CMSA Today - Issue 7, 2017 - 13

C

are transitions, the movement
of a patient between care
settings, is one of the
most discussed phrases in
healthcare today. At one
time, discharge planning was the focus
of hospital efforts. "Discharge planning
starts at admission" was the key phrase for
many years. Over time, daily practice and
research delved into the point of discharge
and exposed the commonalities and risk of
every point of transition in the healthcare
continuum. The conversation evolved from
one limited to preparing for a hospital
discharge into an expansive conversation
about safety, readmissions, communication
and technology. Care transitions are
discussed for patient movement between
any two places of care and have spurred
an industry.
A simple Google search for the phrase
returned more than a million results. There
are organizations, templates, standards,
consultants, articles, coalitions, software,
self-learning tools, conferences, models,
measures, best practices and checklists of
all varieties. The conversation is so expansive, it is hard to know where to start, never
mind how to pick what is most applicable to
the transition in question. Numerous supportive tools guide clinicians of all varieties
to use standard communication methods
and mechanisms, identify key points of
risk and useful follow up to catch problems early. In all this effort, attention and
research, one thing seems to have been
overlooked: the most basic aspects of "How
do I take care of my loved one?"
One of the most common and most
unrecognized experiences of nurses and
other clinicians in the home, whether home
healthcare or hospice, is the always-surprising continuum of how different people do
the same thing. How a caregiver assists
his or her loved one to get out of a chair
for instance. Trained clinicians will help the
person scoot the edge of the seat, check
for sturdy footwear, make sure his or her
feet are flat on the floor and shoulder width
apart, look for armrests to push up from,
move a walker or cane into position, place
one foot in a T position to the lead foot,
bend our own knees, use a gait belt placed

low and snug but not tight around the person's waist or perhaps put our hands under
the armpits and instruct the person to hold
on to our forearms. We have been taught
and practiced these steps, intentionally,
over time and with guidance. This is not
what non-professional caregivers do.
Non-professional caregivers commonly
do a lot of tugging and pulling. There are
false starts, angry words and injuries to
both parties. People grab hands and pull,
yell, push from behind; occasionally, the
chair may even be tipped forward to move
the person out of it. The neck of the caregiver is frequently used as a bar to pull up
on when trying to stand. Shoelaces are
left dangling. Socks on slippery floors are
common. Tugging on the waistline of pants,
pulling shirts and just full-on deadlifts occur
daily. The stress from these moments is
palpable. Both parties are in jeopardy.
Fear is common. Both parties fear sustaining an injury. Shared anxiety expressed as
anger only makes a risky situation more
dangerous.
Adult diapers are another unspoken
basic. How do I secure an adult diaper?
Which way is the front? Can it be changed
if they are lying down? What if they only
stand while I hold them, how do I put on a
new one? Are they different for men versus
women? There are books, videos, helpful
grandparents, childbirth classes and labor
and delivery nurses to guide new parents
to change the diapers of an infant. How do
new caregivers of impaired adults learn this
skill? Commercials teach us to transition
from diapers to underwear like garments
for toddlers. Packages tell us what size of
either product to buy for children. There is
not an equal marketing initiative for adults
with the same needs. Cleaning the peri
area from front to back, retracting the foreskin, cleaning in skin folds and using nonirritating products are all points clinicians
are taught. Over time, these skills become
so basic they are automatic. But first, there
was teaching and learning.
Nurses in homes hear a wide variety of
questions about these basic, almost invisible
skills. How can the sheets get changed if
my loved one doesn't get out of the bed?
How do I wash my loved one if she can't

take a shower? Can I shave his face? What
about the dentures? How do I take them
out? Do I have to take them out? How does
this hearing aid go in? Is it on? How can
she brush her teeth if she can't get to the
bathroom? These are just a few of the more
common questions nurses and other professionals providing care in the home hear or
observe. Far too often, non-professional
caregivers don't ask, they just do.
Sometimes the innovative ways people
invent to "just do" are brilliant, such as
using kids' toys to expand a person's reach.
Often, they are dangerous, like bending
over a bed and trying to lift a person who
cannot help or feeding someone who is
lying down. Sometimes, lack of knowing
leads to not doing, which is also a dangerous choice. When caregivers don't know
how to change the sheets with their loved
one in the bed, sometimes they don't get
changed even when they are soiled. Well
intentioned, devoted caregivers without
knowledge or skill can inadvertently leave
a person in soiled clothes or sheets, leading
to skin breakdown and other problems. A
patient may attempt to avoid urinating to
reduce stress in the home, leading to dehydration and further complications. This lack
of ability and know-how commonly comes
with feelings of shame and embarrassment
for both the person and the caregiver, only
worsening the situation.
These types of basic care are easy to
forget and overlook in a facility setting.
Institutions - hospitals, rehabilitation
facilities and nursing homes - provide this
care consistently, typically with minimal
thought. Planning for care transitions typically includes conversations about when to
change settings of care, where to go and
how to get there. Follow-up visits, medication management, durable medical equipment and communication plans are critical
to a successful transition, but it is not an
exhaustive list.
Prior to the research defining the link
between medication management and
readmissions, medication education was
often taken for granted. Facility-based
nurses often trusted that caregivers already
knew about using the medications correctly. Research demonstrated a significant
DIGITAL * Issue 7 * 2017

CMSA TODAY

13



Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2017

President's Letter
Association News
CMSA Corporate Partners
Care Transitions: Remember the Basics
Leveraging Family Caregivers, Clinical Protocols and Technology to Improve Person-Centered Care
Development and Implementation of Relational Building in the Virtual Work Environment
Patient and Provider Satisfaction
The Case Management Model Act: Professional Case Managers Transforming Health Care
Index of Advertisers
CMSA Today - Issue 7, 2017 - Intro
CMSA Today - Issue 7, 2017 - cover1
CMSA Today - Issue 7, 2017 - cover2
CMSA Today - Issue 7, 2017 - 3
CMSA Today - Issue 7, 2017 - 4
CMSA Today - Issue 7, 2017 - 5
CMSA Today - Issue 7, 2017 - President's Letter
CMSA Today - Issue 7, 2017 - 7
CMSA Today - Issue 7, 2017 - Association News
CMSA Today - Issue 7, 2017 - 9
CMSA Today - Issue 7, 2017 - CMSA Corporate Partners
CMSA Today - Issue 7, 2017 - 11
CMSA Today - Issue 7, 2017 - Care Transitions: Remember the Basics
CMSA Today - Issue 7, 2017 - 13
CMSA Today - Issue 7, 2017 - 14
CMSA Today - Issue 7, 2017 - Leveraging Family Caregivers, Clinical Protocols and Technology to Improve Person-Centered Care
CMSA Today - Issue 7, 2017 - 16
CMSA Today - Issue 7, 2017 - 17
CMSA Today - Issue 7, 2017 - Development and Implementation of Relational Building in the Virtual Work Environment
CMSA Today - Issue 7, 2017 - 19
CMSA Today - Issue 7, 2017 - Patient and Provider Satisfaction
CMSA Today - Issue 7, 2017 - 21
CMSA Today - Issue 7, 2017 - The Case Management Model Act: Professional Case Managers Transforming Health Care
CMSA Today - Issue 7, 2017 - 23
CMSA Today - Issue 7, 2017 - 24
CMSA Today - Issue 7, 2017 - 25
CMSA Today - Issue 7, 2017 - 26
CMSA Today - Issue 7, 2017 - 27
CMSA Today - Issue 7, 2017 - 28
CMSA Today - Issue 7, 2017 - 29
CMSA Today - Issue 7, 2017 - Index of Advertisers
CMSA Today - Issue 7, 2017 - cover3
CMSA Today - Issue 7, 2017 - cover4
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