Improving transitional care and reducing hospital readmissions are critical for the health of patients, making the health care system more effective and, ultimately, contributing to the reduction of health disparities. This year 28 Connecticut hospitals – that is 88% of all hospitals in the state – will be penalized for excessive readmissions by the Center for Medicare and Medicaid Services (CMS). Similarly, Connecticut ranked 39th overall among states in effectiveness in transitioning patients between care settings according to AARP’s 2014 LTSS Scorecard. The problem of hospital readmissions is particularly problematic among Black and Latino/Hispanic patients in our state.
An analysis of the Connecticut Hospital Inpatient Discharge Database showed that ethnic/racial disparities exist in hospital readmissions in Connecticut. Hispanics were significantly more likely to be readmitted within 30 days of discharge following hospitalization for heart failure. Blacks were significantly more likely to be readmitted within 30 days of discharge following hospitalization for chest pain. The cost exacted by readmissions is astronomical. On a national level, the cost amounts to $27 billion annually. A large portion of the cost is borne by Medicare and Medicaid.
There are a number of complex factors that can influence hospital readmissions, including poverty/lack of social supports, low education, low household income, and ethnic/minority status, as well as quality of care. While there is no silver bullet to prevent unnecessary readmissions, one proactive practical response Connecticut can take is to stabilize the environment and supports (family/significant others) available for patients when they return home from a hospital stay.
According to health care experts, caregiver training and engagement is vital to improving care transitions – when patients are discharged from the hospital – and preventing costly readmissions. Family and significant others are the front line of defense against costly hospital readmissions once a patient leaves the hospital. These unpaid caregivers work hard to safely help their loved ones live independently and comply with follow-up and treatment orders. Unfortunately, most of these individuals do not have the medical background or training to properly perform complex medical or nursing tasks required by a loved one.
Fortunately, there is a common sense proposal now under consideration in the General Assembly that can help support unpaid family and other individual caregivers when their loved ones transition home from the hospital. The proposal, S.B. 290, An Act Concerning Patient-Designated Caregivers also referred to as the C.A.R.E. Act would allow patients to designate the name of a family or individual caregiver upon admission into the hospital; provide adequate notification to those identified caregivers before a hospital discharge to home; and gives caregivers an opportunity to receive plain language instruction in the after-care tasks included in the discharge plan to be performed by the caregiver.
AARP and the Commission on Health Equity strongly support S.B. 290 as a practical first-step to help curb unnecessary hospital readmissions and as well as address ethnic/racial disparities in successful care transitions. The logic is pretty simple: when a discharge plan is not realistic or a caregiver is unprepared and untrained, they’re more likely to have issues or make mistakes that may land the patient back in the hospital. But, by providing designated caregivers with basic instruction, we can stabilize the environment to which the patient returns after discharge and foster better health outcomes.
Family and other unpaid caregivers in Connecticut are the backbone of our health care system. Making sure they are prepared to safely care for a loved one after hospital discharge is crucial to a successful recovery. Let’s help more than 700,000 unpaid family/individual caregivers in Connecticut by passing S.B. 290, the CARE Act into law.
