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Getting Transitions In Care Right: Two Agendas For Change

September 3rd, 2013
by Carol Levine

Big changes in health care make headlines. Except when they slip by unnoticed. A memorandum earlier this year from CMS’s Center for Clinical Standards and Quality/Survey & Certification Group to state survey agency directors fits this category. As if the agency’s title weren’t wordy enough, the subject of the memo, issued on May 17, would hardly excite the average reader, even one familiar with health policy: “Revision to State Operations Manual (SOM), Hospital Appendix A—Interpretive Guidelines for 42 CFR 482.43, Discharge Planning.”

The contents of the 39-page memo, however, are what count. The specificity and comprehensiveness of the guidelines have elevated the standards for discharge planning under the Conditions of Participation in Medicare and Medicaid from a familiar but often undervalued set of activities to a major responsibility that surveyors will review for compliance.

The revised guidelines set out clear expectations for hospitals to take discharge planning seriously by, among other actions, assigning trained professionals to the task, involving patients and families (or “representatives” or “support persons”) at every stage, and ensuring that appropriate training and referrals to community services have been completed. The guidelines also emphasize that hospitals must know the capabilities and capacities of post-discharge facilities and communicate effectively with them. When implemented by hospitals and monitored by state survey agencies, these changes will go a long way toward improving transitions in care for patients and their family caregivers and reducing hospital readmissions. Cost savings should follow.

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Your (Untrained And Scared) Family Member Will Set Up Your IV Now!

November 2nd, 2012
by Carol Levine and Susan Reinhard

Time travel, both backward and forward, continues to be a favorite theme in popular culture. If we could travel back just 60 years or so, we would see a vastly different health care system, one geared to provide acute care, not chronic care, and one offering what today would be seen as rudimentary treatments. No one in 2012 would expect a surgeon to use techniques from that era or a doctor to prescribe medications long surpassed by more effective drugs. Yet one important area of health care and long-term care services and supports clings to outmoded terms and measures.

Welcome to the hidden world of family caregivers — broadly defined as the spouses, adult children, other family members, partners, friends and neighbors who provide or manage most of the care of the growing number of noninstitutionalized people with chronic illnesses and disabilities. As our recently released AARP Public Policy Institute and United Hospital Fund report (available here and here) puts it:

Family caregivers have traditionally provided assistance with bathing, dressing, eating, and household tasks such as shopping and managing finances. While these remain critically important to the well-being of care recipients, the role of family caregivers has dramatically expanded to include performing medical/nursing tasks of the kind and complexity once provided only in hospitals.

These tasks include managing multiple medications, not just pills but injections and infusions; wound care; operating medical equipment like feeding tubes, dialysis machines, and mechanical ventilators; and using electronic monitors and other devices.

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The Year Of The Family Caregiver — In What Country?

April 21st, 2011
by Carol Levine

President Obama has begun his campaign for re-election in 2012.  Several Republicans have declared their intention to consider the possibility of running.   Meanwhile, implementation of health care reform proceeds slowly, with threats of defunding and legal action scuttling alongside to keep up.  Policy debates about accountable care organizations, medical homes, and other attempts to bring […]

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Medicare Innovation: Whose Priorities, Whose Interests?

July 14th, 2010
by Carol Levine

Editor’s Note: In addition to Carol Levine (photo and bio above), authors of this post include Eric Coleman, Professor in the Division of Health Care Policy and Research, University of Colorado Denver School of Medicine; and Mary Naylor, Director of the New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing. The opportunity for significant […]

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The Seattle ‘God Committee’: A Cautionary Tale

November 30th, 2009
by Carol Levine

As uncomfortable as it is for many Americans to accept, allocation issues are a permanent feature of our health care system, “reformed” or not.  Who should get the H1N1 flu vaccine first? In a flu pandemic or a biological disaster, who should be put on respirators and who should not?  These hard choices are realities, […]

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