Another big challenge -- caregivers are often confronted with an array of doctors, procedures, paperwork and facilities, with no one to help pull it all together. "In the current system, there's no one accountable," Raphael said. "That's why it can cost you $125 an hour [for a geriatric care manager], because you're trying to fill that hole."
Too often, chronically ill patients and their families simply lurch from one crisis to the next, with no continuity of care to make sure that once patients leave the hospital, they aren't getting readmitted a few weeks later.
"Care has to be coordinated and supported," said AARP president Jennie Chin Hansen, who has 40 years of experience as a nurse. "We have to be preventing things from happening, because there are things that we know cause you to go to the hospital again: taking the wrong medications while you're back home, for example." Chin and other experts focused especially on the crucial 30 days after a hospital discharge. Close monitoring and follow-up during that month can greatly reduce unnecessary suffering and cost, they said.
Across America, much of the in-home care that is provided is carried out by home health care aides, who are often woefully under-trained, the experts said.
"They are the glue that is holding the home health care system together," said Raphael. But, she added, she is "shocked" that, in most states, "we have very minimum training requirements for these para-professional workers who are handling very complex cases."
In New York State, for example, home health care workers are required to undergo 120 hours of training before getting certification. That might sound OK, until you realize that nail techni
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