Public Policy Fellow

Family Caregiving

One great reward experienced from my work here at the Public Policy Institute at AARP is how the  media reports on published reports. Media reports related to our work on Family Caregiving were  released recently. Please refer back to my Blog posting of April 30 to recall my role in this effort. I was pleasantly surprised to see my work acknowledged in the actual report at top of page 87 under the Chapter on “Discussion and Recommendations”. The Planning Committee continues to meet and is seeking funding regarding our future plans to implement these recommendations.

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Family Caregivers Need Help; Lack Information, Training

Patient Care Must Be Redefined To Include Family Members; Professionals and Advocates Pledge To Help Educate Family Caregivers 

In a first of its kind collaboration, national organizations representing nurses, social workers, family caregivers and people age 50+ released a report calling for a re-definition of good patient care to include those family members and friends who provide ongoing, often daily, care. Family members are very often not prepared to take on the task of caregiving--especially as many family caregivers are providing services typically reserved for registered nurses and doctors.

The report, “State of the Science: Professional Partners Supporting Family Caregiving,” is a joint endeavor of the AARP Foundation, the American Journal of Nursing, the Council on Social Work Education and its Journal of Social Work Education, the Family Caregiver Alliance, and Rutgers Center for State Health Policy (New Jersey).

It was released to coincide with a new "Ask Medicare" initiative from the Centers for Medicare and Medicaid Services, of which AARP is a key supporter. Links to our online caregiving resources will be included on a new Web site, www.medicare.gov/caregiver, which will provide accurate and unbiased information to caregivers about Medicare.

Overview of the Report

• Argues that the relationships between and among nurses, social workers, patients and the friends and family who care for them must change as Americans live longer and need more long-term care.
• Redefines best practices in the fields of nursing and social work as they concern caregiving for older adults and the partner organizations have pledged to spread those practices to reach more caregivers.
• Argues for eliminating the barriers to engaging caregivers that nurses, discharge planners and social workers currently face, such as lack of time due to heavy workloads.     
• Outlines the knowledge and skills needed by the caregiving professionals and suggests ways to develop them.
• Lays out an agenda for future research on family caregiving.

The parties to the report pledged to partner with families in new ways to:

• Improve families’ ability to better manage their everyday care responsibilities, reduce their own   burdens and health risks, and promote a better quality of life for both the older adults receiving care and the family members providing it
• Improve professionals’ ability to assess the needs of family, friend, and neighbor caregivers;      provide caregivers with the information and skills needed to deliver care; and lead in the development of family-friendly policies, practices and environments across healthcare settings.

Read More

• Full Report: State of the Science: Professional Partners Supporting Family Caregiving
• Press release on AARP.org

Selected Report Contents:

• Editorial: How Are You Doing? by Susan C. Reinhard, Ashley Brooks-Danso, Kathleen Kelly, and Diana J. Mason
  Nurses and social workers come together to do better by family caregivers.     
• Executive Summary: Professional Partners Supporting Family Caregivers by Kathleen Kelly, Susan C. Reinhard, and Ashley Brooks-Danso
  A "state of the science" symposium brought together leaders in two professions.

Care Coordination

One aspect of the health care system that seems to inspire everyone’s consensus is the need for health care reform. The debate, however, revolves around WHAT to reform. One concept to drive much change that has gained much attention in health policy and political circles is the “medical home”.  The concept of medical home means that the care of people with chronic illnesses will result in better care coordination.  My major project over the last several months has been to identify what every nurse should know about care coordination.  I am nearly finished with a paper describing the role of nurses in care coordination.

Americans are living longer and the number of older adults is rapidly increasing. With increased age comes increased risk for chronic illness. The high and increasing prevalence of multiple chronic conditions poses challenges for our current health care system.  The high cost of care associated with treatment for persons with chronic conditions gives rise to questions about the most appropriate models of care for persons with multiple chronic illnesses.  People with multiple chronic illnesses have substantially more health provider contacts and are more likely to be hospitalized each year than those with only one chronic condition. Prior attempts to manage costly utilization of services by persons with chronic illness have been unsuccessful with traditional fee for service methods. Mounting pressure for health care reform has resulted in consideration of easy solutions to restrain health costs—including the concept of a “medical home”.

The “medical home” concept grows out of the disease management literature and was introduced in 1967 by American Academy of Pediatrics with the intent to provide care to children with disabilities.  In the United States, projects to put this Medical Home concept into practice center on physicians, not nurses. Yet, the medical literature and experience of providers to improve chronic care indicate that nurses are the key to implementing the chronic care model. By nature of our holistic education and role, nurses are in a position to champion the transformation of chronic care. 

Care coordination is one of the priorities to transform the health care system (IOM, 2008).  Nurses have taken on the central role in care coordination for decades, and are now being recognized as leaders in care coordination.  Nursing models that use coordinated care and report outcomes are very helpful in the debate.  Examples of nursing models using care coordination with reported outcomes of this practice include that of the Transitional Care model, EverCare model, and outcomes reported in the literature on Advanced Practice Nursing. 

Recommendations regarding care coordination follow:

• Development of comprehensive, coordinated approaches to financing and delivering a wide range of needed care in Medicare must be supported.  Payment must create incentives to better coordinate care.

• "Medical Home” must be conceptualized as a broader, more holistic health home approach, characterized by client and family centeredness that includes health promotion and disease prevention with contributions of all providers optimized (AAN, 2008). 

• Nursing must continue to transform health care by developing models of care coordination.  Models of care coordination must be supported by evidence with outcomes and cost effectiveness reported.

• Medicare payment must be inclusive of nursing models that include Advanced Practice Nurses as equal practitioners who provide care coordination to Medicare beneficiaries.

My major paper describing nursing’s role in care coordination will soon be finished.  This paper will be a major product that I’ve enjoyed working on during this Fellowship.  Pat Ford-Roegner, Executive Director at American Academy of Nursing (AAN), has mentored me in understanding these issues. 

Read AAN’s briefing paper on this issue...