8 Important Things to Consider When Moving a Medically Complex Child to a New Caregiver

There are many instances in which a medically complex child will need to move and be cared for by a different caregiver. This happens in divorces, foster care, respite care, family emergencies, etc. It is hard enough getting a healthy child settled in a new environment, but when they are medically complex, there are many more things that need to be considered. Sometimes it is not possible, but the earlier one can plan for this transition, the better. Here are a few things to consider when planning a medically complex child's transition to a new caregiver:

1. Educate the new caregiver on the child's hands-on, skilled care needs.

I would say this is one of the most important steps, which is why I listed it first. A child with any medical needs should NEVER be placed with a caregiver that has not been educated in these needs. In some cases, a lack of education could lead to serious injury/illness or even death, depending on the medical need(s).

As previously stated, it is always best to start planning for transitions as early as possible. If the child is not in a hospital or rehab setting, it may be necessary to book appointments in an outpatient setting, with the provider who manages that particular need. In some cases, it can take months to book these type of appointments, particularly if a child is seen at a busy medical facility. Sometimes, depending on the needs, the child may have to be admitted at an inpatient medical facility for teaching to take place.

Some examples of the more common medical tasks that require in-depth training include feedings tubes, tracheostomies, ventilators, diabetes care, infusions, central lines, IV catheters, stomas, wound care, and injectable medication. Please be mindful that this is a list of examples and does not include all medical tasks that may require training. It is always best to check with previous caregivers and medical providers to get a full list of these anticipated training needs. In many cases, education in the above areas can take several hours to several days. In some cases, depending on how extensive the needs are and the caregivers ability to learn, this can even take weeks. A caregiver should be able to independently demonstrate these care needs prior to taking a child into their care.

2. Provide a detailed medication list to the new caregiver and locate a new pharmacy if needed.

A new caregiver should have a list of medications that the child takes including scheduled medications and PRN, or "as needed" medications. This list should include the medication name, concentration or dose form of the medication, the prescribed dose/amount, what time(s) of day the child receives these medications, and how this medication is administered.

Any unused portion of a medication should be sent with a child when they move to their new caregiver. If this can not be done, the pharmacy may be able to work with the insurance to do an override for an early refill, or in some cases, a new prescription from the provider may be necessary. Pay close attention to how a medication is to be stored. Some require refrigeration, while other require protection from light. This is usually indicated on the bottle from pharmacy.

If the child experiences any known side effects from their medication, the new caregiver should be made aware of this if possible. Also, any new side effects or concerns should be reported to the child's medical provider by the new caregiver.

Last but not least, if the geographic location of the child is changing, be sure to select a local pharmacy near the new location. The current pharmacy should be able transfer prescriptions to the new pharmacy. If this can not be done for some reason, be sure new prescriptions get over to the new pharmacy from the child's medical provider asap. If the child's medications are mailed, be sure the mail order pharmacy can service the new location prior to the move. The address and contact information on file will need to be changed at the time of the transition.

3. Provide a list of medical providers to the new caregiver

This list should include all medical providers caring for this child from the primary care physician to all of the specialists. Be sure that the contact information for these providers is also included.

It is also helpful to list what specialty the provider is, what the child sees them for, when the last appointment was, when the next appointment is scheduled, and what the expected follow-up timeframe is.

If the child's geographic location will change, be sure they provider are within a reasonable distance and can be followed up with appropriately. If this will be a problem, it is best to seek out other appropriate providers in advance. Asking the PCP or current specialist for recommendations is always best. You also want to be sure the new provider is in network with the child's health insurance at the time of the transition.

4. Send all supplies and equipment with the child to the new caregiver. Ensure vendors can service the new location.

Medically complex children will often have some, if not many medical supplies and/or equipment that will need to go with them when changing homes. If a list of the supply and equipment vendors can be given to the new caregiver, this is ideal. If this information is unknown, supply boxes and equipment may have the vendor name right on them. When in doubt, call the insurance company to see which vendor has been billing for supplies.

If the child's geographic location is changing, you will want to make sure the current vendors can service the new location. You will also want to be sure they are in network with the child's health insurance company at the time of transition if the insurance will be changing. If not, a new in-network vendor will need to be identified and they will need new prescriptions for supplies.

5. Ensure the child's feeding regimen is known to the new caregiver.

As simple as this might sound to a healthy person, be sure a new caregiver knows how a medically complex child eats. Many medically complex children have specialized diets and/or a specific feeding schedule. Some of them are fed through feeding tubes, some are given IV nutrition, some eat by mouth, and some do a combination of these. Some children have allergies or need to avoid certain foods for medical reasons. Some children need their food or drink to be a certain consistency to allow for safe eating my mouth. Education is key! If you don't know, be sure you ask the medical providers for input. Better to ask than miss something important!

6. Ensure the child's therapies and services are continued.

Many medically complex children are involved in some type of therapy or service. Some examples of these therapies and services include ABA, physical therapy, occupational therapy, behavioral therapy, speech therapy, private duty nursing, visiting nursing, and palliative care. These therapies and services can be done at school, in outpatient clinics, in the home through early intervention or through various agencies.

If the child is going to a new location outside of their current town, they will likely need to change schools, clinics, or agencies that are providing therapies. If an educational planning meeting needs to take place to ensure continuity of services in school, be sure to do this ahead of time. If you need to change agencies or clinics, be sure to find a new one in advance if possible, and again, make sure they are in network with the child's insurance.

7. Provide all medical providers, agencies, vendors, schools, and service providers with the new caregivers contact information.

This sounds simple but can be a time consuming process for a medically complex child with a lot of medical people in their lives. Ensuring that all of these people and places have updated contact information will ensure that the child receives up to date and informed care.

8. Make sure the new caregiver knows where and when to seek urgent medical care.

When in doubt a caregiver should always call 911 when a medical emergency arises. However, other urgent circumstances may come up in which the child will need urgent medical care, however, may not need a call to 911. The new caregiver should always know where the closest and best medical center is to take a child with an urgent medical need. They should not only know this for when they are home, but also when traveling away from home. If there is a hospital with a pediatric department, this is always a better option for children. With that being said, in an emergency, any hospital is a good one.

In conclusion, organization and planning ahead is key when transitioning a medically-complex child from one caregiver to another!

Feeling Overwhelmed?! Let PediNurse help!! We can assist in making an organized and safe transition plan for a child to make these transitions as smooth as possible. This will help make sure that a child's medical needs do not fall through the cracks. Contact us for assistance today:

https://www.pedinurseconsulting.com/contact