Personal Health Care Records (PHR) Products to help avoid an ambulance ride back to the hospital

Personal Health Care Records (PHR) can be a powerful tool for families who have an older member in the hospital. This is especially true at discharge.

What are PHR? Quite simply it’s just a way keeping track of information. The tracking can be as simple as a notebook or as high tech as one of the 150 PHC’s products available online like Lifeledger.

There are about 100-200 PHR on the market right now, so you have a wide range of choices. Just Google personal health care records and you will find many products, including Google’s own version.

What’s in a personal health care record maintained via computer? Most web based PHR contain data. The product information can vary but in general they include:

Identification Sheet – This may be a listing of the older family members demographic information: name, address, telephone number, insurance, and policy number.

Problem List – A list of significant illnesses and operations older family member has had.

Medication Record - A list of medicines currently prescribed to the older family member, as well as medication allergies.

History and Physical – A list of any major illnesses and surgeries the older family member has had and what the physician found when older person went to each doctor’s appointment.

Progress Notes – Notes made by the family caregiver who accompanied the older person to the medical appointment, including observations and treatment plans made by doctors, nurses, therapists, or social workers.

Consultation – An opinion about your older family member’s condition made by a physician other than older person’s primary care physician.

Physician's Orders – The older family members physician's directions to other members of the health care team regarding medications, tests, diets, and treatments.

Imaging and X-ray Reports – Findings of x-rays, mammograms, ultrasounds, and scans.

Lab Reports – Results of tests conducted on body fluids. Common examples include a throat culture, urinalysis, cholesterol level, and complete blood count (CBC).

Consent and Authorization Forms – Copies of consents for admission, treatment, surgery, and release of information.

Discharge Summary – A concise summary of a hospital stay, including the reason for admission, significant findings from tests, procedures performed, therapies provided, response to treatment, condition at discharge, and instructions for medications, activity, diet, and follow-up care.

All of these facets of the PHR are important at discharge but some are more useful.

One big help at discharge is the Progress Notes section. While the family members meet with discharge planners, physicians or training staff , like physical therapists, they can input the directions. Creating your own Cliff Notes, this allows caregivers to better recall all the critical directions being chucked at them.

The “Discharge Summary” element of PHR is a powerful tool for adult children and others .It allows you to keep a succinct summary of what you have to do as a family caregiver to safely keep the older person at home and not headed back to the ER. If you are given a discharge summary you can just scan it into the PHR .

Medication records- another great part of a PHR products The family caregiver can add all the new meds at discharge or just scan them in if the physician or discharge planner give you a hard copy. A giant portion of re-admissions come from patients and their families not taking or administering meds properly after discharge .

Make discharge safe for your older family member and not a treacherous a loop back to the hospital. Look into something as simple as a notebook and pen or as high tech as a web tool such as a PHR. Information is an electric power tool for the aging family, especially one making the dangerous transition from hospital to home .

Care provider tools to insure a safe discharge for family members on Medicare

On Wednesday, July 8th I spoke at the San Francisco Bay area joint CMSA/ GCM meeting about care manager’s role in discharge planning .See my website for details.

When going home from the hospital, there are some tools that might help family caregiver’s insure a safe discharge . Here is a National Transitions of Care Coalitions NTOCC website that has these great tools.

At discharge, your physician or the discharge planner should give you a list of the medicines your elderly family member is taking . This inventory should include dosage , name, what you take the medication for and any special instructions.

If by chance you don’t get this list of drugs, you can use a tool on the NTOCC web site called My Medicine List, to help ask the discharge planner or physician questions to gather the needed information about your older family members medications at discharge. .

Another tool help to aging families on the same NTOCC site is Taking Care of My Health Care. In my June 29th blog , I suggested that the family of a discharged elderly patient should make sure they ask the physician or discharge planner for the discharge plan before their elderly relative goes home.

Taking Care of my Health Care gives an automatic reminder to ask for that discharge plan . It also prompts the family caregiver to ask when the discharged patient will see the next provider and who that next provider will be. It includes at reminder to ask , besides taking your medicines , what else do you have to do post hospitalization. This is a great cheat sheet when an older person begins to be discharged so you are sure they are coming home with the right information to be able to stay at home- not frantically circle back into the hospital.

A last terrific tool put out by Medicare is Planning For Your Discharge: A checklist for patients and caregivers preparing to leave a hospital setting. It is great booklet prompting families , caregivers and discharging older patients to see what needs to be done to get to home and stay there and who will do what when. Check it out.

Health Literacy -Training of Family Caregiver's Can Avoid Return to Hospital

If an elderly relative is in the hospital and you expect to be a family caregiver post discharge , get the hospital to step up to the plate and train you or other family caregivers. As I have said in other blogs, family caregivers are kin, not medical professionals. You often need training to carry out the caregiver tasks you will be asked to do when your relative gets out of the hospital.

Health literacy is a big-ticket item for caregivers. When you learned to drive, it was great to have driver’s ed. Now you need health ed. To maneuver the gridlocked health highways, you need health literacy . In fact, when your relative is discharged from a hospital you may have to run machines like Hoyer lifts or oxygen tanks. So operating baffling machinery fits right in to the health literacy you need to be a family caregiver.

Health literacy for family caregivers may be critical to keeping the older person safe at home and not packed into an ambulance back to the ER . I mentioned in my last blog, you should contact local senior resource agencies for help, through your area agency on aging. They not only offer a slew of services like food delivery and paratransist but some offer training of caregivers.

For example ,if your loved one was hospitalized for stroke or heart problem , contacting the local chapter of the American Heart Association can often get you post discharge support and training . Some communities have stroke centers.

The hospital itself should be training you as a family caregiver. As kin, you should check with the older person’s physician, RN , medical social worker or the discharge planner to find out if the physician has ordered physical therapy or occupational therapy to train family caregivers . If they have not and you need it , advocate for yourself and request the physician write the order.

Physical therapists can train family caregivers in transfer safety, use of assistive devices ( canes wheelchairs etc. ) ambulation , use of medical equipment and many other caregiver tasks.

This health education is not just for the patient but for the family caregiver’s safety. Family caregivers can severely injure themselves while caring for an older family member . Rather than hurt your back, ask the physician to help you get trained in the hospital before the older person comes home.

Family members are often ignored in the hospital yet asked to play a major part in the care at home. Make yourself heard by the physician and hospital staff before you needlessly injure yourself and /or your family member- putting them back in the hospital again.

Community Resources Help Keep Medicare Recipients from Readmission

A Medicare recipient’s readmission to a hospital can depend on families knowing community resources that can help keep the older patient at home and not cycling back through the ER.

Discharge planners are incredibly stressed by huge caseloads and do not have time to attend to every detail of each discharge. Families many times have to do the research for community resources themselves. Ask the physician or discharge planner if the hospital has a library where these local services are listed.

You can find the services you need right around your own corner. For example, if the hospitalized family member needs to go to chemotherapy post discharge, American Cancer Society’s, Road to Recovery Program can be a great source to get transportation to chemotherapy.

If your elderly or disabled Mom or Dad needs outpatient physical therapy, the local area agency on aging senior Para Transit can do door to door pick up and delivery. Driving to doctors appointments, physical therapy , exercise, even shopping is provided for a minimal fee.

If the older person can’t cook meals, Meals on Wheels can provide daily meals and will even provide low salt meals.
If possible, all of these services should be put in place before the older person returns home from the hospital .

Families of hospitalized older people can go to their local Area Agency and Aging ‘s web site and find services in the community. Elderlocator is the national web site to look for. You can also look in your state aging agency’s web site .
For example I live in Santa Cruz California. I would go to Senior Network Services funded through my local Area Agency on Aging . A visit to your area agency on aging can help the family understand what services are covered by Medicare and the older person’s existing insurance policies. Ask for their HICAP or SHIP program.

All these community resources can help you keep an older person from being readmitted to the hospital and safely in the place they most want to be, their own home.

Hospital Discharge Checklists Help Avoid readmission

If a Medicare recipient is readmitted in 30 days, hospitals risk big penalties under President Obama’s proposed new healthcare legislation. Aging families and older people suffer miserably when their relatives are needlessly readmitted to the hospital .

Unnecesary readmissions sometimes signal the hospital did not do everything it could to prepare the family caregiver to minister to the older person’s needs post discharge.

Family caregiver are just that-- family members. They are not nurses , doctors PT or OT. Yet since the advent of “ sicker and quicker” discharge from hospitals , kin have been morphed into unskilled health care providers

To avoid a pointless readmission, family members need to be trained and educated in the hospital to care for the older family member

If you have a hospitalized older family member, here are some tips to advocate for a successful discharge. .

Ask the physician or discharge planner for a discharge checklist . This check off sheet should list the medical conditions suffered by the older person and what you or other caregivers should do to care for this ill person at home . The list should cover:
➢ The patient’s condition and changes that have occurred through the hospital stay
➢ Any symptoms, problems or changes that may happen when the patient comes home
➢ The patient’s care plan
➢ Skills the caregiver must have to carry out that care plan.
When you get the discharge list, this is a great time to decide whether the family caregiver can actually care for the older person . Do they have the ability to give injections if that is called for? Can they transfer the older person from bed to a wheelchair if this is necessary ? If operating a Hoyer lift is part of the care plan, is this something they can do?.

This is especially true when you have elderly spouses are caring for aging husband’s and wives coming home from the hospital .

Can an 87 year old wife give injections when she has macular degeneration? Can an 80 year old husband with arthritis transfer an overweight wife from bed to a wheelchair ?

Discharge checklists help to make sure that the caregiver is trained and really able to render the care needed at discharge. It is a top notch safeguard that helps prevent the patient’s readmission within 30 days.

Training family caregivers of the elderly before Discharge

There is a proposal on the table by the Obama Administration to penalize hospitals if Medicare patients are readmitted within 30 days.

One in five Medicare patients discharged from the hospital is readmitted within 30 days, while half end up back in the hospital within a year,according to a new study published in the April 2 issue of the New England Journal of Medicine the New England .

The groundbreaking research exposes a "frequent, costly and sometimes life-threatening" problem that researchers believe could be prevented through better care coordination,

Part of that better care coordination should include training family caregivers .

Nancy Guberman, MSW, of the University of Quebec, points out that if family caregivers of older people were working for any other health agency or home care agency, or in any other “professions,” worker’s compensation boards would be waging major prevention campaigns, and there would be worker’s comp claims galore because of the caregiver tasks, strain, and burnout these family caregivers endure.

Caregivers of older people often ravage their own physical and mental health. When older friends or family members are hospitalized, the ill older person is often discharged prematurely. Why? Because so many people live so long and with very expensive chronic health care problems, the federal government turned to cost containment during the last four decades, radically shortening hospital stays.

The average hospital stay for people 65 and above in 1970 was 12.6 days. This was sliced by more than half by cost-cutting efforts till today’s older patients are often pushed out of fiscally bleeding hospitals “sicker and quicker” into the arms of their very unprepared family members.

Then their spouses, daughters, friends, and neighbors are asked to do medical tasks those caregivers 10 years ago were never given. This new workload for the family caregiver increases the caregiver’s risk of personal injury, thus prompting Nancy Guberman to say that if they were paid (they are not), worker’s comp would be all over their employer.

The daughter-in-law, son, or husband has to carry out medical tasks that are usually done by skilled medical personnel. These adult children, wives, and friends are asked to bandage and care for wounds, operate pumps and complicated machines at the bedside, give multiple medications, and turn and lift older patients, thus risking back injury.

Those ravages include caregivers’ mental health, and research shows that 40–70% of caregivers of older adults have high levels of depression and anxiety plus feelings of real anger. Many caregivers had these mental health challenges before their older family member entered the hospital. They have often put in years of caring before hospitalization and are mentally drained. Even before a hospitalization, spouses and daughters-in-law of elders have sat bedside for weeks, caring for a progressively ill family member. When that family member is discharged, the caregiver has to operate pumps, change bandages, take blood pressures, and help transfer the elder to the commode while in a state of exhaustion.

This overwhelming burden the U.S. places on family caregivers they assume free of charge. No one pays them.

In 2000, informal caregiving (caregiving by family and friends) had an estimated economic value of $257 billion, exceeding the cost of nursing home care ($92 billion) and home health care ($32 billion).
Family caregivers face health risks and serious illness as a result of their unpaid care—including the struggle with heart disease, hypertension, poor immune function, slower wound healing, increased use of psychotropic drugs, and, as mentioned, emotional strain and mental health problems, especially depression.
As we approach health care reform in Congress this is one large plank that must be addressed

Caregiver's on Line- Help in Cyberspace

Care giving can be a heartache. Hank Williams song, “I’m So Lonesome I Could Cry” sometimes pulls at your heart and plays in your head when you are caring for a family member. Often, you can feel alone.

Online social communities for family caregivers are valuable tools that help to heal that friendless feeling. These web based connections can reduce stress and give caregivers new ideas to solve problems without leaving their home. On line connections can show caregivers are on a huge ship, sailing against a gale with a million other frantic passengers. Meeting other caregivers in the same boat can give family members a chance to learn from others plus pry away that feeling of isolation.

Eldercare ABC is a site begun by caregivers .Forums on the site allow you to connect with other caregivers. Posted articles offer needed information like Medicare, long tern planning, health, finance and many other topics An expert to answer questions is available through the site and there is a blog.

Family Caregiver Alliance has a wealth of information for those who care. The organization has been around for decades as caregiver advocates. They have an excellent web based group where caregivers can meet other family caregivers who share their predicament - select the "Groups" tab at the top of the page to link to the forums for caregiver information.

The Caregiver Discussion Group , also found under the "Groups" tab, is an unmoderated cyber meeting place for families, partners and other caregivers of adults with disorders like Alzheimer’s, stroke, brain injury and other chronic health conditions. The group offers a safe place to talk about the stresses, barriers and good outcomes of providing care for a loved one.

Caregiver Caregiver.com has a "chat room" for caregivers, where caregivers can meet each other, swap stories and tips and join a cyber group of people like themselves. You can find the chat room here.

Not exactly a social community but a way to create an aging family community of care is Lotsa Helping Hands .This site offers an innovative way to set up a caregiving community of family, friends, neighbors to help with the everyday jobs that must be done to care for an older family member. The site offers each community a group calendar for scheduling everyday tasks that need to be done like driving to medical appointments, making a meal, getting someone to bed, driving to a social appointment, like a social day center.

If you live in the west of Ireland there is a word in Irish , comhar, which means a sense of community. Online communities don’t share tea and cookies but are good alternatives for comhar. If you are a caregiver in need of friends, give one a try.