What do you want? What do you need? These are the questions at the heart of any human relationship, from parents struggling to interpret the strange cries and pleadings of their newborn to a couple on a first date wondering what alchemy of words and deeds and gestures will unlock the other’s affections to an employee trying to figure out how to satisfy the contradictory dictates of a dozen bewildering supervisors. No matter what the relationship, there are obstacles to communication, ranging from the personal to the physical to the bureaucratic. These three obstacles often prove to be jointly frustrating for caretakers of older adults, who aren’t always granted the information they need to provide the best care.
The state of California is trying to change at least the bureaucratic obstacle, as a new law that went into effect this year is opening up the health and well-being information accessible to caretakers. SB 675 was signed last year and started being enforced on January 1st, with the new year making a new age for caretakers and the aging loved ones they are helping. It will help them understand what is needed, medically, by demanding that hospitals work with caregivers to have all the information needed to properly take care of a patient after they have been discharged. In removing the bureaucratic obstacles, the personal barriers to communication may also come down.
SB 675 and a New Communication Regime
A frustration for any caretaker are the very well-meaning and important laws regarding patient privacy. These laws do much good, and protect a lot of patients from harm. However, even the best laws have some unintended side effects. State law already mandated that a post-hospital care regime be provided, but it was limited as to who could access that information, and that group didn’t always include caretakers.
A common scenario would go like this: an aging loved one was admitted to a hospital, due to a mild stroke. The hospital didn’t ask who was to be the caretaker after they were discharged. Existing law already makes provisions for arranging the right post-hospital care, of course, but as the patient is getting ready to be released, the caretaker is left out of the loop. They aren’t able to participate in the discharge planning process, and don’t have all the information they need to ensure proper post-hospital care.
Senate Bill 675 aims to change that. Under this new law, a patient can designate a caretaker upon admittance to the hospital. If they are unable to do so, this can be done by a legal guardian. With this new law, the caretaker is able to advise and participate in the discharge process. As the law states, “The hospital shall provide an opportunity for the patient and his or her designated family caregiver to engage in the discharge planning process, which shall include information and, where appropriate, instruction regarding the post-hospital care needs of the patient.” This includes being able to appeal the date of discharge. It is important to note, though, that this only applies to those with inpatient status.
The “post-hospital care” is in many ways the heart of this bill. Caretakers have to have the right information to determine exactly what is the best course of care, especially in the immediate aftermath of discharge, where health situations are at their most crucial. Oftentimes, through no one’s fault, patients are sent home after hospitals make the incorrect assumption about who the caregiver will be, or if the place to which the patient’s being discharged is adequately prepared.
There is a lot of confusion when someone is admitted to a hospital, as doctors and nurses are focusing on immediate care and families are sad and scared. This new bill requires hospitals to figure out what is happening post-hospital, and provides an important reminder that care is a holistic, and hopefully seamless process from a health facility and beyond. The information they are required to share with the caregiver includes:
- Education about patient’s medication, including dosing requirements
- Instruction in the proper use of medical delivery devices
- Detailed medical instruction about what exactly the family caregiver will need to perform
- Instructions delivered in culturally appropriate and sensitive ways (not using clinical medical language, which works great for professionals, but can be bewildering and cold to non-professionals)
All of this is especially important when the caregiver will be a family member (or members) who might not be professionals. SB 675 facilitates the sharing of that knowledge that families need to provide the best care possible, easing the stress that comes with misinformation, confusion, and apprehension about doing the wrong thing.
Breaking Down Communication Barriers
Removing these bureaucratic obstacles to information can help establish better communication in other ways as well. Not knowing how to help someone can build up mutual barriers of shame, guilt, and even misplaced resentment. It is a cascading problem, and it inhibits future communication. This communication is incredibly important as needs change—if there is anger and confusion over how medicine should be taken, then larger emotional and physical issues, such as elderly incontinence, might be avoided until they become a much bigger problem. There could be emotional repercussions to broken communication as well. Too often, family ties fray in sadness and confusion over basic issues that could be resolved if people would just communicate.
SB 675 can’t heal ties on its own, but it can help prevent the fraying by making sure that proper care begins the moment of discharge, and that caregivers have the information they need to provide proper care. Having this knowledge means less asking “what do you need,” and more figuring out, together, how these years can be enjoyable, productive, and exciting ones.
Staying up to date on the issues that matter and that impact caregivers and aging seniors can help ensure the best care. The Institute on Aging is ready to offer support, guidance, and information about important issues that affect you and your loved one. Please contact us today to learn about our programs and resources.
