By Susan Reimer

Baltimore Sun

February 20, 2015 2:25 P.M.

This is what the caregiver for an elderly relative looks like:

She is a woman, aged 45 to 65, and she works full-time. If she is not the spouse, she is a daughter or daughter-in-law or a niece, and she probably has a couple of teen-agers or young adult children of her own. The average age of her charge is 85.

She is required to at least manage medications. But more often than not, she is also required to perform sophisticated nursing tasks, such as managing a port or an intravenous site or performing difficult wound care, or operating medical equipment of some kind. And she doesn’t have any training for these tasks.

A bill in the Maryland Legislature would help this caregiver in a couple of important ways. First, she would have an official designation — named by the patient and recognized by the hospital. The exchange of medical information, often locked behind privacy laws, would therefore be possible.

And the hospital would be required to give her at least four hours’ notice before her charge is released to his or her home or to a rehabilitation facility or nursing home.

And, critically, she would be given the instruction she needs by nursing staff at least 24 hours in advance of that release. Plus, the hospital would provide contact information for community support services.

Del. Bonnie Cullison, a Montgomery County Democrat who sponsored House Bill 1006, knows first-hand what it feels like to find yourself caring for a loved one’s difficult medical condition without the confidence some training would give.

Her wife, Marcia Massey, spent almost a decade undergoing 26 difficult vascular surgeries, and Ms. Cullison was responsible for the delicate wound care that followed.
“The last surgery was in 1999, and it was really hard for me. I had a certain level of understanding, but it was complex,” she said. “And I was much younger then. I am thinking about myself at my age now. It would be so much harder.

“We are sending people home from hospitals with these kinds of needs because we can’t afford to keep them there. I know hospitals are concerned because of staff cuts, but you have to have a conversation so you understand how much a caregiver understands and if they need more information.”

“The fastest growing demographic in Maryland is people over the age of 85, and the average age of the caregivers in this state is 65,” said Sen. Delores Kelley, the Baltimore County Democrat who sponsored the Senate version of the bill, SB 572.

“Sometimes they aren’t even cogent when they are released,” she said of patients. “They are a blank slate. We need more engagement [with caregivers] or these patients are not going to thrive when they are discharged.”

The bill is part of a nationwide effort by AARP, and similar legislation has already passed or is close to passing in 16 states. Virginia passed such a law this month, and it awaits the governor’s signature. New Jersey Gov. Chris Christie signed that state’s version of the law last year.

“We have older people taking care of older people, and it is becoming ever more stressful,” said Tammy Bresnahan, associate director of advocacy for AARP in Maryland. “There is more that can be done.”

But the legislation is meeting resistance in Maryland from hospitals, which believe they are already doing what the bill requires, and that the deadlines — four hours notification before release, training 24 hours before release — would be burdensome.

And, said Carmela Coyle, head of the Maryland Hospital Association, hospitals need to be able to create systems that work for their individual communities. One size does not fit all.

Delegate Cullison and Senator Kelley understand — both personally and because of their work in the legislature — and they are willing to work with hospitals. We shouldn’t be thinking of this as another layer of regulation but as a support system for those who take on the care of the vulnerable.

Because here’s the reality: The population is aging fast. You are either going to be a caregiver, or you are going to need a caregiver.

Susan Reimer’s column appears on Mondays and Thursdays. She can be reached or @SusanReimer on

Copyright © 2015, The Baltimore Sun



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