State Policy as an Opportunity to Evaluate Current Discharge Processes

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State Policy as an Opportunity to Evaluate Current Discharge Processes

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Riverview Health evaluated its processes and implemented strategies to ensure compliance with Indiana’s CARE Act.

The Issue

Effective Jan. 1, 2016, Indiana enacted the Caregiver Advise, Record, and Enable Act, or the CARE Act. The CARE Act requires hospitals to offer each admitted patient who will be discharged home an opportunity to: (1) identify a lay caregiver, (2) communicate with the lay caregiver regarding discharge and (3) offer education and training to the lay caregiver to ensure he or she understands how to care for the patient post-discharge, among other things. This required Riverview Health to evaluate its current processes and implement strategies to ensure compliance with the CARE Act.

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.


We have audited charts to ensure compliance with the CARE Act and are currently evaluating how best to incorporate the form and identification of a lay caregiver into a new electronic health record. Our all-cause readmission rate was already very low, so we have not seen a significant change in this area. In addition, we offered and documented education and training provided to the patient’s support prior to the CARE Act being passed. However, we will continue to monitor our care transition scores through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and consider the potential impact the CARE Act has had on these scores.


Our biggest learning opportunity through this process was to first evaluate our current processes to see what we could tweak or modify instead of reinventing the wheel, or worse, adding one more task to our staff’s already full plate. By looking at the intent of the CARE Act and evaluating what we already do, we were able to make slight modifications to meet the needs of the patients and comply with the CARE Act, without getting caught up in the minutia.

Organizational Background

Organization Name: Riverview Health

Location: 395 Westfield Road, Noblesville, IN 46060, United States

Organization Type: Hospital

Organization Model: Not Set