BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 675
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|AUTHOR: |Liu |
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|VERSION: |April 21, 2015 |
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|HEARING DATE: |April 29, 2015 | | |
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|CONSULTANT: |Vince Marchand |
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SUBJECT : Health facilities: family caregivers.
SUMMARY : Requires a hospital to provide an opportunity for an
individual patient who has been admitted to the hospital as an
inpatient to identify one family caregiver to assist in
post-hospital care, to record that information in the patient's
medical chart, and to provide an opportunity for the patient and
his or her designated family caregiver to engage in the
discharge planning process, as specified.
Existing law:
1.Licenses and regulates general acute care hospitals, acute
psychiatric hospitals, and special hospitals by the Department
of Public Health (DPH).
2.Requires every hospital to have a written discharge planning
policy and process, and requires this policy to require that
appropriate arrangements for post-hospital care, including but
not limited to, care at home, are made prior to discharge for
those patients who are likely to suffer adverse health
consequences upon discharge if there is no adequate discharge
planning.
3.Requires every hospital, as part of the discharge planning
process, if the hospital determines that the patient and
family members or interested persons need to be counseled to
prepare them for post-hospital care, to provide for that
counseling.
4.Requires the discharge planning process to require that
patients be informed, orally or in writing, of the continuing
health requirements following discharge, and permits a patient
to request that friends or family members be given this
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information, even if the patient is able to make his or her
own decisions regarding medical care.
5.Requires every hospital to provide each patient, upon
admission or as soon thereafter as reasonably practical,
written information regarding the patient's right to be
informed of continuing health care requirements following
discharge, and that if the patient so authorizes, that a
family friend or family member may be provided information
about the patient's continuing health care requirements
following discharge.
6.Permits a health facility to disclose medical information
about a patient in order to notify a family member or a
personal representative of the patient about the patient's
location, general condition, or death, if specified procedures
are followed.
This bill:
1.Requires a hospital, subject to the federal Health Insurance
Portability and Accountability Act (HIPAA), to provide an
opportunity for an individual patient who has been admitted to
the hospital as an inpatient to identify one family caregiver
who may assist in post-hospital care, and to record that
information in the patient's medical chart.
2.Requires the hospital, in the event that the patient is
unconscious or otherwise incapacitated upon admittance to the
hospital, to provide the patient or patient's legal guardian
with an opportunity to designate a caregiver within a specific
time period, at the discretion of the attending physician,
following the patient's recovery of consciousness or capacity,
and to promptly document the attempt in the patient's medical
record.
3.Requires a hospital, in the event that the patient or legal
guardian declines to designate a caregiver pursuant to this
bill, to promptly document this declination in the patient's
medical record, when appropriate.
4.Requires a hospital, subject to HIPAA, to notify the patient's
designated family caregiver of the patient's discharge or
transfer to another facility as soon as possible and, in any
event, upon issuance of a discharge order by the patient's
attending physician. Prohibits a lack of contact, if the
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hospital is unable to contact the designated caregiver, from
interfering with, delaying, or otherwise affecting the medical
care provided to the patient or an appropriate discharge of
the patient, and requires the hospital to promptly document
the attempted notification in the patient's medical record.
5.Requires a hospital, subject to HIPAA, to provide an
opportunity for the patient and his or her designated family
caregiver to engage in the discharge planning process, which
is required to include providing information or instruction
regarding the post-hospital care needs of the patient, and
education and counseling about the patient's medications,
including dosing and proper use of medication delivery
devices, when applicable. Requires instruction to be provided
in a culturally competent manner and in a language that is
comprehensible to the patient and caregiver, consistent with
the requirements of state and federal law.
6.Requires a hospital to provide contact information for any
health care service, community resource, or other service
necessary to successfully carry out the care plan.
7.Requires discharge planning policies adopted by a hospital in
accordance with the provisions of this bill to ensure that
planning is appropriate to the condition of the patient being
discharged from the hospital, and to the discharge destination
and meets the needs and acuity of patients and the abilities
of the designated family caregiver.
8.Prohibits the provisions of this bill from requiring a
hospital to either adopt a policy that would delay discharge
or transfer of a patient, or to disclose information if the
patient as not provided consent that meets the standards
required by state and federal laws governing the privacy and
security of protected health information.
9.Defines "family caregiver," for purposes of this bill, as a
relative, friend, or neighbor who provides assistance related
to an underlying physical or mental disability but who is
unpaid for those services.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
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1.Author's statement. According to the author, unpaid family
caregivers provide the majority of long-term care (LTC)
support for their loved ones, yet the health and LTC system is
slow to recognize them as partners. Identifying and meeting
the needs of California's caregivers can help ensure that
appropriate care is provided for aging adults at home or in a
rehabilitation or nursing facility and avoid unnecessary
readmissions or prolonged stays. Without full understanding
and appropriate training to meet the consumer's needs, both
the caregiver and consumer suffer. Assisting a caregiver to
understand the expectations for care to be provided when the
consumer is transferred from one facility to another enhances
that caregiver's ability to advocate on behalf of his or her
loved one. Caregiver tasks at home, especially paramedical
tasks such as tube feeding and wound care, can be complex.
Caregivers often require more information and demonstration
once they are in the home setting and must perform these tasks
by themselves. Enabling them to access information over the
phone or online can prevent costly readmissions and ER visits
as well as stress and suffering for both the caregiver and the
consumer.
2.Select Committee on Aging and Long Term Care Report.
According to the author, this bill is intended to implement
one of the recommendations of the Select Committee on Aging
and Long Term Care's 2014 report, "A Shattered System:
Reforming Long Term Care in California" (report). According to
the Select Committee on Aging and Long Term Care, this report
was the result of a comprehensive effort in 2014 to identify
the structural, policy, and administrative changes necessary
to realize an ideal long-term care delivery system and develop
recommendations and a strategy to achieve that vision. One of
the critical policy areas identified by the report was
"hospital-to-home transitions," with the report stating that
inadequate planning and lack of access to services and
supports in the home setting often lead to repeat
hospitalizations and a greater likelihood of long-term
institutional placement. To address this issue, the report
recommending requiring hospital-to-home transition support for
family caregivers. Specifically, the report recommended that
California enact legislation requiring hospitals to (a) record
the name of the family caregiver when a loved one is admitted
to a hospital or rehabilitation facility; (b) notify the
family caregiver when the loved one is to be discharged to
another facility or home; (c) provide an explanation and live
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instruction of the medical tasks that the family caregiver
would perform; and, (d) provide telephonic technical
assistance to the caregiver when questions arise.
3.Related legislation. ACR 38 (Brown), establishes the
California Task Force on Family Caregiving, to collaborate
with a broad range of stakeholders to examine resources
available to caregivers and make legislative recommendations
regarding the development of an Internet Web site containing
resources for caregivers, the enhancement of outreach and
education efforts, and the development of a caregiver
screening and assessment tool. The task force would be
required to submit an interim report to the Legislature no
later than January 1, 2017, and a final report no later than
July 1, 2018.
4.Prior legislation. AB 1744 (Brown), of 2014, proposed to
require, until January 1, 2018, the California Department of
Aging (CDA) to establish a blue-ribbon task force comprised of
at least 13 members, as specified, to make legislative
recommendations to improve services for unpaid and family
caregivers in California if CDA received sufficient non-state
funds from private sources to implement these provisions.
Would have required the task force to prepare a report of its
findings and recommendations and provide it to the Legislature
on or before July 1, 2017. AB 1744 was vetoed by the Governor,
who stated: "The California State Plan on Aging, the
California Plan for Alzheimer's Disease, the significant
reports and action plans developed by the 33 Area Agencies on
Aging, the Alzheimer's Association, the AARP and so many
others have produced ample evidence for knowledgeable and
caring people to recommend ways to improve support for family
caregivers. Establishing another task force in state law
simply isn't necessary."
SB 633 (Dymally), Chapter 472, Statutes of 2007, required
hospitals to provide every patient anticipated to be in need
of long-term care, at the time of discharge, with contact
information of entities providing information or referral
services relating to community-based options, as specified.
AB 974 (Hall), Chapter, Statutes of 2014, required a hospital to
alert a patient's emergency contact person prior to
transferring the patient from one hospital to another for
nonmedical reasons, and required the hospital to document any
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attempts to contact a preferred contact person in the
patient's medical record.
5.Support. The California Association of Public Authorities for
IHSS (CAPA) states in support that a trip to the hospital can
be an intimidating event for patients and their families.
According to CAPA, as a caregiver, you are focused completely
on your family member's medical treatment, and so is the
hospital staff, so you might not be giving much thought to
what happens when your relative leaves the hospital. Yet the
way this transition is handled is critical to the health and
well-being of your loved one, and according to CAPA, studies
have found that improvements in hospital discharge planning
can dramatically improve the outcome for patients as they move
to the next level of care. The California Association of Area
Agencies on Aging (C4A) also supports this bill, stating that
hospitals are slow in recognizing the importance of working
with the family in a transition plan of the patient being
discharged to home. According to C4A, the family or caregiver
is often ill-equipped to assist with medications, wound care,
or other complex tasks once the patient gets home, and that
providing instruction and resources for further assistance
when the patient is discharged can prevent costly readmissions
to the hospital or emergency room visits.
6.Policy comment. Existing law already requires every hospital
to have a discharge planning process, and as part of that
process, requires that patients be permitted to request that
friends or family members be given information on the
continuing health requirements following discharge. Existing
law also requires a hospital, if it determines that the
patient and family members or interested persons need to be
counseled to prepare for post-hospital care, to provide for
that counseling. This bill creates a new section of law,
without amending those existing provisions, which contain both
new requirements on hospitals, as well as some duplication of
very similar existing requirements. The author may wish to
consider amending the existing discharge planning provisions
of law to add the new requirements imposed by this bill, such
as specifically requiring a hospital to reach out to the
patient to inquire about a family caregiver, and to document
this in the patient's medical record, and either revising or
replacing the provisions of existing law that would no longer
be relevant in light of the new requirements of this bill.
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SUPPORT AND OPPOSITION :
Support: California Association of Public Authorities for IHSS
California Association of Area Agencies on Aging
California Chapter of the National Association of
Social Workers
Congress of California Seniors
Oppose: None received
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