AARP Asks GAPNA for Support of CARE Act
by Julie A. Stanik-Hutt
One of AARP’s initiatives focuses on the Caregiver Advise, Record, and Enable (CARE) Act to better support family caregivers as seniors strive to stay at home safely.
The CARE Act recognizes the critical role family caregivers play in keeping loved ones at home rather than in costly institutions. The key components include:
- Recording the name of the family caregiver when a patient is admitted to a hospital (if the patient chooses to designate one).
- Notifying the designated family caregiver when the loved one is to be discharged to another facility or to home.
- Discussing with the caregiver the patient’s care needs upon discharge.
- Providing the caregiver instruction and coaching regarding how to perform those activities.
AARP reached out to the GAPNA Health Affairs Committee asking for help identifying NPs willing to provide testimony to support the CARE Act in six states where bills were introduced in 2018. GAPNA and AARP shared information in those key states and GAPNA member, Julie Stanik-Hutt, took an active role in advocacy.
In early February, Julie traveled two hours to Des Moines to testify at the Senate subcommittee on the Iowa CARE Act, SSB 3123. She shared her personal and professional perspectives based on 40 years’ experience in hospital-based care of adults and older adults.
She told the legislators, “As more and more care has moved from hospitals to ambulatory models, and hospital lengths of stay have been reduced, we rely more and more on family members and friends to become the patient’s caregivers. Sometimes we call this aftercare. These caregivers perform activities at home that nurses and other healthcare workers would provide if the person were still in the hospital; activities that support an individual to perform the basic activities of daily living.
Caregivers help people to get in and out of bed, take their medications, eat, get to the bathroom, wash up in the morning, and get ready for bed at night. They help people monitor their condition (blood sugar, temperature, weight, etc.), change wound dressings and empty drainage collection devices, assist the person to do physical therapy exercises or breathing treatments. They also administer insulin and heparin injections.”
She went on to say “To keep patients safe, it is absolutely critical that both the patient and the caregiver (family member, friend, or neighbor) are well prepared to do the tasks required. The caregiver needs to be identified early in a hospitalization, so that there is adequate time for them to learn the tasks that will be required. It takes time for the hospital nurses to reach caregivers, schedule time for them to come to the hospital to be taught, and to practice the needed tasks. Caregivers also need time to think about and ask questions regarding how they will manage the care in a home environment. It’s best to do this before being sent home with the person and expected to perform the care all by themselves. Assuming responsibility for doing this work can be overwhelming to the caregiver. Sometimes they just feel lost.”
Patients who will be homebound and have an identified nursing need are usually eligible for at least one home visit from a nurse. But many patients aren’t considered homebound and don’t get any home visits after a hospitalization.
To help these individuals, Julie has established a volunteer practice, within a local church’s health ministry, to help patients and family members with the transition to home. She calls it self-care coaching. She helps patients as they assume responsibility for self-care after hospital discharge. “If caregivers had more time to learn these tasks, patients would have safer transitions home and make fewer self-care errors, things that produce unexpected office and emergency department visits, and readmissions. If we could adequately address this problem, I’d be happily out of a job.”
Her testimony was much appreciated by AARP and other allies such as American Heart Association and American Cancer Society. The testimony restarted the conversation on this bill in the Senate, highlighting the opportunity for Iowa to do better for older adults and caregivers. The state AARP staff worked with the Iowa nurses association to gain their support and with hospitals to reduce their concerns. Additional rural health and community-based health associations added their support.
AARP was very appreciative of Julie’s efforts and sent a follow-up email: “You really were a star among many good stories and perspectives shared today. I heard praise for you today from multiple people in the room, including more neutral observers.”
Julie A. Stanik-Hutt, PhD, ACNP, GNP, FAANP, FAAN
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