2: Patient and Family Advisory Councils Master Class 3: Shift Change Huddles at Bedside 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 Master Class 6: PFE and Discharge Planning Checklists Links to Previous Master Classes 5

6 Background Joyce Reid RN MS Vice President, Community Health Connections Georgia Hospital Association jreid@gha.org

7 Barriers to Identifying Caregivers Language Multiple visitors Race/Ethnicity Leadership engagement Lack of not listening to cues 7

8 Steps to Identify Caregivers Caregivers are not always who you expect them to be Identification process is important 8

9 Joyce Reid RN MS Vice President, Community Health Connections Georgia Hospital Association jreid@gha.org Thank you, and please contact me with any questions:

10 Family Caregivers: Who They Are, Why They Matter, and How To Engage Them John Schall Chief Executive Officer Caregiver Action Network February 24, 2014 JSchall@CaregiverAction.org

11 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. Two out of every 5 adults are family caregivers Alzheimers is driving the numbers up. 15 million family caregivers caring for more than 5 million with Alzheimers. Alzheimers is driving the numbers up But its 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. But its not just the elderly who need caregiving 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. Wounded veterans require family caregivers, too And its 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 Alzheimers. And its not just women doing the caregiving Family caregivers are the backbone of the Nations long-term care system. Family caregivers provide $450 billion worth of unpaid care each year. Thats more than total Medicaid funding, and twice as much as homecare and nursing home services combined. Family caregivers are the backbone of the Nations long-term care system

12 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 patients household duties/take over breadwinner role

13

14 Family Caregiver Toolbox

15 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 Checklist Doctors Office Checklist Medication Checklist Safe and Sound: How to Prevent Medication Mishaps

16 Ideally, Hospitals Would… Designate caregiver in the patients medical record Recognize and include caregiver as part of the health care team Meet with caregiver to discuss patients plan of care Notify caregiver before transfer to another facility Instruct caregiver at discharge* Follow up on after-care tasks after discharge*

17 How to Connect with CAN www.CaregiverAction.org www.facebook.com/CaregiverActionNetwork @CaregiverAction Help for Cancer Caregivers www.HelpForCancerCaregivers.org Rare Disease Caregivers www.RareCaregivers.org

18 Stacey Koenig Senior Director Patient- and Family- Centered Care/Philanthropic Auxiliaries DeeJo Miller Family Centered Care Coordinator Parent on Staff Hospital Spotlight: Childrens Mercy Hospitals

19 354 beds 370,321 outpatient visits 147,938 ER/UC visits * All numbers Fiscal 2012 Childrens Mercy Hospitals and Clinics 13,397 admissions 19,144 surgeries 20+ outreach clinics

20 20 A Pediatric Hospital: Our Story

21 Childrens Mercy: A Parent Perspective

22 22 Engaging 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

23 23 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

24 24 Family-friendly Medication Administration Record (MAR)

25 25 Facilities Updates New in-patient tower Accessible Family Care Station Clinic waiting rooms Inpatient Parent Rooms Gift shop redesign Handicap accessible parking spaces

26 Patient/Family Advisors on Committees

27 Thank you, and please contact me with any questions: Stacey Koenig Senior Director for Patient- and Family- Centered Care and Philanthropic Auxiliaries skoenig@cmh.edu DeeJo Miller Family Centered Care Coordinator/Parent dkmiller@cmh.edu

28 Tools to Engage Family Caregivers Partnership for Patients Patient and Family Engagement Master Class February 24, 2014 Jennifer L. Rutberg, Senior Program Manager Families and Health Care Project United Hospital Fund

29 http://www.nextstepincare.org © 2014 United Hospital Fund

30 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

31 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

32 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 http://www.uhfnyc.org/publications/880905 Day of Transition Initiative IMPACT © 2014 United Hospital Fund

33 Thank you! Jennifer Rutberg (212) 494-0751 jrutberg@uhfnyc.org http://www.nextstepincare.org © 2014 United Hospital Fund

34 Metropolitan Hospital Center and HHC Health and Home Care Fiona Larkin, LCSW, Associate Executive Director HHC Health and Home Care CHHA Richard A. Siegel, LCSW, Senior Associate Director Metropolitan Hospital Center

35 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) 35

36 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

37 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

38 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

39 Metrics Heart Failure 30 Day Re-admissions

40 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.

41 Caregiver and Patient Story He 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 )

42 Thank you, and please contact us with any questions: Fiona Larkin, LCSW, Associate Executive Director HHC Health and Home Care CHHA Fiona.larkin@nychhc.org Richard A. Siegel, LCSW, Senior Associate Director Metropolitan Hospital Center Richard.siegel@nychhc.org

43 Please write your questions in the chat box. Question & Answers

44 Success Stories/Emerging Best Practices Working Group Vulnerable Populations Working Group Affinity Group Updates

45 Please contact Weber Shandwick with any questions: Amarcus@webershandwick.com 202-585-2224 Thank You 45


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