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Helping Those Who Help Hospital Patients After They Head Home

Bill would improve instructions and bolster support given to family members and other caregivers

Lilyan Cralle
Lilyan Cralle of Willingboro says better guidance for caregivers might have helped her and her father when he suffered a series of heart attacks 25 years ago.

Leaving the hospital can be confusing for sick or elderly patients, many of whom rely on a family member or other caregiver to keep track of prescriptions and instructions for follow-up treatment.

The confusion can become a crisis if the caregiver doesn’t know about those prescriptions or instructions.

A bill advancing in the Legislature, A-2955, would require hospitals to ask patients if they want to designate a caregiver, who would then be notified before the patient is discharged and provided with a plan describing what help the patient will need after discharge.

Hospitals also would be required to give the caregiver instructions for all of the tasks the patient will need help with; provide an opportunity for the caregiver to ask questions and get answers, and supply contact information for a hospital employee who can answers questions that might arise later.

AARP and its New Jersey chapter are the chief proponents of the bill, with AARP officials noting national statistics showing that 46 percent of family caregivers perform medical or nursing tasks for people with multiple chronic physical and cognitive conditions while 78 percent manage medications, including administering intravenous fluids and injections.

Willingboro resident Lilyan Cralle recalled struggling to get information to help care for her father 25 years ago, when he suffered 16 heart attacks over a 12-month period.

“He was normally a very bright intelligent man, but in his weakened condition, and with whatever medication they gave him, when they would tell him discharge” information, he didn’t have the capacity to remember everything, Cralle said. “I can remember one specific time when I came to take him from the hospital and he had no prescriptions. And I had to go hunt down doctors and say, you know, ‘Where are these?’ ”

Cralle, an AARP volunteer who testified in favor of the bill, said a caregiver is in a position to make sure patients follow through on care recommended after discharge from the hospitals, “so it’s a safeguard for the hospitals too, in a way.”

AARP has made improved assistance for caregivers a priority this legislative session, including a measure that would provide up to $675 in tax credits to caregivers.

James McSpadden, a lobbyist with AARP in Washington, D.C., said the bill is particularly important for New Jersey because the state ranks 42nd of the 50 states in the percent of caregivers who said they usually or always receive the support they need. In a 2009 AARP survey, 75.6 percent of New Jersey caregivers said they receive the help they need, which was below the national average of 78.2 percent.

“By providing the caregiver with information well before discharge, the caregiver can manage the transition from one care setting to another,” McSpadden told legislators at a May 8 hearing on the bill. The Assembly Health and Senior Services Committee released the bill on an 11-0 vote. The bipartisan bill sponsors include Speaker Vincent Prieto (D-Bergen and Hudson).

McSpadden noted that managing multiple medications, administering injections, operating specialized medical equipment and caring for wounds can be challenging for caregivers.

“The information is key in reducing stress in a stressful time,” McSpadden said. He added that some hospitals already require more extensive instruction to caregivers than what is included in the bill, “so it’s setting a new standard,” rather than mandating a different approach.

While the New Jersey Hospital Association hasn’t taken a position on the bill, its staff members have worked with legislators and AARP to address hospital officials’ concerns with the measure.

The hospital caregiver bill drew support from the state chapter of the National Academy of Elderly Law Attorneys, among other groups.

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