A New State Law: Is It Helping Caregivers or Shifting Blame?

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A NEW STATE LAW: IS IT HELPING CAREGIVERS OR SHIFTING BLAME?

What’s your take? What’s your experience?

In 2016 New York State implemented a law which has been enacted in 35 States across the country, the “Caregiver Advice, Record and Enable Act (The CARE Act).” AARP has been the lead advocate for their passage. It requires hospitals to allow patients to formally designate a caregiver before being sent home and for hospital workers to provide the caregiver with instruction or training on how to perform tasks for the patient at home, such as changing bandages or administering medication. The United Hospital Fund is spearheading the promotion and implementation of the law locally and maintains an excellent resource library for caregivers.

Intellectually the CARE Act has great merit. But on a day-to-day operational level how is it being monitored? Are consumers aware of the law so that they may assure that they receive proper instruction? Are family members AWARE OF THE ENTITLEMENT when admitted to the ER in the middle of the night? Are hospital and emergency room staff adequately staffed to provide the instruction?

We recall that the landmark Institute of Medicine 1999 report “To Err Is Human: Building A Safer Health System” identified the vast scope of preventable medical errors occurring in the hospital setting and encouraging the system to engage the family in care management as a strategy for improvement.

The CARE Act may very well be an outcome of the Institute's Quality of Health Care in America Committee’s deliberations. There is concern however that the volunteer non-paid caregiver as a result will now be held responsible for care management outcomes together with the hospital’s paid professionals, that the burden of responsibility for preventable medical errors is being shifted.

Under the leadership of Carol Levine, The United Hospital Fund is to be commended for its efforts to foster hospital accountability by hosting the seminar “Implementing the CARE Act: What’s Working? What’s Not?” and posting a June report “New York’s Care Act One Year Later.” UHF is encouraged by the response of self-reported compliance.

Hospital staff attending the seminar found that it is having a major impact. While one can legitimately argue that their self-reported survey responses were skewed through selection bias – hospitals that attended the seminar were predisposed to CARE Act adherence – still, the information collected has value as an agenda for follow up activity and as a benchmark of implementation.

It would be equally helpful to obtain valid and reliable data from the caregiver’s perspective.

Was instruction provided?
Was it meaningful and helpful?
Were the tasks doable?

Indeed, scientific research on the subject, not only on its impact in New York but in other states around the country where it has been introduced may very well merit a grant funding award or graduate school dissertation approval. Findings of such a study would have significance to practitioners, policy makers and caregivers alike.

“ I wonder whether hospitals are adequately staffed to provide the required education prior to discharge. As caregiver and consumer advocate I found an internationally renowned medical center so severely short-staffed that I needed to make a tumult and insist on speaking to the administrator on duty to received nursing assistance for an ER patient. “

R Becker LOY/Center for Healthy Living

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