“Self-care deficit” contributes to rehospitalizations among home care patients
Attorney and home care legal expert Elizabeth C. Hogue shares details about the CoPs that apply to hospitals and discharge planners regarding counseling family members of the discharged patient.
This piece encourages the collaboration between discharge planners, family members, and home care providers to ensure that he patient has a support network as they transition to the home to ensure continued improvement and increase the chances that the patient is not readmitted to the hospital.
Part 6: Hospital Conditions of Participation for Discharge Planning: Counseling Family Members
Conditions of Participation (CoP’s) of the Medicare Program for hospitals include CoP’s for discharge planning. This is the sixth in a series of articles about these requirements. Hospitals that do not meet these requirements may lose their certification and ability to receive payments from the Medicare and Medicaid Programs.
CoP’s governing discharge planning first state that hospitals must have a discharge planning process that applies to all patients. The Centers for Medicare and Medicaid Services (CMS) says that the CoP’s it develops apply to all patients, not only to patients whose care is paid for by the Medicare and Medicaid Programs. The CoP’s then say that hospitals’ policies and procedures must be specified in writing. Hospital discharge planners should review written policies and procedures required by the CoP’s to make certain that they reflect applicable requirements and current practice. Discharge planners/case managers may be required to demonstrate that they are following their written policies and procedures. At 42 CFR Section 42.43(c)(5), the CoP’s state as follows: “As needed, the patient and family members or interested persons must be counseled to prepare them for post-hospital care.” A recent study reinforces the importance of compliance with this requirement in order to improve care transitions and avoid readmissions.
The October-December issues of Advances in Nursing Science journal reported on a study about how elderly patients fared after discharge from the hospital. A team of researchers; including Hong Tao, Assistant Professor at the University of Wisconsin Milwaukee College of Nursing; concluded that patients who lacked support when receiving home health services after discharge from hospitals did not do as well as patients who had a solid support system for self-care. According to the study, a “self-care deficit” post-hospitalization correlated to readmissions to hospitals. A key component of the ability of patients to self-care was whether patients had family members who served as primary informal caregivers. Patients who received more care were likely to be better able to care for themselves and avoid readmissions. The study concluded that the rate of readmissions is likely to decrease when social/environmental support for patients is improved. Patients who received environmental support from family caregivers in the form of psychosocial support, facilitating access to medical care, or service as financial and/or health agents were better able to avoid rehospitalization.
In other words, the involvement of family members in patients’ care after discharge to home is crucial. The CoP referenced above makes it clear that discharge planners/case managers are required to counsel with families prior to discharge to make certain that they are prepared to fulfill this vital role. Concerted effort between both hospitals and home care providers is certainly needed in order to “wrestle readmission rates to the ground.” Counseling with families by discharge planners/case managers while patients are still in the hospital is vital to this effort.
©2013 Elizabeth E. Hogue, Esq. All rights reserved.