What We Tried

First, we had to understand the CARE Act, specific to Indiana, and why it was passed. If we were going to ask our staff to do something new or different, we had to give them a “why” to get them on board and engaged in the process. There were two significant pieces that we had to cover – identification of the lay caregiver and offering education. We decided on a form for the patient to complete that identifies a lay caregiver or the patient’s declination of such. This form is completed by a discharge planning assistant, placed in the paper-lite chart, and then scanned into the record post discharge.

Next we evaluated potential strategies specifically about who initiates the form. We considered registration, nursing and case management. Ultimately, we felt case management was the most appropriate “owner” of obtaining this information, as they also discuss advance directives and the Important Message from Medicare with patients. We then evaluated current processes and potential duplication. We found that our plan of care and discharge instructions covered the necessary components of an “at-home care plan,” which is also required by the Act. In addition, we already offered education and training to a patient’s support system, which is then documented in the patient record. Therefore, we didn’t need to significantly change our practice to meet this requirement.

Last, we educated staff and are identifying ongoing learning opportunities. We initially provided education to staff through an online education platform. The training consisted of a PowerPoint presentation reviewing what the CARE Act stands for, why it was passed, how it impacts patients and what staff need to do with the information.

However, we received feedback that, despite an 89 percent completion rate of the training, nursing staff did not have a clear understanding of what a lay caregiver was or what they were to do with the information. As a result, we had information available to nursing staff during our “skills days,” when nurses obtain their annual certifications and necessary trainings. Our skills days were less than a month ago, so we are still evaluating our next training needs.