Family Caregiver Engagement Cuts Hospital Readmissions by 25%

Healthcare organizations that practice meaningful family caregiver engagement and integrate caregivers into the patient discharge process can reduce hospital readmissions by one-quarter, according to research from the University of Pittsburgh Medical Center.

The analysis investigated the effects of family caregiver engagement, reportedly validating the Caregiver Advise, Record, and Enable (CARE) Act, an AARP-sponsored law that has passed in over 30 states and the District of Columbia. The CARE Act calls for hospitals and other healthcare organizations to incorporate informal family caregivers into the discharge process, providing them with the requisite information to take care of their loved ones at home.

Led by senior investigator A. Everette James, JD, MBA, a research team analyzed 15 publications regarding patient discharge planning in older adults.

The studies included a total of 4,361 older patients being discharged from the hospital into family or informal caregiver care. About 60 percent of caregivers were spouses or partners, and 35 percent were adult children.

The chance of 90-day readmission was reduced by 25 percent and 180-day readmission by 24 percent when providers integrated caregivers into the discharge process, the studies found.

Family caregiver engagement strategies varied by study, the research team observed. However, common tactics included connecting patients and caregivers with community resources, providing written care plans and medication reconciliation, and using patient education strategies such as teach-back and demonstrations.

“Due to medical advances, shorter hospital stays and the expansion of home care technology, caregivers are taking on considerable care responsibilities for patients,” said lead author Juleen Rodakowski, OTD, MS, OTR/L.

“This includes increasingly complex treatment, such as wound care, managing medications and operating specialized medical equipment,” continued Rodakowski, who is also an assistant professor in the Department of Occupational Therapy in Pitt’s School of Health and Rehabilitation Sciences. “With proper training and support, caregivers are more likely to be able to fulfill these responsibilities and keep their loved ones from having to return to the hospital.”

While reducing hospital readmissions certainly has its patient satisfaction payoffs, it is also good for the healthcare organization’s financial bottom line. Hospital readmissions are costly for providers, and reducing them by engaging family caregivers in creating quality at-home care experience will help quell healthcare costs.

Additionally, healthcare organizations face penalties for hospital readmissions under the Hospital Readmission Reduction Program (HRRP). Per the HRRP, CMS must reduce payments to inpatient prospective payment system (IPPS) hospitals for excess hospital readmission.

Properly engaging family caregivers can help mitigate potential HRRP penalties, noted James, who is also the director of Pitt’s Health Policy Institute and its Stern Center for Evidence-Based Policy.

“While integrating informal caregivers into the patient discharge process may require additional efforts to identify and educate a patient’s family member, it is likely to pay dividends through improved patient outcomes and helping providers avoid economic penalties for patient readmissions,” said James.

Furthermore, informal and family caregivers save money for patients and other health payers. Family caregivers usually perform at-home care for free, saving patients or their health payers the cost of formal, clinician caregivers.

Informal, family caregivers perform 80 percent of long-term care, putting a considerable dent in at-home care costs, according to one report from the Congressional Budget Office (CBO).

Aside from cost concerns, full family engagement helps improve patient safety, said Jill Harrison, PhD, Director of Research at patient advocacy group Planetree.

“When a patient is in the hospital, they need an extra set of eyes and ears to understand things,” Harrison explained in a previous interview. “Having a family member by their bedside after surgery is one of the greatest things a family member can do in terms of safety.”

Likewise, family engagement during the discharge process is crucial for patient safety.

“By and large, we are discharging patients into the care of family members,” Harrison noted. “If they are not trained, aware, and educated, patients are likely to end up back in the hospital.”

Healthcare organizations must determine a path forward for family engagement, enacting a set of strategies to ensure family caregivers are equipped with the necessary knowledge to provide adequate at-home care for their loved ones. Additionally, health policymakers must create financial means by which hospitals can leverage these family engagement strategies.